Talk:Disease mongering

It

It is evident that Lynn Payer originally coined the concept, and that Moynihan has run off with it. Here Ray reviews Payer's book, and afterwards he makes "journalistic" submissions to the BMJ exploring the concept. The BMJ's editorial policy is clearly to uncritically accept this agenda. JFW | T@lk 15:52, 28 May 2007 (UTC)

do not delete without seeking consensus

editors should not simply delete info without making a case to do so in discussion. As a sign of good faith I have omitted the Breggin sentence. I would hope that others follow wiki policy. WP:CON --scuro 16:40, 30 May 2007 (UTC)

WP:BRD - I must prefer a pointed edit with a good edit summary. If you want to discuss instead then I'm quite happy doing that.

This article is about "disease mongering" as a term and a phenomenon. The Baughman interview does not mention the term, and the way you describe his opinion is not exactly consistent with "disease mongering". I'd prefer to use the term "diagnostic creep" for this.

Stating that "This is a straw man argument" is WP:NOR unless you can provide a citation for this opinion. I will have to remove this sentence.

Could you rephrase the opinion attributed to Baughman so it makes sense? JFW | T@lk 21:26, 31 May 2007 (UTC)

I would like discussion better, a page like this will attract major POV pushers. There are numerous documented Baughman interviews where he uses the term. Did he coin the phrase? It sounds like Baughman. I didn't look too hard but did see one interview from 96 where he used the term. I will take a crack at better phrasing. --scuro 04:25, 1 June 2007 (UTC)

With all due respect, the new version is even worse. The page Fred Baughman doesn't even use the term. The first use of the term is in the title of Lynn Payer's book from 1992. I have removed the Baughman sentence until you can provide more conclusive evidence here.

At the moment, you are suggesting that the term is almost exclusively used by Scientologists and Antipsychiatrists. This is almost certainly not correct, unless that particular association is just limited to psychiatry. JFW | T@lk 09:55, 1 June 2007 (UTC)

PS This page has already attracted POV pushers in the past. JFW | T@lk 10:07, 1 June 2007 (UTC)

"the media has bought into this psychiatric disease mongering, and that's why it is rampant. That's why the drugging of our children is rampant". http://www.newstarget.com/020227.html

I'm not suggesting anything. I stating that the term is often used by antipsychiatry and scientology critics. If you believe that there are different groups that use the term in different ways, then add this to the article to make it better.--scuro 11:29, 1 June 2007 (UTC)

I'm really wondering what you're trying to achieve. None of your other sources (re. scientology and antipsychiatry) mention the word "disease mongering". Therefore, I submit that much of what you've been saying is conjecture and interpretation. Perhaps you ought to review WP:NOR before you make further reverts to my reasonable edits. JFW | T@lk 00:37, 3 June 2007 (UTC)

Here I am asking again that you seek consensus before deleting material. WP:CON Have you actually read this policy? I strongly suggest that you do so that we no longer see the disruptive editing that is currently happening http://en.wikipedia.org/wiki/Wikipedia:Disruptive_editing#Dealing_with_disruptive_editors.--scuro 03:13, 11 June 2007 (UTC)

No attempt at consensus is made before deletions and edits are made->pov pushing

Simply editors do whatever they want to do without communicating first. Check the logs. Deletions are made and then perhaps after the deletion we may get a comment in discussion. Neutrality in such an environment is impossible. --scuro 04:40, 3 June 2007 (UTC)

You are being unnecessarily difficult. I have given ample reason why I made the deletions that I made. You seem to be intent on putting words into Fred Bauchman's mouth. He does not seem to be a major user of the term "disease mongering". To label the article {{NPOV}} is a misrepresentation of the discussion (or the lack of it) that we've been having over here. JFW | T@lk 06:53, 4 June 2007 (UTC)

If you accuse me of POV pushing, could you please state which POV I seem to be pushing? JFW | T@lk 06:55, 4 June 2007 (UTC)

should this article be deleted?

Wiki asks that editors discuss the content not the person. Your tone is judgmental and so are your words. A simple way around that is to write in the third person, avoid personal comments, and focus on content. I have deleted the BiP section. Healey is fringe (not minority or majority) and the line of thought goes against WP:NOR. I'll concede that I have no citable sources at this time to further the Baughman conclusion and will let that information stay off the page for now.

Yes, lack of discussion is a problem, lets correct that. Disease mongering is a loaded term to begin with in that it is a highly judgmental phrase. I'm not sure if it even warrants an article especially if the article is used to give legitimacy to fringe and derogatory voices. I can find plenty of examples where the term is used by antipsychiatrists. Even a good number of the sources listed in the article are AP sources. It would be good to get more balance in the article by adding and citing mainstream or even minority opinions within the medical profession itself. If no one within the medical profession sees this as an issue or uses the term then one really has to question if the term/article isn't just about POV pushing. Here are Wiki policies that should be considered.

