pharmaceuticalized American life

7

Category : General, Medical Rants, Pharma

Tense? Lonely? There’s Promise in a Pill

In his hilarious stand-up routine, Chris Rock talks about the ubiquitous television drug commercials that “keep naming symptoms till they get one that” the viewer’s got. Sometimes, he says, the ads don’t even tell you what the pill does: “You see a lady on a horse or a man in a tub, and they just keep naming symptoms: ‘Are you depressed?’ ‘Are you lonely?’ ‘Do your teeth hurt?’ ” He adds that one commercial he saw went, “Do you go to bed at night and wake up in the morning?”

“They got that one!” he says. “I got that. I’m sick. I need that pill!”

Mr. Rock’s observations are almost too close to the actual truth to be considered satire, as Greg Critser’s provocative new book, “Generation RX,” makes clear. Indeed, baby boomers and their offspring have become the most medicated generation ever, devoted consumers from cradle to grave of every manner of pharmaceutical imaginable – pills that not only cure real diseases, but that also promise, in Mr. Critser’s words, to “do everything from guarding us against our excesses of drink, food and tobacco, to increasing our children’s performance at school, to jump-starting our own productivity at work, to extending our very time on this mortal coil.” Boomers, who grew up using drugs recreationally, have become a generation that lives almost full time in the Valley of the Dolls: bombarded by direct-to-consumer ads, they are happy to self-medicate, and their cost-conscious H.M.O.’s are happy to substitute antidepressants for expensive talk therapy, prescriptions for repeated doctor visits.

This book looks to be an interesting addition to our ongoing discussion about big Pharma.

Although Mr. Critser skims a little too briefly over the stories of specific drugs like Vioxx and Seldane that have been recalled for serious safety reasons, he does an effective job of showing why the F.D.A.’s speeded-up review process, combined with Big Pharma’s aggressive pushing of its drugs, has led to such tragic cases. He also raises important questions about the possible damage that the long-term use of pharmaceuticals may cause – from liver damage to cascading drug interactions to the more intangible psychological effects of young people relying on antidepressants and attention-deficit-disorder drugs to cope with the stresses of life.

“The principal forces that have so deeply pharmaceuticalized American life are hardly likely to abate anytime soon,” he writes. “Managed care over the next decades will continue to depend heavily upon pills as a proxy for physician care. Cost-conscious employers and insurers will make sure of that. As will Wall Street – particularly as baby boomers begin to cash in their retirement funds, which have been floating on that nice, easy cushion of double-digit pharmaceutical company returns for two decades. The average pharma C.E.O. will feel the heat and continue to do what he has been doing, only faster.”

As a general internist, I should do my best to limit the number of drugs my patients receive. I try to rely on good evidence that each additional drug will add benefit. This is the great challenge in the complexity of patient care in 2005. I hope that quality measures will address this problem.

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Comments (7)

Lipo, Botox and feel good pills are the rage. A recent article indicated those leaving New Orleans wanted their Viagra scrips filled before they left town. It is no wonder our insurance cost are so high.

My fight is with a doctor who says: “Everyone takes them and your insurance will pay.”

I think this is right on, especially the part about the CEO’s.

And now DTC TV ads wants you to talk to your surgeon about using named prosthetic appliances for joint surgery. What an insult to orthopedic surgeons as though they need their patients input suggestions for their surgical procedures. Next, the patients will be coached on TV regarding the best needles and suture material! ..Maurice.

This issue seems more a cultural phenomena and medical practioners are along for the ride.

maybe this is false, but I see children brainwashed by TV
shows and the advertsers that support shows which emphasize materialism, indulgence , and the buy now/pay later mantra. Hedonism is the underlying theme.

No wonder when kids become adults they want pills to buy in lieu of practicing common sense behaviors that are health promoting.

