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4_Selling Sickness - Moynihan (1)

4_Selling Sickness - Moynihan (1) - Education and debate...

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occurs as people age—is an example of a risk factor being conceptualised as a disease. Unlike medicalising baldness, conceiving osteo- porosis as a disease is ethically complex. Slowing bone loss can reduce the risk of future fracture—just as low- ering blood pressure can reduce a person’s chance of a future stroke or heart attack—but for most healthy people, the risks of serious fractures are low and / or distant, and in absolute terms, long term preventive drug treatment offers small reductions in risk. For example, in a placebo controlled trial in which alendronate was taken for four years by women who were free of fracture but had bone mineral density measurements 1.6 standard deviations below the mean for normal young adult white women, the incidence of radiographic vertebral fractures was 3.8% in the placebo group and 2.1% in the treatment group. 14 This equated to a 44% relative reduction in risk but an abso- lute risk reduction of only 1.7%. Furthermore, the promotional focus on chemical solutions for the complex problem of preventing frac- tures takes attention away from a variety of modestly effective non-pharmacological strategies, such as dietary supplementation with calcium and vitamin D, smoking cessation, and weight bearing exercise. 15 Despite the ethical complexities, osteoporosis remains a strong example of disease mongering because the corporate role in changing the way popu- lations think about bone loss has been so extensive. Drug companies have sponsored meetings where the
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