monger, n: derived from the Greek manganon, a device used for deceiving.1
“Disease mongering is harming individuals and health services. It is a juggernaut that needs to be stopped.”2
—New Scientist
In 1865, the English surgeon Joseph Lister performed the first antiseptic surgical procedure. His method involved spraying a solution of carbolic acid (phenol) onto surgical instruments, surgical incisions, and dressings and spraying carbolic acid into the air. Lister insisted that surgeons wear clean gloves and wash their hands in a 5% solution of carbolic acid before and after surgery. His methods were a great advance in reducing postoperative infections. Along with Semmelweiss, who earlier in Vienna recommended similar hand-washing precautions surrounding childbirth, Lister is widely regarded as the father of modern antisepsis. Lister was also honored by having the bacterial genus Listeria named after him, the most notable member of which is Listeria monocytogenes, a food-borne pathogen.3
Another honor of sorts was bestowed on Lister. In 1879, Dr. Joseph Lawrence and Jordan W. Lambert marketed a surgical antiseptic they called Listerine. Its use quickly spread beyond the operating theater; it was sold in concentrated form as a floor cleaner and as a treatment for gonorrhea. In 1895, it was marketed to dentists for oral care, and, in 1914, it became the first over-the-counter mouthwash marketed in the United States.4
By the 1920s, the Lambert Pharmacal Company, Listerine’s maker, was confident they had found a cure; now all they needed was a disease. So they made one up. Advertiser Gordon Seagrove, who was called to a meeting at Lambert to discuss how the company could expand its market, tells how it happened. The company’s chief chemist was asked to describe the product and its uses. As he uninspiringly read his statement, Seagrove recalls, “He mentioned halitosis. Everybody said, ‘What’s that?’ ” Learning that it meant unpleasant breath, everyone thought, “Maybe that’s the peg we can hang our hat on.”5
Before that time, halitosis was an obscure medical term that almost no one had heard of. Advertisers began to promote Listerine as a cure for this condition, which, they said, could blight anyone’s chances of succeeding in romance, marriage, and work. Soon, people all over America were suffering from halitosis.
One Listerine ad featured a lovely woman sitting alone on a couch playing with her pet dogs, with the caption, “What she really wanted was children.” The reason she had to settle for dogs, the ad implies, is that she didn’t use Listerine for her halitosis. Another ad showed a distressed, glamorous woman in evening attire lamenting, “I was a hitchhiker on the highway of love”—until, of course, she began using Listerine. In another ad, a disconsolate young woman is described as “Often a bridesmaid but never a bride”—a phrase that became lodged in the national vocabulary. Listerine targeted men too. In one ad, a prospective bride asks, “Can I be happy with him in spite of that?” In another, a man is being dismissed by his employer and handed his final paycheck. “Would you have told him the truth?” the ad asks.
As advertising scholar James B. Twitchell says, “Listerine did not make mouthwash as much as it made halitosis.”6 Promoting halitosis worked spectacularly. The company’s total revenues rose from $115,000 to more than eight million dollars in only seven years.
Listerine’s success had widespread influence in American advertising. Ad men everywhere began identifying personal concerns and anxieties that could be abolished by specific products. As one advertising expert acknowledged in a trade publication, “Advertising helps to keep the masses dissatisfied with their mode of life, discontented with ugly things around them. Satisfied customers are not as profitable as discontented ones.”6
It was delicate business, however. Some companies felt that issues such as bad breath were too personal and sensitive to capitalize on, while others plunged ahead. In 1919, one company, Odo-Ro-No, which made a woman’s deodorant of the same name, beat even Listerine to the punch. While most deodorant ads of the day appealed to the daintiness and sweetness of the female user, Odo-Ro-No brazenly urged women to perform the “Armhole Odor Test.” If they flunked, this indicated they were suffering from “B.O.” They thus became the first company to use B.O. in an ad. It was actually a concession to delicacy, however, since B. O. meant, but did not really say, “body odor.”
The trick was to inflate a common, everyday condition to the level of pathology, which, if not attended to, could blight one’s prospects for happiness and success. The goal was to craft ads as “quick-tempo socio-dramas in which readers were invited to identify with temporary victims in tragedies of social shame,” says historian Roland Marchand7, 8—a mini-soap opera in print.
