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 Disease Mongering for Restless Leg Syndrome by Jeffrey Dach MD
A textbook example of disease mongering by the pharmaceutical industry is the case of Requip for Restless Leg Syndrome.
What is Requip and Mirapex?
Requip is a powerful drug for Parkinson’s Disease. Requip is also used to treat movement disorders caused by anti-psychotic drugs for mental patients (such as Prolixin and Haldol). Mirapex is similar to Requip.
Adverse side effects of Requip includes compulsive gambling and hypersexual behavior.(1)
Image at upper right courtesy of Library of Congress, 1936 Photo Portrait shows Florence Thompson with several of her children in a photograph known as "Migrant Mother."
Magnesiun Deficiency Causes Restless Legs
Magnesiun deficiency causes muscle cramps at night and is the most common cause of Restless Leg Syndrome. (2) Sixty Eight Per Cent (68%) of Americans are Magnesium deficient, according to the USDA Agricultural Research Service.(3) Restless Leg Syndrome, or leg muscle cramping during sleep is not a reason for powerful Parkinson's drugs. Inexpensive magnesium supplementation usually resolves the problem. Using a drug like Requip instead of supplementing for magnesium deficiency is the height of lunacy, and would be comical if it wasn't tragic. This is typical drug mongering indicative of a broken medical system.
Magnesium Deficiency, Not Requip Deficiency
In a medical study by Hornyack, Restless Leg Syndrome (RLS) significantly improved after supplementing with magnesium (about 300 mg each evening for four to six weeks).(4) Another study by Popoviciu showed that magnesium deficiency causes neuromuscular excitability and impaired sleep.(5) Another study by Bartel showed IV Magnesium to be curative for Restless Leg Syndrome when IV magnesium was incidentally given to pregnant women as a treatment for eclampsia.(6) Magnesium supplementation is especially important for diabetic patients with insulin resistance.(7)
There are many more studies in the medical literature showing the connection between magnesium deficiency and restless legs at night, muscle cramps and muscle pain. We have found in our experience that oral magnesium supplementation works quite well, resolving the problem promptly in most cases.
What is Disease Mongering?
Step One: Create an Illusory Disease called a "Syndrome"
 Disease mongering is a marketing program that creates the illusion of disease where in fact, there is none. Instead a real disease, the marketing program uses a symptom or a "risk factor" to create fear in the mass market.
We saw disease mongering in a previous report on Bisphosphonate drugs (Fosamax, Actonel and Boniva), with Sally Field as television spokeswomen.(8) These Sally Field ads create the fear of a real disease called osteoporosis in millions of women who have a lesser diagnosis called osteopenia. Fracture rates actually increase in this Osteopenia group when they take bisphosphonates.
A true disease requires definite pathologic markers that clearly differentiate normal from abnormal. An example of a real disease is heart disease in which arteries are blocked, cancer in which abnormal cells can be seen on biopsy, and hypothyroidism in which there are typical symptoms of fatigue, weakness, puffy face, dry skin, cold body temperature and abnormal lab values.
Step Two: Market the new illusory disease with a phoney Grassroots Organization
To popularize the new illusory disease condition, a pretend grassroots organization is created such as the Restless Legs Syndrome Foundation, a phoney organization sponsored with money from the GlaxoSmithKline (GSK) and Boehringer Ingelheim, makers of the RLS drugs. This is a pure marketing ploy.
Step Three: Create A Phoney Marketing Gimmick called "Awareness Week"
In order to make the "worried well" fear they have the new syndrome and need the drug, RLS Awareness Week was invented, and supports groups set up to offer a symptom check list so the masses could self-diagnose themselves as victims and ‘sufferers’ of the illusory disease.
Step Four: Direct to Consumer Advertising
DTC Television ads imply that your doctor missed your symptoms and failed to diagnose your new syndrome called "Restless Leg". The ads are not required to be truthful and instead convey misleading, false or incomplete information. (see videos below). Thirty Nine Special Interest Groups have asked Congress to ban DTC drug advertising.(9)
Consumer Reports Evaluates the Requip Ad Video
consumer reports video imbedded (below)
Here is the Original Requip Ad (below):
Here is the Original Requip Ad (above)
Where are the Responsible Prescribing Physicians?