WP:SOAP Wikipedia articles are not propaganda or advocacy of any kind. Of course, an article can report objectively about such things, as long as an attempt is made to approach a neutral point of view.

WP:UNDUE - If a viewpoint is held by a significant minority, then it should be easy to name prominent adherents; - If a viewpoint is held by an extremely small (or vastly limited) minority, it does not belong in Wikipedia (except perhaps in some ancillary article) regardless of whether it is true or not; and regardless of whether you can prove it or not.

WP:DP

• Content not suitable for an encyclopedia

--scuro 10:56, 4 June 2007 (UTC)

I agree with your removal of the bipolar-related content. Again, direct accusations of "disease mongering" are lacking in those sources.

I don't think the article should be deleted. In its present form it gives a fairly objective overview of the perceived phenomenon. What is lacking still is a reliable voice from the pharmaceutical industry defending the process of "promoting" disease entities. I think few people disagreed that erectile dysfunction was unpleasant, but Pfizer cashed in on Viagra's success largely through the wider recognition of the symptom amongst health professionals and patients alike. This is a bona fide phenomenon. Moyhinan and his lot clearly feel this is unethical. They label this as "disease mongering". This article describes their objections and their use of the term. Lynn Payer's book, of course, predated this. It is perfectly neutral to describe this.

There is no case for SOAP (who is using what as a soapbox?), UNDUE (these views are well documented and recognised) nor DP (this is verifiable and well documented). If your beef is with antipsychiatry, perhaps this is not the right battleground. JFW | T@lk 03:33, 5 June 2007 (UTC)

What is lacking are citations from the minority medical community which agrees that disease mongering occurs. So far all I see are citations from people with books to sell and the antipsychs. That would give this article some real legitimacy. Otherwise this article looks to be nonencyclopedic, undue weight, and ultimately subjective. I'll weight for possible improvements but will nominate that the article be deleted if none are forthcoming.

Also there needs to be a clear delineation between the way that disease mongering is used by two separate entities. The way a scientologist uses disease mongering is not the way that Moynihan uses it. If that delineation can't be kept in the article then clearly we have a case of POV pushing.--scuro 03:40, 6 June 2007 (UTC)

Stop using the term "POV pushing". You clearly have no idea what you are saying. POV pushing happens what someone is pushing a POV. I don't think I am that person. Rather, you need to be clearer what points you want to get accross. Educate me. Once you've stated what you want, you will probably find me agreeing with it or offering a reasonable explanation why I do not.

Let's try again. Obviously the phenomenon "disease mongering" is being used by anti-psychiatry voices to bemoan the fact that the psychiatric profession has broadened the definitions of certain conditions and indications of common psychopharmaceuticals. This is not much different from the "disease mongering" that the Australian contingent is so worried about. In what sense are there two phenomena, and what would be the nature of your favoured "delineation"? JFW | T@lk 05:23, 6 June 2007 (UTC)

Does the "disease mongering" crowd simply consist of antipsychs and like minded vocal critics or are there noteworthy critics who also make this complaint? If Psychiatry is creating disorders surly a minority of doctors, some medical association, or some government would point this out. If that is the case then we would have two branches of critics, the fringe and the real critics. Otherwise if we are only left with the vocal critics we would simply have a POV pushing article and the inclusion of it in Wikipedia would also be POV pushing. Find some critics who are respected in the medical field. Do this quickly before I nominate the article for deletion. I'd also suggest that you spend a far greater degree of your time looking for this info then characterizing me or my words in a derogatory way. You have been warned twice now action will follow the next example. --scuro 11:06, 6 June 2007 (UTC)

You are still mistaken in your application of the term "POV pushing", and perhaps you should adopt a more constructive tone. Threats are certainly unconstructive, and I suspect that a vote for deletion will meet with a decision to keep.

If the BMA lends its news collumns to several articles on "disease mongering" in the non-psychiatric sphere, then obviously this is an opinion that needs to be included. As long as this opinion is described neutrally, no policy has been violated.

I'm going to ask a few colleagues to offer their opinion here. You can read my message on WT:CLINMED. JFW | T@lk 01:00, 7 June 2007 (UTC)

I can for instance find many citations on ADHD medication. I can also find some citations that state that ADHD medication causes irreversible brain damage. I can string those two together and create what looks to be a legit article on ADHD meds causing brain damage. Same potential problem here. What is lacking in this article is more legitimate information. Yes there are some good links and there even looks to be a good respectable and citable professor who made public statements about disease mongering. But where is the beef!???! Much needs to be added to the article. The main legitimate voices should be identified. The major points that they make should be flushed out.

