CiteULike | Further Information

• {"link"=>{"url"=>"http://www.citeulike.org/user/danielhind/article/768751"}, "post_time"=>"2010-02-21 19:58:08", "tag"=>["disease-mongering", "pharmaceutical_industry"], "linkout"=>[{"type"=>"DOI", "url"=>"http://dx.doi.org/10.1371/journal.pmed.0030191"}, {"type"=>"Pubmed", "url"=>"http://view.ncbi.nlm.nih.gov/pubmed/16597180"}, {"type"=>"Hubmed", "url"=>"http://www.hubmed.org/display.cgi?uids=16597180"}], "username"=>"danielhind", "article_id"=>"768751"}
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Mendeley | Further Information

{"title"=>"The fight against disease mongering: Generating knowledge for action", "type"=>"generic", "authors"=>[{"first_name"=>"Ray", "last_name"=>"Moynihan", "scopus_author_id"=>"7004209504"}, {"first_name"=>"David", "last_name"=>"Henry", "scopus_author_id"=>"36012659800"}], "year"=>2006, "source"=>"PLoS Medicine", "identifiers"=>{"scopus"=>"2-s2.0-33646231981", "pui"=>"43653339", "pmid"=>"16597180", "issn"=>"15491277", "isbn"=>"0037-5675", "doi"=>"10.1371/journal.pmed.0030191", "sgr"=>"33646231981"}, "id"=>"848d7aca-c2f0-3a89-a204-644206062e9e", "abstract"=>"Disease mongering turns healthy people into patients, wastes precious resources, and causes iatrogenic harm. Like the marketing strategies that drive it, disease mongering poses a global challenge to those interested in public health, demanding in turn a global response. This theme issue of PLoS Medicine is explicitly designed to help provoke and inform that response", "link"=>"http://www.mendeley.com/research/fight-against-disease-mongering-generating-knowledge-action", "reader_count"=>106, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Professor > Associate Professor"=>12, "Librarian"=>2, "Researcher"=>18, "Student > Doctoral Student"=>5, "Student > Ph. D. Student"=>15, "Student > Postgraduate"=>4, "Student > Master"=>9, "Other"=>9, "Student > Bachelor"=>15, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>3, "Professor"=>11}, "reader_count_by_user_role"=>{"Unspecified"=>2, "Professor > Associate Professor"=>12, "Librarian"=>2, "Researcher"=>18, "Student > Doctoral Student"=>5, "Student > Ph. D. Student"=>15, "Student > Postgraduate"=>4, "Student > Master"=>9, "Other"=>9, "Student > Bachelor"=>15, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>3, "Professor"=>11}, "reader_count_by_subject_area"=>{"Unspecified"=>9, "Agricultural and Biological Sciences"=>8, "Philosophy"=>4, "Arts and Humanities"=>3, "Business, Management and Accounting"=>4, "Computer Science"=>4, "Economics, Econometrics and Finance"=>1, "Nursing and Health Professions"=>2, "Medicine and Dentistry"=>40, "Neuroscience"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>2, "Psychology"=>8, "Social Sciences"=>20}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>40}, "Social Sciences"=>{"Social Sciences"=>20}, "Psychology"=>{"Psychology"=>8}, "Unspecified"=>{"Unspecified"=>9}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>2}, "Arts and Humanities"=>{"Arts and Humanities"=>3}, "Neuroscience"=>{"Neuroscience"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>8}, "Computer Science"=>{"Computer Science"=>4}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>4}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>2}, "Philosophy"=>{"Philosophy"=>4}}, "reader_count_by_country"=>{"Belgium"=>2, "United States"=>1, "Poland"=>1, "Italy"=>1, "Germany"=>1}, "group_count"=>6}

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• {"url"=>"http%3A%2F%2Fjournals.plos.org%2Fplosmedicine%2Farticle%3Fid%3D10.1371%252Fjournal.pmed.0030191", "share_count"=>5, "like_count"=>4, "comment_count"=>10, "click_count"=>0, "total_count"=>19}

Journal Comments | Further Information

• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/5f99de4f-61d4-4460-8ee4-43e03c99d55b", "title"=>"Confessions of a Disease Monger", "body"=>"Author: James Phelps\nPosition: Medical Director\nInstitution: Co-Psych.com, PsychEducation.org\nE-mail: jimp@psycheducation.org\nSubmitted Date: April 24, 2006\nPublished Date: April 24, 2006\nThis comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.\n\nI am a disease monger. I teach primary care doctors how to identify bipolar disorder. Worse yet, I take money from pharmaceutical companies for doing so. I use it to subsidize my practice so that I can treat patients with no insurance, or little money, who now account for over a third of my patients -- in part because the pharmaceutical companies have drained so much money out of the health care system. Ironic, isn't it?