Disease Mongering: Inventing Illness To Sell A Cure

Disease mongering has transformed human body diversity into a medical crisis requiring pharmaceutical intervention. When Ray Moynihan wrote that "there's a lot of money to be made from telling healthy people they're sick," he exposed a corporate strategy that reaches its most devastating form in the creation of "ob*sity" as a disease. This wasn't accidental harm caused while trying to help people - this was intentional pathologization of natural human variation, funded by pharmaceutical companies and legitimized through corrupt alliances between industry, doctors, and supposed patient advocacy groups. 

In this episode, I expose how the disease creation itself causes harm separate from any treatment: social exclusion, healthcare denial, psychological trauma, economic exploitation, and the erosion of bodily autonomy. We created a disease whose only "treatment" doesn't work and causes the very harms we attribute to the disease. They didn't just gnaw away at our self-confidence—they gnawed away at our right to exist. 

Moynihan, Ray, Iona Heath, and David Henry. ‘Selling Sickness: The Pharmaceutical Industry and Disease Mongering’. BMJ : British Medical Journal 324, no. 7342 (2002): 886–91. https://doi.org/10.1136/bmj.324.7342.886.

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Transcript

Hello, and welcome to Episode 9 of Season 6 of the Fat Doctor Podcast. I'm your host, Dr. Asher Larmie. I'm not gonna lie, I'm starting to lose my voice. I'm really flagging. I've been recording one after the other after the other, this is my third podcast that I'm recording today.

And I'm not sure I'm gonna make it, but I'm locking in, and I'm gonna try, because I'm really looking forward to this podcast episode. I'm gonna start with a quote today. It's from a paper by Moynihan, I think that's how you say it, Heath and Henry from 2002.

Published in the British Medical Journal.

And the quote is this.

There's a lot of money to be made from telling healthy people they're sick.

Yes.

There is a lot of money to be made from telling healthy people that they're sick.

They were describing something called disease mongering.

And I really like this term, disease mongering.

It's the practice of essentially widening the boundaries of treatable illness.

To essentially create a market for pharmaceutical products.

So we widen our definition of disease to include certain conditions that some would argue are just part of life, or just part of growing old, or just one of those things, and we turn them into illnesses. Disease carries with it very specific expectations. And in doing so, we make room for drug companies to make a shit ton of money.

It kind of, I guess, it's talking about how, once upon a time, disease was a social construct, right? Illness was a social construct, to a degree. Sometimes it's really obvious, and there are pathological findings, and we can say this is disease, but still, in many cases, it's still socially constructed, but now it's corporately constructed. Drug companies want to make money.

And so they think, I need, in order to make money, I need to find a condition that affects a lot of people, because even if only a small percentage of them will buy my treatment, that's still a lot of money to be made, right? So I've got to find a condition that affects a lot of people.

I have to turn it into a disease.

And then, even if only 3% of them buy my products, it's 3% of a lot of people, there's a lot of people, right?

And that's disease mongering.

And Moynihan, Heath, and Henry describe the ways that pharmaceutical companies create these alliances, and so it's drug company, it's doctors who are key opinion leaders.

And then consumer groups.

Like the World Obesity Federation, and the Obesity Action Coalition, and various other consumer groups. Public relations firms, so, you know, they pay, and medical communications companies. Now, medcoms.

Maybe you haven't heard of medcoms. Medical communication companies are specialized agencies, right? Their job is to act as intermediaries between the pharmaceutical industry, the biotech industry, the medical devices companies, and the stakeholders. Who are the stakeholders? Physicians, patients, and regulating bodies. All of these are the stakeholders. So their job is to communicate the information that the drug companies want you to know to the people who prescribed the drugs or take the drugs. So the patient and the doctor.

So what they do is they take clinical trial data, they take graphs and pictures and results, and they create these educational materials, these promotional materials, they produce manuscripts for journals, so a lot of journal articles that are published were created. If you've got enough money, basically, you pay for a medcom company to come along and write the actual paper so that it sounds good. They produce conference materials, they produce digital campaigns, all to increase the awareness of the new treatment or the new technology. And the pharmaceutical industry pays them to do that. And they get invited, and they produce the work that then becomes part of doctors' conferences, and also it's the consumer groups, like I said, the World Obesity Federation's a classic example. And then you've got your PR firms, and they come along, and they actually disseminate the information.

It's very slick, this industry. Very impressive.

But pharmaceutical companies are creating all sorts of illnesses, and have done in the last 25 years, and this study looked at lots of different ones, like male pattern baldness, and social phobias, and osteoporosis, and things like, I'm not here to debate whether they exist, whether they should exist, or whether they're right or wrong.