If instead the article is just used as a platform to give legitimacy to antipsych bashing which we saw in the now deleted BiP section, and also in disease spoof section then clearly the article meets WP:SOAP. I can call this soapboxing if POV pushing bothers you. This seems to be an article that you created. I have created several articles myself and take great pride in them. When other editors ask for changes to the articles I created, I do it. I am asking you to improve this article. Also, I have no idea why you are deleting the ADHD and BiPolar example, could you please explain yourself. Another revert of good content (ADHD example) will break Wiki's 3 revert ruleWP:3RR. --scuro 01:57, 7 June 2007 (UTC)

Scuro, I think you are confusing a few issues here. This article should be specifically about allegations of "disease mongering". If this term has not been used in reference to a case, this case should not be in this article. To include such cases would be original research, a reinterpretation that has not (yet) been publicly accepted. I have explained this a number of times now. I will continue to delete cases that you think may refer to "disease mongering" while in fact this just reflects your opinion (or an opinion projected on antipsychiatrists).

The disease spoof section is an obvious example of Moynihan turning the whole thing on its head. There is no soapboxing here. I would suggest you avoid quoting Wikipedia policy articles out of context. (On the same note, perhaps you ought to actually read WP:3RR before bantering it about.) The ADHD and bipolar section was original research; I stated clearly in my edit summary why I deleted this so-called "example". JFW | T@lk 09:05, 10 June 2007 (UTC)

BiPolar/Healey/NPOV tag

Healey is a noted antipsych so the Bipolar section and the citations used support it are clearly a case of WP:SOAP. The section needs to be deleted. I'm going to put a NPOV tag on the article until other editors give guidance.--scuro 11:31, 8 June 2007 (UTC)

The Healey article is part of the 2006 PLoS series. It is not deserving of special attention, and Dara Koper (talk · contribs) is discouraged from backing up Healey's POV with lots of references until she can explain why bipolar needs to be singled out.

Scuro, I really suggest you do not insert the {{NPOV}} tag unless absolutely necessary. Please refer to this Arbitration Committee case before inserting it again. JFW | T@lk 09:05, 10 June 2007 (UTC)

Lovely and I couldn't agree more thanks for that link. That link suggests communicating in discussion before tags are put on or taken off. If you could agree we could have all additions/deletions discussed first here in discussion. That would cool things down a bit.

The issue of the bipolar section was brought up in a previous discussion. At the time we agreed that it didn't belong. It was added again so instead of getting into an editing war I simply added the NPOV tag. Thanks for removing the section and I have no objection currently to the removal of the tag.

It is time that you add some meat to this article as requested before. This article will not become a soapbox WP:SOAP for Scientology and Antipsychiatry bashing. You need to add the voices and ideas of the citable people have spoke on this issue...enough with the Antipsych parade.--scuro 03:24, 11 June 2007 (UTC)

PLOS?

Can you tell me if PLoS peer review is much like Breggin's ICSPP peer review, in that is insular and makes no attempt to engage the wider community of academic and scientific voices in the field? If this is the case then it wouldn't be an acceptable citable source.--scuro 03:29, 11 June 2007 (UTC)

I'm not making any guesses on PLoS. Given that it's an online journal without a specific reputation, all options are open. JFW | T@lk 15:34, 12 June 2007 (UTC)

WikiProject class rating

This article was automatically assessed because at least one WikiProject had rated the article as stub, and the rating on other projects was brought up to Stub class. BetacommandBot 16:25, 10 November 2007 (UTC)

Motivational deficiency disorder

This is a serious, real disease which has ruined my life and the lives of many others. —Preceding unsigned comment added by 75.142.22.24 (talk) 07:55, 12 May 2008 (UTC)

Edits of Oct 8

Hi Hgrosser, I see you have reverted my edits, which were made to remove healthcare related content that is not sourced per MEDRS guidelines. The relevant guideline is

"Ideal sources for biomedical material include general or systematic reviews in reliable, third-party, published secondary sources, such as reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally recognised expert bodies."

