Restless Leg Syndrome, Requip and Disease Mongering by Jeffrey Dach MD

Disease Mongering for Restless Leg Syndrome

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

Image at upper right courtesy of Library of Congress, Portrait shows Florence Thompson with several of her children in a photograph known as "Migrant Mother." CREATED/PUBLISHED:  1936 Feb. 

Magnesiun Deficiency Causes Restless Legs

Magnesiun deficiency causes muscle cramps at night and is the most common cause of Restless Leg Syndrome.(Bilbey)

Two Thirds of Americans Are Magnesium Deficient

Sixty Eight Per Cent (68%) of Americans are Magnesium deficient, according to the USDA Agricultural Research Service.   Restless Legs, or leg muscle cramping during sleep is not a reason for a powerful Parkinson's drug.  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, people with Restless Leg Syndrome (RLS) had significant improvement after supplementing with magnesium (about 300 mg each evening for four to six weeks). (Hornyack) Another study showed neuromuscular excitability and impaired sleep caused by magnesium deficiency. (Popoviciu)

Another study showed IV Magnesium curative for Restless Leg Syndrome, when IV magnesium was incidentally given to pregnant women as a treatment for eclampsia. (Bartel)  There are many more studies in the medical literature showing the connection between magnesium deficiency and restless legs at night.  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.  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. 



Consumer Reports Evaluates the Requip Ad Video
consumer reports video imbedded (below)



Here is the OriginaL Requip Ad (below):
 

Where are the Responsible Prescribing Physicians?

 
Dr. Moira Dolan says:

"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."

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:

Television Ads, Videos

http://www.requip.com/tv_commercial.html
Requip TV comercial

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.

http://www.youtube.com/results?search_query=requip&search_type=
Requip videos on U-tube

http://www.dailycomedy.com/videos/567
Comedy video discussing requip reatless leg and their marketing

Disease Mongering
   


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 

http://www.medicalaccountability.net/essay_RLS.html
http://www.medicalaccountability.net/

Disease Mongering Restless Leg Syndrome By Moira Terese Dolan, M.D.

http://www.pbs.org/kcet/wiredscience/story/76-the_business_of_disease.html
The Business of Disease

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

http://www.knowledgeofhealth.com/report.asp?story=Disease+Mongering+and+the+American+Health+Movement
Bill Sardi on Disease mongering

http://www.bmj.com/cgi/content/full/324/7342/886
BMJ 2002;324:886-891 ( 13 April ) Selling sickness: the pharmaceutical industry and disease mongering Commentary: Medicalisation of risk factors
Selling sickness: the pharmaceutical industry and disease mongering Ray Moynihan, journalist a, Iona Heath, general practitioner b, David Henry, professor of clinical pharmacology c.

http://www.diseasemongering.org/downloads/abstracts.pdf
ABSTRACTS FROM THE INAUGURAL CONFERENCE ON DISEASE MONGERING

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

http://www.yourlawyer.com/topics/overview/requip

Suffered from Requip Side Effects?

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

http://deliverrants.blogspot.com/2006/08/we-have-nothing-to-fear-but-pharmas.html
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?
 
http://us.gsk.com/products/assets/us_requip.pdf
REQUIP® (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).

http://www.mirapex.com/
Mirapex web site

http://www.rls.org/
Restless Leg Foundation Web Site

Magnesiun Treats Restless Leg Syndrome

http://www.aasmnet.org/JCSM/Articles/020213.pdf

Intravenous Magnesium Sulfate May Relieve Restless Legs Syndrome in Pregnancy, Sharon Bartel1; Sarah Zallek, M.D.Saint Francis Sleep Disorders Center, Illinois Neurological Institute, Peoria, IL; 2University of Illinois College of Medicine at Peoria, Peoria, IL

http://www.purecaps.com/healthnotes.asp?org=pureencaps&ContentID=1255009
Treatable causes of restless leg syndrome

http://www.consumerlab.com/tnp.asp?siteid=consumerlab&docid=/tnp/pg000817
Consumer Labs Restless Leg Syndrome Treated with Magnesium

http://www.ncbi.nlm.nih.gov/pubmed/9703590
Hornyak M, Voderholzer U, Hohagen F, et al. Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: An open pilot study. Sleep. 1998;21:501,505.

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.

