Our Daily Meds

Debbie says:

I finished Our Daily Meds, by Melody Peterson, last week. Sometimes, I think I understand the scope of a social problem, until I read a detailed and well-researched account and realize that what I knew was just the tip of the iceberg. Usually, that’s because I just can’t be cynical enough to take in what’s actually happening.

book cover

This book is a perfect example: Peterson is writing about how the American pharmaceutical industry has intentionally transformed not just the country’s prescription drug habits, but our national health, our attitudes towards our health, and our real income levels.

Basically, Peterson convinced me that it isn’t possible to be cynical enough. Her basic premise is that, while the benefits of prescription medications are obvious and crucial, the concept of marketing them like toys or candy has done an incomprehensible amount of harm. Drug marketing is not only pretty advertisements in public media, it’s also hundreds of millions of dollars spent paying medical doctors and movie stars to convince other medical doctors to prescribe drugs without any scientific evidence for their use–and sometimes with significant scientific evidence that those drugs do harm. It’s taking over the medical journals with articles actually written by the drug companies and their affiliates, lying eloquently about what the drugs do. It’s packaging strong narcotics in berry-flavored lollipops, and writing “children’s books” about how a particular drug transformed an unhappy child’s life.

Peterson details how drug companies have literally (and consciously) invented “diseases,” (such as “overactive bladder”) because they had a drug (in this case for incontinence) that not enough people needed. She has a chapter on Neurontin: an epilepsy drug so ineffective that the FDA approved only as a second drug to supplement some other seizure drug. (Why was the approval so limited? Because it “had not reduced the number of seizures in most volunteers in the company’s clinical trials” and “5 to 10 percent of the epilepsy patients taking [it] actually got worse.”)

The small-time approved use didn’t fit the company’s bottom line. And the law says once a drug has been approved for any single use, doctors can prescribe it “off label” for other uses. So the company decided to sell Neurontin for profitable uses, “from children with attention deficit disorder to adults with sexual dysfunction,” as well as migraines and uncontrolled hiccups. This would be bad enough, if the company had not then gone on to mount a wide-ranging illegal campaign to bribe doctors to prescribe it for these uses … and to pay doctors to convince other doctors to prescribe it. They spent tens of millions of dollars on upscale events at expensive restaurants and country clubs, where paid doctors spoke about nonexistent benefits and drug company salespeople got huge commissions based on number of prescriptions written.

Peterson comes off as a sensible researcher, not a starry-eyed crusader. She never forgets that most of the drugs she is discussing actually do some good. One thing I thought the book might be when I bought it was a deep critique of “brain meds,” but instead she writes about psychoactive drugs as part of the greater pharmaceutical picture, which is much more useful.

She also discusses some hidden social issues: she estimates the number of drug-related deaths in the U.S. at more than 250 per day (!) and shows how these deaths are hidden in the statistics. (I understand that, because anorexia and bulimia deaths are hidden the same way; the cause is “pneumonia” or “heart failure,” and the underlying issues disappear.) She talks about the measurable presence of trace pharmaceuticals in urban water supply (a 2002 study found prescription drugs, fragrances, insect repellents, disinfectants, and other household chemicals in 80% of the streams sampled in 30 states). She discusses the thriving high-school and street-corner market in pretty pills, and the highway and military deaths caused by prescription drug misuse or overuse. She talks about the marketing of drugs to children and the elderly, despite no studies regarding those groups: this results in particular in overprescribing for the elderly, whose body systems often process drugs less efficiently.

I’m a critical reader: I always look for how the author might be slanting her data to make her points. I saw that occasionally in this book, but the vast bulk of the time, Peterson was either giving me statistics on something I already basically believed, or convincing me it was worse than I thought.

Why is this a body image issue? Because body image isn’t just about how we look; it’s also about how we feel. And one of the nastiest aspects of the whole slimy mess is that by promoting sweetness and light, the drug companies have made Americans perceive ourselves as sicker, more in need of help, and less powerful than people anywhere else in the world. (And America’s government and citizens have supported the effort.)

The U.S. is the only country that has let this madness run unchecked. Peterson’s last chapter is a prescription for how to fix this on a personal level and a social level. If your stomach is strong enough, this book is well worth your time.

7 thoughts on “Our Daily Meds

  1. This sounds fascinating and I will be checking it out. The US may be the only country (that I know of) with direct-to-consumer prescription advertising, but just about everywhere else, it’s perfectly acceptable to advertise to medical professionals of all kinds. The drug companies cut down on research down outside the US so that all we have to rely on are the limited and highly edited US drug trials, then push the advertising and pressure groups so that the drug is licenced quickly in other markets. Vioxx is the classic example of this going horribly wrong.

    With regard to “no studies in the elderly” this is quite correct – and there’s often no studies in children or women, either. And I will certainly applaud a book that talks about the drug industry and over-medicating in general – people taking psychiatric drugs and assorted analgesics know all about having our very real problems dismissed or undertreated (or wrong treated) because our conditions are “not real” or “just a drug company beat-up”.

  2. The weird thing is that,simultaneously, some of that off-label stuff can actually be useful. I know people who have had really bad side effects from Neurontin, including one with a seizure disorder.

    But it’s made my life a lot better. My doctor handed it to me for an odd use that it might or might not be any good for–the joint pain caused by MS. It turns out to control low-level spasticity, a twitching that nobody else could see, but which was just frequent enough to make it hard for me to sleep.

  3. Something that goes hand in hand with this is the lobbying done to lower diagnostic standards for things like diabetes and blood pressure. Lower diagnostic standards mean more people are diagnosed with diseases they don’t have in order to prescribe drugs they don’t need so pharmaceutical companies make more money.
    And Vioxx isn’t the only example of pushing drugs before their results in people are fully known. Phen-fen is another prime example of this, aided and abetted by the fear of being fat that is so pervasive in our society (and is spreading world-wide). Create an epidemic so you can create more drugs to treat that epidemic, and who cares what the side effects of those drugs are as long as money is being made.

  4. Let’s not let the cause of this evil go undercounted. This is not some peculiarity of drug companies. The underlying cause is fairly straighforward. Capitalism, as it is practiced in the U.S. is dangerous and unhealthy. This is especially true when profit drives decision making around issues of the public good.

  5. Lilacsigil, yes. One of the things that struck me about the book was the specific point that elderly livers and kidneys process chemicals differently than those of people of other ages. Peterson says drug doses for the elderly, even of good drugs, are frequently higher than they should be, which makes sense to me.

    Anonymous, yes. These drugs can be extremely useful, including in off-label situations. That’s part of the tangle, I think.

    Vesta, defintely yes. As a person with “prediabetic” blood sugar levels, I think a lot about those changes in threshold.

    Marlene, of course. And, at the same time, plenty of capitalist countries rein this crap in. Even if we don’t smash capitalism in the foreseeable future, we can still do better than we do now.

  6. I’m glad you reviewed this book. I remember reading a review of it in the New York Times maybe a couple years ago and thinking, “Wow, I’d like to read this book.” I had forgotten about it until just now, though — thanks for reminding me.

    Peterson comes off as a sensible researcher, not a starry-eyed crusader. She never forgets that most of the drugs she is discussing actually do some good.

    I had wondered about that! Often, books and articles about overmedication/overdiagnosis of trumped-up “illnesses” will dive headlong into conspiracy-theorist territory, which annoys me.

    strong narcotics in berry-flavored lollipops … “children’s books” about how a particular drug transformed an unhappy child’s life

    Wow, that’s creepy.

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