\n\nMy website is #1 on Google for searches on bipolar II. See if you think it looks like disease mongering. Hundreds of people have written thanking me for explaining bipolar II and the concept of a bipolar spectrum, indicating that this new perspective really helps them understand their longstanding symptoms. To my immediate recall, none have complained about being led astray by an overbroad interpretation of bipolarity.\n\nNotice that, just like your guest editor Mr. Moynihan, I could be mongering even now, as I too have a new book. At least I'm not trying to attract attendees to my conference. Tricky, isn't it. Has there been an oversimplification in this analysis?\n\n(My website earned an Honorable Mention, Moffic Award for Ethical Practice in Community Psychiatry, 2005)", "isRemoved"=>false, "created"=>"2009-03-30T23:52:40Z", "lastModified"=>"2009-03-30T23:52:40Z", "creator"=>{"userId"=>"172479"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>true, "body"=>"Disease Monger\n(see www.PsychEducation.org, Funding page)"}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.0030191", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2009-03-30T23:52:40Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/581df1f1-d57c-4282-b8f3-164bdf4a2f8a", "title"=>"The Fight Against Disease Mongering: Generating Knowledge for Action", "body"=>"Author: 'Kevin' 'Hall'\nInstitution: Citizens Commission on Human Rights Eastern United States\nE-mail: kevinmh@erols.com\nSubmitted Date: April 19, 2006\nPublished Date: April 24, 2006\nThis comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.\n\nThank you for your Restless Legs and Disease Mongering articles. It's great that you are exposing that pharmaceutical companies fund disease advocacy groups and exaggerate the prevalence of symptoms to promote concocted \"disease\" for profit. This is especially true in mental health wherein all the \"diseases\" are voted into existence and never discovered by real science. Pharmaceutical companies fund many of these advocacy groups like the National Alliance of the Mentally Ill and Children and Adults with Attention Deficit Disorders to push their drugs and to promote their phony \"diseases.\"", "isRemoved"=>false, "created"=>"2009-03-30T23:52:52Z", "lastModified"=>"2009-03-30T23:52:52Z", "creator"=>{"userId"=>"172479"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.0030191", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2009-03-30T23:52:52Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/7f884927-f7a3-4156-b656-68e2b49042d2", "title"=>"Disease mongering: one of the hidden consequences", "body"=>"Author: Dr Ken Gillman MRCPsych\nPosition: Doctor\nInstitution: Pioneer Valley Private Hospital\nE-mail: kg@matilda.net.au\nAdditional Authors: 0\nSubmitted Date: April 27, 2006\nPublished Date: May 4, 2006\nThis comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.\n\nI have previously suggested that the medical profession might consider being more proactive concerning various problematic areas in their interactions with the pharmaceutical industry by exercising their considerable power and improving the scientific quality of research [1]. There is a strong tendency for doctors to be trusting and accepting of the good intentions and honesty of others. It takes a substantial amount of evidence for doctors to adopt the contrary posture of distrust. Perhaps the profession is, understandably, at that point with pharmaceutical companies.\n\nA significant hidden area related to disease mongering is the inevitable increase in doctors' medico-legal insurance costs. The pharmaceutical industry has generally been quite successful in getting doctors to shoulder the blame for the negative consequences of drug treatment. They are quick to inform the profession (and patients, by covert direct to consumer advertising) of any evidence favourable to the promotion of their drug, but slow to update the product information, or inform doctors about side-effects, complications or drug interactions [2]. It is dishonest to actively promote supposed advantages (to patients) whilst consciously failing to look for or alert doctors to, the disadvantages. Furthermore, inducing patients to attend doctors and pressure them into colluding with drug company advertising is a subtle form of bullying.