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Paul Krugman: Wealth Versus Health: “Last year the administration claimed that it could easily cut taxes without tapping the Social Security surplus. Those claims were false, but Sept. 11 provided cover: who cares about lockboxes when we’re in pursuit of evildoers?” NY Times

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Selling Sickness:

A special issue of the British Medical Journal is devoted to the growing problem of ‘medicalisation’ — the burgeoning tendency to treat personal and social problems as if they were diseases or medical conditions. For example, one feature article deals with the important role of the drug companies in this process — The pharmaceutical industry and disease mongering:

‘There’s a lot of money to be made from telling healthy people they’re sick. Some forms of medicalising ordinary life may now be better described as disease mongering: widening the boundaries of treatable illness in order to expand markets for those who sell and deliver treatments. Pharmaceutical companies are actively involved in sponsoring the definition of diseases and promoting them to both prescribers and consumers. The social construction of illness is being replaced by the corporate construction of disease…

Disease mongering can include turning ordinary ailments into medical problems, seeing mild symptoms as serious, treating personal problems as medical, seeing risks as diseases, and framing prevalence estimates to maximise potential markets.’ British Medical Journal [thanks, Adam]

Incisive medical commentator Dr Michael Fitzpatrick, author of the 2000 book The Tyranny of Health: doctors and the regulation of lifestyle, many of whose views I share, responds to the BMJ‘s handling of ‘medicalization’ in Spiked!:

Many have welcomed this as a sign that the medical profession is waking up to the problems resulting from the spread of medical influence over wider and wider areas of life. A closer look reveals that the leading journal of British medicine is in a state of confused introspection rather than engaged in serious questioning of current trends in practice.

The feature that won wide attention was the BMJ’s list of the Top 20 ‘non-diseases’ – everyday problems that GPs are increasingly expected to deal with in their surgeries today. In fact, this feature reveals the journal’s difficulty with the subject of medicalisation.

The list includes boredom, bags under the eyes, big ears, grey hair, ugliness, freckles (indeed these are all in the Top 10). Now in my 20 years as a doctor, nobody has ever presented any of these as symptoms, never mind believing them to be diseases. The list does not seem to work as a joke – it also includes problems such as loneliness and unhappiness, which though not very amusing, do commonly bring people into doctors’ surgeries. Number 18 is pregnancy, which is perhaps the only condition in the list which could be considered a normal human experience that doctors have a tendency to treat as a disease. The Top 20 feature manages both to trivialise medicalisation while also avoiding the real issues at stake.

The BMJ’s Top 20 leaves out a wide range of conditions that in recent years have come under the medical umbrella, yet many would consider to be ‘non-diseases’. These include ME/chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, whiplash, repetitive strain injury; syndromes such as attention deficit hyperactivity disorder, post-traumatic stress disorder or social phobias; addictions to alcohol and drugs, and also to nicotine and gambling; teenage pregnancy, domestic violence, bullying. It is perhaps not surprising that the BMJ doesn’t consider these conditions within the framework of medicalisation: many have been promoted in recent issues of the BMJ.

It’s no accident that many of Fitzpatrick’s ‘top 10’, similar to the list I might make (my concerns with some of these conditions will be familiar to consumers of FmH as well as my academic teaching), are dealt with within my own specialty of psychiatry, since psychiatry is all about problems arising from the ways we see ourselves and the world. After a brief detour through the curious issue of the BMJ‘s resurrection of Ivan Illich and his Medical Nemesis, Fitzpatrick goes on to show how the BMJ critique misses the point, tries to be too facetious by half, and lacks a coherent critical viewpoint.

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All wrapped up with nowhere to go:

Five ‘X-Files’ to go – Is the truth really out there? “Too bad all signs point to Chris Carter, the show’s creator, reneging on — or at least drastically fudging on — a promise he made when he decided to pull the plug on the show: to wrap up as many of the myriad loose ends as possible.” SF Gate As one of the only two things on commercial television (the other was Homicide) I had any compulsion to watch over the last decade, this might have distressed me if (a) the show hadn’t become such an unwatchable parody of itself in the last few seasons — even before the cast changeover; and (b) it was even barely plausible that Carter could wrap up the loose ends, which it isn’t. The scriptwriters’ greatest skill, with regard to the central conspiracy theme, has been obfuscation, leaving such a tangled web of self-contradiction that no resolution is even remotely possible. (“I want to believe” indeed…) The only things left to hope are that cocky Chris Carter has learned a lesson from all this, and that the anticipated return of David Duchovny’s Fox Mulder in the last episode (yes, I’ll watch if I can, for old times’ sake…) will not be a painful embarrassment.