Have you ever heard of defensive medicine? That's the term used by the "reform" lobby to describe a physician ordering tests or procedures purely to prevent litigation. Examples include MRI's and CT scans, cancer screenings, etc. I've written about why I don't think defensive medicine is bad for patients, and so has Greedy Trial Lawyer. The gist of both of our arguments is that an ounce of prevention is worth a pound of cure; wouldn't you rather your doctor err on the side of caution when treating you? "Family Guy" also extols the virtue of excessive medical caution in the episode The Tan Aquatic With Steve Zissou. From Wikipedia:

"When Brian advises Stewie to "wait and see" whether or not he has cancer, Stewie says "Jim Henson had a wait and see attitude, and look what happened to him. Now we've got wrong-sounding Muppets," a reference to Henson's failure to properly address a cold he had, which led to pneumonia, and ultimately his death in 1990."

But this post isn't about defensive medicine. It's about offensive medicine. Cyrus Dugger cited an example of offensive medicine in which his dentist tried to push unnecessary procedures that were conveniently covered by Cyrus' insurer. Cyrus declined the procedures, but undoubtedly some patients do choose to have unnecessary services performed. While Cyrus' dentist and other unethical doctors may practice offensive medicine, they're amateurs at best. The real masters of offensive medicine are pharmaceutical companies, which have lined their pockets with billions of dollars – including taxpayer dollars – by pushing unneeded medications on healthy patients.

From June 26-30 of 2005, The Seattle Times published "Suddenly Sick," a chronicle of the pharmaceutical industry's campaign to convince healthy Americans that they need to take prescription medication every day for the rest of their lives. By exaggerating the likelihood of illnesses and influencing the definition of diseases, pharmaceutical companies have been successful in persuading healthy individuals to seek treatment for trivial or nonexistent maladies. There's even a term for these healthy people: The Worried Well.

"Suddenly Sick" explains that in the case of some illnesses, new guidelines promulgated by doctors with financial ties to pharmaceutical companies have classified millions of people as diseased. In fact, according to those guidelines, three out of four Americans has a disease that should be treated by prescription medication. One disease which had its definition broadened is obesity. Under the new guidelines, Shaquille O'Neal is considered obese. Now, if ever an individual could honestly say, "I'm not fat, I'm big-boned." It's Shaq. Thankfully, Shaq never took phen-fen to treat his obesity.

Obesity isn't the only disease to have its definition expanded dramatically. "Suddenly Sick" explains how lowering the thresholds for high blood pressure has created a windfall for pharmaceuticals.

"In recent years, expert panels from prestigious medical-research organizations such as the World Health Organization (WHO) and the federal National Institutes of Health (NIH) have called for lower thresholds for blood pressure.

Behind each of those panels were the giant pharmaceutical companies that manufacture the new and expensive hypertension drugs.

In May 2003, for example, an NIH panel recommended broader use of hypertension drugs at lower blood pressures. Nine of the 11 authors of the guidelines had ties to the drug companies (see chart).

The drug industry welcomed the new treatment guidelines and marketed them vigorously. Not surprisingly, as doctors followed the new guidelines and treated hypertension at lower readings, sales of the newer drugs increased.

Last year, patients and their insurance companies spent $16.3 billion for blood-pressure pills, up $3 billion from five years earlier."

That's a sales increase of over 500% in five years. I don't know how much the pharmaceuticals paid the doctors at the WHO and the NIH, but even if it were in the millions, the pharmaceutical companies had an excellent return on their investment.

So we have major pharmaceutical companies paying doctors who study disease guidelines; those doctors recommend expanding the disease guidelines in such a way that millions of patients would instantly be considered diseased. Coincidentally, the pharmaceutical companies that paid the doctors just happen to have products to treat the diseases. For some reason, few people question the neutrality of the doctors and the validity of their recommendations. Imagine if a group doctors on the payroll of various law firms recommended expanding the definition of medical malpractice in such a way that millions of patients would instantly be considered victims of medical malpractice. Coincidentally, the law firms that paid the doctors just happen to specialize in medical malpractice lawsuits. I bet few people wouldn't question the neutrality of the doctors and the validity of their recommendations.

I'm neither a doctor nor disputing whether the new guidelines promulgated by pharmaceutical-paid physicians are beneficial. What I am questioning is whether it makes sense to allow pharmaceutical companies to play such an important role in determining the guidelines for the diseases their products treat. How can pharmaceuticals with billions of dollars on the line be expected to remain objective as to the benefits of their products? Should doctors on the payroll of pharmaceuticals be prohibited from influencing the definition of diseases? Or should those doctors have to disclose their financial ties to pharmaceutical companies? These are all questions that we as a society need to consider. "Suddenly Sick" presents evidence that pharmaceuticals work to expand the definitions of disease to include truly healthy patients. Even a small expansion in disease guidelines can lead to thousands of people taking prescription medication they otherwise wouldn't. That can lead to millions or even billions of dollars in sales for the pharmaceutical industry. Who pays for these unnecessary prescriptions? Taxpayers, in the form of Medicare funding, and insured individuals and their employers in the form of insurance premiums. Unquestionably, there is a substantial profit motive for pharmaceuticals to encourage the expansion of disease guidelines. This profit motive can only have grown larger in light of the aging population and the Medicare prescription drug coverage.

"Suddenly Sick" isn't the only resource chronicling the efforts of the pharmaceutical industry to sell to the well. Journalist Ray Moynihan and University of Victoria, British Columbia research Alan Cassels authored the book "Selling Sickness: How Drug Companies Are Turning Us All into Patients." Here is an article from those authors, entitled "Selling to The Worried Well":

"The epicentre of this selling [to The Worried Well] is the United States, home to many of the world's largest pharmaceutical companies. The US has less than 5% of the world's population but represents almost 50% of the global market in prescription drugs. Pharmaceuticals spending in the US continues to rise more rapidly than anywhere else, increasing by almost 100% in just six years, not only because of steep increases in the price of drugs, but because doctors prescribe more and more of them."

If the five percent of the world population in the U.S. consumes fifty percent of the prescription medicine in the world, one wonders why so many tort "reformers" argue that the U.S. tort system and the FDA are preventing medications from coming to market in the U.S. If anything, it sounds like the legal and regulatory systems in other countries are blocking medications from their populations.

I highly recommend reading "Suddenly Sick" with but one caveat: You may become suddenly sick of the offensive medicine practiced by pharmaceuticals and its effect on your pocketbook.