Vast sections of this article are taken from a popular book that expresses the opinions of that particular author prsented in the voice of Wikipedia. This is a violation of NPOV as well as of the sourcing guidelines. The article itself defines the phrase "Disease mongering" as a pejorative, then goes on to apply it to several companies and industries in Wikipedia's voice. Surely you will understand that this is as blatant an example of NNPOV as can be imagined. Best, Formerly 98

Whether a given human experience is defined by society as "a disease" is not actually "biomedical information". MEDRS doesn't apply to the main aspects of this subject. We should probably be looking for sociology sources. WhatamIdoing (talk) 22:52, 10 October 2014 (UTC)

Hi @WhatamIdoing:

Interesting thought.

I'd call the term "disease mongering" simply a pejorative for "over-medicalizing everyday problems with the goal of gaining an exploitative profit". But because where the line between acceptable medical marketing and over-medicalization lies is a value judgment, I don't think you'll find a single mainstream definition in the social science literature or anywhere else. Like promiscuity, disease mongering is in the eye of the beholder because it involves a value judgment.

I'd like to see the article discuss these issues without taking sides, describing a range of opinions and not being based exclusively on the opinions of Ray Moynihan, Lynn Payer and anti-psychiatry activists. They have their opinions, others disagree with them. Moynihan called osteoporosis prevention disease mongering. The American College of Clinical Endocrinology, the American College of Obstetricians and Gynecologists, the North American Menopause Society and the UK National Osteoporosis Guideline Group disagree with this position, recommending that post-menopausal women with certain bone scan results take alendronate or other resorption inhibitors. (After Moynihan's paper was published,alendronate was shown to reduce the risk of hip fractions, which are associated with a very high 6 month mortality rate in the elderly). Most dentists I know would disagree with Payer's caustic remarks about Listerine and halotosis. I remember the ads, they were rather silly. But generally speaking, people with bad breath have it because they have gum disease, and Listerine is recommended by the American Dental Association for the treatment of that. mistatement, but the ADA does recognize halitosis as a "recognizable disorder deserving professional attention" per the reference I have added to the text.

I think these examples point to the difficulty and inappropriateness of calling out specific activities as disease mongering in Wikipedia's voice. Off the top of my head, I can't think of any examples that are so clearly over the top that one cannot find at significant minority that believes the activity was appropriate. If I am correct in this WP:NPOV requires presenting both sides of the issue and not taking sides.

I think we can present all sides to this issue, making clear that different people have different defintions of disease mongering and where the line is between disease and inappropriate medicalization. It should also present a range of opinions and not just be based on those of Mr. Moynihan and Ms. Payer. You will find few efforts to directly rebut such criticisms in the literature, but if we are going to note the opinion of an industry critic that restless leg syndrome is a made up disease created by the pharmaceutical industry, balance requires that we mention that the European Federation of Neurological Societies, the European Neurological Society and the European Sleep Research Society consider it a real disorder and have written treatment guidelines for it. Formerly 98 (talk) 05:23, 11 October 2014 (UTC)

Well said—agree thoroughly. That approach is the one that would explore the topic comprehensively and in an NPOV way. Not saying all the work toward it would have to be accomplished anytime soon—am saying that that's the strategic vision that shows the direction the article should grow in. Quercus solaris (talk) 16:46, 11 October 2014 (UTC)

Thanks. Another issue I think would be interesting to touch upon are the regulatory issues that drive medicalization, but I'm not sure if there is a way to do that without violating WP:OR. Baldness and Hypoactive Sexual Desire Disorder are widely cited as examples of "disease mongering". I think most people have no objection to the idea that if a company can come up with a safe product that helps bald people not lose their hair, and people want to buy it, the transaction should be legal. You would probably get reasonably wide agreement in the case of a drug that restores the ability to enjoy sex as well. But in the U.S. at least, CFR 21 states that drugs must have an approved label, and that label must state what "disease or condition" the drug treats. The aforementioned transactions cannot occur unless baldness and lack of sexual desire are medicalized due to regulatory considerations.

"This section [of the drug label] must state that the drug is indicated for the treatment, prevention, mitigation, cure, or diagnosis of a recognized disease or condition, or of a manifestation of a recognized disease or condition, or for the relief of symptoms associated with a recognized disease or condition." - CFR21 201.57 (c)2

If anyone has an opinion on the WP:OR aspects of this (whether it would be a violation, or if there is a good source discussing the issue we can use), I'd appreciate their thoughts. Formerly 98 (talk) 17:17, 11 October 2014 (UTC)

I think we've all agreed, then, that this is pretty much not MEDRS territory, because "value judgments" aren't biomedical. I'd be happy to see all sides presented, so long as we don't end up with WP:GEVAL problems.

On the legal "need" to medicalize things: I'm not sure that's the whole story. I think that it might still be possible to sell a remedy for baldness as a cosmetic treatment, like antiperspirant. Antiperspirants are considered both cosmetics and drugs under US law[1], and they aren't (usually) approved to treat any disease at all. It's possible that a cure for male-pattern baldness would be handled the same way.