Just as the early advertisers pushed the boundaries of decency in their time, advertisers flirt with propriety today. Sometimes it backfires. A few years ago, the makers of Scope mouthwash, Listerine’s major competitor, named TV host Rosie O’Donnell one of America’s “least-kissable” celebrities.9 O’Donnell responded on her television show by declaring that Scope tastes “like scum.” Listerine, sensing a promotional opening, offered to give $1,000 to one of Rosie’s favorite charities every time a guest kissed her on the program. Soon, her guests were pointedly kissing her when introduced. With every kiss, an electronic graph was shown with the dollar amount raised—along with Listerine’s logo. By the time Scope apologized and the standoff ended, O’Donnell had raised over $100,000.
Disease mongering
Listerine pioneered a practice that has come to be called “disease mongering.” The term was introduced by health-science writer Lynn Payer in her 1992 book Disease-Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick.10 Payer, formerly chief medical correspondent for the International Herald Tribune and health editor for the New York Times, defined disease mongering as “trying to convince essentially well people that they are sick, or slightly sick people that they are very ill.” She identified 10 disease-mongering tactics:
•Taking a normal function and implying that there’s something wrong with it and that it should be treated;
•imputing suffering that isn’t necessarily there;
•defining as large a proportion of the population as possible as suffering from the “disease”;
•defining a [condition] as a deficiency disease or disease of hormonal imbalance;
•getting the right spin doctors;
•framing the issues in a particular way;
•using statistics selectively to exaggerate the benefits of treatment;
•using the wrong end point;
•promoting technology as risk free; and
•taking a common symptom that could mean anything and making it sound as if it is a sign of a serious disease.
Fictionosis
“There’s a lot of money to be made from telling healthy people they’re sick,” say journalist Ray Moynihan, physician Iona Heath, and pharmacologist David Henry in the British Medical Journal. “Pharmaceutical companies are actively involved in sponsoring the definition of diseases and promoting them to both prescribers and consumers. The social construction of illness is being replaced by the corporate construction of disease.”11
When fear kicks in, people often suspend the skepticism they would ordinarily apply on other occasions and believe what they’re told.12 This is particularly true where health and safety are concerned.
This was demonstrated in the April 1, 2006, issue of the British Medical Journal. Moynihan, a visiting editor and contributor to the BMJ, published an article entitled “Scientists Find New Disease: Motivational Deficiency Disorder.” Moynihan, who is Australian, described how Australian scientists have discovered that extreme laziness may have a medical basis and that this constitutes a new condition called motivational deficiency disorder (MoDeD). One in five Australians is affected, Moynihan reported. The chief symptom is overwhelming apathy. Extreme cases can be fatal because the condition diminishes the motivation to breathe.
Neurologist Leth Argos, a member of the team that identified the disorder, said the condition can be diagnosed by low scores on a motivation rating scale and by positron emission tomography. “The disease is poorly understood,” Argos stated. “It is underdiagnosed and undertreated.” Argos is an advisor to Healthtec, a small Australian biotechnology firm that is conducting clinical trials of indolebant, a cannabinoid CB1-receptor antagonist.
Julie Deardorff, a reporter for the Chicago Tribune, was intrigued by the BMJ report. She tried unsuccessfully to contact Argos for comment. Suspecting she’d been had—the date of the BMJ article was April Fool’s—she finally contacted pharmacologist David Henry, who was quoted in the article. Motivational deficiency disorder “is a complete fabrication,” he confessed. “We wanted to show that it is easy to talk up a disorder. Using authoritative sources, you can make it all sound very plausible.” Deardorff playfully called the new disease “fictionosis,” and her article in the Chicago Tribune was picked up by media around the country.13
This particular fictionosis was announced at the inaugural Conference on Disease Mongering held in Newcastle, New South Wales, Australia, April 11-13, 2006. This first-of-a-kind meeting brought together academics, researchers, health professionals, health managers, journalists, writers, and consumers who were concerned about “the trend to corporate definitions of diseases with a primary interest in making profits rather than a concern for public health.”14
A “mockumentary” about motivational deficiency disorder is available in DVD through professor David Henry at david.henry@newcastle.edu.au. Papers from the Conference on Disease Mongering can be downloaded for free from the peer-reviewed, open-access, on-line journal PLoS Medicine (PLoS = Public Library of Science) at http://collections.plos.org/diseasemongering-2006.php.