What I'm telling you is they were created by the pharmaceutical industry, and this paper makes it very clear, it shows this is how they did it.

So I'm not gonna argue with you as to whether or not obesity is a disease. I already discussed this in a previous episode. Go back, listen to that episode if you haven't done already. I'm not here to argue whether or not it's a disease. I am here to tell you that the pharmaceutical industry paid for it to be recognized as a disease.

And today, I want to talk to you about not just the money that there is to be made, but the consequences of telling healthy people that they're sick.

What does that actually do?

How is that actually harming people?

So, when we look at disease mongering, especially through the lens of this particular paper, which I thought was very helpful, I want to look at the different ways that the disease mongering is applied to this quote-unquote obesity, this condition of fatness, which, as I've told you many times before, literally obesity means to be fat. That's all it means. So it doesn't have a special meaning, it doesn't have a special definition, just means fat. So we'll use those two terms interchangeably.

But I'm using this very offensive word because it is the term that has been used to pathologize, to medicalize a natural state of being.

And it's important that we understand that when I say the word obesity, I don't think it's a real thing. I'm arguing that it's not a real thing, but I need us to understand that when we use that term, it becomes a clinical sort of a clinical condition, as opposed to just an observation. Hey, dude, you're fat, you're tall, you're brunette, you've got a big nose, these are just observations.

So when we're talking about disease mongering, we take ordinary processes and we turn them into medical problems.

That's one of the things that we do. Like I said, like baldness. It's not a medical problem.

But the people who created Minoxidil wanted to sell it as a medical problem, so that doctors would prescribe treatment. I don't know how successful they were, but they definitely wanted to do that.

Our bodies exist naturally in different sizes. They always have, from the beginning of history. And I know there are these people out there who are banging the same drum, oh, we're getting fatter and fatter, and there was no such thing as obese people. Yes, there was.

You've got no proof. Yes, I agree with you that we are, as a nation, getting fatter, but that's basically because we're weight cycling. It's because we're all dieting. It all started when we started dieting. Before we were dieting, we were not getting fatter. It's all to do with dieting. Oh, sure, sedentary lifestyle almost certainly has played a role as well, but we're all sedentary. Some people are getting fatter, and some people aren't.

And so it's not because you're sedentary, you don't get to say, I'm thin because I'm not sedentary. Fuck you, you're as sedentary as the rest of us. Sure, I get it, you go to the gym, congratulations, yay you! It doesn't actually mean anything. But, moving on from that, I hope I upset some of you. Not you, my faithful listeners, I'm talking about the people on YouTube.

So bodies exist naturally in different sizes. Weight gain with age is normal, and has always been normal. And we have data to prove that people were getting fatter as they got older 100 years ago, and before. We took human diversity and we turned it into a pathology, and again, I've talked about this in a previous episode, how we went from average weight to ideal weight to correct weight. There was a process. It involved the weight loss industry, and funding from some very important people in medical insurance companies, and it took some really passionate people like Ansel Keys and Lewis Dublin and various other people who were just determined for us to look at natural human diversity and pathologize it.

But they had financial reasons for doing this. They were financially invested.

So they took an ordinary process, turned it into a medical problem. They presented mild symptoms as a serious disease.

Being fat doesn't cause symptoms. People sometimes say, oh, I feel much better when I'm not fat. Okay, sure, that's so vague, it's not helpful. You feel better how? Oftentimes, it's, you know, oh, my joints and my breathing and blah blah blah.

I've met fat people who were super athletic, super competitive, super bendy, super, you know, you can't, if being fat caused these symptoms, then why are there fat ice skaters? And, you know, I know they're not very common, but they still exist, so being fat in itself doesn't cause symptoms. It's more that we become obsessed and blame every ache, every pain, every condition is now blamed on being fat, and we've internalized this message, so now when we have a symptom, we're like, oh, it's because I'm fat.

I mean, lots of reasons for it, but you've been told it's because you're fat, and so now you believe it's because you're fat, and then, once you believe it, and you keep saying it over and over again, you become brainwashed.

So the personal and social problems that you experience as well are medicalized, so social exclusion, discrimination, employment barriers, these all become medicalized, right? It's like, oh, if you weren't fat, you wouldn't be excluded. If you weren't fat, you wouldn't be discriminated against. If you weren't fat, you wouldn't lose your job, or you'd be more likely to get hired. I mean, that is true, but the problem is that we're being discriminated against. It's not because we're fat, that's not the problem. The issue here is the discrimination. When we medicalize fatness, then we're like, oh, yes, you know, social exclusion due to obesity is a terrible thing, that's why we should cure obesity, as opposed to, that's why we should stop people from socially excluding fat people. You know what I mean? Instead of addressing the bias, we pathologize the target of the bias.