Here's a question for both you: Should we take this article and {{mergeto}} Medicalization? WhatamIdoing (talk) 22:01, 11 October 2014 (UTC)

Hi @WhatamIdoing:

I think it would be better merged (it seems strange to me to have an article with a pejorative as the title) but I don't feel real strongly about it. As for the issue about cosmetic vs. pharmaceutical, I don't know the whole story but I'm pretty confident that anything taken systemically is going to be either a nutritional supplement (if it is a component of foods ordinarily consumed by Americans) or as a drug. Formerly 98 (talk) 22:53, 11 October 2014 (UTC)

Excellent idea to merge this into medicalization, in my opinion. With a section headed "disease mongering". Reason: there is no simple, objective line between the two (no discrete point on a spectrum, with its location objectively agreed, where medicalization first becomes disease mongering), which that section of the merged article would explicitly state. It would explicitly say something about how the label "disease mongering" is a subjective label for certain subsets of medicalization, but that people disagree about which instances can fairly be labeled thus. That said, I do believe in the existence of things like war mongering and disease mongering, just as much as street drug "pushing" does exist (eg, the first one's free), but it's true that labeling instances is extremely difficult/subjective/contentious. Quercus solaris (talk) 14:49, 12 October 2014 (UTC)

Then it's unanimous. Who wants to take the first crack at merging? Just getting it all on the same page will be a good first step. WhatamIdoing (talk) 16:58, 12 October 2014 (UTC)

I can take a run at it, but probably later this week. If someone wants to do it before me, that's fine with me. Don't we have to go through a deletion review or something though?

I agree entirely that it exists, as every industry (not just pharmaceuticals) attempts to create and not just fill existing demand. To be honest, I think its much less of an issue than it used to be, as most of the drugs that were aimed at the primary care market are now off-patent and DTC spending has fallen nearly 40% from its 2006 peak. Companies are now making all their money off of very expensive drugs for cancer, rheumatoid arthritis, and viral diseases like HCV, and you can disease-monger all you like, nobody is going to pay for these out of pocket based on having seen a TV ad and the insurers will have their own criteria for who gets them reimbursed.

Why the pharma industry was the near sole topic of this article escapes me as well.

http://bunionsurgeryny.com/procedures/flat-foot-surgery/

http://www.sacdc4m.com/

http://m.2020sandiego.com/

http://www.ocf.berkeley.edu/~ahsleep/teensleep.html

Formerly 98 (talk) 17:00, 12 October 2014 (UTC)

Unless you reasonably expect someone to object (I don't), then bureaucratic stuff should be avoided. The instructions are at Wikipedia:Merging#How to merge. WhatamIdoing (talk) 22:47, 12 October 2014 (UTC)

Cellulite example

About this recently removed statement: I think that needs a citation if we're going to keep it. If you sell cellulite creams, you could be selling it merely as a cosmetic thing, equal to hair dye, without any disease mongering involved. Disease mongering requires communicating that something makes you sick, not that it makes you (allegedly) ugly. WhatamIdoing (talk) 23:43, 10 October 2014 (UTC)

OK, fair enough for now. I still think cellulite is worth mentioning in this article in future (even though that phrasing turned out to be the wrong way to discuss it), because it is an important example of what is discussed above by User:Formerly 98 (the subjective line between physiologic and pathologic, which inevitably involves sociologic as well as biomedical aspects—that's me summarizing it in one of various ways to put it). It is undeniable that some makers of cellulite creams would like it if some members of the general public (people without medical expertise) believe that they have a "disorder" that requires an over-the-counter "remedy"—something more than just "I prefer brunette to silver hair color" (two equally valid options)—something more like people feeling that others are looking at them with a "cover your shame, please" attitude ("do something about that skin problem—there are topical preparations for that"). People in the fat acceptance movement, fighting anti-fat bias, can speak to this sociologic instance. If you look at quack skin-lightening creams back 50 to 100 years ago, it is analogous—there were plenty of eugenicists who said that being black was a biological inferiority, although that is not quite the same as adding "...and there's a drug you can take to improve it" (people of the one-drop theory didn't believe there was any "cure" for "racial inferiority" in an individual who already had the "affliction"—they wanted to prevent births of future such individuals). Another topic is the assertion that one could/should use psychotherapy to "cure" oneself of being gay. Anyway, enough for today, but all of these are valid potential topics for mention in this article. Quercus solaris (talk) 16:38, 11 October 2014 (UTC)

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