As medical anthropologist Kalman Applbaum, of the University of Wisconsin-Milwaukee, states, there is nothing new about the current pharmaceutical practice of disease mongering.15 These methods are a direct successor to the marketing techniques of the patent-medicine makers of the 19th century. Novelist Henry James was so vexed by these hucksters he called them “nostrum-mongers.” His brother, Harvard psychologist William James, who is considered the father of American psychology, was also exasperated by them. He railed that “the authors of these advertisements should be treated as public enemies and have no mercy shown.”16
Free market?
What’s wrong with giving pharmaceutical companies free rein in the marketplace? Today, the “free market” has taken on an almost religious connotation for many. It is an article of faith among free-market devotees that, if the market is permitted to work in an unobstructed fashion, it will eventually bestow its sweet benefits on all the world’s people. Seen from this perspective, the free market resembles a disembodied Santa Claus who travels the globe blessing people and making their lives richer and happier.
What drives this view? Applbaum identifies three core beliefs commonly associated with this image of the free market. “The first is that human beings are creatures of limitless but insatiable needs, wants, and discomforts. The second is that the free market is a place where these needs might be satisfied through the exercise of free choice. The last of these beliefs is that the surest way to innovation in all industries is unfettered competition in the market.”16
But, just in case the needs of humans are not limitless and insatiable, the marketers try to make certain they are. They must ensure that our satisfaction is never fully achieved; otherwise, there might come a point at which we’d stop buying their stuff. Modern marketers should give themselves a pat on the back because they have been colossally successful in creating unending want on the part of consumers. As anthropologist Marshal Sahlins points out, “[I]n the world’s richest societies, the subjective experience of lack increases in proportion to the objective output of wealth.”17 In other words, “[T]he richer we get, the more we want.”16 We may complain about this upward spiral, but we are willing victims. It is estimated that we Americans spend, on average, three years of our lives watching advertisements on television, which causes us to focus not on what we have but on what we lack and to want more and more.16
It is difficult to understand how anyone, with a straight face, could preach the virtues of consumer free choice in the modern marketplace, when the goal of marketers is to manipulate, calibrate, and control the very choices they claim are free. What about innovation? Does free-market competition spur the development of new drugs to treat disease? Not according to recent books on the subject.18, 19 Drug companies spend more on marketing than on research and development.20 As Applbaum says, “[O]nce a firm becomes principally driven by marketing—the case for most companies in most industries since the 1980s—then innovation comes to mean an elaboration of meaningless differences among a field of comparable “me too” products. . . . More harmfully, expanding and altering the consumer’s perception of disease is just as effective, and evidently a lot easier, than finding new cures.”16
Our drug makers always reject these objections. They dismiss those who complain about the excesses of the drug industry—disease mongering, record profits, collusion with politicians, trivial innovation, the manipulation of the design and reporting of clinical trials—as enemies of free-market capitalism who just don’t get it.
Some drug makers and marketers are undoubtedly highly motivated. They believe humankind’s health hangs in the balance, and they are doing something about it. In their view, they are performing a valuable public service and their actions are ethical. Why shouldn’t their noble efforts be rewarded? “Doing good while doing well,” as they like to say.16
This rationale appears increasingly hollow and deceptive to many insiders in medicine. The evidence, too extensive to be reviewed here, is the theme of two recent books on the subject: The Truth About the Drug Companies: How They Deceive Us and What To Do About It, by Marcia Angell, senior lecturer in Social Medicine at Harvard Medical School, and On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health, by Jerome P. Kassirer, former editor-in-chief of the New England Journal of Medicine and distinguished professor at Tufts University School of Medicine.18, 19 The main points of both books have been nicely summarized by Angell in an article available on-line at http://www.nybooks.com/articles/1724421.
A mongered disease: Erectile dysfunction
Joel Lexchin, of the School of Health Policy and Management, York University, Toronto, Canada, considers Viagra (Pfizer, New York, NY) a microcosm of the debate about disease mongering.22 Viagra was originally considered a treatment for erectile dysfunction (ED) secondary to organic causes such as diabetes, prostatectomy, and spinal cord damage. Gradually, however, “the blue pill” escaped confinement to this niche and underwent “therapy creep.” Today males from teenage boys to centenarians are using it. It’s implied that a man need not suffer from anything pathological to enjoy the benefits of Viagra. He might merely want a “better” sex life, whatever that might mean to him, or he might merely be curious about what he’s missing if he doesn’t use Viagra. In fact, it almost seems these days that the main reason to use the blue pill is because one is, well, a man.
