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Disease mongering in South Asia – a long way to go

Posted by plosmedicine on 31 Mar 2009 at 00:27 GMT

Author: Ravi Shankar
Position: Associate Professor
Institution: KIST Medical College, Imadol, Lalitpur, Nepal
Additional Authors: Subish P, Giri BR
Submitted Date: June 17, 2008
Published Date: June 19, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Dear Editor

We read with interest the essay titled ‘Disease mongering is now part of the global health debate’ by Ray Moynihan, Evan Doran and David Henry (PLoS Med 2008;5:e106).
We are keenly interested in disease mongering and inappropriate and irrational drug promotion and have taken initiatives at our level to improve the situation in South Asia. Fairness creams are widely promoted in South Asia. Fairness creams promote a racist ideal of beauty and we had considered whether promotion of fairness creams meets the criteria of disease mongering in a previous issue of PLoS Medicine.(1) We had written a review article on Disease mongering for the Singapore Medical journal, a widely circulated journal in Asia. (2) In the article we had discussed disease mongering in an Asian context and debated whether alternative and complementary medicine practitioners among others may be guilty. We had presented a poster on disease mongering on a small scale (mini mongering) by protagonists other than the pharmaceutical industry at the inaugural conference on disease mongering held in Newcastle, Australia. Later the paper was published in the journal of Rural and Remote Health.(3)
We had presented the paper on fairness creams during a Dermatology Update at the Manipal College of Medical Sciences, Pokhara, Nepal. The second author (PS) had presented a paper on ‘Disease mongering’ during the Sixth IPSF-Asia Pacific Pharmaceutical Symposium- 2007 organized in the Kathmandu University, Dhulikhel, Nepal.
The department of Pharmacology regularly conducts learning sessions on disease mongering for the basic science medical students. Student opinion about the sessions was studied and was positive.(4) The first author (PRS) had presented the problem of and the consequences of disease mongering at the KIST Medical College, Imadol, Lalitpur, Nepal. This institution has a functioning Medicine and therapeutics Committee which is working hard to promote the more rational use of medicines in the hospital.
However, there has been a lack of initiatives to combat disease mongering in the larger society outside. There have been no discussions on disease mongering in the media or even in academia. The major problem in South Asia is lack of access to medicines but in many areas drugs are aggressively marketed and promoted. Cosmetics and various herbal preparations are promoted even more aggressively and the regulatory requirements for these products are less stringent. Beauty treatments and cosmetic surgery are becoming more common. The issue of drug promotion is slowly gaining awareness. Many medical schools have started to teach students to critically analyze drug advertisements and a non-governmental organization Health Action International Asia Pacific (HAIAP) is active in the field of pharmaceutical promotion. Other organizations have started to address this important issue. An online discussion forum (Netrum) moderated by Dr. Vijay Thawani from Nagpur, India had often discussed pharmaceutical promotion.
Thus we in South Asia are very much behind the west in combating disease mongering. Academicians here and there have begun discussing the phenomenon. However, widespread awareness even in the academic community is lacking. A concerted effort is needed to research disease mongering in Asia and especially in South Asia, to bring the phenomenon to public awareness and lay down the framework for interest and action on the part of policy makers.
1) Shankar PR, Giri BR, Palaian S (2006) Fairness creams in South Asia--a case of disease mongering? PLoS Med 3: e315.
2) Shankar PR, Subish P (2007) Disease mongering. Singapore Med J 48: 275-80.
3) Giri BR, Shankar RP (2007) Disease mongers in a nation in transition? Rural and Remote Health 7: 621.
4) Shankar PR, Subish P, Saha AC (2007) Learning session on disease mongering – student feedback. Journal of Clinical and Diagnostic Research 5: 390-395.

No competing interests declared.