Medical Article

The Cart is Leading the Horse
We, and that is not only us medics, generally identify a disease before we look around for its treatment. Observers argue that, these days, the sequence sometimes is reversed:  the marketing of a pharmaceutical agent gives birth to a disease, often by “medicalizing” what actually is a natural part of human existence. This has created an epidemic of insomnia, particularly in the US.

Researchers examined recent trends in the diagnosis and treatment of sleeplessness. Between 1993 and 2007, patient complaints of sleeplessness more than doubled and the diagnosis of insomnia rose more than sevenfold. Both these increases, however, were dwarfed by the skyrocketing number of prescriptions written for sleeping pills. Benzodiazepine prescriptions increased modestly by 50 % whereas prescriptions for non-benzodiazepine sedative hypnotics (another dangerous sounding word for sleeping pills) like Zolpidem soared 30-fold.

The figures for the US in 2007: 5.7 million complaints of sleeplessness, 6.1 million diagnoses of insomnia and 16 million prescriptions written. The authors suggest that “life problems are treated with medical solutions”, without much attention being given to anything but the prescription pad (Am J Public Health 2011 Aug; 101:1429).

The authors make a cogent case for the creation of a pseudo-epidemic of insomnia. To be fair, it could also be argued, that in the pre-zolpidem era the dearth of convenient therapy meant that patients never bothered to complain (Journal Watch Sept 15; 31:141).
That’s as far as scientist’s opinion goes. Now let’s start thinking for ourselves.

A few years ago the expression “life-style-medicine” was coined referring to cosmetic surgery, Viagra, medicines supposedly treating male hair loss or whole-body-CAT-scans amongst others. Doctors who were educated to heal the sick and injured and alleviate sufferings and pain would find it difficult to understand that modern society has changed in a way, that even non-health-related situations could cause tremendous sufferings. Boobs to small, head to bald, neighbour to unfriendly – problems change not only over an individual lifetime, but also over a century of ‘modern life’. Problems of all sorts were different 50 years ago. Nowadays comfort has reached levels never experienced before. Serious shortcomings are unknown experiences for many or even most people in a so-called western society with an accompanying lack of tolerance of even minimal frustration.

And trends in medicine do naturally take part in that. ‘Old’ doctors, and I am not only thinking of Methodists and Quakers, will raise a moral (index) finger and say “this is not what medicine is about”…. ? Hm.

On top there is famous infamous consumerism – buying things to be happy. Medications are just another part of that – underlying the same principles of marketing, selling and shareholder value.

Once the motor vehicle was invented there is no way back unless we run out of fuel.
The same is true for medicine, unless public health systems cannot be maintained at today’s level anymore because the politicians had been spending too much money they had never had and serious cuts need to be taken.

But as long as we have 4€ spare we want to experience the comfort of buying a packet of uninterrupted good night’s sleep – that’s how it is.
And if on top we are lucky enough to live in a Mediterranean country, we can most of the times by-pass official statistics, doctors and other annoying obstacles and just go to the chemist around the corner to buy ‘mothers little helper’ over the counter.

All this is a social phenomenon we, as Doctors, can observe and mostly not change. But Wolfgang as much as I feel obliged to inform undogmatically, when there is more marketing than medicine or when health risks are involved with too much consumerism.

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