The real scandal underlying this issue is the corrupt collusion between the pharmaceutical industry, the FDA, and many medical reasearchers and “experts” who are secretly on the take from Big Pharma, rigging studies and tilting national guidelines to sell more drugs to us. Big Pharma has bought the FDA in the same way that Big Oil has bought the White House and the food industry owns the USDA.

What’s particularly sinister about this is the inordinate faith that the American public places in doctors and officially-sanctioned research trials. So, for example, when official guidelines for total cholesterol were lowered from 220 to 200, 24 million potential new statin drug customers were created overnight. The public bought the edict completely and began obsessing about their lipid numbers. What they didn’t realize is that the majority of the committee members voting to lower the guidelines were secretly on the payroll of companies making statins. (This was also true of committee members voting to readmit Vioxx to the marketplace, despite research showing it is a dangerous product.)

The tragedy is that we are a nation of sheep. The White House tells us Iraq is a threat that must be erased and we unquestioningly vote for war. Doctors tell us that high cholesterol is a health danger that we must control (even though, like Iraq, this connection has never been proven) and we rush out to purchase an expensive drug that weakens our muscles, fogs our recall ability, and endangers our livers and kidneys.

In both instances (and many others) we are getting what we deserve for our ignorance. The sad thing is that there will be much (needless)suffering before we come to our senses and demand the truth. This is probably why evolution is such a painfully slow process.

The very real problems posed by the medical establishment today are mirrored in the problems we have with our government. When will we demand a system that provides facts, instead of spinning them? Are things already too far out of our control for this to be possible?

Until we come up with a government (and medical system) that honestly serves the public and tells the truth, we are going to have to do the hard work ourselves.

A lot also comes down to laziness. We’ve got great data on prevention of diabetes and guess what? Exercise is better than pills (Da Qing study, Diabetes Prevention Program trial, etc.). But when I discuss the options with patients, frequently the answer is “I’ll take the metformin.” Meds are a quick and easy fix. Unfortunately, meds are often only a temporary fix. Patients will always be able to out eat and out sit our meds. Maybe if patients had more of a financial incentive, e.g, they had to pay for the statins/Strattera/metformin out of pocket, there would be more incentive. But that’s a whole other can of worms.

“Lipo, Botox and feel good pills are the rage. […] It is no wonder our insurance cost are so high.”
Lipo or Botox are not covered by any insurance that I know about; you cannot even use the money from your “personal health account” to pay for them. Neither are Restylane, Renova or any other item used for cosmetic purposes. So these are bad examples – women want to look better and younger and are willing to pay for it. This has been true for centuries, the only difference is that now there are more options. Besides, looks often have an impact on one’s ability to get a job – whether or not the job requires good looks. This is really a bad example, IMHO.

As Jim Punkre says – blame drug advertising, guidelines that recommend that more and more healthy people take drugs and classify risk factors as deseases (high cholesterol, osteopenia, attention deficit disorder, etc.) With the stringency of many of these guidelines it is difficult to find a single person over the age of 40 who would not be taking something. Give me a shred of proof that statins prevent a single death in otherwise healthy women, even in those with risk factors; yet the guidelines make no difference between sexes. Some of the statins ads feature this slim healthy woman in a swimsuit. I barely manage to stay below the cholesterol numbers specified in the guidelines, and I am size 5, active and eat all the right foods. In a few years, my LDL will go above the guidelines no matter what I do.

The doctors have no choice but follow the guidelines because otherwise they’d be sued if something goes wrong.
But each of those drugs that can prevent some condition some years down the line there is a risk of a side effect here and now. While many of these side effects are not serious, they may impact quality of life now, but nobody cares about such minor issues. Also, especially in case of older people, it is often impossible to say if something a side effect of a drug or of age.
If you are a patient who is reluctant to go on prescription drugs for life, you have to spend hours researching all pros and cons because more likely than not nobody is going to give you the cons; then you have to overcome your reluctance to say “no” to the doctor. Most people don’t bother.

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