Tag Archives: pharmaceutical industry

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.

The Medicalization of Human Variety

Laurie and Debbie say:

We’ve been thinking about social and political effects of psychoactive drugs for a long time and these two articles by Marc Bousquet seemed like a good reason to talk about that now.

In 2003, six million American schoolchildren—about 15 percent—took methylphenidate (Ritalin) alone. Methylphenidate has replaced Prozac as the drug defining an entire cohort.

Before we start: We know that there are people who take Ritalin, and other psychoactive drugs, and experience a serious improvement in their lives. We always support people making whatever choices make their lives better.

That being said, 15% of schoolchildren represents not an occasional disorder but an epidemic, and the drugs are apparently going to a lot more people than just the children (and adults) for whom they are prescribed:

Students themselves actively seek the ADHD diagnosis. The pills have many uses related to the spectacularized culture of testing, overwork, stress, and body-consciousness—they aid in concentration, provide wakefulness, suppress appetite, assuage certain emotions, and improve athletic performance. They can be crushed and snorted or smoked recreationally in ways similar to methamphetamines. The diagnosis itself directly addresses high-stakes testing: medicated or not, ADD and ADHD-diagnosed students can request additional time in many testing circumstances.

Many more students than diagnosed use the medication: There is an active black market in Ritalin in every educational environment from primary school through graduate degrees. Students pay up to $10 a dose for “vitamin R.”

Just as thematized in the mass culture of the professional-managerial class (in TV shows like Desperate Housewives), there are widespread reports of parents using Ritalin prescribed to their children to meet the demands of their own “standards-based” existences. In families trapped in low-wage jobs, parents may also take Ritalin to meet the demands of their own working lives in the service economy or, sometimes, illegally sell it to make ends meet.

While student respondents acknowledge [recreational] use, overwhelmingly the main use is to keep up with work or performance pressure in a high-stakes culture. “I don’t think I could keep a 3.9 average without this stuff,” said one high-achieving college student (Jacobs, NYT). Another report shows that continuous assessment of scholarship recipients leads to usage: “I don’t know what I would do without it,” said another. “There’s no way I could have kept my scholarship if I didn’t use it” .

When we look at over-riding social trends, rather than individual choices, there’s lots to be nervous about here. As we see it, widespread application of drugs to common social experiences has at least two consequences for the society. One is the tendency to try to solve a social problem with an individual medical response: if 15% of American schoolchildren really need drugs to keep up in the classroom, could something be wrong with the classroom? We know that there’s an amazing amount “wrong” with our classrooms and our school systems–are we using Ritalin and other drugs to keep us from having to tackle those issues?

Second, drugs are prescribed for “disorders.” ADD, ADHD, and many other diagnoses are often about an inability to fit in to an increasingly high-pressured, single-track, one-solution culture, just as bariatric surgery is about an inability to fit in to a culture trying to be “all fit one size.” We were both simultaneously reminded of the wonderful Oliver Sacks story of the man who took his Tourette’s medication during the week, but stopped taking it on the weekends so he could keep the joy he got from drumming. Many of these drugs blunt other responses, minimize other reactions, take away an ability to see/hear/feel/experience. When given to young children, it seems very likely to us that the drugs may have a permanent blunting effect, or cause other permanent changes in how these children learn to see/hear/feel/experience the world.

The whole picture gets a little more menacing when you add in “Oppositional Defiant Disorder,” about which the same author wrote an earlier short piece on “Oppositional Defiant Disorder,” also in the Chronicle.

A diagnosis of ODD can result in medication with powerful tranquilizers like Risperdal and Zyprexa.

A massive therapeutic industry of behavior modification, including pharmaceutical companies, now targets parents, promising cures for “defiant children.”

One of the most pervasive ad campaigns draws on the rhetoric of homeland security to label youth defiance “The War at Home,” urging a corrections mentality on the family: “The focus of treatment should be on compliance and coping skills, not on self-esteem or personality. ODD is not a self-esteem issue; it’s a problem-solving issue.”

[Clinical psychologist Bruce] Levine suggests that in many cases the symptoms of ODD are rational resistance to authoritarian abuses and “rebellion against an oppressive environment,” explanations rarely considered by educators or mental health professionals.

This is not so new; in the 1950s, defiant kids (especially girls) were psychiatrically diagnosed and prescribed electroshock therapy (which is also coming back into medical fashion, sadly enough). While ADD/ADHD is primarily a diagnosis of the high-achieving middle class, ODD is a label easily used to subdue working-class and underclass students, and medicalize their completely justified rage at their treatment by society.

We are in the very very early days of brain science; once you get through the maze of “serotonin uptake,” “receptor binding,” and “protein affinity,” you invariably get to “the mechanism is not well understood.” This means that we often don’t know what these drugs actually do. (Ritalin was developed to treat Mohr’s syndrome, a rare disfigurement syndrome which affects the mouth, nose, and fingers.)

What we do know is that when brain medications are the first line of defense with young children and early teens, they often grow up believing that drugs are the answer to everything. And the pharmaceutical industry is more than happy to keep cranking out expensive, poorly understood “answers” as the problems multiply.

Day-dreaming, fascination, high energy, excitement, willfulness: these things enrich the human experience. They are important to kids, important to adults, important to living together in society. So far, we don’t have the science or the capability to medicate them out of existence, but we do seem to be trying to minimize them, in the name of promoting competiive success and minimizing anger, frustration, pain, and despair. If we aren’t judicious in our decisions about what are disorders and what is us, we stand to lose a great deal more than we gain.

Thanks to Arthur D. Hlavaty for the pointer.