\n\nMedical insurers tend to accept full responsibility on behalf of doctors without much attempt to bring others into legal actions, especially drug companies. Since both patients and doctors are being fed misinformation it may be that a greater part of the responsibility for difficulties should be apportioned to drug companies. Perhaps both doctors and drug companies need to be reminded that only doctors are able to sign prescriptions and take the primary responsibility for the consequences. It may be time for medical organizations and authorities to impose conditions and demand more information from pharmaceutical companies if they are going to agree to sign the script. As but one of many possible examples, how many doctors realise that drug toxicity data is rarely made available and that much of the data presented to regulatory authorities is not available to ordinary doctors? I suggest that those in the profession who are in a position to influence such matters should give serious consideration to these, and other similar, questions and exercise their power.\n\n1.\tGillman, P.K., Pharmaceutical company influence. Public Library of Science: Medicine, 2006. 2(12): p. e392\nhttp://medicine.plosjournals.org/perlserv/?request=read-response&doi=10.1371/journal.pmed.0020392#r1068.\n2.\tGillman, P.K., Drug interactions and fluoxetine: a commentary from a clinician's perspective. Expert Opinion on Drug Safety, 2005. 4(6): p. 965-8.", "isRemoved"=>false, "created"=>"2009-03-30T23:53:49Z", "lastModified"=>"2009-03-30T23:53:49Z", "creator"=>{"userId"=>"172479"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>true, "body"=>"None"}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.0030191", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2009-03-30T23:53:49Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/8dcf10db-be21-4704-a436-692a1b1cfecf", "title"=>"Fairness creams in South Asia - a case of disease mongering?", "body"=>"Author: Ravi Shankar\nPosition: Medical Doctor\nInstitution: Manipal College of medical Sciences, Pokhara, Nepal\nE-mail: pathiyilravi@gmail.com\nAdditional Authors: Mr. Bishnu Rath Giri, Mr.Subish Palaian\nSubmitted Date: April 12, 2006\nPublished Date: May 4, 2006\nThis comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.\n\nWe read with interest the article by Moynihan R and Henry D on disease mongering [1]. The authors had argued that disease mongering is the opportunistic exploitation of a widespread anxiety about frailty and faith in scientific advance and 'innovation'.\n\nIn South Asia there is a widespread preference for 'fair skin' and this has been exploited by the manufacturers of 'fairness creams'. 'White' skin has a colonial notion of power and superiority. The emergence of a 'paler' global entertainment industry has served as a fillip to the marketing of an international beauty ideal [2]. Beauty pageant winners in India are all extraordinarily tall, breathtakingly slim and have a light honey-colored skin color and peddle western ideals of beauty [3]. South Asian culture has carried within itself a capacity for female objectification. Matrimonial columns and/or websites reveal the influence of a young woman's skin color on her marketability to marriage partners [3].\n\nThe craze for modern fairness creams has emerged in the last fifty years [2]. International cosmetics giants were the initial manufacturers but these days Indian and South Asian companies are playing an important role in the skin-bleaching and cosmetic markets [2,3]. Fairness creams have been estimated to account for up to 40percent of the profits of the cosmetics industry [3]. Recently a fairness cream has been launched exclusively for men [4].\n\nAdvertisements aim to produce a hierarchy of values based on the notion that 'fairness' is an object of desire [2]. The process of being fair has been represented as an active process. Regular use of fairness creams has been claimed to halt the production of melanin and to bring out 'natural'beauty.\n\nPromoting a particular body image or behavior pattern as the preferred one and then selling medicines or products to help people attain the particular ideal may be regarded as disease mongering [5]. Fairness cream manufacturers have exploited the preference for a fair skin, portrayed it as a necessary prerequisite for success and promoted the use of their product to achieve the ideal. Controlled studies on the efficacy and safety of fairness creams are lacking.\n\nDisease mongering companies form alliances with doctors, consumer groups and the media to promote sales of their drugs. Fairness cream manufacturers sponsor beauty pageants and carry out an advertising blitz in the print and audiovisual media [3]. They create hype about their product. Many leading manufacturers have expanded their range to include lotions, cold creams and soaps.\n\nHowever, most fairness creams are non-prescription products and the medical profession may not be the main target of marketing professionals. However, doctors as responsible and respected members of society have an important role to play in spreading awareness about this racial distortion of body image. Fairness creams may satisfy many of the criteria of disease mongering. The issues of freedom of choice, economic impact (personal and on the society), profits, social issues and ideal body image should be seriously debated.