We turn marginalization into a medical problem that requires a cure.

You know, you'll see it all over the guidelines. Weight loss is a cure for depression.

No, the cure is, the solution is to stop discriminating against fat people.

But, obviously, anyway, you get what I'm trying to say.

I think one of the biggest ones is the risk factors as a disease thing, and they used the example in the paper of osteoporosis. It was really interesting to read, as somebody who's just always treated osteoporosis, to read it and go, holy fuck, is that where that came from?

But, you know, as you know, there are certain conditions that are associated with higher weight, with being fat, so we say that weight causes them, instead of saying they're associated, we say weight, higher weight is a risk factor for it, it's gonna cause it, and that the treatment is weight loss.

We conceptualize the risk factor as the disease. You see what I mean? People go, okay, well, what disease, you know, obesity is a disease, what about it? It's a disease, oh, well, it increases your risk of heart disease.

In which case, heart disease is the disease.

Yeah?

Not being, even if it does increase your risk of heart disease, the disease is heart disease.

Heart disease happens to thin people and fat people.

So you can't use that as a definition of disease, right? It's a risk factor for something else. That's bullshit. It's just a risk factor.

If it is a risk factor, which, again, we also...

The more people that we can include in our prevalence, like, when we want to go about disease mongering, and when we want to get medical professionals to take this seriously, it helps to say millions, billions, you know, it helps to have these very inflated statistics. So how do we go about doing that? Well, we have to widen the net, as it were. And that's exactly what we've been doing, right?

Like, once upon a time, being fat was 20% above the average, and then we started having BMI limits, and then it was anything over a BMI of 25. We've widened the net, we've increased the number of people who are included in the definition of our disease to overinflate our prevalence, our incidence rates.

You know, in 1998, the BMI cutoffs were created, and all of a sudden, everybody became sick overnight, we know this.

This is particularly controversial, actually, when it comes to childhood obesity, and I'm going to be talking about this in a later podcast episode. I don't have time to talk about it today, but it's really, really concerning. But yeah, we're doing all of these things to create this disease that doesn't exist.

And the problem here is not, we already know that the treatments for obesity cause harm, so that's not the problem I'm talking about, that's not what I'm talking about. I will be talking about eating disorders, weight cycling, various other things. In chapter 5 of my book, that's all I talk about, the harm, the treatment itself, how dangerous the treatment is, and how the treatment itself is just as likely to explain all of these associations than anything else.

So let's put that to one side for a moment. The treatment of obesity causes harm. But in this episode, that's not what I'm talking about. I am talking about the fact that the disease creation itself caused harm. Separate from the treatment. The creation of the disease has caused the harm.

That is what this episode is really about.

Disease mongering is actually causing harm to people like you and me. How?

First of all, again, social exclusion. Once fatness is a disease, then fat people become diseased people.

That justifies discrimination.

Oh, we're just doing it for your health.

Because you have a disease.

So we get to discriminate against you because you have a disease.

Employment discrimination is legitimized. Everything. We care about your health, we're doing it for your own good.

Oh, or my favorite, oh, well, is a doctor supposed to lie just to spare your feelings?

No, a doctor is not supposed to lie to spare my feelings. A doctor should consider my feelings, but I'm not saying a doctor should lie, I'm saying that calling me diseased is a lie.

That's the lie.

The lie is that you're telling me I have a disease when you have absolutely no proof that I have a disease. You just made it up.

And then we use this disease to deny people healthcare. Imagine creating a disease and then using the disease to deny people healthcare.

Healthcare is to treat diseases.

But we go, oh no, no, no, lose weight first, and then we can give you treatment.

So it stops being a disease, and it becomes the most important disease. Treat it first, then we'll treat everything else.

So we've gone from, it's a disease, to, yes, it is a disease, and that's how we get away with everything. And actually, not only is it a disease, but it's the most important disease, which is why we will deny you all the other healthcare until we treat it first. Actual conditions go untreated, medical care becomes conditional on weight loss.

You're being blamed for having a disease that caused the other disease.

So you go to your doctor with, I don't know, I've come up with one. Okay, we'll go with sleep apnea, because that was in a previous episode. You go to your doctor with sleep apnea, and instead of, they don't just blame you for the sleep apnea, they blame you for the so-called disease that causes sleep apnea.

It's practically meta, it's crazy, this is Inception stuff.

