Concept of 'overactive bladder' serves commercial interests rather than patient interests, experts say

Two Finnish experts question the concept of the 'overactive bladder syndrome'. According to them, this syndrome is mostly beneficial to those with commercial interests, while from the patient perspective and for the development of treatments, it may be detrimental.

"The overactive bladder syndrome has become an accepted way to simplify a complex array of symptoms and leads people to believe that an overactive bladder is an independent disease in itself. However, the truth is not as simple as this, as there are usually several factors at work explaining the symptoms. This is also one of the reasons why so called overactive bladder medications often do not bring the hoped result," says Kari Tikkinen, MD, PhD, from the HUCS Department of Urology.

The article on overactive bladder syndrome, which was co-written by Tikkinen, who currently holds a senior researcher post at the McMaster University in Canada, and Anssi Auvinen, Professor of Epidemiology from the University of Tampere, was recently published in the European Urology journal. For the article, the researchers systematically reviewed the studies on overactive bladder and the channels through which these studies have been funded.

The authors argue that the symptoms of an 'overactive bladder' ought to be studied individually and not as an ambiguous constellation of symptoms. This way the underlying causes of the symptoms can be better understood and more effective treatments can be developed.

The expression 'overactive bladder' was coined at an industry-sponsored symposium held in 1997. The following year, the FDA approved the first drug for the treatment of 'symptoms of overactive bladder', after which the pharmaceutical industry launched high-profile, worldwide promotional campaigns for drugs aimed at treatment of the syndrome.

According to the current definition, overactive bladder (OAB) syndrome is defined as the presence of urinary urgency with or without urgency incontinence, usually with increased daytime frequency and nocturia in the absence of infection or other obvious pathology.

"The definition is vague and ambiguous because it includes unspecific terms, such as 'usually' and 'with or without', and the unclear expression 'other obvious pathology'," Tikkinen says and continues, "For the pharmaceutical industry this definition is probably quite useful, as it is partly the reason why one medicine can be prescribed to a large number of patients."

Research into overactive bladder has increased significantly over the past ten years and the pharmaceutical industry has invested heavily in it. "It has previously been shown that research funded by commercial actors often ends up unpublished if the results don't serve the interests of the company," Tikkinen points out.

Tikkinen and Auvinen also bring to the fore that in many studies on prevalence of overactive bladder, very mild symptoms have been classified as abnormal.

"More independent, non-commercially funded research on the subject is needed. There are, in the end, a huge number of people who suffer from urinary urgency and increased urinary frequency, and current treatments are not bringing sufficient relief," Tikkinen says.