Disease Branding


Disease branding is a public relations and marketing industry term for the more pejorative term disease mongering, a phenomenon at the very centre of the way global pharmaceutical firms market their products.

Whether perceived as mongering or branding, the process refers to "widening the boundaries of treatable illness in order to expand markets for those who sell and deliver treatments," (1) as explained by the well-known Austrailian health journalist Ray Moynihan who has written extensively on the topic. Widely covered in the medical and lay press, disease mongering applies the principles of branding to a supposed malady or abnormal condition—increasing public awareness of this so-called medical condition, so that each consumer becomes a potential patient. Examples are many, including some so taken for granted today they may well come as a surprise.

Strategically, the idea is not a new one: the goal is to increase sales by growing the potential target market for a product (creating more potential customers), as opposed to by marketing the product to existing known target consumers (selling more product).
By increasing awareness of a "disease," the pharmaceutical marketer therefore increases demand for their product, which they are then well positioned to supply product to meet. In defining the "sickness," the owners of the "cure" stand to profit greatly.

As Patricia Parsons, a public relations & communication professor at Mount Saint Vincent University in Canada has pointed out, disease branding "neatly sidesteps the increasing criticism and even legal obstacles that face or threaten direct-to-consumer advertising of branded, prescription drugs." (2) The practice, which has been enormously successful from a marketing point of view in developing entirely new markets for pharmaceutical products, has also been harshly criticized. Critics have suggested that it de-normalizes perfectly normal human biology for the sake of increasing profits; they have said disease mongering promotes "non-existent diseases and exaggerates mild problems to boost profits." (3)



Why 'branding?'


Branding of products and companies pervades our society. And the processes of disease branding are more akin to those of corporate brand management than to direct product advertising. When done well, disease brands grow large and powerful enough that products may be meaningfully advertised based upon them, without mentioning the underlying condition at all.


The Tim Hortons brand, for example, includes everything about the Tim Hortons experience—the entire place the company holds in the life of a consumer. The values at the core of its brand are in a word, Canadian—the idea of being a good neighbour, of community, and of dependability. Strong brand management has made Tim Hortons stand for more than coffee, and because consumers feel affinity to its brand, they make Tim Hortons a part of their lives. The coffee simply completes the brand experience—it is not advertised directly, and quite literally, it sells itself, to the tune of millions of dollars per day.

Similarly, disease branding builds the brand of a so-called disease. The goal is to have consumers, and potential patients, see themselves in the branding efforts, to say, quite literally, "that's how I feel." In fact, proponents say, "the ultimate goal of a successful disease-branding program is that the brand should transcend the marketing campaign and be adopted and sustained by the physician and marketing community." (4)

Consider this example: a television ad for Restless Legs Syndrome. The time is spent selling the disease, the product positioned only after the "brand" is established.



In the initial phases, disease branding often includes sponsorship of pharmaceutical research and resulting papers—which brings up further ethical questions. In his how-to guide, disease brander Vince Parry, leader of Y Brand consultancy, suggests beginning with an audit of the science around a given condition, conducting a workshop of medical and marketing professionals to "build consensus around a few powerful concepts." (5) Parry is referring to marketing concepts—the way bad breath, for example, will become the much more sinister and easily sold halitosis. From this core "brand" of the disease, medical lay press, advertising, and traditional public relations tactics can be called upon to build a brand for the disease like one might any other.



History and examples


The well-known mouthwash Listerine is credited with—or accused of, depending upon your perspective—pioneering disease branding, according to Larry Dossey's 2006 editorial in Explore magazine. (6) Though he refers to it as disease mongering, Dossey's example explains the advertising success Listerine accomplished in the early 1920s by the creation of the "disease" halitosis, which could equally be celebrated as successful disease branding. Another example used is the creation of the notion of body odour, which a deodorant company was at the ready to cure with its products.

More recent examples are well known. Compiled from Dossey's article and several others in a brief review of medical and lay press literature, the following is a brief list of conditions for which medical need has been either entirely created or amplified by effective disease branding. In many cases, the most comprehensive site available on these topics and the top result in a search engine is owned by, or sponsored by, a drug company.


Beginning with Lynn Payer's influential 1992 book Disease Mongers: How Doctors, Drug Companies, and Insurers and Making You Feel Sick, public criticism was turned up on the process of developing and marketing diseases. Entire issues of PLOS Medicine and the British Medical Journal were devoted to the topic. The business and lay press caught on as well, with exposes (7) like University of Victoria researcher Alan Cassels' multi-part series in the Toronto Star called the "ABCs of Disease Mongering," based on his book by the same name.