\n\nReferences:\n1)\tMoynihan R, Henry D. (2006) The fight against disease mongering: generating knowledge for action. PLoS Med 3:e191.\n2)\tGoon P, Craven A. (2003) Whose debt? Globalisation and white facing in Asia? Intersections: Gender, History and Culture in the Asian context. August 2003, Issue 9. http://wwwsshe.murdoch.edu.au/intersections/issue9/gooncraven.html. Accessed on March 26, 2006.\n\n3)\t Lal P. Selling beauty queens and fairness creams. www.popmatters.com. Posted January 2, 2004. Accessed on March 26, 2006.\n4)\tChadha M. Indian men go tall, fair and handsome. http://news.bbc.co.uk/go/pr/fr/-/2/hi/south_asia/4396122.stm. Published 2005/11/02. Accessed on March 26, 2006.\n5)\tShankar PR, Dubey AK. (2006) Disease mongering and medical doctors. Br Med J South Asia edition 22:16.", "isRemoved"=>false, "created"=>"2009-03-30T23:53:57Z", "lastModified"=>"2009-03-30T23:53:57Z", "creator"=>{"userId"=>"172479"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>true, "body"=>"None"}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.0030191", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2009-03-30T23:53:57Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/702d075f-d24b-4e69-b4b1-b68f50befd7d", "title"=>"The Fight against Disease Mongering", "body"=>"Author: Brian Holmes\nPosition: Hen Teaser\nInstitution: No affiliation was given\nE-mail: icthioo3@adelphia.net\nSubmitted Date: April 12, 2006\nPublished Date: May 4, 2006\nThis comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.\n\nI'm not a Doctor or a Scientist, nor a Hen Teaser for that matter. But I worked in a Nursing home for a year. What I do know is that every resident in there had a \"disease\".\n\nCorrect me if I'm wrong (i was once) but doesn't the Nursing Home need some sort of \"diagnosis\" in order to recieve money from Medicade or Medicare? I don't think you can lay this entirely on the drug companies. Besides it makes you sound like the Hillary Clinton.", "isRemoved"=>false, "created"=>"2009-03-30T23:54:01Z", "lastModified"=>"2009-03-30T23:54:01Z", "creator"=>{"userId"=>"172479"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.0030191", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2009-03-30T23:54:01Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/7bdbb90c-8f6c-404d-ab44-2a34976be168", "title"=>"Defining disease in the information age", "body"=>"Author: Olavo B. Amaral\nPosition: M.D.\nInstitution: Depto. de Bioquimica - Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil\nE-mail: olavoamaral@yahoo.com.br\nSubmitted Date: May 08, 2006\nPublished Date: May 9, 2006\nThis comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.\n\nYour issue on disease mongering defines the term as \"widening the boundaries of illness\" by \"taking a normal function and implying that there's something wrong with it and that it should be treated\" [1]. While there is undoubtedly a strong case to be made for this sort of practice by pharmaceutical companies, perhaps we should also question ourselves on what we mean by \"disease boundaries\".\n\nAll of the conditions touched by the issue (bipolar disease, ADDH, restless legs syndrome, sexual dysfunctions) share the fact that they represent spectra of symptoms felt by virtually everyone, but which for some people can reach a point in which they become disturbing. However, since the benefit of treating these symptoms is ultimately dependent on their significance in a patient's life, it seems doubtful that anyone but the patient can adequately define the \"boundaries\" of illness for these conditions.\n\nThe existence of these large \"grey zones\" between disease and normality (as well as the difficulty of doctors in dealing with them) might help to explain the crescent habits of \"lifestyle drug use\" and self-prescription of psychiatric medication [2]. While this undoubtedly carries risks, it seems to be an obvious development in an age where information on anything (including drugs) is so widely available. Moreover, tampering with body chemistry is nothing new (alcohol, coffee, chocolate or sunlight are examples), and it is hard to expect people will not do it because of pharmaceutical labels. Therefore, complain as we may, it is unlikely that this trend can be feasibly prevented.