Targeting Uncertainty in Pharmaceuticals

Have you ever Googled your symptoms?

Most of us who reach out to the Internet when we start to feel ill probably have the same goal- we wish to find out what’s wrong with us and how we can treat it. The feeling of being ‘ill’ is the development of any number of changes within the body in an uncontrolled manner. As we start to notice these negative changes- be it a stuffy nose or something more serious- we immediately begin to grasp for means of control, for something concrete and quantifiable. This simple act of searching the Internet can be seen as a deliberate process of searching for reassurance.

The search to lessen uncertainty usually begins with a name, the product of our Internet searches or doctors visit. Having a label is a way of verbalising the things we’re feeling in the hope that we’ll then be able to get treatment (and sympathy). Medicine, though an extremely uncertain art in itself, offers patients the perception of certainty. A diagnosis, however bad, is more comforting than not knowing. However, language itself is infectious: it spreads from person to person, embedding itself and impacting the way in which the everyday is lived. Language, or in this instance, medical terminology, therefore mimics the conditions it describes. By naming and classifying certain conditions, we transform illness. It becomes diagnosable, communicable, both an official and a social event. In economic terms, these classifications can have significant effect.

‘Innovative pharmaceuticals’
The top selling drug in the world is Humira, produced by AbbVie, with sales estimated to reach $18 billion by 2020. This blockbuster drug can be used in the treatment of arthritis, psoriasis and bowel diseases.

Humira’s website, laid out in a multi-coloured patchwork, invites you to click on your condition to find out more information, assuring the casual visitor that “We’re with you every step of the way”. In short, it’s a pretty glossy sales pitch; this is perhaps unsurprising when taking into account AbbVie’s marketing budget. In 2015, more than $25 million was spent on direct-to-consumer TV advertising in the US for Humira alone.

The entire consumer experience can be read as offering a path to certainty. The narrative presents the drug as an opportunity, not only for getting better but also for peace of mind. Focus is on transformation; the campaigns lead you to celebrate in others’ health and medical certainty, achieved through consumption of a specific medicine, and invite you to join them. Advertising such as this is undertaken with the notion of empowering the consumer. This empowerment therefore targets consumer uncertainty, offering an alternative to their illness experience by emphasising the simplicity and certainty offered by branded drugs.

To consider an example, in October 2015, Fibromyalgia was officially assigned a formal diagnostic code for use in the US. According to NHS.uk, symptoms of Fibromyalgia include widespread pain, increased sensitivity to pain, muscle stiffness, headaches, fatigue, sleep loss, IBS, dizziness and depression. This classification means that it is now recognised as a distinct entity, a specific condition that has been catalogued and attributed with a discrete list of symptoms. The cause of this condition is currently unknown and it has therefore been included into the group of ‘invisible disorders’.

However, there are several treatment options that have become available and are currently underdevelopment. Most notably is Lyrica, one of the best selling drugs in the world with sales of $6.0 billion in 2014, manufactured by Pfizer. Many Internet sites describing Fibromyalgia specifically highlight Lyrica as a recommended drug. Despite numerous complaints from consumers that it is not particularly effective in treatment of Fibromyalgia, as a generalised anticonvulsant it has the ability to treat a range of issues. Lyrica has, for instance, been approved in Europe to treat generalised anxiety disorders. Consequently, the impact on both patients and companies responsible for the development of drugs such as these is significant.

The collaborative process: redefining health
Much of the lobbying for formal recognition of Fibromyalgia, in keeping with trends for emergent conditions, was made by patient groups dissatisfied with what they saw as incorrect diagnosis. ‘Invisible disorders’ such as Fibromyalgia, whilst causing issues for doctors, represent a significant opportunity for pharmaceutical companies, as they are typically diseases with nonspecific symptoms and a broad spectrum of severity. Consequently, the process of creating illness profiles is collaborative, matching patient demand with the appropriate pharmaceutical product through careful manipulation of both public and professional perceptions of the illnesses. In the words of Adriana Petryna and Arthur Kleinman: “There is much magic in the way pharmaceutical companies target individuals and their bodies, influence the course of therapeutic events and manipulate collective needs and wants” [2006].

The face of modern medicine has undergone rapid development in response to the Internet, which has provided a new platform for patients and pharmaceuticals to be connected. Areas of medical uncertainty, targetable through websites, hold significant potential for large pharmaceutical brands as they offer a direct channel to consumers. This includes social media, with more and more companies using spaces like Instagram for publicising new treatment opportunities, embedded in lifestyle posts.

So what is the effect of this treatment of uncertainty? Whilst ostensibly the process of pharmaceutical development is good for both business and consumers, it is important to note that the extreme commercial outlook of large pharmaceutical companies inevitably has some negatives. Beyond just cost- the price of Humira rose by 68.7% in 3 years- there is a tendency for pharmaceutical companies to neglect the production of more urgently needed medication, which is understood to be an unprofitable investment for research.

Furthermore, many academics have written about the impact that over medicalisation has on the way we live our lives. Medicalisation is the process of transforming certain areas of human experience by altering the boundaries of what is considered to be ‘normal’ so that human conditions become treated as medical conditions. This is partly possible through our googling habits as we fuel the need for absolute certainty and lessen the space for individualised experience and self-management. In doing so, we also drive demand for corresponding pharmaceuticals to further satisfy our desire for certainty.

Thus, whilst pharmaceutical sales rise and consumer satisfaction is fulfilled to an extent, difficult questions are raised as to the effect this has on the way we perceive our health and well-being. In this market of targeting uncertainty, the boundaries between health and illness can become blurred. As more opportunities for treatments are presented, they are capitalised on. There is significant profit in our medical uncertainty; that’s something we can be certain of.

Elizabeth Harris


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