We are all sick in power

We are all sick in power. This is the truism worthy of Dr. Knock, the famous character of Jules Romains, who makes a customer by using marketing tricks, has never been so topical. To sell more and more drugs, major pharmaceutical companies do not hesitate to play on this sensitive chord behind the scenes, and the strategy pays off. While the number of diabetics, hypertensives and respiratory insufficiencies has increased significantly in recent years, " this is only marginally due to the aging of the population, environmental degradation and changing habits. Philippe Even *, director of the Necker Institute Industry maneuvers to broaden the definition of diseases further explain this phenomenon . "

* Author with Bernard Debré of the Guide of the four thousand useful, useless or dangerous drugs (edition Cherche Midi).

Always lower thresholds

The first weapon used to bring new parts of the population into medical purse: the downward revision of the normality thresholds of the main biological constants , to which the powerful lobby of the laboratories is no stranger. In the nineties, for example, a patient was considered hypertensive when his blood pressure exceeded 16 / 9.5. Today, the bar is set at 14/9. This modification had "the mechanical consequence of significantly increasing the number of people considered hypertensive, so that of patients taking antihypertensives, " says Dr. Sauveur Boukris *, general practitioner and teacher at the University Paris-Diderot. As the tension increases with age, two thirds of French people over 60 are now in the target. In the same way, since the year 2000, we are cataloged as diabetic as soon as our blood sugar reaches 1.26 g / l, against 1.4 g / l previously: 10% of decrease which increased the number 20% of patients ! For triglycerides, the normality threshold also decreased drastically, from 2.3 to 1.7 mmol in July 2003. Same for LDL cholesterol (the "bad cholesterol"), whose level fell from 3 to 2, 6 mmol. As a result, cases of hypercholesterolemia have multiplied as if by magic. They have almost tripled (13 to 36 million) in the United States alone.

* Author of the Factory of Sickness (Cherche Midi).

Beware of all-out screening

When it comes to health, the best is sometimes the enemy of good. By multiplying the examinations, we end up turning some healthy patients into patients. Certainly, from the age of fifty, mammography can detect breast cancer at the early stage and optimize the chances of recovery. But not too much, because all the minitumers do not evolve into aggressive cancers.

Some even regress spontaneously. Dealing with them with loss and noise can cause unnecessary damage. In addition, repeated x-ray exposures are not safe. " By altering the DNA strands, they are likely to generate malignant tumors in the long run ," explains Catherine Colin, radiobiologist at the Lyon-Sud Faculty of Medicine (see VB No. 848, February 2012). More criticized still: the dosage of PSA, supposed to detect prostate cancer. Given the number of "false positives" (about 70%), many unaffected men undergo biopsies or unnecessary treatments, with disastrous consequences (impotence, incontinence ...).

We are all manipulated

And that's not all. If our test results are just below the red line, a new nebula opens: that of premature. A very recent invention that imposes on non-patients increased surveillance and possibly a first prescription of drugs under the pretext of prevention. Your blood sugar fluctuates between 1.1 and 1.2 g / l? You are wearing the label "prediabetic". Your blood pressure is around 1 3,5 / 8,5? You are catapulted into the field of prehypertension. Do your bones begin to demineralize with age? A diagnosis of osteopenia (or preosteoporosis) will probably be made.

Not really sick, but likely to be one day or the other. " This is a classic case of disease creation that consists of turning a risk factor into real disease in order to sell drugs to people in good health, " says Dr. Boukris. An ingenious sleight of hand orchestrated by pharmaceutical laboratories and their opinion leaders.

To establish their sacrosanct profits, the industrialists do not skimp on the means. Reinvigorating about 45% of their turnover in marketing and influence peddling ( against only 5% for research, 15% for development and 10% for the manufacture of products ), they are indisputably fire of all woods . In particular, they exercise considerable control over the information provided to practitioners, as they sponsor continuing medical education, which neither the National Health Insurance Fund nor the Ministry of Health can assume. They are also the ones who finance the medical congresses, the work of some experts as well as a part of the budget of the health agencies. They are ubiquitous in law firms thanks to their army of eighteen thousand medical visitors who encourage practitioners (under the guise of providing information and advice) to prescribe profusely. Not to mention the advertising campaigns published in the professional medical press, targeted e-mails worthy of the best marketing schools and small discreet gifts. Their efforts are not in vain since nine out of ten consultations end in France with an order. A gesture that has become reflex and faster than explaining to everyone the benefits of sport and a better diet. However, as noted by Dr. Boukris, the best treatment to reduce for example a beginner hypertension is to limit the consumption of foods rich in salt (cold cuts, cheeses, cooked dishes ...) precisely to delay the taking of tablets . But, since the majority of city practitioners are paid on a fee-for-service basis, some parents are in a hurry and prescribe in a hurry. Sometimes remedies for uses other than those officially authorized.