\n\nTherefore, if we want to prevent disease mongering, perhaps we should start by focusing on our own concept of \"disease\". Maybe it is time we start to loosen the grip on our powers to define disease and start working less as diagnosing machines and more as decision facilitators for patients. It seems quite absurd to decide on a \"concept\" of erectile dysfunction or depression which can define who should be treated. On the contrary, our role should be to inform patients of the benefits and risks of treatment (or non-treatment) for their particular condition. This also means being comfortable with the fact that, no matter which criteria one uses to define disease, there will always be \"normal\" people who will want treatment as well as \"sick\" people who will refuse it. And in both cases they are probably entitled to do so, without necessarily receiving a diagnosis of \"normal\" or \"sick\".\n\nMoreover, since the trend for self-prescription is not likely to be prevented, and since the pharmaceutical industry will surely try to capitalize on it, perhaps we should also worry about making nonprofit, unbiased scientific information more available to the public. Education on health matters is an important responsibility which traditionally has been overlooked by doctors in most countries. Now, if ever, seems to be the time to change that, as if physicians do not concentrate on it, drug companies will be happy to do it for them.\n\nIt is obvious that medicine cannot abandon the concept of disease boundaries, since most of our medical knowledge and research is still based on it. Moreover, there are fields in which medical responsibility on defining these boundaries is sure to remain important (e.g. attribution of public funds, research studies, treatment of children). But after reading so much on disease mongering, it seems to me that if we become a little more flexible in admitting that \"disease boundaries\" for many conditions are an oxymoron, perhaps the pharmaceutical industry will make less of a fuss in trying to convince people they are ill. My guess is that this would do everybody a favor.\n\t\n\nReferences\n\n1. Payer L (1992) Disease-mongers: How doctors, drug companies, and insurers are making you feel sick. New York: Wiley & Sons. 292 p.\n2. Applbaum K (2006) Pharmaceutical marketing and the invention of the medical consumer. PLoS Med 3(4):e189.", "isRemoved"=>false, "created"=>"2009-03-30T23:54:16Z", "lastModified"=>"2009-03-30T23:54:16Z", "creator"=>{"userId"=>"172479"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.0030191", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2009-03-30T23:54:16Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/2e7ecf53-c1f5-44b4-bb9c-5fb71d702320", "title"=>"A Reform of Rewarding Systems to Fight against Disease Mongering", "body"=>"Author: Alberto Donzelli\nPosition: MD - Director of Service of Health Education of ASL Città di Milano (Italy)\nInstitution: ASL Città di Milano - via Ricordi 1 - 20131 Milano (Italy)\nE-mail: adonzelli@asl.milano.it\nAdditional Authors: Luigina Ronchi, Dr - Member of Board of Movimento Consumatori Milano – Italy\nSubmitted Date: August 09, 2007\nPublished Date: August 13, 2007\nThis comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.\n\nThis essay proposes some cures:\n\na) to generate better knowledge, that is:\n-data on the impact of disease mongering (DM),\n-indices to measure inappropriate medicalisation,\n-publicly funded rigorous studies to promote noncommercially oriented information about disease,\n-the conflicts of interests of panel members, professional bodies and sponsors.\n\nb) to take actions:\n-at a consumer level, not accepting pharmaceutical company sponsorship;\n-amongst journalist circles, reducing the media’s propensity to exaggerate disease prevalence and severity;\n-at professional organizations’ level, recommending that industry-funded disease-awareness campaigns should not be advertising of drugs;\nat shareholders level, to refuse the excess of DM.\n\nWhat about the public health level? How many chances have these measures to effectively counteract DM? We think very little, because they do not capture the root of the problem, which lies on the main current rewarding systems in the health market, and on their logical consequences on the behaviour of nearly all providers.\n\nIf the health systems follow models that actually “pay for the disease”, no wonder that the market adapts its behaviour and “sells the disease” as much as possible, diagnosing/anticipating it even if the prognosis does not change, dramatizing it and even “creating” it.\nPaying for the disease puts Health Boards and Systems, and Hospitals, and practices, and doctors in structural conflict of interests with health and wellbeing.\n\nIt is time for public health systems to undertaking two main actions.