If you're like me and sometimes get sleepy in the afternoon you are probably just caffeine deficient. Hyper energetic kids, who may be Ritalin deficient, can be easily treated by the doctor's prescription pad. Experiencing the hot flashes that come with menopause? Yup, that's an easy one to diagnose, you're estrogen deficient.

Okay, both caffeine and Ritalin deficiencies seem way off tune, but not "estrogen deficiency" which has played lead fiddle in the menopause orchestra for 40 years. By recasting a "deficiency" as a disease, marketers shaped the ground to sell one of the most prescribed treatments in the history of the world ' hormone "replacement" therapy.

Ever since Dr. Robert Wilson published his 1966 book, Feminine Forever, (he referred to menopausal women as "sexless caricatures of their former selves"), mongering menopause has been a well-orchestrated effort. Public relations firms hired by drug makers have used almost every PR trick in the book, employing camouflaged celebrities, fake grassroots campaigns, and professional associations for hire to continually riff on the "estrogen deficient" chord.

The music died for HRT in 2002 when a large clinical study found that using these drugs over the long term actually increased a woman's cardiac and cancer risks. Suffice to say redefining the normal passage of life as a disease despite the potential risks of doing so is a technique sure to boost sales.

We've got the male version too ' "andropause." You have to ask if the fact that as we guys age, and get grumpy, less efficient in bed, and want to nap more often is a disease worth medicating? That handy list of symptoms has been repackaged into a dangerous condition of testosterone deficiency easily cured testosterone gel rubbed on your chest. Cue the music to the Six-Million Dollar Man as the voiceover intones: "Gentlemen, we can rebuild him."

Ads for testosterone drugs encourage doctors to drill their middle-aged male patients with questions: "Are you tired? Moody? Have a low sexual interest? That checklist pretty well sums up most guys my age who are naturally losing their mojo, but the ad's tagline says it all: "Getting old is natural. The goal ... to make feeling old optional."

For any mongered disease, there are those few at the extreme end of the spectrum who may well benefit from being medicated. Drugs may very much make their life better even if they remain in the dark about the long-term effects of those drugs.

It took us 40 years to discover that long-term HRT increased health risks in women, and there's no quality studies of long-term use of testosterone replacement, whose side effects include acne, prostate disorders, skin irritation, impaired urination and abnormally large breasts. Growing breasts? Mmm, that would make me a bit grumpy.

At the end of the day you have to ask if calming hot flashes or gaining a little bit of extra mojo are worth any risks whatsoever because, how does one say this nicely, "You're not actually sick!"

Given the rise and fall of hormone replacement therapy, and her twin brother testosterone replacement therapy, it's worth remembering that there is a lot of money to be made telling healthy people they are sick.

Alan Cassels is a drug policy researcher and author of The ABCs of Disease Mongering: An Epidemic in 26 Letters (Emdash, 2007). cassels@uvic.ca.

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