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23 November 1998

Debating drugs

The rise of 'lifestyle drugs' is a result of the medicalisation of everyday life, argues Dr Michael Fitzpatrick

The term 'lifestyle drug' has emerged as a pejorative label for a range of new medications marketed for the treatment of conditions such as impotence (Viagra), shyness (Seroxat) and obesity (Xenical). One of the first tasks of the newly established National Institute for Clinical Excellence is to decide whether or not such drugs should be made available through the national health service.

The current ban on Viagra has provoked a public debate about the problem of the rising NHS drug bill - currently 6.3 billion - and the need to contain this through some form of rationing.

The problem of lifestyle drugs does not, however, begin with the drugs, but with the extension of medical influence over wider and wider areas of people's lives. The long-established trend to redefine problems experienced by individuals - such as alcoholism or drug abuse - in medical terms, such as dependency or addiction, has acquired apparently unstoppable momentum in recent years. Children who might once have thought to be behaving badly or performing poorly at school are now diagnosed as having attention deficit hyperactivity disorder or specific learning difficulties. Adults formerly regarded as awkward or boorish are now recognised as having a social phobia. People once considered fat or thin are now known to be suffering from a range of eating disorders.

The redefinition of an individual or social problem as disease inevitably leads to a quest for an appropriate treatment. Given the fact that these newly defined conditions appear to afflict a substantial proportion of the population, it is further inevitable that any treatment that appears will prove highly costly. Though the government is quite happy to preside over a nation of hypochondriacs (a condition now little diagnosed as it has become universalised), it is less enthusiastic about footing the bill for treating every manifestation of the new disease awareness.

The major defect of the rationing debate is that it questions the legitimacy of particular drug treatments, but not the diagnoses of the conditions they claim to treat. Furthermore it lumps together different types of problems. Viagra, for example, is a new treatment for an old problem: it differs from a number of established treatments for the same problem in that it appears to be both more effective and safer. Seroxat is not a new drug at all, but its manufacturers merely want to extend its range of indications from the long-recognised condition of depression to the newly pathologised condition of shyness. Xenical is yet another drug treatment for obesity, a condition in which numerous such treatments have claimed success only to be revealed in practice as ineffective (if not dangerous).

Perhaps the most invidious consequence of the great lifestyle drug rationing debate is the way in which it prepares public opinion for measures to restrict the availability of drugs of proven efficacy in serious diseases, simply on grounds of cost. Thus, for example, it was reported last week that some 45 per cent of health authorities will not pay for the drug Clozapine, a fairly new treatment for schizophrenia, which is both more effective and has less side-effects than traditional treatments, purely on grounds of the cost of treating the relatively high numbers of people requiring such medication (Guardian, 21 November).

The most useful way to approach this problem would be for the medical profession to restrain its zeal for medicalising everyday life and for the government to restrain its niggardly inclination to restrict public access to drugs of proven merit.

Dr Michael Fitzpatrick is chairing the debate 'Lifestyle drugs: curse or cure?' at the Royal Institution, 21 Albermarle Street, London W1, on Thursday 3 December 7.30pm. The speakers are Rita Carter, author of Mapping the Mind, Professor Susan Greenfield, director of the Royal Institution, and Dr Gill Samuels, director of science policy at Pfizer.

For tickets and more information call (0171) 930 3647.

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