\nFirst, they should react more boldly and give clear-cut answers, highlighting the possible health and economic risks, for both the individual and the community, of many technologies, rather than simply claiming that “there is not sufficient evidence” to recommend/pay for them.\n\nMore important, the NHSs should reform the health organizations’ financing systems and the professionals’ remuneration schemes, so that their interests become aligned to the patients’ and community health (expressed as an unequivocal outcome, that is longevity) rather than to their diseases.\n\nDifferent ways to pay for diseases are:\n• Fee-for-service, reimbursement systems, price for drugs\n• D(iagnosis of disease)RGs\n• Disease management\n• Private practice (fee-for-service rewarded)\n• Payment for inputs, processes, outputs not related to outcomes.\n\nDifferent ways to pay for health are (1):\n1) Capitation weighted for the patient’s age, in a yearly continuous progression, i.e. a centenarian weighs ten times an adolescent.\nThis would be an equitable way to pay for the additional work for caring for patients getting older; but, above all, it would give a strong signal of a health policy targeted to the main objective of a Health System: a healthy longevity for all. It would give a virtuous incentive - not related to the quantity/complexity (both easily induced by providers) of performed services – to help own patients’ cohort to age more and better, thus aligning ethics and better income for GPs (1).\n2) A complementary way to pay for Health is: further incentives, based on health (or economic) outcomes (or levels of outcome), may be added for special objectives, not rewarded enough by the age-weighted capitation (1) (for example:\n- babies breastfed for one year or more over challenging thresholds (based on local epidemiological data)\n- women 50-70 years screened with mammography in a good quality program over definite thresholds\n- hypertensive subjects treated with first line low-dose thiazide-type diuretics over high and very high thresholds).\n\nBut fee-for-service incentives should be avoided, because they increase technological abuse, profitable services irrespective of their effectiveness, and the sale of sickness.\n\nReferences\n\n1. Donzelli A. (2004) Allineare a etica e salute della comunita dei cittadini le convenienze dei diversi attori in Sanita. Mecosan – Management and Economia Sanitaria, 50: 131-147", "isRemoved"=>false, "created"=>"2009-03-31T00:12:29Z", "lastModified"=>"2009-03-31T00:12:29Z", "creator"=>{"userId"=>"172479"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.0030191", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2009-03-31T00:12:29Z", "replies"=>[]}

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• {"id"=>"1050832320410849280", "text"=>"Che cosa ? Disease Mongering? :#PLOSMedicine: The Fight against Disease Mongering: Generating Knowledge for Action https://t.co/isBCBNWtMY", "created_at"=>"2018-10-12T19:35:23Z", "user"=>"EtienneLorenza", "user_name"=>"?????? ?? ??????? ??", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1041225572989456384/9EGl7K2E_normal.jpg"}
• {"id"=>"1087752119766208512", "text"=>"This article in PLOS Medicine from 2006 goes into further detail on disease mongering: https://t.co/4YqUhhUr3z", "created_at"=>"2019-01-22T16:41:29Z", "user"=>"EdenAtherton", "user_name"=>"Eden Atherton", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1068938014183829504/cPqqLXiC_normal.jpg"}
• {"id"=>"299543621626122240", "text"=>"PLOS Medicine: The Fight against Disease Mongering: Generating Knowledge for Action http://t.co/06by4qOI", "created_at"=>"2013-02-07T15:42:19Z", "user"=>"bycomet", "user_name"=>"地域医療日誌", "user_profile_image"=>"http://a0.twimg.com/profile_images/429552004/2009-09-20_15.01.41_normal.jpg"}
• {"id"=>"299717859532238848", "text"=>"RT @bycomet: PLOS Medicine: The Fight against Disease Mongering: Generating Knowledge for Action http://t.co/06by4qOI", "created_at"=>"2013-02-08T03:14:40Z", "user"=>"Ph_shige", "user_name"=>"しげ", "user_profile_image"=>"http://a0.twimg.com/profile_images/2189571323/6g1Kl9k2_normal"}
• {"id"=>"347446986519216128", "text"=>"#PLOS: The Fight against Disease Mongering: Generating Knowledge for Action #archives http://t.co/2Gj9lIzre3 #AMA #obesity #nocomment", "created_at"=>"2013-06-19T20:13:11Z", "user"=>"Melf1013", "user_name"=>"Mel", "user_profile_image"=>"http://a0.twimg.com/profile_images/3440389709/dcdea3d0c9c5e1a9a5572459e946f2d3_normal.jpeg"}
