Vaccines, Viagra, and Vioxx: Medicines, markets, and money - When life-saving meets life-style

In this Commentary, life-style drugs will be termed as "those drugs for which there is a definable and real, but limited, therapeutic need, but a need that has been significantly stimulated by the cycle of pharmaceutical company advertising and pressure and public demand." The key to the continuing expansion of the life-style drug market is a progressive narrowing of the definition of "normal" coupled with campaigns launched by the pharmaceutical industry that persuade both patients and clinicians that a major and treatable disease does exist and that drug treatment, rather than acceptance of hair loss or occasional lack of sexual interest, and so on, is both necessary and appropriate. The expansion of the market for prescription drugs in this manner is now an integral part of the business model of the pharmaceutical industry. For society, the expanding role of these drugs, particularly those directed at "desires rather than diseases," raises ethical issues of our increasing obsession with a medically directed quest for perfection, and financial issues of the cost of this quest on the health care system and its priorities. For the pharmaceutical industry, there are questions of whether its role is life-saving or life-styling for a Huxleyan "Brave New World."