Are we at risk of being at risk?

Who decides what constitutes a disease and what is normality? Over the centuries such decisions have been the preserve of the medical profession, aided more recently by modern medical science. But the profession has grown too close to those who profit from developing drugs for new diseases and is no longer fit to make these decisions. This in brief is Ray Moynihan’s thesis, developed over years of reporting on the relationship between doctors and the drug industry, and vigorously reprised in this week’s journal (doi:10.1136/bmj.c4442).
Moynihan’s target this time is prehypertension, a condition that along with preosteoporosis and prediabetes has the potential to transform most of the world’s adult population into patients. And although lifestyle change may have been the original treatment plan for those with "high normal" blood pressure, the drug industry is making plain its interest in this vast potential market.
Indeed Moynihan maintains that the industry has been active in creating the market in the first place. Of the US guideline committee that first created the diagnostic category of prehypertension in 2003, 11 of 12 members eventually declared multiple ties to industry, he reports. Now an industry funded conference aims to initiate guidance on drug treatment for people with prehypertension. Professional societies will be asked for their endorsement. The main society in this case is the American Society of Hypertension and nine of its 13 voting board members have ties to industry. So is it time for society at large to take more of a role in deciding who should be classified as sick? Unless the profession can regain its independence from commercial influence, my answer is yes.
Cite this as: BMJ 2010;341:c4766