Wie wir zu Patienten gemacht werden
(The Disease Inventors: How we are turned into patients)
by Jörg Blech
reviewed by Mira de Vries
“Mira, you would like this book,” several MeTZelf members exclaimed when it was first published in 2003. The problem was that contrary to most Dutch people, I don’t read German, having been educated abroad. Thankfully in 2005 a translation into Dutch by Hans Driessen appeared. My ignorance of German even earned me a bonus, because this translation has a postscript by my favorite Dutch language author on health matters, Ivan Wolffers, MD PhD.
Blech does not trivialize serious diseases nor deny that some medical treatments are vital. Rather, he protests how pharmaceutical corporations pathologize everyday life and invent diseases to promote their products. Among the non-diseases for which perfectly healthy people are now urged to seek medical treatment are hair loss, shyness, aging bones, high cholesterol levels, high blood pressure, too little sexual excitement, irritable bowels, ugliness, pregnancy, delivery, jetlag, unhappiness, hangover, infants’ turned in feet, child unruliness, fears, menopause, male hormonal changes with age, defective genes, and ultimately, dying. (Blech doesn't include HIV-AIDS because he believes in it, nor does he mention the vague complaints for which doctors massively overprescribe NSAIDs and proton pump inhibitors.)
Rather than increase health, the treatments for these conditions vastly damage our health. In industrialized countries, medical treatment is the third largest cause of mortality. (Although no doubt drugs contribute heavily to mortality, it seems to me that how much is unknowable, especially as the doctors who prescribe them also control the entries on the death certificates.) Furthermore, trivial treatments divert resources and funds from where they are truly needed. (He overlooks damage to the environment.)
How do the pharmaceutical giants push their products? With around 5,500 articles that appear daily in more than 25,000 medical journals around the world, research projects of unreplicable scope, manipulated research results, incessant press releases which journalists copy verbatim in their dailies, managing physicians’ education, authoring medical guidelines, hiring respected professors to lecture on their products, fake research paying physicians $100 per recruited patient, wining and dining physicians at supposed educational courses, paying physicians $50 for receiving a drug representative, disease awareness campaigns, paying famous people handsome sums to promote their “disease” on talk shows, and sponsoring patient organizations, to name a few examples.
Blech points out that not only patients are victimized by these practices, but physicians as well. They are increasingly expected to solve social problems rather than medical ones.
He proposes five ways of remedying the situation:
Ivan Wolffers’s brief postscript is disappointing. He has written umpteen excellent books on the pathologization of everyday life and the fraudulent practices of the pharmaceutical industry, so you’d think he would praise Blech to the hilt. Instead he attempts to play down his message:
Humans try to find words to communicate about disease and health. Medical jargon, as recorded in international medical thesauruses, contains more terms than any other language. Some concepts may have as many as eighty synonyms. The less a thing is understood, the more words are thought up for it. (my translation)But “humans” don’t write medical thesauruses. Only a tiny sub-group of humans do, namely pharmaceutically sponsored physicians and medical researchers.
Wolffers further likens Blech’s theme to a conspiracy theory, and tries to shift attention from it to the growing gap between rich and poor. This otherwise lofty endeavor is inappropriate here because, as Blech demonstrates, precisely people in the wealthy, industrialized countries, as well as the wealthier layer in less wealthy countries, comprise the largest population of victims of the pathologization of everyday life. Could it be that Wolffers’s recent bout with prostate cancer, about which he talks and writes publicly, has left him beholden to the industry?