A Problem of Law
Item: An Egyptian rights lawyer is sentenced to 5 years in jail and 300 lashes of the whip for bringing anti-anxiety drugs (xanax – alprazolam) into Saudi Arabia. The judge notes the perpetrator’s “good morals” in explaining his “lenient” verdict (anti-anxiety drugs are banned in Saudi Arabia.)
Item: Florida regulators led by Governor Rick Scott ration stimulants and opiates to Florida pharmacies. Patients with narcolepsy, unable to find the medication that keeps them awake, sleep all day and are unable to work. Chronic pain patients go into sudden opiate withdrawal.
Why are so we crazy about drugs?
The Golden Age
The postwar period ushered in major advances in pharmaceuticals. Many of the new drugs – particularly antibiotics – quickly became regarded as miraculous.
In the 1920’s and 30’s many healthy young people died of pneumonia. By the 1950’s the same people got up from bed in a day.
The pharmaceutical companies took advantage of these advances and goodwill to remarket their industry as “ethical drugs.” Just as nuclear power would provide clean energy for everyone forever, the “ethical drugs industry” would eradicate the main scourges of humanity aided by global teams of selfless scientists and physicians.
The era of powerful medicines commenced.
However, by the 1970’s new drug innovation was already diminishing, falling into an eventually dramatic decline. Faced with expensive failure following failure, Big Pharma morphed from huge research led companies into marketing and distribution giants. The curative powers of new medications were vaunted while their unpleasant “side effects” were downplayed, disregarded or disowned. Just as the movie studios went for “blockbusters”, drug companies protected their “big earners.” Expecting gigantic yearly revenues, companies lied about the negative results of non-steroidal anti-inflammatories like Vioxx, pain medications like oxycontin, new neuroleptics like seroquel, and many others. They became content to pay billions in fines rather than forgo tens of billions in revenue. Lying and getting caught became another cost of business.
A new era had begun.
Angels and Monsters
Media is another industry where sensationalist claims earn outside profits. Yet when it comes to news and entertainment, both spectacular success and failure prove equally lucrative. And few stories are better than “heroes” that fall fast (for a present example cue Lance Armstrong).
Drug “breakthroughs” continued to be supported by an excited media, but so were reports of public malfeasance. A film like “The Fugitive” where a heroic surgeon is framed for his wife’s murder to protect the roll-out of a new drug reflected the changed mood. Drugs were both good and bad – angels and monsters in the same package.
And gradually the distance between “ethical drugs” accepted by government agencies and the illicit, illegal variety sold in the hundreds of billions of dollars by drug cartels, started to meld in media stories. The realization came that “prescription” drugs might be the same pills as those sold on the street, and could prove equally deadly (cue oxycontin).
Good was bad and bad was good – especially if you were writing TV news.
Big Pharma has struck back vigorously. Billions are spent on direct consumer advertising in the US, though such drug ads are banned in much of the world. Drug companies have realigned with “pharmacy benefit” operations to create oligopolistic cartels that – like the Hollywood studios of old -control supply and distribution. Generic drugs that twenty years ago cost pennies now cost quarters or half dollars, the curious result of Wall Street quarterly profit “demands” and the cluttered and confused free for all that is the American health care “system.”
Meat and Poison
The public continues to be confused and angry about drugs – “ethical” or illegal – and what they do. Popular and ancient food-drugs – like coffee, tea, and alcohol – are now frequently modified into “legal” concoctions like energy drinks that cavort in the regulatory fantasy land of “nondrugs”. Marijuana is declared to be no less dangerous to the population than alcohol, a rather curious argument to back legalization. Side effects of FDA approved pharmaceuticals are described in lengthy, unreadable small print within television ads, followed by the deeply intoned let’s pass off all responsibility phrase “ask your doctor”. Meanwhile patients receive printouts from pharmacies that prominently define as side effects the very symptoms and ailments the drugs are designed to treat. It’s time to recognize a few realities:
1. Drugs are information molecules that change the body. They can be ingested as foods, solutions, capsules and tablets, legal and illegal, over the counter and through a pharmacy, in a vein or through your eyes, skin, or bottom.
2. All drugs have effects you want and side effects you don’t. These vary hugely from person to person.
3. Drugs that can save your life can also kill you – including the same pill in the same person, the results completely changed by context and timing.
4. The real conversation should be not about health care costs “savings”, nor the internationally catastrophic “drug wars” that periodically plunges much of the world into violent chaos. It should be about health.
Are drugs helpful to populations? Do they make groups of people ill or well? Does the overall well-being they produce – physical, mental and social – outweigh the harms they can and do create?
One man’s meat is another’s poison. That is particularly true in the world of drugs and drug therapy. Though oversold by Big Pharma – especially when compared to the much greater public health contributions of sanitation, nutrition, education and vaccination – drugs still make lives better for billions of people. It’s time to look past headlines, TV ads and screaming blogposts and ask what each drug does for the greatest good of the greatest number.
And retain sanity and flexibility in the discourse – even in 2013.
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