Moira Dolan, MD of the Medical Accountability Network says the following:
"The Restless Legs Syndrome campaign includes all of the essential ingredients for successful disease mongering. Annual Mirapex (Boehringer) sales are over $324 million and Glaxo’s Requip makes over $500 million a year. The astounding transparency of the whole-cloth invention of RLS for the sales of the corresponding drugs reflects poorly on the prescribing physician. It represents a gross abdication of the responsibility of doctors to act as advocates and at least sentient information managers for their patients." (10)
How to Make Money in the Drug Industry
 Identify a nutritional deficiency in the population (such as magnesium deficiency), create a new syndrome caused by the nutritional deficiency (such as Restless Leg), and then start a disease mongering campaign to convince the masses to take an expensive, dangerous, powerful drug (Requip and Mirapex) instead of an inexpensive mineral such as magnesium, or a vitamin that actually solves the problem. This template can be copied and repeated many times over, and it is.
Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood Fl 33021
954-983-1443
http://drdach.com/
http://www.jeffreydach.com/
References:
(1) http://news.nationalgeographic.com/news/2005/07/0712_050712_parkinsons.html
Compulsive Gambling, Sex Linked to Parkinson's Drugs Stefan Lovgren for National Geographic News July 12, 2005
(2) http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2146789
Can Fam Physician. 1996 July; 42: 1348–1351. Muscle cramps and magnesium deficiency: case reports.D. L. Bilbey and V. M. Prabhakaran
(3) http://www.ars.usda.gov/Services/docs.htm?docid=11219
USDA Agricultural Research Service,Percentage of individuals meeting DRI - Magnesium - 32 per cent
(4) http://www.ncbi.nlm.nih.gov/pubmed/9703590
Sleep. 1998 Aug 1;21(5):501-5.Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study.Hornyak M, Voderholzer U, Hohagen F, Berger M, Riemann D. Department of Psychiatry and Psychotherapy, Albert-Ludwigs-University, Freiburg, Germany.
(5) http://www.ncbi.nlm.nih.gov/pubmed/8363978
Rom J Neurol Psychiatry. 1993 Jan-Mar;31(1):55-61. Clinical, EEG, electromyographic and polysomnographic studies in restless legs syndrome caused by magnesium deficiency. Popoviciu L, Aşgian B, Delast-Popoviciu D, Alexandrescu A, Petruţiu S, Bagathal I. Academy of Medical Sciences, Department of Neurology, Tirgu-Mures, Romania.
(6) http://www.aasmnet.org/JCSM/Articles/020213.pdf
Intravenous Magnesium Sulfate May Relieve Restless Legs Syndrome in Pregnancy
Sharon Bartel; Sarah Zallek, M.D. Journal of Clinical Sleep Medicine, Vol. 2, No. 2, 2006
(7) http://www.ias.ac.in/currsci/dec252002/1456.pdf
Magnesium deficiency and diabetes mellitus Chetan P. Hans, R. Sialy and Devi D. Bansal
CURRENT SCIENCE, VOL. 83, NO. 12, 25 DECEMBER 2002.
(8)
http://jeffreydach.com/2008/03/09/bisphosphonates-for-osteoporosis-a-closer-look-at-the-data-by-jeffrey-dach-md.aspx
Bisphosphonates for Osteoporosis, A Closer Look at the Data by Jeffrey Dach MD
(9) http://www.commercialalert.org/news/news-releases/2006/05/39-health-seniors-groups-call-on-congress-to-end-to-dtc-prescription-drug-ads
NEWS RELEASE May 24th, 2006 39 Health & Seniors Groups Call on Congress to End to DTC Prescription Drug Ads. Gary Ruskin, executive director of Commercial Alert.
(10) http://www.medicalaccountability.net/essay_RLS.html
Selling Drugs and Disease, the Case of the Restless Leg Syndrome By Moira Terese Dolan, M.D. of the Medical Acountablilty Network
Aditional References
Television Ads, Videos
(11) http://www.requip.com/tv_commercial.html
Requip TV comercial
(12) http://blogs.consumerreports.org/health/2007/11/finally-an-anti.html
November 01, 2007 Finally, an antidote to TV drug ads consumer reports Jamie Hirsch evaluates the Requip Ad.