To create a more tumescent market, Pfizer embarked on a highly effective strategy to make Viagra a treatment option for men with any degree of ED, including rare or transitory failures of potency. On its Web site (http://www.viagra.com/ed/index.asp), Pfizer states that “in fact, more than half of all men over 40 have difficulties getting or maintaining an erection. This issue, also called erectile dysfunction (ED), occurs with younger men as well. You should also know there is something you can do about it. Millions of these men have already improved their sex lives with VIAGRA. Want to improve your sex life? You’ve come to the right place.”
Data from the National Health and Social Life Survey show that emotional stress from worsening economic and social conditions can elevate the risk of sexual difficulties.23 Nothing this nuanced appears on the Viagra Web site. To be fair, depression and stress are mentioned under “Causes of erectile dysfunction (ED),” but they are granted only a cursory nod and with the comment that “[ED] is usually caused by an underlying health problem,” which, one presumes, is in the body, not the mind.
One comes away from the Viagra Web site confused. If ED usually reflects “an underlying health problem,” why do the men on the Web site in their 30s and 40s appear so healthy and virile? A “VIAGRA sports” page (http://www.viagra.com/sports/index.asp) drives home the idea that Viagra is for active, sports-loving males. Rafael Palmeiro, formerly with the Texas Rangers baseball team, is a spokesman on Viagra television ads. Pfizer has joined with Sports Illustrated magazine to create the Sportsman of the Year Trivia Challenge (http://siviagratrivia.secondthought.com/trivia_content.html) and is also advertising heavily at NASCAR races. The recurring message is that Viagra is for red-blooded, all-American guys who aren’t actually unhealthy but who just need a little help sometimes.
Pfizer’s efforts have been undeniably successful. Between 1998 and 2002, the group showing the largest increase in Viagra use was men between ages 18 and 45, only one third of whom had a possible organic reason for using the drug.23 Yet Pfizer denies targeting younger men or that it is positioning Viagra as a lifestyle drug. “Have we gone out and given our advertising agency instructions to speak to this young population? No, we haven’t,” says Mariann Caprino, a company spokesperson.24 It appears otherwise. The first television ads for Viagra featured a geriatric Bob Dole (born 1923), the 1996 Republican presidential candidate. Today, Dole is nowhere in sight, having been replaced by prominent sports figures, as mentioned.
Pfizer also launched a $35 million campaign to influence insurers to pay for the drug. A leading healthcare provider, Kaiser Permanente, refused, estimating that it would need $100 million to pay for Viagra requests from its nine million members.23
After Viagra had been on the market for only seven months, Pfizer estimated that the drug had been prescribed for 150,000 women.25 Many reports were glowing, and a research program was launched to study its effects in females. It didn’t pan out. After eight years of work and tests involving 3,000 women, Pfizer abandoned the project. Viagra, it seemed, had little effect on a woman’s willingness, or desire, to have sex.26
Perhaps Pfizer can relax in its efforts to grow the Viagra market. It’s happening without any effort on their part, by ways in which they probably never dreamed. In May 2005, Italian police discovered a racetrack linked to the Sicilian Mafia on the outskirts of Naples, where stallions were pumped full of Viagra and other drugs to fix races. “We were able to ascertain the use of the famous Viagra to increase the performance of the horses,” police commander Mario Pantano told a local television station. The track and horses were seized. It remains unclear how Viagra affected the horses’ speed.27
What was the Mafia thinking? Surely many of them had tried Viagra. They should have known that the last thing the blue pill makes a male want to do is run fast.
A desirable side effect
Viagra can cause abnormal vision, rhinitis, dyspepsia, and headache, which are side effects nobody wants. But there is one potential Viagra side effect everyone is hoping for: saving threatened and endangered species.
Certain animals have been hunted for centuries for body parts that are used in traditional Chinese medicine as aphrodisiacs: the velvet of reindeer antlers, the genitals of male seals, snake blood, toad skin, tortoises, rhinoceros horn, and tiger penises and testicles. The booming sales of Viagra in the late 1990s coincided with a marked slump in the slaughter of some of these animals. According to Frank von Hippel, a biologist at the University of Alaska in Anchorage, and his brother William, a psychologist at the University of New South Wales in Sydney, Australia, Viagra may have decoyed buyers away from the illegal trade in body parts of some threatened species.28
Could Viagra be a safety net for these animals? It’s plausible. Immediately following its release, the clamor for Viagra spread around the world. Soon, it was selling for $100 a pill in Saudi Arabia, 10 times the US price. Japanese companies began flying men to Hawaii to obtain it. Physicians began selling it on the Internet. Knockoff blue pills cropped up in foreign countries overnight. Experts aren’t certain whether Viagra has taken the pressure off any endangered creatures, and more data are needed. But, if it turns out to have done so, this will have been one of the most blessed side effects ever discovered for any drug.