The present paper reports biochemical and neurophysiological investigations in ten cases with restless leg syndrome. Other neuropsychiatric affections and factors which could generate the symptomatology of restless legs syndrome were not included. The EEG recordings demonstrated evident reticular neuronal hypersynchrony generated by hyperpnoea (sinusoidal slow waves). The classical EEG investigations pointed out neuromuscular hyperexcitability, but some modifications of the functional parameters of the neuromuscular excitability and conductibility (signs of neuropathy) were also noticed.

http://www.springerlink.com/content/u51346w213147836/
Magnesium depletion in patients on long-term chlorthalidone therapy for essential hypertension

http://www.ars.usda.gov/Services/docs.htm?docid=11219
USDA Agricultural Research Services, 68 % of people in US  do not meet DRI for MAgnesium

http://www.mgwater.com/
Magnesium Information Web Site

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.

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 Aridon1, Alessandro Oldani2, Marco Zucconi2 and Giorgio Casari1 1 Human Molecular Genetics Unit, Department of Neuroscience, Dibit-San Raffaele Scientific Institute, Milan and 2 Sleep Disorder Center, University Vita-Salute San Raffaele, Milan, Italy

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

http://www.commercialalert.org/news/news-releases/2006/05/39-health-seniors-groups-call-on-congress-to-end-to-dtc-prescription-drug-ads
thirty nine groups ask congress to ban drug DTC advertising

Magnesium Deficiency

http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1345822&pageindex=1#page
Can Med Assoc J. 1985 February 15; 132(4): 360–368.  PMCID: PMC1345822
A clinical approach to common electrolyte problems: 4. Hypomagnesemia.
C Berkelhammer and R A Bear

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2146789
Can Fam Physician. 1996 July; 42: 1348–1351.  PMCID: PMC2146789
Muscle cramps and magnesium deficiency: case reports.
D. L. Bilbey and V. M. Prabhakaran

http://www.ncbi.nlm.nih.gov/pubmed/8264519
Miner Electrolyte Metab. 1993;19(4-5):314-22.Links
Clinical manifestations of magnesium deficiency.Abbott LG, Rude RK.

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.


http://www.ncbi.nlm.nih.gov/pubmed/6499696

Drugs. 1984 Oct;28 Suppl 1:143-50.
Magnesium deficiency. Causes and clinical implications.

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),

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.

http://www.ncbi.nlm.nih.gov/pubmed/7020347
Acta Med Scand Suppl. 1981;647:125-37.Links
Magnesium deficiency. Etiology and clinical spectrum.Flink EB.

http://www.ncbi.nlm.nih.gov/pubmed/7922443
New Horiz. 1994 May;2(2):186-92.Links
Should we supplement magnesium in critically ill patients?Olerich MA, Rude RK.

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

http://blogs.consumerreports.org/health/2007/11/finally-an-anti.html
consumer reports video on requip ad

<object width="425" height="355"><param name="movie" value="http://www.youtube.com/v/pDvm-5Sochs&hl=en"></param><param name="wmode" value="transparent"></param><embed src="http://www.youtube.com/v/pDvm-5Sochs&hl=en" type="application/x-shockwave-flash" wmode="transparent" width="425" height="355"></embed></object>
consumer reports video imbedded

http://www.youtube.com/watch?v=pDvm-5Sochs
Consumer Reports Video on Requip

<object width="425" height="355"><param name="movie" value="http://www.youtube.com/v/PL3G1MngqK4&hl=en"></param><param name="wmode" value="transparent"></param><embed src="http://www.youtube.com/v/PL3G1MngqK4&hl=en" type="application/x-shockwave-flash" wmode="transparent" width="425" height="355"></embed></object>
Requip Ad Video Imbedded

http://www.youtube.com/watch?v=PL3G1MngqK4
Requio Ad video in U tube

Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood Fl 33021
954-983-1443
http://drdach.com
http://www.jeffreydach.com

Disclaimer http://www.drdach.com/wst_page20.html www.drdach.com disclaimer

(c) 2008 Jeffrey Dach MD All Rights Reserved  
Reproduction or copying strictly prohibited, except with permission of the author

 del.icio.us  Stumbleupon  Technorati  Digg 

 
Trackbacks
  • No trackbacks exist for this entry.
Comments
  • No comments exist for this entry.
Leave a comment

 Enter the above security code (required)

 Name (required)

 Email (will not be published) (required)

 Website

Your comment is 0 characters limited to 3000 characters.