disease mongering, menopause, pharmaceutical companies, primary care

Disease Mongering

Disease Mongering.  The act of turning a normal ailment into a serious illness.

This phenomenon is rampant today, and it drives me nuts.

It seems that the first step in disease mongering is to create a scary, official sounding acronym.  ED.   RLS.  GERD.  Sounds a hell of a lot more impressive and official than impotence,  restless legs, and heartburn.

I recently had the thrilling experience of seeing disease mongering at its finest.  The latest ailment to afflict Americans? VVA.  Vulvovaginal atrophy (said in a deep, important voice).  Otherwise known as vaginal dryness and thinning of the membranes due to menopause.  VVA (said again in a deep, important voice) sounds much more serious and impressive.

This is not a new entity.  Post-menopausal women have been experiencing vaginal dryness and pain with intercourse since…well, since the first woman ever went through menopause.  I don’t think it’s a deep, dark secret.  It’s even a question on the checkoff list that I give all my patients at their annual physical.

Shionogi Pharmaceuticals would have us think otherwise.  They have started a marketing blitz to convince Americans of the seriousness of this new condition, VVA.

They have a new drug on the market- Osphena.  It’s what’s called an selective estrogen receptor modulator.  This means that it binds to certain estrogen receptors (in the vaginal mucosa, in this case) and not to others (like in the breast).  It’s kind of similar to Evista, an osteoporosis medication that selectively binds to estrogen receptors in the bone.  As a matter of fact, Osphena was originally developed as an osteoporosis medication.  When it didn’t work to treat that, it became a drug in search of a disease.  And thus, VVA was born.

Shionogi is working really, really hard at marketing this.  One of their reps snuck a box of these into my waiting room.

Snazzy pink bracelets.   Just what everyone wants to see after a month of pinkwashing.  These say, “Break The Silence.”  What silence?  The shameful silence of VVA, of course.    I cleared that box out of the waiting room as soon as I found out about it.  My office manager braided the bracelets into a long, pretty pink chain.  We’re going to use it to decorate the office Christmas tree.
The medication comes in these discreet little totes.
Why?  I don’t know.  Why would someone need to carry the pills in this special little bag?
Here’s the brochure about the medication.

I love the off-the-shoulder sweater.  Post-menopausal women are still sexy, see!

Here’s the main thing that I dislike about this.  Atrophic vaginitis, otherwise known as VVA (in deep, important voice!) has always been around.  There are multiple excellent, safe medications to treat it.  Topical estrogen, in cream, tablet, or vaginal ring insert works great.  I’ve NEVER had it not work for a patient.  It has a long safety record.  Whereas Osphena in a new drug.  It carries a risk of endometrial proliferation, which can lead to endometrial cancer.  And it actually increases hot flashes.

No wonder they have to work so hard to market it.

The moral of the story is: disease mongering exists.  It’s marketing at its finest, as it preys on our fear of disease.  Be aware of it and be wary of it.  And just because a drug is advertised on TV doesn’t mean it’s the best choice.  Find a doctor whose expertise you trust, and take his or her’s advice rather than an advertising agency’s.

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