Disease awareness campaigns by the pharmaceutical industry: consequences for health care �and society – the example of obesity marketing�

Oskar Lindfors

Karin Mossberg

Margrét Ólafía Tómasdóttir

Hálfdán Pétursson

Staffan Svensson

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Conflict of interest declaration

Oskar Lindfors : none

Karin Mossberg : none

Margrét Ólafía Tómasdóttir : none

Hálfdán Pétursson : none

Staffan Svensson : none

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1. Outline of Novo Nordisk’s obesity awareness campaign in Sweden�Staffan
2. GLP-1 analogs – effect/side-effects, STEP-programme�Hálfdán
3. Obesity – treatment options, causes, genes vs society�Karin
4. Disease mongering, stigmatization, reactions, motivation�Margrét/Oskar
5. Development prognosis – what will happen with anti-obesity drugs?

All!

This presentation available at: bit.ly/NCGP2022

Feedback welcome to: staffan dot svensson at pharm dot gu dot se

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1. �Outline of Novo Nordisk’s�obesity awareness campaign�in Sweden

Marketing components

• Ads in newspapers
• Ads in medical journals
• Ads sent to physicians & nurses
• Invites to lectures, seminars
• Marketing surveys
• Campaign webpages
• Podcasts, videos
• Patient & professional organisations
• Targeted (¿co-edited?) newspaper articles
• Collected here: pharm.nu/novo

• faktaomvikt.se
• pod.space/ettviktigtsamtal
• truthaboutweight.global
• truthaboutweight.global/dk
• truthaboutweight.global/is
• truthaboutweight.global/fi
• truthaboutweight.global/no

Novo Nordisk’s obesity web pages

• rethinkobesity.com, rethinkobesity.ca, etc
• pro.novonordisk.se/obesitas
• pro.novonordisk.com/rethink-obesity
• novonordiskworks.com
• novonordisk.com/obesity

Aimed at patients

Aimed at health care workers

Patient organisations

• Hälsa oberoende av storlek (HOBS), “Health regardless of weight”, Sweden
• Landsforeningen for overvægtige, Denmark
• Norway, Finland, Iceland?
• Nordic Obesity Alliance (NOBA) : HOBS + Landsforeningen
• Sponsored by Novo Nordisk, et al
• European Coalition for People Living with Obesity (ECPO)
• Sponsored by Novo Nordisk, et al
• Obesity Action
• Sponsored by Novo Nordisk, et al

Joint Novo/Pat org projects

• HOBS: behandlaobesitas.nu
• The report En tillräcklig och jämlik obesitasvård (A sufficient�and equitable obesity care), 2019
• Sponsored by Novo Nordisk, written by HOBS with marketing�firm Reform Society/Re-Think
• Short film Den svenska sjukvården förlorar slaget (Swedish �health care fights a losing battle)
• Seminars with Petter Odmark, Mats Eriksson, Göran Hägglund�from Reform Society/Re-Think
• Facilitated by Novo Nordisk

Professional organisations

• Svensk förening för metabol- och obesitaskirurgi (SFOK),�Swedish association of obesity surgeons
• Sponsored by Medtronic and Ethicon
• Svensk Förening för Obesitasforskning (SFO),�Swedish association of obesity researchers
• European Association for the Study of Obesity (EASO)
• Mother organisation of SFO, sponsored by Novo Nordisk, et al
• European Congress on Obesity, arranged by EASO
• Sponsored by Novo Nordisk, et al
• European Society of Endocrinology (ESE)
• Sponsored by Novo Nordisk, et al
• World of Obesity (WOF)
• Sponsored by Novo Nordisk, et al

Co-edited (?) news articles

2. �GLP-1 analogs – effect/side-effects, STEP-programme

STEP 1-8 + SELECT

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Semaglutide 1.7

CVD

Serious side effects

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STEP-1 : NEJM 2021;384(11):989–1002

STEP-2 : Lancet 2021;397 (10278):971–984

3. �Obesity – treatment options, causes, genes vs society

Obesity

Behaviour (diet, physical activity)

Environment

Medication

Hormones (GLP-1)

Feeling of hunger/fullness

Genes

Type of

adipose tissue

Microbial

dysfunction

Adverse childhood experience

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Stranden, Foyn Gundersen, Getz, Kirkengen,