• {"id"=>"466440336391143424", "text"=>"#PLOSMedicine: The Fight against Disease Mongering: Generating Knowledge for Action http://t.co/AiqOHOmAa7", "created_at"=>"2014-05-14T04:50:16Z", "user"=>"RSiemieniuk", "user_name"=>"ReedSiemieniuk.", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3688661143/086ed00642ec8842200ea5578e1111c7_normal.jpeg"}
• {"id"=>"955531933823524865", "text"=>".@S_brimble, why do i think you like this? \n\np.s. its from more than 10y ago.. \ncc @hswapnil \n\nhttps://t.co/szACSgcgpK", "created_at"=>"2018-01-22T20:05:40Z", "user"=>"poyanmehr", "user_name"=>"Poyan Mehr", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000508296315/5c265216d5bd5187204735edf41902ff_normal.jpeg"}

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• {"title"=>"Disease mongering", "url"=>"http://en.wikipedia.org/wiki/Disease_mongering", "timestamp"=>"2019-01-26T11:40:15Z"}
• {"title"=>"Selling Sickness", "url"=>"http://en.wikipedia.org/wiki/Selling_Sickness", "timestamp"=>"2019-02-25T02:46:19Z"}
• {"title"=>"Leonore Tiefer", "url"=>"http://en.wikipedia.org/wiki/Leonore_Tiefer", "timestamp"=>"2019-02-03T19:23:05Z"}
• {"title"=>"病気喧伝", "url"=>"http://ja.wikipedia.org/wiki/病気喧伝", "timestamp"=>"2019-03-03T13:47:58Z"}

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• {"month"=>"6", "year"=>"2011", "pdf_views"=>"35", "xml_views"=>"2", "html_views"=>"224"}
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• {"month"=>"8", "year"=>"2011", "pdf_views"=>"16", "xml_views"=>"2", "html_views"=>"162"}
• {"month"=>"9", "year"=>"2011", "pdf_views"=>"26", "xml_views"=>"0", "html_views"=>"245"}
• {"month"=>"10", "year"=>"2011", "pdf_views"=>"20", "xml_views"=>"0", "html_views"=>"285"}
• {"month"=>"11", "year"=>"2011", "pdf_views"=>"25", "xml_views"=>"0", "html_views"=>"341"}
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• {"month"=>"2", "year"=>"2012", "pdf_views"=>"41", "xml_views"=>"0", "html_views"=>"383"}
• {"month"=>"3", "year"=>"2012", "pdf_views"=>"52", "xml_views"=>"2", "html_views"=>"381"}
• {"month"=>"4", "year"=>"2012", "pdf_views"=>"67", "xml_views"=>"5", "html_views"=>"436"}
• {"month"=>"5", "year"=>"2012", "pdf_views"=>"32", "xml_views"=>"2", "html_views"=>"300"}
• {"month"=>"6", "year"=>"2012", "pdf_views"=>"27", "xml_views"=>"1", "html_views"=>"243"}
• {"month"=>"7", "year"=>"2012", "pdf_views"=>"25", "xml_views"=>"2", "html_views"=>"237"}
• {"month"=>"8", "year"=>"2012", "pdf_views"=>"27", "xml_views"=>"7", "html_views"=>"190"}
• {"month"=>"9", "year"=>"2012", "pdf_views"=>"37", "xml_views"=>"0", "html_views"=>"205"}
• {"month"=>"10", "year"=>"2012", "pdf_views"=>"36", "xml_views"=>"4", "html_views"=>"286"}
• {"month"=>"11", "year"=>"2012", "pdf_views"=>"26", "xml_views"=>"0", "html_views"=>"279"}
• {"month"=>"12", "year"=>"2012", "pdf_views"=>"29", "xml_views"=>"0", "html_views"=>"162"}
• {"month"=>"1", "year"=>"2013", "pdf_views"=>"16", "xml_views"=>"0", "html_views"=>"165"}
• {"month"=>"2", "year"=>"2013", "pdf_views"=>"31", "xml_views"=>"3", "html_views"=>"238"}
• {"month"=>"3", "year"=>"2013", "pdf_views"=>"23", "xml_views"=>"0", "html_views"=>"288"}
• {"month"=>"4", "year"=>"2013", "pdf_views"=>"27", "xml_views"=>"0", "html_views"=>"288"}
• {"month"=>"5", "year"=>"2013", "pdf_views"=>"20", "xml_views"=>"0", "html_views"=>"290"}
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• {"month"=>"7", "year"=>"2013", "pdf_views"=>"15", "xml_views"=>"0", "html_views"=>"169"}
• {"month"=>"8", "year"=>"2013", "pdf_views"=>"22", "xml_views"=>"2", "html_views"=>"156"}
• {"month"=>"9", "year"=>"2013", "pdf_views"=>"28", "xml_views"=>"6", "html_views"=>"237"}
• {"month"=>"10", "year"=>"2013", "pdf_views"=>"25", "xml_views"=>"2", "html_views"=>"279"}
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• {"month"=>"8", "year"=>"2014", "pdf_views"=>"19", "xml_views"=>"4", "html_views"=>"401"}
• {"month"=>"9", "year"=>"2014", "pdf_views"=>"20", "xml_views"=>"1", "html_views"=>"392"}
• {"month"=>"10", "year"=>"2014", "pdf_views"=>"27", "xml_views"=>"0", "html_views"=>"568"}
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• {"month"=>"1", "year"=>"2015", "pdf_views"=>"11", "xml_views"=>"0", "html_views"=>"217"}
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• {"month"=>"5", "year"=>"2015", "pdf_views"=>"22", "xml_views"=>"1", "html_views"=>"272"}
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• {"month"=>"1", "year"=>"2016", "pdf_views"=>"18", "xml_views"=>"0", "html_views"=>"160"}
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• {"month"=>"8", "year"=>"2016", "pdf_views"=>"12", "xml_views"=>"0", "html_views"=>"122"}
• {"month"=>"9", "year"=>"2016", "pdf_views"=>"28", "xml_views"=>"0", "html_views"=>"328"}
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• {"month"=>"1", "year"=>"2017", "pdf_views"=>"19", "xml_views"=>"0", "html_views"=>"529"}