(13) http://www.youtube.com/results?search_query=requip&search_type=
Requip videos on U-tube
(14) http://www.dailycomedy.com/videos/567
Comedy video discussing requip reatless leg and their marketing
Disease Mongering
(15) http://medicine.plosjournals.org/perlserv?request=get-document&doi=10.1371/journal.pmed.0030170
Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick Steven Woloshin*, Lisa M. Schwartz
(16) http://www.pbs.org/kcet/wiredscience/story/76-the_business_of_disease.html
The Business of Disease from Wired Science
(17) http://www.consumerreports.org/cro/health-fitness/health-care/medical-ripoffs-11-07/requip-commercial/requip-commercial.htm
What the ad doesn't tell you Excerpts from a Requip ad, deconstructed, Consumer Reports.
(18) http://www.knowledgeofhealth.com/report.asp?story=Disease+Mongering+and+the+American+Health+Movement
Bill Sardi on Disease mongering
(19) http://www.bmj.com/cgi/content/full/324/7342/886
Selling sickness: the pharmaceutical industry and disease mongering Commentary: Medicalisation of risk factors, Selling sickness: the pharmaceutical industry and disease mongering Ray Moynihan, journalist, Iona Heath, general practitioner, David Henry, professor of clinical pharmacology. BMJ 2002;324:886-891 ( 13 April )
(20) http://www.diseasemongering.org/downloads/abstracts.pdf
ABSTRACTS FROM THE INAUGURAL CONFERENCE ON DISEASE MONGERING
(21) http://jeffreydach.com/2008/03/09/bisphosphonates-for-osteoporosis-a-closer-look-at-the-data-by-jeffrey-dach-md.aspx
Bisphosphonates for Osteoporosis, A Closer Look at the Data by Jeffrey Dach MD
(22) http://www.yourlawyer.com/topics/overview/requip
Suffered from Requip Side Effects? Lawyer wants to litigate.
(23) http://www.cbsnews.com/stories/2007/04/05/health/webmd/main2650648.shtml?source=RSSattr=Health_2650648
24-Hour Parkinson's Drug: Longer Relief? Longer-Acting Requip May Reduce Need For Commonly Used Levodopa April 5, 2007. CBS News.
(24)http://deliverrants.blogspot.com/2006/08/we-have-nothing-to-fear-but-pharmas.html
Blogger Comment: WE HAVE NOTHING TO FEAR BUT PHARMAS THEMSELVES I was watching TV the other night and saw a commercial for some new medication for something that sounded serious … “RLS”! They went on to explain that RLS was “restless leg syndrome.”WHAT?
(25) http://us.gsk.com/products/assets/us_requip.pdf
REQUIP Web Site: (ropinirole hydrochloride) Tablets REQUIP (ropinirole hydrochloride) is an orally administered non-ergoline dopamine agonist.It is the hydrochloride salt of 4-[2-(dipropylamino)ethyl]-1,3-dihydro-2H-indol-2-one monohydrochloride and has an empirical formula of C16H24N2O•HCl. The molecular weight is 296.84 (260.38 as the free base).
(26) http://www.mirapex.com/
Mirapex web site
(27) http://www.rls.org/
Restless Leg Foundation Web Site
Magnesiun Treats Restless Leg Syndrome
(28) http://www.purecaps.com/healthnotes.asp?org=pureencaps&ContentID=1255009
Treatable causes of restless leg syndrome, Pure Encapsulations Newsletter
(29) http://www.consumerlab.com/tnp.asp?siteid=consumerlab&docid=/tnp/pg000817
Consumer Labs Restless Leg Syndrome Treated with Magnesium
(30) http://www.springerlink.com/content/u51346w213147836/
Magnesium depletion in patients on long-term chlorthalidone therapy for essential hypertension.
(31) http://www.mgwater.com/
Magnesium Information Web Site
(32) http://www.mbschachter.com/importance_of_magnesium_to_human.htm
The Importance of Magnesium to Human Nutrition by Michael B. Schachter M.D., F.A.C.A.M.
Genetic Marker for Restless Leg Syndrome: Financed by Drug Companies to Market Requip. This is a rare marker affecting a small number of people. Magnesium Deficiency is far more common. This is a blatant misuse of genetics.
(33) http://brain.oxfordjournals.org/cgi/content/full/126/6/1485
Brain, Vol. 126, No. 6, 1485-1492, June 2003 Autosomal dominant restless legs syndrome maps on chromosome 14q, Maria Teresa Bonati1, Luigi Ferini-Strambi2, Paolo Aridon, Alessandro Oldani2, Marco Zucconi and Giorgio Casari Human Molecular Genetics Unit.