Other examples
Erectile dysfunction may be the best-known example of disease mongering, but it is the tip of the iceberg. Several additional examples are listed below. All of them display one or more of the features described by Moynihan, Heath, and Healy in their seminal 2002 BMJ article “Selling Sickness: The Pharmaceutical Industry and Disease Mongering”29: (1) the ordinary processes or ailments of life are classified as medical problems; (2) mild symptoms are portrayed as portents of serious disease; (3) personal or social problems are seen as medical ones; (4) risks are conceptualized as diseases; (5) disease prevalence estimates are framed to maximize the size of a medical problem. Among them are the following:
•Female sexual dysfunction30; •attention deficit hyperactivity disorder (ADHD)32; •restless legs syndrome33; •social shyness/social anxiety disorder/social phobia30; •irritable bowel syndrome30; and Financial costs
No tax-funded healthcare system can sustain the cost of drug treatment for all the risks for which the drug companies would like to treat the population. Thus, Heath urges politicians to wake up to “the increasing capacity of this industry to bankrupt universal health-care systems.”34
Although the United States does not have a universal healthcare program, we are not immune to the bankrupting power of Big Pharma. Consider the Medicare Part D Prescription Drug Plan, which went into effect in 2006 and was supposed to help seniors afford costly medications. The plan was largely crafted by the insurance and drug companies. Not surprisingly, the measure provides billions of dollars in subsidies to insurance companies and health maintenance organizations.35 There are also built-in profits for drug makers. As Helene Levens Lipton, of the Institute for Health Policy Studies, University of California-San Francisco School of Medicine, says, “[U]nder the new benefit, Medicare does not have the authority to negotiate with drug companies for lower drug prices; in fact, it is currently prohibited from doing so. Many analysts assert that this prohibition will lead to runaway drug expenditures under Medicare Part D; if the government could negotiate directly with health plans, it would have enormous purchasing power, which could drive down drug prices. The cost of Medicare Part D—its long-term financial sustainability—is already a problem.”34
This is another example of the hypocrisy of those drug companies that preach the virtues of the free market: rig the market from the inside by prohibiting negotiations for volume discounts, thereby guaranteeing high prices for your products. As a result of such tinkering, the “unfettered” market has become anything but.
The result often appears to be financial assistance to the drug companies, not to the needy seniors who need it most, many of whom have to choose between buying food and buying prescription drugs. The result has been chaotic as seniors around the country discover that they often have to pay more, not less, for their medications through the government plan. As the Los Angeles Times reported in April 2006, “[This] finding has been borne out in a handful of surveys around the nation by program critics. For instance, a review by the Senior Action Network, a grass-roots advocacy group in San Francisco, found that Costco’s prices on the top 100 drugs used by Medicare beat prices of all 48 plans in California in more than half the cases.”36
We must realize, Heath maintains, that the rationale of the drug companies for the vigorous drug treatment of risk factors—that it reduces health costs in the long run—does not stand up to scrutiny. “The costs of health care are highest during the year before death, regardless of the age at which death occurs. Everyone must die and be cared for while dying, and no amount of preventive pharmaceuticals can reduce the cost of providing this crucial end-of-life care.”36, 37
Disease mongering shortchanges people worldwide. Because fabulous profits can be made in rich countries on lifestyle drugs, these have become the main arrows in the quiver of the disease mongerers. This means that the development of treatments for illnesses that affect poor people in poor countries gets less attention than it might38—a shift of attention from the sick to the well and from the poor to the rich.39
Reverse mongering
The pharmaceutical industry tries to present a united image to the public, such as through the Pharmaceutical Research and Manufacturers of America (PhRMA) organization, which represents the country’s leading pharmaceutical and biotechnology companies (http://www.phrma.org/). Recently, however, the pharma family has begun feuding, as some companies have begun attacking the products of their competitors in what can be called reverse mongering.