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• {"month"=>"4", "year"=>"2017", "pdf_views"=>"43", "xml_views"=>"0", "html_views"=>"410"}
• {"month"=>"5", "year"=>"2017", "pdf_views"=>"34", "xml_views"=>"2", "html_views"=>"558"}
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• {"month"=>"1", "year"=>"2018", "pdf_views"=>"23", "xml_views"=>"1", "html_views"=>"222"}
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• {"month"=>"3", "year"=>"2018", "pdf_views"=>"28", "xml_views"=>"2", "html_views"=>"118"}
• {"month"=>"4", "year"=>"2018", "pdf_views"=>"45", "xml_views"=>"2", "html_views"=>"149"}
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• {"month"=>"10", "year"=>"2018", "pdf_views"=>"34", "xml_views"=>"0", "html_views"=>"111"}
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• {"month"=>"3", "year"=>"2019", "pdf_views"=>"33", "xml_views"=>"2", "html_views"=>"127"}
• {"month"=>"4", "year"=>"2019", "pdf_views"=>"27", "xml_views"=>"0", "html_views"=>"72"}
• {"month"=>"5", "year"=>"2019", "pdf_views"=>"32", "xml_views"=>"1", "html_views"=>"100"}
• {"month"=>"6", "year"=>"2019", "pdf_views"=>"10", "xml_views"=>"0", "html_views"=>"57"}
• {"month"=>"7", "year"=>"2019", "pdf_views"=>"19", "xml_views"=>"0", "html_views"=>"58"}
• {"month"=>"8", "year"=>"2019", "pdf_views"=>"15", "xml_views"=>"1", "html_views"=>"55"}
• {"month"=>"9", "year"=>"2019", "pdf_views"=>"16", "xml_views"=>"0", "html_views"=>"108"}
• {"month"=>"10", "year"=>"2019", "pdf_views"=>"32", "xml_views"=>"0", "html_views"=>"101"}
• {"month"=>"11", "year"=>"2019", "pdf_views"=>"33", "xml_views"=>"0", "html_views"=>"113"}
• {"month"=>"12", "year"=>"2019", "pdf_views"=>"18", "xml_views"=>"1", "html_views"=>"58"}

Figshare

• {"files"=>["https://ndownloader.figshare.com/files/1559223"], "description"=>"<p>(Illustration: Anthony Flores)</p>", "links"=>[], "tags"=>["countries"], "article_id"=>1078572, "categories"=>["Medicine", "Biochemistry", "Mental Health", "Mathematics", "Pharmacology", "Biotechnology"], "users"=>["Ray Moynihan", "David Henry"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.0030191.g001", "stats"=>{"downloads"=>1, "page_views"=>19, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Most_people_in_Western_countries_take_medication_to_treat_or_prevent_illness_or_enhance_well_being_/1078572", "title"=>"Most people in Western countries take medication to treat or prevent illness or enhance well-being", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2006-04-11 11:17:41"}

PMC Usage Stats | Further Information

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• {"month"=>"7", "scanned-page-browse"=>"0", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"50", "year"=>"2010", "pdf"=>"11", "unique-ip"=>"36", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
• {"scanned-page-browse"=>"0", "month"=>"8", "cited-by"=>"0", "abstract"=>"1", "full-text"=>"31", "unique-ip"=>"35", "pdf"=>"14", "year"=>"2010", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
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• {"scanned-page-browse"=>"0", "month"=>"10", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"57", "unique-ip"=>"48", "pdf"=>"20", "year"=>"2010", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
• {"month"=>"11", "scanned-page-browse"=>"0", "cited-by"=>"1", "abstract"=>"0", "full-text"=>"125", "year"=>"2010", "pdf"=>"28", "unique-ip"=>"87", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
• {"scanned-page-browse"=>"0", "month"=>"12", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"126", "unique-ip"=>"72", "pdf"=>"48", "year"=>"2010", "figure"=>"2", "scanned-summary"=>"0", "supp-data"=>"0"}
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• {"month"=>"4", "scanned-page-browse"=>"0", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"13", "year"=>"2012", "pdf"=>"7", "unique-ip"=>"13", "figure"=>"1", "scanned-summary"=>"0", "supp-data"=>"0"}
• {"scanned-page-browse"=>"0", "month"=>"5", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"3", "unique-ip"=>"3", "pdf"=>"1", "year"=>"2012", "figure"=>"0", "scanned-summary"=>"0", "supp-data"=>"0"}
• {"month"=>"5", "scanned-page-browse"=>"7", "cited-by"=>"0", "abstract"=>"0", "full-text"=>"0", "year"=>"2006", "pdf"=>"0", "unique-ip"=>"0", "figure"=>"39", "scanned-summary"=>"32", "supp-data"=>"25"}
• {"scanned-page-browse"=>"14", "month"=>"6", "cited-by"=>"5", "abstract"=>"0", "full-text"=>"0", "unique-ip"=>"1", "pdf"=>"0", "year"=>"2006", "figure"=>"48", "scanned-summary"=>"33", "supp-data"=>"30"}
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Relative Metric

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F1000Prime