It causes psychological harm as well, right? When you're told that your body is diseased, especially if you're a child, that causes huge psychological, that's traumatizing in many cases.

In this paper, I think it was in this particular paper, but certainly either in this paper or in this book, Moynihan described disease mongers as gnawing away at our self-confidence.

Disease mongering gnaws away at our self-confidence.

I was like, yeah, that's exactly what it does.

It's bad enough that I have to deal with people judging me because of the way I look, and making all sorts of assumptions about me. But now, I'm also, I'm losing confidence in myself.

I'm losing confidence in my body. I was talking to a friend of mine the other day, and I had to remind her, hey, you know all of these studies are based on thin people? Like, we don't know what your fat body can do.

And just as a reminder, the quote-unquote obesity paradox, the fatter you are, the better your outcomes in many things. Surgical outcomes, after a heart attack, after a stroke, kidney failure, cancers, all sorts of things. Fat people do better after ICU admissions. So actually, instead of thinking, oh, do you know what? My fat body might actually be benefiting me in this situation. She was like, oh, not only have I got this condition, but I've got this condition, and I'm fat. So she was thinking of it as a really negative, she'd lost all confidence in her body's ability to fight this condition, and I was like, well, no, maybe it's the opposite way around. Maybe being fat is the reason you're going to be able to fight it.

But generally, this gnawing away at our self-confidence has a real impact, and the mind over body thing, I don't want to get into that again for the purpose of this episode, but there is definitely evidence that if you believe that you're sick, you're not going to do as well than if you believe that you are well, or that you can be well. Has an impact.

When we pathologize fat bodies, we pathologize people, and that has a psychological impact, which has an impact on your physical health as well.

And this is a very circular trap we found. This is very circular, and it only, again, benefits the weight loss industry. Discrimination causes stress, which causes poor health outcomes. Poor health outcomes are attributed to higher weight. That is used to justify even more discrimination, and we create this self-fulfilling prophecy, which has to stop. It's getting worse and worse and worse!

We have a fundamental human right to live in whatever body we choose to live in. I'm being serious now. I can do whatever the fuck I want to do. If I want to shave my head, if I want to cover my face in tattoos, if I want to dress a certain way, or to, whatever, I have a fundamental right to do that!

You might say, well, I don't choose to employ somebody with tattoos over their face, and so if you want to get your face tattooed, well, you're going to have to deal with the consequences. Sure, but I still have the right to exist in that body.

And you don't have the right to deny me my basic fundamental entitlements. The right to healthcare, the right to a fair trial, the right to freedom of speech, you know, my basic, everybody's basic human rights, as defined by whatever country you live in. You don't get to deny me those rights based on what I look like.

Nobody does. Based on choices I've made about my body, fuck you. You don't get to deny me healthcare because I'm a drug user, or I drink excessive amounts of alcohol, or I'm a smoker, and yet you deny me my right to healthcare routinely.

Listen. There are certain situations where I understand, smokers might be told you can't have oxygen therapy, right? Because you might blow up the place. Fair enough. That's legit.

But we don't use smoking as a reason to deny people healthcare. Although, to be fair, in the UK we sort of do a little bit now, so I should probably use a different example.

We don't use cocaine use to deny people healthcare. Sorry, I'm not gonna send you to the specialist until you stop using cocaine. I don't do that.

I don't get it. I don't get it.

I'm digressing.

There is a real level of economic harm that happens here as well, and we don't talk about this enough.

The money that we spend on treatments that don't work, some of us are spending thousands on bariatric surgery, some of us are spending thousands on these weight loss injections, some of us spend thousands and thousands on diets over the years. The amount of money we spend on treatments that don't work, these fuckers are taking our money and laughing all the way to the bank, because they know it's not gonna work, or it's not gonna work in the long term, they don't care, they just want to make the money.

But it goes beyond that.

Healthcare resources, right, are diverted, so money that should have been spent on one thing is being spent on another.

Public health funds are being diverted en masse to weight management companies, to pharmaceutical companies who are producing weight loss drugs, to bariatric surgeons. Again, they're getting rich without any evidence. Because we have created a disease, and once we've created a disease, we need to find a fucking cure. And so we pay this money to people who are offering a cure. So there's individual economic harm, and there is global economic harm as well.

All of these things are a direct harm caused, are directly caused by creating this condition. I'm not talking about treating this condition. I'm just talking about creating the condition itself.

That's how dangerous and harmful it is. It's why I am so adamant that we stop calling obesity a disease, that we stop treating it as a medical condition.

You can observe that I'm fat, but stop telling me that being fat is a medical condition, because it's not.

