Letter in the BMJ on Disease Mongering
Déjà Vu All Over Again
This Letter to the Editor by Peter Lurie, M.D., MPH, et al appeared in the July 27, 2002 edition of the British Medical Journal
EDITOR . . . Moynihan et al's article on disease mongering by the pharmaceutical industry reminded us of an old Bronx baseball saying, originating with Yogi Berra: "It's déjà vu all over again." 3M has for years sponsored the 3M/National Vaginitis Association (www.vaginalinfections.com). This produces a newsletter for health professionals (the Vaginitis Report) and materials for patients. Like the groups described by Moynihan et al, the 3M/ National Vaginitis Association is ostensibly an educational resource run by health professionals.
Unfortunately, its activities include a large element of disease mongering. Mild symptoms are offered as portents of serious disease, and doctors are encouraged to be aggressive in their attempts to diagnose and treat vaginal infections, specifically bacterial vaginosis. As luck would have it, 3M produces a drug that treats bacterial vaginosis. More recently, the 3M/National Vaginitis Association established a free telephone number to distribute a free "educational brochure" promoted by a television personality.
The association provides a further example of what Moynihan et al describe as using statistics to "maximise the size of a medical problem." A survey sponsored by the association found that "one-third of women believe that vaginal odor is normal, and approximately 24% believe that it's normal to experience vaginal itching." This is offered as evidence of women's "lack of knowledge" about vaginal health. The association's website encourages women to contact a healthcare provider when they experience such symptoms.
In fact, good evidence from the primary literature says that both odour and itching occur in women without vaginal complaints., The idea that vaginal complaints are due to infectious agents has been heavily promoted by 3M through the association and is implicit in the very naming of its website, which refers to vaginal infections. Yet we know that many women with vaginal complaints do not have an identifiable infectious pathogen.
It is time for clinicians to rethink the almost reflexive response, encouraged by the pharmaceutical industry and its front groups, of reaching for the prescription pad when a patient presents with vaginal complaints. As Yogi Berra also said: "You can observe a lot just by watching."
Montefiore Medical Center, Bronx, NY 10458, USA
Public Citizen's Health Research Group, Washington, DC 20009, USA
 Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical industry and disease mongering [with commentary by P C Gøtzsche]. BMJ 2002; 324: 886-891 [Full Text]. (13 April.)
 3M/National Vaginitis Association. National survey reveals most women still are unaware of bacterial vaginosis (BV), the most common vaginal infection. St Paul, MN: 3M/NVA, 2002. (21 February 2002.)
 Doty RL, Huggins GR. Changes in the intensity and pleasantness of human vaginal odors during the menstrual cycle. Science 1975; 190: 1316-1318 [Medline].
 Priestley C, Jones B, Dhar J, Goodwin L. What is normal vaginal flora? Genitourinary Med 1997; 73: 23-28.
 Centers for Disease Control and Prevention. Guidelines for treatment of sexually transmitted diseases. MMWR 1998;47(RR-1).