The industry press has fired back. Pharmaceutical marketers like Parry celebrate disease branding as a path to success, suggesting even that it does social good by bringing old diseases to light to further research and uncover hidden dangers, bring obscure conditions to light that might otherwise never be diagnosed or treated, and eliminating stigmas, so that people suffering in silence may feel comfortable to seek treatment. (8) In a pointedly worded letter to the editor of the British Medical Journal, British Pharmaceutical Industry medical director Richard Tiner writes that "the pharmaceutical industry is not inventing disease but rather working hard to develop new, innovative drugs for the overall benefit of humankind." (9)

The disease branding of Dr. Jekyll, the disease mongering of Mr. Hyde. What is a pharmaceutical PR executive to do?



Ethical questions for public relations practitioners


In an article for the academic public relations press in 2006, and one of few ethical considerations of the approach from a communications or marketing perspective, Patricia Parsons provides a scathing indictment of disease branding based upon her five pillars for ethical decision making. In summary, disease branding does more harm than good, it falsely labels normal conditions as something else, and it makes people believe they are sick when they are not, which creates a social drain from a healthcare perspective—it therefore fails on four of five of Parsons' ethical tests, all but one surrounding the invasion of privacy.

Parsons' five pillars synthesize a number of theoretical ethical constructs, and applies disease branding to these pillars. Considered against two of those theoretical underpinnings—the categorical imperative and utilitarianism—directly, disease branding also struggles for legitimacy.

From nearly any perspective of Kant's categorical imperative, disease branding seems not to qualify as ethical. It clearly uses people as a means to an end, setting aside their actual health for what they can be persuaded to believe their health is. This was fundamental to Kant's main ethical rule.

From a utilitarian perspective, requiring the greatest happiness of the greatest number, disease branding at first would seem to be ethical. Pharma marketers would be quick to point to the mass of prescriptions as patients once unhealthy, who are now not only healthier but happier. Upon further examination, of course, disease branding convinces many more perfectly healthy and happy individuals, who would never have perceived themselves to be sick, that they are indeed unhealthy and in need of help. They spend time in doctors' offices they could be spending enjoying their lives. This, of course, is the goal of disease branding, and where its real success lies. Therefore, it also seems unethical from a utilitarian perspective.

Importantly, and in fairness, the boundaries around disease branding are open to interpretation and personal perspective. Consider the retiring, "tough-guy" construction worker who would never otherwise have considered treatment for the flu. Is it disease branding for the maker of a flu shot to increase awareness and understanding of this proven disease, so that it becomes treatable to this patient? In cases like this, it may well be that some of the methodologies and best practices of disease branding may actually do some social good, but not at the exclusion of a traditional public education model.

On the whole, however, the creation of new diseases and the marketing of them as treatable illnesses requiring prescriptions seems ethically questionable. Practitioners would be well-served to read the extensive literature and determine their own moral beliefs, and those of their employers, before embarking on this proven pharmaceutical marketing strategy.

Notes



1. Moynihan, R., Heath, I., and Henry, D. (2002). Selling sickness: The pharmaceutical industry and disease mongering. British Medical Journal. 324, pp. 886-891.

2. Parsons, P. (2007). Integrating ethics with strategy: Analyzing disease branding. Corporate Communications: An International Journal. 12:3, pp. 267-279.

3. BBC News. (2006). Drug firms inventing diseases. Retrieved November 7, 2008 from http://news.bbc.co.uk/1/hi/health/4898488.stm

4. Parry, V. (2007). Disease branding: What it is, why it works, and how to do it. Pharmaceutical Executive. October, 2007, pp. 22-24.

5. Ibid, p. 24

6. Dossey, L. (2006). Listerine's long shadow: Disease mongering and the selling of sickness. Explore. 2:5, 379-385.

7. Cassels, A. (2008). Spreading disease by word of mouth: A is for Archie with AMDD, and B is for Ben who has Bad Boy Behaviour. The Toronto Star. March 4, 2008, p. L5.

8. Parry, V. (2007).

9. Tiner, R. (2002). The industry works to develop drugs, not diseases. Letter to the editor. British Medical Journal, 325, p. 216.



Links for further reading


Drugs companies 'inventing diseases to boost their profits' - Times Online
http://www.timesonline.co.uk/tol/news/uk/health/article704221.ece

BBC NEWS | Health | Drug firms 'inventing diseases'
http://news.bbc.co.uk/1/hi/health/4898488.stm

Psychiatry and disease mongering: Road Rage Disorder is latest spontaneously "discovered" disease
http://www.naturalnews.com/019418.html

Disease mongering and drug marketing
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1369125

Are Pharmaceutical Companies Inventing Diseases, New Study Suggests They Are
http://www.medicalnewstoday.com/articles/41427.php

Disease Mongering: Corporations Create New 'Illnesses' - Health Supreme
http://www.communicationagents.com/sepp/2006/04/13/disease_mongering_corporations_create_new_illnesses.htm

The making of a disease: female sexual dysfunction -- Moynihan 326 (7379): 45 -- BMJ
http://www.bmj.com/cgi/content/full/326/7379/45