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Combating disease mongering: An educational initiative takes a small first step

Posted by plosmedicine on 31 Mar 2009 at 00:07 GMT

Author: Ravi Shankar
Position: Associate Professor
Institution: Manipal College of Medical Sciences
Additional Authors: Subish P, Saha AC
Submitted Date: March 21, 2007
Published Date: March 21, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

We read with great interest the article by Dr. Iona Heath on Combating disease mongering [1]. The author had clearly outlined the challenge to professionals from disease mongering and the role of doctors in combating the phenomenon. The article and the special theme issue of PLoS Medicine had inspired us to start an educational initiative on disease mongering.

Medical students as future doctors have an important role to play. The department of Pharmacology at the Manipal College of Medical Sciences, Pokhara, Nepal teaches medical students to critically analyze drug advertisements and promotional materials [2]. The department concentrates on teaching students to use essential medicines rationally. As an extension of this activity we have started an educational session on disease mongering for the third and fourth semester undergraduate medical students. At Pokhara, Pharmacology is taught in an integrated, organ system-based manner with the other basic science subjects during the first four semesters. Student feedback was collected using a questionnaire and the opinion about the session was compared among different subgroups.

The learning session was conducted during the pharmacology practical. Reference materials related to the topic were made available in the college library. The topic of the session was informed to the students a week in advance. The session was activity-based and the group of 37 or 38 students was divided into small groups of 7 or 8 students each. The students were first shown a documentary on the creation of a new disease called ‘Motivational Deficiency Disorder’. Then the first author (PRS) gave a brief presentation about disease mongering. The groups were given a set of problems related to disease mongering. A few of the problems were whether the promotion of fairness creams in South Asia can be considered as disease mongering, the role of traditional medical practitioners in disease mongering and should direct-to-consumer advertising be legalized in South Asia. The groups presented their findings followed by a discussion.

The students were explained the aims and objectives of the study and were invited to participate. A participant consent form was given to each respondent explaining the purpose and conduct of the study. Respondents who agreed to participate and signed the consent form were included in the study. Basic demographic information was obtained and each respondent's agreement with a set of 15 statements was obtained using a modified Likert-type scale.

One hundred and seventeen students participated. The response rate of the third semester was 89.3% (67 of the 75 students) while of the fourth semester it was 69.1% (47 of the 68 students). Three students did not indicate their semester. The median total score was 53 and the interquartile range was 7 (maximum possible score was 75). Nepalese and Indians were the major nationalities. Majority of students were self-financing and were from urban areas. No significant difference in total scores was seen among the various subgroups. The students showed maximum agreement with the statement that doctors have an important role to play in combating disease mongering. The students wanted a student seminar to be conducted on the topic of disease mongering. They wanted similar sessions in the future.

The overall student opinion was positive. A single session can serve only as a preliminary introduction to a complex topic. Sessions for interns and medical officers are required. The session should be continued and strengthened and similar sessions for students during the clinical years can be considered.


1) Heath I (2006). Combating disease mongering: Daunting but nonetheless essential. PLoS Med 3 (4):e146.
2) Giri BR, Shankar PR (2005). Learning how drug companies promote medicines in Nepal. PLoS Med 2(8):e256.

No competing interests declared.