Magnesium Deficiency
(34) http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1345822&pageindex=1#page
Can Med Assoc J. 1985 February 15; 132(4): 360–368. A clinical approach to common electrolyte problems: 4. Hypomagnesemia.C Berkelhammer and R A Bear
(35) http://www.ncbi.nlm.nih.gov/pubmed/8264519
Miner Electrolyte Metab. 1993;19(4-5):314-22. Clinical manifestations of magnesium deficiency.Abbott LG, Rude RK.
(36) http://www.ncbi.nlm.nih.gov/pubmed/7977315
Am J Kidney Dis. 1995 Jun;25(6):973. Magnesium deficiency: pathophysiologic and clinical overview. Many therapeutic agents cause renal Mg wasting and subsequent deficiency. These include loop and thiazide diuretics, aminoglycosides, cisplatin, pentamidine, and foscarnet. Magnesium deficiency is seen frequently in alcoholics and diabetic patients, in whom a combination of factors contributes to its pathogenesis. Hypomagnesemia is known to produce a wide variety of clinical presentations, including neuromuscular irritability, cardiac arrhythmias, and increased sensitivity to digoxin. Refractory hypokalemia and hypocalcemia can be caused by concomitant hypomagnesemia and can be corrected with Mg therapy.
(37) http://www.ncbi.nlm.nih.gov/pubmed/6499696
Drugs. 1984 Oct;28 Suppl 1:143-50. Magnesium deficiency. Causes and clinical implications.
(38) http://www.ncbi.nlm.nih.gov/pubmed/14977544
Front Biosci. 2004 May 1;9:1278-93. Magnesium in clinical medicine.Touyz RM.
new technologies to measure the intracellular free concentration of magnesium ([Mg2+]i),
(39) http://www.ncbi.nlm.nih.gov/pubmed/17402291
Magnes Res. 2006 Dec;19(4):237-43. High fructose consumption combined with low dietary magnesium intake may increase the incidence of the metabolic syndrome by inducing inflammation. Rayssiguier Y, Gueux E, Nowacki W, Rock E, Mazur A.
(40) http://www.ncbi.nlm.nih.gov/pubmed/7020347
Acta Med Scand Suppl. 1981;647:125-37. Magnesium deficiency. Etiology and clinical
spectrum.Flink EB.
(41) http://www.ncbi.nlm.nih.gov/pubmed/7922443
New Horiz. 1994 May;2(2):186-92. Should we supplement magnesium in critically ill patients? Olerich MA, Rude RK.
(42) http://www.ncbi.nlm.nih.gov/pubmed/3282851
Magnesium metabolism in health and disease.Elin RJ.Clinical Pathology Department, National Institutes of Health, Bethesda, Maryland. A large segment of the U.S. population may have an inadequate intake of magnesium and may have a chronic latent magnesium deficiency that has been linked to atherosclerosis, myocardial infarction, hypertension, cancer, kidney stones, premenstrual syndrome, and psychiatric disorders.
Videos
(43) http://blogs.consumerreports.org/health/2007/11/finally-an-anti.html
Blog entry for Consumer Reports video discusses disease mongering in the Requip Video Ad
(44) http://www.youtube.com/watch?v=pDvm-5Sochs
This is the video for the Consumer Reports Video on Requip
(45) http://www.youtube.com/watch?v=PL3G1MngqK4
This is the original Requip Ad video in U tube.
Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood Fl 33021
954-983-1443
www.drdach.com
www.jeffreydach.com
www.naturalmedicine101.com
www.truemedmd.com
link to this article:
http://jeffreydach.com/2008/04/02/restless-leg-syndrome-requip-and-disease-mongering-by-jeffrey-dach-md.aspx
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The reader is advised to discuss the comments on these pages with his/her personal physicians and to only act upon the advice of his/her personal physician Also note that concerning an answer which appears as an electronically posted question, I am NOT creating a physician -- patient relationship. Although identities will remain confidential as much as possible, as I can not control the media, I can not take responsibility for any breaches of confidentiality that may occur .
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I was diagnosed with severe RLS 15 yrs ago, way before RLS was a victim of "disease mongering". No one knew what it was. I found a support group on line, not the one listed above that was started in 1998. No affiliation with the foundation at all. I thought I had died and gone to heaven when I found a couple other people with the same problems I had. I was literally at the point of suicide. But, I guess thr RLS Foundation put that idea in my head, too, even though I did not know they existed until a couple of years later.