“[I]n a move that may astonish even the most jaded critics of ethically challenged pharmaceutical marketing, makers of sleeping pills are now paying doctors to publish bad things about competing drugs,” writes Daniel Carlat, professor of psychiatry at Tufts Medical School, in his New York Times article “Generic Smear Campaign.”40
The stakes in this money scramble are huge. In 2005, 42 million prescriptions were filled for sleep aids such as Ambien (Sanofi-Aventis, Bridgewater, NJ) and Lunesta (Sepracor, Marlborough, MA). Yet many people have never heard of one of the most widely prescribed hypnotics in the United States, trazodone, which is available as a generic drug and as Desyrel (Warner Chillcott Laboratories, Morris Plains, NJ). The generic form costs as little as 10 cents a tablet, whereas Ambien and Lunesta can cost three dollars or more per pill. “[E]ach time a psychiatrist prescribes trazodone,” says Carlat, “a potential sale of Lunesta or Ambien is lost. No doubt that is why, in the past few years, several articles have been published in professional journals that can only be described as trazodone-bashing.” In one such article, the disclosure statement reveals that Sepracor, the company that makes Lunesta, “assisted in the preparation” of the article and paid the author a fee for “the services he provided in support of the development” of the manuscript.41
This practice of negative marketing can be discouraged, suggests Carlat, by requiring a complete description of the links between drug companies and physician authors, what the physician actually did in the preparation of the article, and the dollar amount he or she was paid. “I suspect it would be a rare doctor,” says Carlat, “who would want such information to come to light.”41
Toward a solution
London physician Iona Heath, discussing how to combat disease mongering, says, “The challenge of combating the current epidemic of disease mongering is daunting, and anyone looking for ready solutions should read no further. Those seeking a way forward find themselves ranged against powerful economic, political, and professional interests. There is an apparently limitless amount of money to be made from marketing pharmaceutical remedies for diseases and even more from remedies to reduce risk factors for disease.”41
Why are we such suckers for the disease mongerers? How can we immunize ourselves against them? Heath locates our susceptibility in our fear of suffering and death. Throughout most of human history, the solace of salvation in the next life provided people with the courage to accept burdens and to sacrifice during this one. Today, the comforts of religion are no longer real for many people. As a result, “Death has become more final, and salvation must be sought before death in an ever-expanding longevity. [If we are adequately to respond to the false hopes raised by disease mongering, we shall have to cultivate] an ability to acknowledge, accommodate, and move beyond these profound existential fears. . . . The way forward will rely on a capacity to rediscover courage and stoicism as both private and civic virtues. . . .”37
Practical steps must also be taken. Heath challenges medical professionals to genuinely disentangle themselves from the pharmaceutical industry. Unless they do, their judgments can never be completely objective. The drug companies spend millions of dollars to “educate” physicians; they would not do so if prescribing habits and industry profits were not affected by this support.
In addition, Heath wisely suggests that we need a more courageous and honest brand of science, a science that is willing to acknowledge the limits of its expertise and that is less tempted to promise more than it can deliver.
We should stop pathologizing normal biological variations, such as male-pattern baldness, and normal ranges of human experience, such as social shyness.
We must cease portraying risk factors for disease as diseases in themselves, which must be hounded out of existence with pharmaceuticals.
We should try more enthusiastically to prevent illness and to correct the social and economic conditions that are correlated with sickness and shortened lives, such as poverty, illiteracy, and dropping out of school.42
We need more research on the psychological impact of labeling someone as “at risk.”
A way out
“Human societies,” Heath believes, “are driven by the effects of greed and fear. . . . The greed is for ever-greater longevity; the fear is that of dying. The irony and the tragedy is that the greed inflates the fear and poisons the present in the name of a better, or at least a longer, future. Ultimately, the only way of combating disease mongering is to value the manner of our living above the timing of our dying (emphasis added).”37
How? One way is to cultivate a sense of connectedness with our fellow human beings, and ultimately with something transcendent, however it is named; to reacquire a sense of persistence beyond physical death; in other words, to deemphasize our obsession with a finite personal self and its lifestyle by developing a sense of the spiritual.
Is it surprising that the best defense against disease mongering may be a spiritual one? I think not. In the course of history, spirituality—an abiding sense of connectedness with something greater than the individual self—has slain more behemoths than has any other strategy. How ironic it would be if our confrontation with the excesses of Big Pharma proves to be a nudge along the spiritual path.
Try mongering that!
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