January 28, 2010

Exporting Depression

Ethan Watters has a fascinating New Scientist report on how U.S. drug companies are basically "exporting" Western notions of mental illness to other countries, in order to create new markets for their products:
The challenge GSK faced in the Japanese market was formidable. The nation did have a clinical diagnosis of depression—utsubyo—but it was nothing like the US version: it described an illness as devastating and as stigmatising as schizophrenia. Worse, at least for the sales prospects of antidepressants in Japan, it was rare. Most other states of melancholy were not considered illnesses in Japan. Indeed, the experience of prolonged, deep sadness was often considered to be a jibyo, a personal hardship that builds character. To make paroxetine a hit, it would not be enough to corner the small market for people diagnosed with utsubyo. As Kirmayer realised, GSK intended to influence the Japanese understanding of sadness and depression at the deepest level. ...

Which is exactly what GSK appears to have accomplished. Promoting depression as a kokoro no kaze—"a cold of the soul"—GSK managed to popularise the diagnosis. In the first year on the market, sales of paroxetine in Japan brought in $100 million. By 2005, they were approaching $350 million and rising quickly.
Now, this sort of marketing of illness is hardly novel. Back in 2005, I wrote a piece for Mother Jones about the "corporate-sponsored creation of disease" (and, please note, that's not my paranoid lefty term for the practice, but a phrase taken from a Reuters Business Insight report written for Pharma execs). Drugmakers aggressively push iffy conditions like "premenstrual dysphoric disorder" in order to extend patents and boost sales. Not surprisingly, GSK again makes a cameo:
When GSK, an American drug company, wanted to repackage its best-selling antidepressant, Paxil, to treat "social anxiety disorder"—a questionable strain of social phobia that requires medication rather than therapy—it hired PR firm Cohn & Wolfe to help raise awareness about the condition. Slogans were developed: "Imagine being allergic to people." Posters featuring distraught men and women described the symptoms, which only seem like everyday nervousness to the untrained eye: "You blush, you sweat, shake—even find it hard to breath. That's what social anxiety disorder feels like." Journalists were faxed press releases so that they could write up stories about the new disorder in the New York Times and Wall Street Journal. (Does the deadline-pressed journalist need a bit of color for her story? No problem: Patient-advocacy groups, usually funded by drug companies, can provide patients to interview.) GSK even got University of California psychiatrist Murray Stein to vouch for the drug. Stein, it turns out, was a paid consultant to seventeen drug companies, including GSK, and had run company-funded trials of Paxil to treat social anxiety disorder.
How devious. Anyway, the international angle is new to me and grimly riveting. Here's a New York Times Magazine piece by Watters that further explores the phenomenon, focusing less on the corporate angle and more on the broader fact that "we in the West have aggressively spread our modern knowledge of mental illness around the world. ... That is, we've been changing not only the treatments but also the expression of mental illness in other cultures."
-- Brad Plumer 5:54 PM || ||