Treating desires not diseases: a pill for every ill and an ill for every pill?

My first recollection of modern pharmaceuticals is from the winter of 1942–1943, when my younger sister, suffering from pneumonia, was treated with M&B693 from May and Baker Pharmaceuticals (http://www.may-baker.com/). The doctor and my mother sat up all night nursing her through ‘the crisis’, which she survived. Most families, at least in the rich world, have similar stories to tell of how medicines developed in the past half century have saved their lives, shortened their illnesses and have made previously terminal diseases, if not curable, then at least treatable. For all of this, academic medicine and science and, notably, the pharmaceutical industry are owed much. However, these positive attributes of the industry are in danger of being obscured by a pattern of business practices that places profit above patient, emphasizes marketing over medicine and exaggerates disorders to promote drug sales. These practices, which are compounded by the extensive, Washington-based, political lobbying that is carried out by pharmaceutical companies, contribute to the increasing wave of public distrust directed at these companies. The 1 April 2006 issue of The British Medical Journal ran a short note by the Australian journalist Ray Moynihan describing a new disease – motivational deficiency disorder [1]. Apparently affecting one in five Australians and diagnosed by neurologist Leth Argos through both positron emission tomography scans and scoring scales, the disease was described as treatable with a new cannabinoid CB1 receptor antagonist indolebant. Several news organizations ran with this story, accepting it as authentic presumably for two main reasons. First, the story was released on 31 March (albeit 1 April in Australia), and, second, it sounds plausible. Motivational deficiency disorder fits in with restless legs syndrome, female sexual dysfunction, social anxiety disorder, intermittent explosive disorder, irritable male syndrome and other assorted contemporary ‘diseases’. It also fits well with the barrage of pharmaceutical advertising that viewers in the USA are subject to. Indeed, one knows exactly the demographics of a TV program audience by