Paper short abstract:

Using diabetes as an example, we consider how the pharmaceutical industry has commandeered authoritative medical knowledge, and state-sponsored oversight institutions, to recast the condition such that it builds and protects a blockbuster drug market.

Paper long abstract:

While generally assumed that evolving medical concepts reflect the latest scientific knowledge, health care is a highly lucrative economic sector, and may be best understood in terms of strategic market manipulations. Using diabetes as an example, we argue that the pharmaceutical industry commandeers authoritative medical knowledge, and influences state-sponsored oversight institutions, to recast the condition in ways that build and protect the market it serves. The industry has produced information and promoted its interpretation in ways that have resulted in important revisions in how the condition is understood and addressed, paving the way for blockbuster drugs. By converting "risk" into a pathology requiring pharmaceutical management, and changing professional standards for who is tested, how they are tested and how tests are interpreted, industry affiliates, facilitated by sympathetic professional and regulatory bodies, have fabricated a diabetes "epidemic" and treatment standards that require heavy use of pharmaceuticals. Despite weak or contrary evidence of the benefit of maintaining tight glucose control, and substantial indication that the pharmaceuticals used toward this end may be harmful, poly-pharmacy is now common place even for those with only mildly elevated glucose levels. We note that such data and regulatory manipulations are the everyday business practices of this industry which are likely being applied to many other illnesses and conditions. We call for considering the real public health costs of tolerating this pervasive and multi-faceted industry distortion of the facts, and allowing their influence over the agencies intended to provide checks and balances to industry aspirations.

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