260757 Corporate shaping of basic public health definitions including disease entities and primary prevention

Tuesday, October 30, 2012 : 4:50 PM - 5:10 PM

Beatrice Manning, PhD , Division of Management, Policy and Community Health, School of Public Health, University of Texas, Health Science Center at Houston, Houston, TX
This presentation uses existing research on relatively new diseases, such as osteopenia and hypercholesteremia, to document how the web of corporate interests shapes the most basic definitions of health, illness and primary prevention. It will then explicate how these definitional strategies are used by the three major corporate sectors (big pharma, medical equipment companies and private health insurers) within health care to leverage public payment programs to the maximum. Through corporate involvement, particularly by pharmaceutical companies, in the definition of diagnoses, new “illnesses” are created as drugs are available to treat them, e.g., hypercholesteremia, which used to be a symptom of heart disease and is now a stand-alone diagnosis. The growth of this definitional strategy by pharmaceutical companies is examined in combination with the insurance company strategy of paying for treatment of recognized disease entities, and the need for expensive medical equipment to “diagnose” these diseases definitively. Osteopenia, for example, is diagnosed using expensive imaging machines. The test is covered under Medicare and often is considered primary prevention. The “disease” is defined statistically (not biologically) such that at a minimum more than 13% of adults over 50 who have bone density tests will be diagnosed as having osteopenia. Medication, paid for under Medicare Part D, is available, and treating osteopenia before it becomes osteoporosis can be defined as primary prevention. Research across diseases will be used to expose the role of the three for-profit sectors in disease creation and treatment using mainly public money.

Learning Areas:
Biostatistics, economics
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Describe how pharmaceutical companies and medical equipment companies influence the definition of health, illness and primary prevention. Describe the flow of public money to big pharma, medical equipment and insurance companies resulting from these definitions.

Keywords: Economic Analysis, Public Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked in public health for over 10 years in health economics and policy development. I have taught a course on the pharmaceutical industry at the University of Texas School of Public Health and at the State University of New York Downstate Medical Center and often been a guest speaker at academic institutions and meetings on health care finance.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.