And when I was looking at this article on disease mongering, I was reading it, and there were various conditions, and it was really interesting, but I was like, yeah, but it's worse for fat people, sorry. Like, maybe we shouldn't compare, but it is worse for fat people.

First of all, because of the scale. It affects a huge proportion of the global population.

Also because of the visibility, you cannot hide a fat body. There are lots of conditions that you could have that you can hide, but you can't hide being fat.

The other thing is its permanence. Once you're labeled as obese, that's it. You're done.

You will always have that label following you. You will take it with you, every insurance company, every employer, every single person, anyone who wants access to your medical notes will see in the list of medical conditions, preexisting medical conditions, it will say obesity. Like it's a thing.

And they will be able to use that to increase, to charge you higher premiums, to deny you healthcare coverage, to deny all sorts of things.

It's permanence, because don't you forget, weight loss isn't sustainable for the vast majority of people, so once you've been labeled, you have that label for life.

As I said, that gives people the right to discriminate against you, because it's a disease!

But other diseases don't make discrimination socially acceptable. You're not allowed to discriminate against a person because of a medical condition like IBS. IBS is one of the examples that they used.

Really interesting. Again, I treat IBS, I know people with IBS, IBS is no joke. But, interesting how the pharmaceutical industry kind of created this concept of irritable bowel syndrome to describe symptoms that absolutely exist in real life. But whether or not you think it's a disease, we can all agree that nobody gets discriminated against based on the fact they have IBS.

You can still be employed. If somebody is, if your employer tried to fire you for having IBS, you would have protections, right? Legal protections, they can't do that.

But they can fire you for being fat.

So I think that this particular quote-unquote disease of obesity is different. It's treated differently to most diseases, because discrimination is not only socially acceptable, but in many cases, legally acceptable as well.

There's also the organizations that are involved. Again, you don't see that level of organizational involvement in other conditions, like the WHO, and our governments, local and national governments, so many big, important professional bodies, all have something to say about this condition in a way that you don't see, again, for IBS. I mean, I don't hear people talking about IBS in getting ready for the next election campaign. We don't see that, we don't have governments spending hundreds of thousands on inquiries into how to make the nation have less IBS. It just doesn't happen. It would be nice if it did, actually, but it doesn't.

So it's just, the ultimate irony, really, we know that weight loss doesn't work, we know that dieting causes harm, we know weight stigma worsens health.

But yet we created a disease whose only treatment doesn't work and causes the very harms that we attribute to the disease.

Make that one make sense. I'm gonna say that again.

We created a disease whose only quote-unquote treatment doesn't work and causes the very harms that we attributed to the disease.

You kind of, it was very clever. It was a very, very clever, well-thought-out plan, and certain individuals and certain corporations and certain companies seriously played the long game. You gotta respect them for what they did. There was something very devious about this.

But yeah, it's a bit of a problem, isn't it?

We didn't accidentally harm fat people while trying to help them.

That would be bad. But that's not what happened.

This was disease mongering. This was intentional.

You know, Moynihan says that disease mongering gnaws away at our self-confidence. True, but it went beyond that. They didn't just gnaw away at our self-confidence, they gnawed away at our right to exist, our access to healthcare, our social belonging, our bodily autonomy. They created a disease category that harmed people before any treatment was ever prescribed.

Just the diagnosis itself was harmful.

And they did it to make money.

Chapter 4 of my upcoming book is all about how doctors are causing harm, rather than preventing it. Doctors are causing the harm. It focuses on weight stigma, it talks about how weight stigma is literally killing people.

Chapter 5 goes on to talk about how the treatment for this so-called disease is making you sick.

And that is going to be the subject of the next few podcasts, I'm going to be talking about that in more detail coming up, but if you want a first look at the book, then join the book club, be part of my online community, The Weighting Room, and you don't have to wait, you can get involved right now.

I'd love to hear what you think about some of the things that I'm talking about right now. I'm curious to see how they're landing, so please, please, let me know! Send me, write something in the comments, or send me a voice note, you can do that through the podcast, you can send me a voice message. You can email me. Make sure you're on my mailing list, so you can email me anytime. You can, probably don't try and communicate with me through social media, because I'm probably not paying attention to that, but get in touch, and let me know how things are landing, and what you're thinking, and if you've got any questions.

I very much appreciate you all. I'm flagging. It's time to go to bed, folks. I think I just need to go and rest now. I'm pretty sure my kids are giving me a lurgy. But yeah, looking forward to next week. Couldn't tell you what I'm doing, because I haven't thought that far ahead, but I'm sure it's going to be great. Take care of yourselves.

Bye-bye.