After going through every med, herb, known to mankind that was supposed to help, 10 yrs later the only thing that helps me is narcotics and Ultram.
Yes, I tried Requip, Mirapex, Permax(off the market now), and they did make me sick, and I could not tolerate them. But,for a lot of people these meds are magic. These serious side effects of impulsive behavior occurs at the higher dose that Parkinson's patients take. People with RLS take 1/8 to 1/4 the dose that PD patients take.
But, you, as an MD should probably already know that.
And, magnesium is a treatment for LEG CRAMPS, NOT RLS. I know of at least 500 people who have or do use it. We know the definite difference between cramps and the awful feeling of RLS. You can walk a cramp off in a few minutes, but you may walk for hours or days trying to calm down an RLS attack.
To tell the truth, I was not crazy about the DTC ads for Requip and Mirapex. They do not describe RLS correctly, and they do make it sound as though if you take this little pill all will be well. well, for a lot of people it isn't. I do object to the tone of the Consumer Report video. I expected something a little more professional from them.
Just my 2 cents. But, I am definitely calling you out on the magnesium. RLS runs in my family. My mother, my 2 sisters, both nieces,and 2 of my uncles have it. Kind of supports the findings of an RLS gene being discovered.
I suffer, yes the word is suffer, from RLS 24/7/365, as well as being disabled with chronic pain, CFS, major depression from no sleep, Insomnia even when my legs are quiet on a rare night. It is no way to live, and I wouldn't wish it on my worst enemy.
Donna
________________________________________________________________________
Dear Donna,
Thanks for your comments and your personal viewpoint on RLS. We welcome comments such as yours and hope others will share their experiences with RLS and magnesium.
warmest regards,
Jeffrey Dach MD
www.drdach.com
natural medicine 101
disclaimer
Reply to this
I, too, have RLS. No comparison to cramps (I have those occasionally also). And Donna is correct---it is very hard to describe. I was on Mirapex probably 8 yrs. (from the first night I took it, I thought it was a miracle pill) but it became less effective. I now take a generic of Klonipan (sp?). I sleep well most nights, but occasionally I toss & turn and can't get comfortable and my feet sting. But at least my legs aren't jumping 6" up off the bed. Something indescrible happens inside the body also and then I am fully awake. Would like to know what Donna is taking now. Mirapex & generic Klonipan are the only ones I have taken. I am sorry Donna hasn't found something that works well for her....she is correct, that is no way to live! Phyllis
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I’ve seen ads on TV for Caduet. It has two ingredients. One is Amlodipine and the other is Atorvastatin. With my RxDrugCard I can get 30 tablets of Amlodipine for $9 and 30 tablets of Simvastatin for $9. I’ll bet they are charging more than $18 for this new drug! The unthinking public is going to pressure their doctors into giving them something just because it’s new, when something old or generic would do the job for cheaper. Does the same apply to Requip?
Rita
__________________________________________________________________________
Dear Rita,
You might want to read my article,
Cholesterol Lowering Statin Drugs for Women, Just Say No by Jeffrey Dach MD
Reply to this
I came across your site this morning accidentally as I was trying to find a good article on magnesium and leg cramps to send to my husband's, aunt's daughter as I had spoken to my Aunt last night and she told me about the terrible 'Charlie horses' she had been having recently.
I knew that magnesium could probably help her as she takes several prescription drugs and I knew from recent experience that her body was probably deficient. Magnesium is very inexpensive so I sent an email to her daughter and told her about it and then found your article to include.
I don't know who you are but I just was to say thank God there are people out there like you who will speak up. My opinions of the medical industry have been well tested this past summer after both my daughter and I had severe reactions to two different prescription drugs and of course they aren't the problem according to main stream physicians.
Neither of us have been sick people throughout our lives and believed what we were told when we visited the local doctor until this incident. We refused to remain on the prescription drug roller coaster and instead spent a huge amount of time learning how to fix our problems without more drugs and in turn became fairly educated at what the body is deficient in. I have always been angry at the all powerful drug ads on TV and the amount of people who listen and decide they have the latest syndrome.
Thank you for being brave enough to yell loudly and keep up the fine work. I have always been 'out of the box' in my thinking and praise those who take on the giant 'empire of deceit'.
Sincerely.
LK from Texas
_____________________________________________________________________
Dear LK from Texas, Thanks for your kind comment,
regards,
jeffrey dach md
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