Selling sickness: where the idea comes from
Disease mongering is the widening of the boundaries of illness, or the promotion of new diagnoses, in order to expand the market for treatment, and “selling sickness” is the phrase that captures the idea behind it: that a diagnosis can be marketed like any other product when the definition of who counts as sick is flexible. This page traces where that idea came from, the people and works that shaped it, and the arguments it makes. It describes the books and the scholarly collection neutrally and does not reproduce their text. It is an independent reference with no connection to the 2006 Newcastle conference or any prior owner of the domain, and it is not medical advice.
Lynn Payer and the naming of a phenomenon
The concept has a clear starting point. The American medical writer Lynn Payer coined “disease mongering” in her 1992 book Disease-Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick. Payer’s argument was that several parties, clinicians, manufacturers, and insurers, each gain something when more people believe they are ill, and that together they nudge the culture toward seeing ordinary life as a series of treatable problems. She was not accusing anyone of fraud so much as describing a system of incentives that quietly favors more diagnosis over less. That framing, incentives rather than villains, still marks the more careful writing in the field.
Moynihan, Cassels, and Selling Sickness
The idea reached a mass audience through the Australian health journalist Ray Moynihan and the Canadian drug-policy researcher Alan Cassels, whose 2005 book Selling Sickness gave the phenomenon its most memorable name and its most quoted illustrations. Its subtitle, describing how large pharmaceutical companies are “turning us all into patients,” summarizes the thesis: that the growth industry is not only in medicines but in conditions themselves, which can be defined and expanded to fit a product.
Moynihan had already helped sharpen the concept in a widely read 2002 article in the BMJ, written with Iona Heath and David Henry, that set out the mechanisms of disease mongering and offered a taxonomy of cases, from turning ordinary processes such as aging into medical conditions to recasting risk factors as diseases. Selling Sickness extended that analysis into book length, walking through cases such as high cholesterol, female sexual dysfunction, and social anxiety. Read as a summary of the movement, the book’s contribution was less any single revelation than the assembly of many examples into one coherent pattern.
The PLoS Medicine collection of 2006
The critique gained academic weight in April 2006, when the open-access journal PLoS Medicine published a themed collection of articles on disease mongering, timed to coincide with the first conference devoted to the subject. The collection gathered researchers who examined specific conditions and the general dynamics of medicalization, and because it was peer-reviewed and freely available, it helped move “disease mongering” from journalism into the scholarly literature. It is frequently cited as the point at which the term became a recognized object of study rather than a slogan.
The arguments the critique makes
Stripped to its core, the selling-sickness argument rests on a few linked claims, each of which can be assessed on its own evidence.
- Boundaries are movable. The line between healthy and sick is set by committees and guidelines, not by nature alone, so it can be shifted.
- Incentives favor expansion. Manufacturers, and sometimes clinicians and patient groups, benefit when the definition of illness grows, which creates steady pressure in one direction.
- Marketing can sell the diagnosis. Promotion increasingly targets the condition itself, teaching people to interpret an everyday feeling as a symptom before they reach a clinic.
- Overdiagnosis carries real costs. Labeling and treating large, mildly affected populations brings anxiety, side effects, and expense that are easy to overlook when only benefits are counted.
The strongest versions of the argument are careful to stay balanced. Medicalization has also relieved suffering, reduced stigma, and widened access to effective care, and the critics who matter acknowledge this. Their claim is not that medicine is bad but that its margins are shaped by commerce, and that patients and clinicians are better served when those pressures are visible.
A note on the phrase in popular culture
Because “selling sickness” is a vivid phrase, it has surfaced outside the medical literature, including as the title of a Boston Legal television episode that dramatized a courtroom fight over pharmaceutical marketing. That fictional treatment is a separate cultural artifact and is not a source for the concept; readers looking for the episode’s cast, judge, or plot are searching for the drama, not the health-literacy idea described here. The distinction is worth making so that the serious critique is not confused with its screen depiction.
How the idea connects
The intellectual history matters because it explains why the field speaks the way it does. Payer supplied the name and the incentive-based framing; Moynihan and Cassels supplied the cases and the public reach; the PLoS Medicine collection supplied the academic footing. Together they turned a suspicion, that some illnesses are marketed, into a structured argument with named mechanisms and documented examples. Those mechanisms are dissected on the tactics page, the cases are examined on the examples page, and the whole picture is drawn together in the pillar overview of disease mongering.