America and Pharmaceuticals – A Love Story

“Every educated physician knows that most diseases are not appreciably helped by medicine.” So says Richard C. Cabot, M.D. of Massachusetts General Hospital. Despite the many studies and medical professionals that support Dr. Cabot’s opinion, we persist in the use of toxic chemicals to treat disease. The Department of Health and Human Services says Americans take more prescription drugs now than ever before; at least half of us take one, and one in six of us take three or more medications. It’s unlikely that western medicine will undergo a major shift in philosophy anytime soon, but it certainly begs the question: why do Americans take so many prescription drugs?

In the 1980’s the Reagan Administration portrayed the Food and Drug Administration (FDA) as a bloated bureaucracy that was getting in the way of business by making it too difficult for new drugs to be approved. Admittedly, it was a slow process. It could take two years to get approval for a new drug and if you were part of the AIDS crisis that surfaced in those years, two years was too long. Reagan’s push to decrease government’s role in all businesses meant slashing the budgets of regulatory agencies like the FDA. A weaker FDA was seen as a good thing by drug companies who wanted to bring new AIDS drugs like Agenerase (amprenavir) to market. But lower funding meant the FDA was understaffed, so Congress came up with the Prescription Drug User Fee Act (PDUFA). The act stipulated that a fee be paid by pharmaceutical companies to the FDA for each new drug application, essentially allowing drug makers to pay staff salaries at the agency. The number of staff at the Center for Drug Evaluation and Research (CDER) doubled overnight. Today, the FDA receives about $260 million a year from these fees, blurring the boundary that had previously existed between the FDA and the drug industry. The boundaries are even fuzzier because FDA officials are allowed to move to jobs within the pharmaceutical industry; if someone doesn’t want to burn bridges with a drug company, they may be inclined to approve new drugs, whatever the findings may be. Finally, the FDA gets input from outside advisory panels made up of doctors who are experts in their fields. Most of these doctors receive payments as consultant fees, research grants and support for travel to conferences from drug companies. This doesn’t bode well for consumers looking for unbiased scrutiny of new drugs because “expert consensus guidelines” have a potent effect; doctors can be held liable if they do not adhere to accepted standards of care. As a result, while the number of people with disease is not growing, the number of adult Americans taking medication is increasing – half of us take prescription drugs every day.

It’s not surprising then, that in 1997 the FDA allowed direct-to-consumer advertising of pharmaceutical drugs on television. It also lifted the requirement for ads to list every possible side effect. In the next year TV ads increased retail sales of the most popular drug types by 12% and Americans began popping more and more anti-depressants, cholesterol-lowering drugs, antihistamines, heartburn remedies and nasal sprays. The Kaiser Foundation found that for every dollar spent on advertising, retail sales increased by $4.20. As of 2009, the U.S. and New Zealand were the only developed nations that allowed direct-to-consumer advertising of pharmaceuticals. The industry, however, is lobbying hard for the same rights in Canada and Europe.

Now that drug makers are sending us to our doctors for the drugs we see on TV, 54% of them will prescribe specific brands if we ask. And worse still, the companies seem to be finding new ailments we’ve never heard of and new drugs to treat them with. Ever heard of “restless leg syndrome”? I confess that I get it myself sometimes, and yes, it drives me crazy. So I get up and stretch. Problem solved. Chronic kidney patients may actually need a solution in the form of a prescription drug, but most of us don’t. The trend to medicalize conditions like menopause, irritable bowel syndrome, sexual dysfunction and osteoporosis amounts to drug-mongering. Often minor conditions are hyped into full-blown diseases which demand expensive, sometimes risky chemical intervention.  

I often remark that pharmacists know more about drugs than the physicians who prescribe them. With over 5000 medical journals and one million articles published each year, physicians can’t keep up. They depend on information provided by the pharmaceutical industry and on the reps that visit their offices. Drug makers hire academic physicians to give lectures – with company approved slides only. Drug companies also reward doctors who prescribe their drugs frequently with trips dinners and other gifts. Research studies show that, although doctors deny that the perks have any effect on their prescribing practices, there are changes in objective measures, like how often a doctor will try to have a drug from a particular company put on his hospital’s formulary.

 No matter how you slice it, America has a prescription drug problem. We spend twice as much on drugs as other countries and have worse health outcomes. In other words, we’re paying for drugs that don’t work . Sometimes the drugs we take are life-savers – antibiotics, for instance, or immune suppressant drugs that sustain transplants. But future advances in health will likely come more from changes in lifestyle, diet and exercise than from medications. Almost all of the chronic conditions for which pills are prescribed are preventable through such changes. Even conditions like cancer are partially preventable.

We Americans are in love with the idea that we can take a pill and have our problems go away. We want what we want and we want it now, so taking other actions to improve our health – diet, exercise, stress reduction, smoking cessation, and the like – just aren’t that appealing. Once we have developed a chronic condition or find ourselves in pain pharmaceuticals can make a world of difference but they ought to be our final, not first line of defense. And we’ve grown incredibly cynical. The idea of whole, unadulterated foods, clean air, activity and relaxation as preventive medicine has been derided as some sort of hippy-dippy, counter-culture nonsense. What’s being sold to us as the remedy for all ills, physical or emotional, is another drug. In the end it comes down to one question: how is that working for us?

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