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Defining Mental Illness and Psychiatric Disability
Published in Joel Michael Reynolds, Christine Wieseler, The Disability Bioethics Reader, 2022
The DSM has considerable influence on psychiatric practice throughout the world, but criticism has followed the manual since its inception. Over the decades, one repeated concern is that the DSM contributes to “disease mongering” – the creation of conditions to fit psychotherapeutics, whether with respect to their development or sales. The diagnostic categories within the DSM expand significantly and become more inclusive with each edition, so much so that current estimates are that half of Americans qualify for a DSM diagnosis at some point in their lives (Kawa and Giordano 2012, 7). As a related concern: “the ‘pathologization of deviance’ and the ‘medicalization of social ills’ are potential effects of psychiatric diagnoses and treatment trends” (ibid.). Each new edition of the DSM has moved increasingly toward biomedical modeling, including attempts to incorporate neuroimaging and genetics. Research and insurance reimbursement dollars have also increased accordingly (ibid., 6). Concerns about biased diagnoses, disease mongering, expansive pathologization, and biomedical modeling culminated in a social-political movement for a group of mental health professionals, current and would-be patients, and the general public.
Different faces of governance
Published in Kevin Dew, Public Health, Personal Health and Pills, 2018
Biegler and Vargas (2016) suggest that one explanation for the success of DTCA advertising is evaluative conditioning, where favourable attitudes to a product or service is achieved by pairing that product or service with images or sounds that are ordinarily positively received, technically termed images or sounds of positive valence (Biegler and Vargas 2016). Images and music that evoke pleasant feelings not only have a positive emotional effect but can influence people’s beliefs. In their experimental study of a fictional drug, Biegler and Vargas found that people who saw the drug paired with positive images were more likely to believe that the drug was safer and more effective than people who saw it paired with neutral or negative images. Positive images used in the research included the use of cute animals and chocolate bars. In addition to DTCA and online pitches to potential patients, drug company promotion work can include disease awareness campaigns, which critics might refer to as disease mongering, the creation and support of advocacy groups that can lobby for the drug companies, and underwriting large sporting events (Ebeling 2011).
Financing Pharmaceutical Research and Development
Published in Hans Löfgren, The Politics of the Pharmaceutical Industry and Access to Medicines, 2017
Direct to consumer (DTC) marketing is banned in all developed countries with the exception of New Zealand and the US, on the ground that firms are likely to mislead and manipulate consumers. Firms compete for market share on the basis of selling medicines that are often similar to other drugs within the same therapeutic class. Consumers have little knowledge of the efficacy of specific medicines and treatments, but can be swayed by advertising. The experience of DTC marketing in New Zealand and the US has not been positive (Angell 2005; Coney 2002). A great deal of industry promotion is ‘disease mongering’, a ploy to convince consumers that they are sick and need medication, with promotion through television, radio, magazines, newspapers, billboards, and so on (Moynihan and Cassels 2005).
Prescribing in 2019: what are the safety concerns?
Published in Expert Opinion on Drug Safety, 2019
A separate issue that leads to potentially inappropriate polypharmacy is that of over-diagnosis leading to Too Much Medicine – a campaign that has recently been highly by the British Medical Journal (https://www.bmj.com/too-much-medicine). Expanded disease definitions, disease mongering and medicalization, commercial vested interests, increased patient expectations, litigation, and fear of uncertainty are all cited as potential reasons why patients end up being over-prescribed medications. One of the leading causes of additional prescribing is due to ‘diagnosis drift’ where primarily serious states of disease have given way to milder and more prevalent states of disease [11]. Prescribers should be aware of overprescribing that poses a threat to human health with significant resource implications.
Depression Screening During Pregnancy and the Postpartum Period: Enhancing Informed Consent Practices
Published in Women's Reproductive Health, 2018
Akansha Vaswani, Justin Michael Karter, Lisa Cosgrove, Shannon M. Peters, Madeline Brodt
Disease mongering, or the widening of illness boundaries (Illich, 1976; McHugh & Chrisler, 2015), is facilitated by contemporary psychiatric taxonomy, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM; Moynihan & Henry, 2006; Tiefer, 2006). One way the DSM does this is by promoting a “drug narrative,” that is, the conflation of science and marketing such that the drug provides a solution to a problem, and the drug's efficacy provides proof of the validity of a new disorder (Matheson & McCollum, 2008). For example, previous editions of the DSM included a bereavement exclusion that instructed clinicians not to make a diagnosis of major depressive disorder (MDD) after the loss of a loved one given that it could represent a natural reaction to grief. The DSM-5, however, eliminated the bereavement exclusion, thereby medicalizing the experience of shock and grief and allowing clinicians to give a diagnosis of MDD just two weeks after the loss of a loved one. Even more problematic is the inclusion of a new and explicit statement encouraging the use of pharmacotherapy; “recovery [from bereavement related depression] may be facilitated by antidepressant treatment” (American Psychiatric Association [APA], 2013, p. 155).
Schrödinger's Disease and the Ethics of (Non)Diagnosis: The Problem of Medically Unexplained Symptoms in Contemporary Medical Practice
Published in The American Journal of Bioethics, 2018
We also live in an area of “disease-mongering” and remedy advertising: where diagnoses are extended through stretching disease categories (genetic tendency to breast cancer, pre-diabetes). An absence of a disease label is therefore surprising to patients and profoundly unsettling. Disease-mongering in the name of “awareness” is also an ethical choice, raising the risks of disease anxiety and overscrutiny of symptoms. Patients who are reminded to scrutinize their bodies for signs of incipient disease must find it confusing when disease cannot be found.