Hagen, Prytz Mjolstad

A 50‐year history of the health impacts of Westernization on the lifestyle of Japanese Americans

J of Diabetes Invest, Volume: 11, Issue: 6, Pages: 1382-1387, First published: 20 April 2020, DOI: (10.1111/jdi.13278)

https://hbr.org/2018/05/what-it-takes-to-think-deeply-about-complex-problems

Obesity treatment

• Lifestyle interventions
• Medications
• Bariatric surgery

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Lifestyle interventions

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Medications

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• Orlistat
• Liraglutide, naltrexon/bupropion, semaglutide

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Aaseth et al. Biomedicine & Pharmacotherapy. 2021

Bariatric Surgery

Gastric bypass

Sleeve gastrectomy

Bariatric surgery results in

• Rapid and pronounced weight-loss�
• Prolonged survival

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• Lowers the risk of obesity-related comorbidities

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Reges et al. JAMA 2018;319:279-90. Adams et al. N engl J Med 2007;357:753-61.

Arterburn DE et al. JAMA 2015;313:62-70. Sjöström et al. N Engl J med 2007;357:741-52.

Corcoulas AP et al. JAMA Surg 2018;153:427-34.

Sjöström et al. JAMA 2014;311:2297. Schiavon 2018;137:1132-42. Ashrafian H et al. Obes Surg 2015; 25:1239-50.

Are the harms about �bariatric surgery investigated?

• Adverse events and reoperations rates are insufficently reported
• Most trials followed participants for only one or two years, therefore the long‐term effects of surgery remain unclear

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Nudel et al. Metabol Clin Exp. 2019. 92;206-16.

Other options?

4. �Disease mongering, stigmatization, reactions, motivation

Disease mongering

• Disease mongering is a pejorative term for the practice of widening the diagnostic boundaries of illnesses and aggressively promoting their public awareness in order to expand the markets for treatment.
• Among the entities benefiting from selling and delivering treatments are pharmaceutical companies, physicians, alternative practitioners and other professional or consumer organizations.
• It is distinct from the promulgation of bogus or unrecognised diagnoses.

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Disease mongering

• A set of practices which include the following:
• Stating that normal human experiences are abnormal and in need of treatment
• Claiming to recognize suffering which is not present
• Defining a disease such that a large number of people have it
• Defining a disease's cause as some ambiguous deficiency or hormonal imbalance 
• Associating a disease with a public relations spin campaign
• Directing the framing of public discussion of a disease
• Intentionally misusing statistics to exaggerate treatment benefits
• Setting a dubious clinical endpoint in research
• Advertising a treatment as without side effect
• Advertising a common symptom as a serious disease

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Figure 1. Percentage of Doctors That Use Information Provided by Drug Company Representatives in Their Clinical Practice

Heath I (2006) Combating Disease Mongering: Daunting but Nonetheless Essential. PLOS Medicine 3(4): e146. https://doi.org/10.1371/journal.pmed.0030146

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030146

Unnecessarily making people patients by either :

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• Turning normal life into illness�– disease mongering, medicalisation, overdefining 

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• Identifying abnormities that would never cause harm�– overdetection

Overdiagnosis

Diagnoses causing more harm than good

Brodersen J, Schwartz LM, Heneghan C, et al

Overdiagnosis: what it is and what it isn’t

BMJ Evidence-Based Medicine 2018;23:1-3.

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(International Society of Men’s Health, sponsored by Bayer AG)

Literature

Stigmatization

Body discrimination /fat disgrace /fat prejudice

• Very strong organization in Iceland
• Active in public debate
• Active debate against doctors
• Active debate against media

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• Obesity as a disease is part of medicalisation
• Research has repeatedly shown a lack of relationship between obesity and ill health
• Measurements of obesity are flawed

Obesity redefined – no way between

• Disease requiring life long treatment?
• With expensive medication or surgery

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• Medicalisation of normal variation of the human body?

5. �Development prognosis – what will happen with anti-obesity drugs?

Obesity treatment

Karin Mossberg

GP, PhD

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Disease mongering and stigmatization

Margrét Ólafía Tómasdóttir, GP Iceland