When the Virus is the Market

Most people associate epidemics with infectious diseases such as flu or malaria. But similar dynamics can arise around the widespread use of addictive or harmful consumer products such as cigarettes, guns or drugs, a phenomenon that Jonathan Quick, M.D., calls a “market-driven epidemic.”

“It’s pretty clear that more and more death certificates may read cancer, diabetes, suicide and murder, but the root causes are market-driven epidemics,” Quick, an adjunct professor in the Duke Global Health Institute, said during a Feb. 19 Think Global event. “They have mastered the science of hijacking our brains’ pleasure center.”

The event, featuring Quick and four researchers who are studying examples of market-driven epidemics, explored how companies have often obscured or denied mounting evidence of health harms associated with their products to extend their profitable lifespan. Panelists noted that these market-driven epidemics have contributed to 23 million deaths worldwide, but they also emphasized that decisive action by public health officials has often slowed the use of harmful products, in many cases preventing even wider health harms.

Eszter Rimanyi, a chronic disease epidemiologist working with Quick, said market-driven epidemics often evolve through five phases: market development, evidence of harm, corporate resistance, mitigation and market adaptation. She cited tobacco use as an example of a market-driven epidemic that has extended over many decades. Although reports about harmful effects from tobacco began to surface as early as 1912, it was not until the U.S. Surgeon General reported a definitive link between smoking and lung cancer nearly four decades later that tobacco use began to decline in the U.S.

“We see how authoritative public health voices communicating information directly can have a big impact on individual consumer behavior,” she said. “It’s a very clear stance from the government.” 

Anna Lembke, M.D., professor and medical director of addiction medicine at Stanford University School of Medicine, described how the makers of prescription opioids obscured evidence that opioids were addictive by pushing narratives about “pseudo-addiction” among patients who were prescribed opioid pain medications, which they claimed could be treated by prescribing more opioids. 

“The longer you take an addictive substance, the more you alter your brain and are more likely to become addicted to that substance,” Lembke said. “There will always be a subset of the population who are more vulnerable to addiction, even with short-term exposure.” 

Public advocacy was also important in identifying risks associated with use of infant formula, particularly in low- and middle-income countries, noted Aunchalee Palmquist, Ph.D., a medical anthropologist who studies breastfeeding and lactation at DGHI.

“Most people don’t have access to the resources they need to keep formula preparation safe for the vast majority of the world in which these products are marketed,” she said, noting that ethical marketing is vital in resource-scarce settings. 

Jonathan Lowy, J.D., a lawyer who has litigated cases against the gun industry for more than 25 years, discussed the importance of legal action in another form of market-driven epidemic, the sale and use of guns in the U.S. Lowy said class-action lawsuits have been instrumental in spurring gun reforms and holding dealers and manufacturers responsible for skirting federal and state regulations. 

“One way to get to the problem outside of the political system is [representing] victims of these reckless, and in some cases, unlawful conduct,” Lowy said. “It can place an incentive on manufacturers to act more safely.”

As with deaths and injuries from guns, the health impacts of market-driven epidemics such as sugar, ultra processed foods and even social media are felt not just in the U.S., but globally, Quick noted. He said he hoped the discussion – along with continued research – provide a starting point for identifying the actions that can slow such epidemics and center human health and safety. 

“We’re looking to find who has succeeded and how they succeeded,” Quick said, adding that although battles may be lost in the effort, the war is still winnable.