That's what happened with the Mediator. This drug indicated against diabetes has often been issued as a simple appetite suppressant, resulting in the exposure of a large number of people with serious side effects that we know. Out-of-specification prescriptions are not condemnable if the efficacy of the potions is recognized, their dangerousness low, if there is no other therapeutic solution and if the patient's condition warrants it. But it is clear that abuse is legion , as for statins, these capsules supposed to reduce cholesterol levels in individuals likely to develop cardiovascular disease. After conducting clinical trials on increasingly diverse groups to expand the market (diabetics and hypertensives, seniors over 70 years ...), laboratories push the plug even further. They recommend watering the healthy ones. And some generalists follow the movement. As proof: 30 to 40% of prescriptions of statins would be unjustified and would not fall under the indications, according to Social Security.

An excess all the more alarming that some five million people consume that cholesterol is, for many doctors, not a disease but just a marker of risk. And that the potential side effects of statins are not anecdotal: risk of liver injury, heart failure, muscle damage or diabetes. Develop a serious pathology to guard against another whose occurrence is not guaranteed, the game is it worth the candle?

Claim a real piece of information

Who says disease diagnosis often says prescription medication. After the recent scandals of the Mediator and last generation pills, is it reasonable to swallow them all without flinching? " We must not demonize drugs, says Professor Bernard Bégaud, pharmacologist at the University of Bordeaux, nor rely on them blindly. Many of their serious side effects result from misuse. The Diane Pill, for example, responsible for death by venous thrombosis, was the only indication in France for the treatment of acne. No one should have prescribed it as a contraceptive, especially without mentioning the associated risks. Do not hesitate to ask your doctor about the advantages and disadvantages of your treatments in order to make an informed decision.

The exploitation of malaise

Psychotropic drugs are also subject to increasing slippage. Initially developed to treat severe depression, they have more or less become remedies to do everything to dispel the malaise: both against sadness and reaction anxiety that difficult sleep or mood swings. " Badly accepted loneliness, worry about the future, difficulties to adapt to situations have now become so many reasons for consultation and prescription, " says Dr. Boukris. The slightest exacerbated emotion, existential anxiety or character trait a bit soaked can give rise today to a lasting take of "pills of happiness". As a result, we are the biggest consumers of tranquilizers in Europe, especially benzodiazepines, these molecules (Xanax, Lexomil, Temesta, Seresta ...) used as anxiolytics, sleeping pills or muscle relaxants. One in five French people swallowed it in 2010, according to the National Agency for the Safety of Medicines and Health Products, about half of which were off-label or off-label. " It is common that the prescription is renewed for several years while their consumption should not exceed a few weeks or months, " notes Professor Bernard Bégaud *, pharmacologist at the University of Bordeaux. However, this mess is dangerous, since psychotropic drugs upset the cellular balances in the brain and can thus make the bed of disturbing disorders: agitation, access to violence, change in consciousness, weight gain, anorexia ... Worse: as shown by a study by Professor Bégaud published at the end of September 2012 in the British Medical Journal, their long-term use can promote or anticipate the onset of Alzheimer's disease. "People who have been using benzodiazepines for a number of years have a risk of dementia increased by 50 to 60% compared to those who have never taken it," says the specialist. A typical case of disease manufacture.

The wind is not about to turn with the rampant medicalization of the wave to the soul. DSM, the international manual of classification of mental disorders that serves as a reference for most psychiatrists, is constantly enriched with new so-called pathologies requiring treatment. As noted by Dr. Boukris, each new version published has a direct impact on the turnover of pharmaceutical labs. No wonder they are funding a number of experts involved in writing this professional "Bible". The first DSM, published in 1952, listed a hundred diseases. The DSM II, released in 1968, contained one hundred and fifty-four. The DSM III, dating from 1980, counted more than two hundred and ninety. And, to rake even wider, the latest version, scheduled for May 2013, defines nearly five hundred ! But, above all, it extends the diagnostic criteria and the contour of pathologies so as to include as many individuals as possible. What generate a real artificial epidemic of mental illnesses.

* Director of the Inserm research unit for pharmacoepidemiology.

The folklore of psychiatry

To recruit new patients, the authors of the "bible" of mental illnesses (the famous DSM) do not go with the back of the spoon. We can all or almost all be concerned. Speaking alone in his bathroom, having trouble grieving two months after the death of a loved one or showing a decline in desire for his partner are now listed as diseases. A very capricious child can be disruptive mood dysregulation disorder, a disorder classified as a depressive disorder, as well as premenstrual dysphoric disorder, that is, women who crush black. at the beginning of the rules.