Designing a disease -- and its drug

It's just like any other Web site devoted to a drug, really -- the home page for Havidol features an attractive person smiling contentedly, a link to prescribing information (including a chemical formula), and the standard side effects spiel now familiar to anyone who's seen TV drug commercials. The site itself even contains TV and print ads, a self-assessment test to find out if Havidol is right for you, and customer testimonials.But look a bit closer. The drug is described as "the first and only treatment" for dysphoric social attention consumption deficit anxiety disorder, or DSACDAD -- termed "the #1 concern of contemporary life."

Side effects include "co-dependency with inanimate objects," "inter-species communication," and "terminal smile." In rare instances, patients reported a sudden urge to change physicians. In other words, neither the drug, nor the condition it treats, are real.The Web site is the controversial creation of Australian artist Justine Cooper. A recently-closed gallery exhibit, housed in an unassuming building across the street from Marty's Auto Repair in Manhattan, served as a shrine to the drug -- replete with magazine and TV ads, billboards, a larger-than-life gold-plated pill in a glass case, and a "designer" jacket with a fabric pattern inspired by the drug's fictional chemical formula. Cooper, who is attractive and extremely soft-spoken, says the exhibit and its accompanying Web site are primarily a commentary on Big Pharma, and how we deal with non-deadly conditions, such as Restless Legs Syndrome and Premenstrual Dysphoric Disorder (severe pre-menstrual syndrome).

Cooper acknowledges that the conditions are real, but suggests that drugs aren't always the right solution. And when pharmaceutical companies market drugs for these products, they shape a society in which "everyday life is pathologized and then can be medicalized."Havidol is also meant to mock society's constant desire for more -- our sense of never being good enough, beautiful enough, thin enough, or successful enough. The site describes people with DSACDAD as those who "believe that despite the opportunities, achievements and acquisitions [they] already have, something is still missing." In an ad both in the exhibit and on the Web site, a beautiful young woman explains that Havidol is the drug she desperately needed her whole life without realizing it. "If you feel like I did, you may have a lifestyle-threatening condition," she says while lounging in a pool. "Thankfully, Havidol can help." Complaints against disease mongering are nothing new -- Austrian social critic Ivan Illich first raised the subject in his 1976 book Limits to Medicine: Medical Nemesis, the Expropriation of Health. Still, many feel that today it is spiraling out control. And many of the heavily marketed drugs, which can be seen in direct-to-consumer TV ads in the United States and New Zealand (the only two countries in which such advertising is legal), are the types of "lifestyle" drugs Cooper is parodying with Havidol. In order to continue earning expected profits, pharmaceutical companies try to widen the boundaries of illness to sell more drugs, says Joel Lexchin, a professor of health policy and management at York University in Toronto. Lexchin, who wrote about Pfizer's attempts to redefine erectile dysfunction (part of a recent collection of articles about disease mongering in PLoS Medicine), argues that disease mongering isn't just a nuisance -- it could have serious consequences. Many of the drugs that are marketed directly to consumers are new, he points out, with recent safety profiles, making widespread use a concern. Although no one from Big Pharma has commented publicly on Havidol -- the five companies contacted by The Scientist declined to do so as well -- Cooper says she has received many positive comments. Audiences have said they appreciate the jab at Big Pharma, enjoy the general cultural commentary, and like that the project pokes fun at advertising, Cooper notes.

"That's more of an outcome than I could've hoped for." But Cooper's exhibit has not escaped controversy. Naturally, some doctors insist that non-life-threatening conditions can have major consequences for patients, and drugs can provide real relief. The most severe form of Premenstrual Dysphoric Disorder impairs women as much as major depression would, says psychiatrist Margaret Altemus at Cornell's Weill Medical Center, and antidepressant drugs are considered "the most effective treatments." With Restless Legs Syndrome, the most common first-line therapies are dopamine agonists. Often, says Nidhi Undevia, a sleep specialist at Loyola University Chicago's Stritch School of Medicine, popping a pill really does make the syndrome "dramatically go away." Patients, too, have been upset -- as well as confused -- by Havidol. Through the Web site's "contact us" page, Cooper has been accused of making fun of serious mental health problems and for humiliating patients who, believing the drug to be real, have asked their doctors about it. Cooper, who was the first artist-in-residence at New York's American Museum of Natural History, says that she's had so much fun with Havidol, she plans to continue working on it. She is considering designing a site for the drug's fictional mother company, Future Pharms, and developing a related computer game.Melinda Wenner mail@the-scientist.comImages courtesy of the artist and Daneyal Mahmood GalleryCorrection (posted March 23): The original story said Illich was Australian. He was born in Austria. The original story also pointed to a Web site that appeared to endorse Havidol. On closer inspection, the link we provided contains the word "scam." The Scientist regrets these errors.Links within this articleHavidol http://havidol.comJustine Cooper http://www.justinecooper.comDaneyal Mahmood Gallery http://www.daneyalmahmood.comK. Grens, "The most intimate self portrait," The Scientist, March 16, 2007. http://www.the-scientist.com/news/display/52941/Restless Legs Syndrome http://www.rls.org/NetCommunity/Page.aspx?&pid=178&srcid=-2PMDD http://www.clevelandclinic.org/health/health-info/docs/2400/2447.asp?index=9132Advertisement featuring "Elle" http://havidol.com/elle.htmlI. Illich, Limits to Medicine: Medical Nemesis, the Expropriation of Health http://www.amazon.com/Limits-Medicine-Medical-Nemesis-Expropriation/dp/0714529931J. Lexchin, "Bigger and Better: How Pfizer Redefined Erectile Dysfunction," PLoS Medicine http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0030132Collection of articles on disease mongering, PLoS Medicine http://collections.plos.org/plosmedicine/diseasemongering-2006.phpMargaret Altemus http://www.med.cornell.edu/research/margaretaltemus/M. Fogarty, "Depending on cigarettes, counting on science," The Scientist, March 24, 2003. http://www.the-scientist.com/article/display/13635/Nidhi Undevia http://www.lumc.edu/templates/luhs/physearch/primary_lastname_results.cfm?seq_cntr=2937Havidol Feedback Forum http://daneyalmahmood.com/images/artists/justinecooper/havidol/other/feedback.doc