Some Wisdom from Jane Brody
“Some forms of ‘medicalisation’ may now be better described as ‘disease mongering’ – extending the boundaries of treatable illness to expand markets for new products.”
-Ray Moynihan, Iona Heath, David Henry in the British Medical Journal, 2002; 324:886-91.
Moynihan is one of the leading critics of the pharmaceutical industry. He has a strong belief that the industry effectively invents diseases by the medicalization of conditions in such a way that convinces healthy people that they are sick. One example used in the paper cited above is in the area of osteoporosis:
“Like high blood pressure or raised cholesterol levels, the medicalisation of reduced bone mass – which occurs as people age – is an example of a risk factor being conceptualized as a disease… Slowing bone loss can reduce the risk of future fracture – just as lowering blood pressure can reduce a person’s chance of a future stroke or heart attack – but for most healthy people, the risks of serious fractures are low and/or distant, and in absolute terms, long term preventive drug treatment offers small reductions in risk.”
Is bone-thinning a disease? Of course not. But, if you are a petite female of Asian or northern European background, bone thinning is the first sign of osteoporosis. Unfortunately, when journalists like Moynihan make statements like this, it results in people ignoring health issues and taking the steps necessary to forestall diseases like osteoporosis. Thus, it was refreshing to see Jane Brody’s recent article in The New York Times (November 1, 2011) entitled “A Reminder on Maintaining Bone Health.”
Brody believes that osteoporosis is under diagnosed because of a reluctance to get bone density tests and under treated because people avoid drug therapy for fear of side effects. At age 60 she was found to have osteopenia, a condition characterized by low bone density but without frank osteoporosis. She likens osteopenia to prediabetes or prehypertension. At this stage, one doesn’t need to take drugs but lifestyle changes are recommended, such as regular weight-bearing and strength-training exercise, intake of calcium and vitamin D, smoking cessation and limited alcohol consumption. However, people with osteopenia can benefit from drug therapy if they have already had a fracture.
But what about the safety of drugs for osteoporosis? Brody does an excellent job in discussing the risk-benefit profile of bisphosphonates, the major class of drugs prescribed for this disease.
“On average, the bisphosphonates reduce the risk of a fragility fracture by 30 – 50%. By comparison, the risk of the most talked about serious side effect – an atypical fracture of the femur, or thigh bone – is miniscule.”
What appealed to me about this article is the fact that an independent journalist from The New York Times has basically pointed out that bone loss is a real issue and needs to be treated long before symptoms arise. Brody’s messages are pretty clear: monitor your bone health; at the first serious signs of bone loss you should make life-style changes; if your bone loss evolves into early osteoporosis, you should work with your doctor to identify the medicine best suited for you. Unlike Moynihan’s minimization of a common disease of aging women and even some men, Brody has provided a thoughtful commentary on how best to approach bone loss. It is great advice.