So what exactly is "disease mongering?" It's the concept of selling sickness to otherwise healthy people. Many people have normal ailments that are simply a part of life. Not every symptom means that something is seriously wrong or even wrong at all. But if you can expand and broaden the idea of what diseases exist — or "medicalize" what may be normal signs of aging — then you can also expand the opportunities for treatments. And that, coupled with aggressive promotion, can create a lucrative industry. That's disease mongering in a nutshell.
Thomas Perls, co-author of the editorial, practices geriatric medicine at Boston Medical Center and has become a well-known critic of the burgeoning anti-aging industry. He believes the baby boomer generation has become particularly vulnerable to disease mongering, mostly because of savvy marketing campaigns.
"They're a well-educated, wealthier group of people who, on a regular basis, are exposed to new cures saying, 'We can stop or reverse your aging,' or 'We can make this go away,' or 'We can make your sex life better,' " Perls said in a phone interview. "They may take it hook, line and sinker, especially if it's someone in a white coat with a stethoscope around their neck."
The "disease mongering" claim doesn't sit well with those on the other side of the spectrum, who claim that testosterone has valid and proven uses.
"The allegation of 'disease mongering' is highly disturbing," said Abraham Morgentaler, a practicing urologist, associate clinical professor of urology at Harvard Medical School and author of the book, "Testosterone For Life." "This type of allegation is nearly always made by individuals with no experience treating patients with the condition, and so they have never seen men suffering from testosterone deficiency, nor observed the satisfying response with treatment. This is a real condition experienced by real men."
In the editorial, Perls and his co-author, David Handelsman, a professor of endocrinology at the ANZAC Research Institute at the University of Sydney in Australia, write that disease mongering also plays a big role in the "anti-aging" marketing for human growth hormone. The use of HGH is only medically valid for three conditions, all of which are rare.
"The disease mongering is a misinformation campaign," Perls said.
The editorial cites a 10-fold increase in testosterone prescriptions in the United States in the past decade. Pharmaceutical sales of testosterone increased from $324 million in 2002 to $2 billion in 2012.
That growth hasn't gone unnoticed. Time Magazine featured a "Manopause" cover last summer, with the subtitle "Aging, Insecurity and the $2 billion industry." Critics have raised concerns about safety issues, misleading advertising and lax guidelines for prescribing testosterone. Earlier this month, the FDA cautioned that many men are using testosterone for "no apparent reason other than aging," and that the "benefits and safety" of such use have not been determined. The FDA required manufacturers of testosterone products to change labels to disclose the approved uses for testosterone and to reflect the possible risks of heart attacks and strokes. The agency also required manufacturers to carry out a well-designed clinical trial to examine the safety risks.
Testosterone, a male hormone and anabolic steroid, is used to treat men diagnosed with hypogonadism, a condition where the body cannot produce enough testosterone because of problems with the testicles, pituitary gland or the hypothalamus. When the FDA convened a committee to discuss testosterone last fall, much of the dialogue focused on the increasing trend of giving testosterone for aging and, in some cases, without even testing testosterone levels before beginning the treatment.
Mark E. Richards, a North Bethesda plastic surgeon who treats hundreds of patients with hormone therapy, testified at the FDA committee meeting in September. Richards, who uses "bio-identical testosterone pellet therapy" in his practice, said he was disappointed that many of the committee members seemed unaware of existing medical literature on testosterone.
When it comes to the "disease mongering" argument that Perls takes, Richards said he can't entirely disagree with that position.
"He's half-right in that the pharmaceutical industry has hyped it beyond the scientific reality of the situation," Richards said. "He's wrong in that there is a legitimate medical problem that occurs with low testosterone."
"Certainly there has been some inappropriate advertising and marketing," said Campbell, an internal medicine physician. "Some of the ads out of there might be well-intentioned, but they do tend to target a man's masculinity."