04 December 2007

It's for stuff, not for people

All right, so I've told you I've been researching the pharmaceutical industry. I've been reading all these books about it and trying to find as many stories I can, and thinking about all these stories I'm hearing from my relatives. What keeps me watching Sicko and reading nonfiction titles like Over Dose and Hooked and looking for a way to tell this story is that everyone's health has declined so much in the past few years. It's my own personal Freakonomics study. My hypothesis: what everyone has in common is prescription drug use.

I'm seeing people gaining more weight that ever, being more anxious about their health, and having a more fragile connection to their bodies and their states of health. I'm seeing a scary kind of dependence on something that is completely foreign, external, and about whose long-term effects little is truly known. As many of these authors I'm reading (Brody, Brownlee, Angell, Cohen, Abramson, etc.) are saying, we're all subjects in one giant health experiment.

I think my first shock came when I realized that FDA approval for a drug doesn't necessarily mean much. With all the information that has come out about the way drugs are marketed and priced, brand-names vs. generics, and the way drug companies are manipulating study results these days, not to mention the utter chokehold the U.S. insurance industry has on the economy, it's pretty clear that big pharma is not in it for the public good, and our regulatory watchdogs aren't in much of a position to do anything about it.

Yet the public good was the motivator until surprisingly recently, until drugs started to be marketed directly to individuals on TV and in magazine ads, an approach that was unthinkable until as recently as the late 1960s. This approach had been suggested before then but was rejected for its potential to weaken the important expertise of the doctor in the critical doctor-patient relationship. And indeed this has come to pass, with people insisting that they need their doctors to prescribe Viagra or fen-phen or Vioxx -- or, worse, Prozac for their teenagers.

So I've been amassing data and now I'm trying to spin out a tale that shows some of these facets. How the FDA can't really stop a drug that a drug company is heavily invested in, especially if it's predicted to be a "blockbuster" drug. How even with less oversight and fewer controls than ever, it's in the drug makers' interests to make the FDA out to be the big bad bottleneck that keeps these miraculous substances out of the hands of the people who need them so badly. I see how studies are designed to make one pharmaceutical company's drugs look better in comparison to existing formulations, or even compared to a placebo (looky here, this is two percent better than a sugar pill!). I see how study authors are paid to reach and write up forgone conclusions.

The one I love is how big pharma likes to say it's expensive to bring new drugs to market because of the cost of the necessary research and development. Get this, though: A huge chunk of what these corporations list as expenses includes the "opportunity cost" of not being able to market and sell their drug while it is in the development and trial phase. So when companies say "It costs $1.7 billion US to launch a new drug," this translates to: "We've been restricted from earning $850 million while the FDA's been twiddling their thumbs." Add to this the subsidies they get from the taxpayers (who fund the research hospitals where drugs are developed and tested), and the fact that drug companies turn around and start extracting profits from products developed on the public's dime without compensating the original researchers or institutions -- except through different channels that give them more control over the outcome. Once in place, the institutions seldom want to jeopardize these funding sources; without them their institutions would suffer.

And now if you look at the drugs in the development pipelines, they are the ones for "lifestyle management" (or even enhancement -- see Viagra and its me-too drugs), rather than to cure AIDS and malaria and other persistent ailments that beset those among us who don't have the luxury of overeating and underexerting ourselves. I'm guessing cancer drugs are major blockbuster hopes, and that we'll see these issues playing out again when there are some candidates that druge companies think will fill that gap in current treatment options.

Yesterday I watched Michael Moore's latest documentary, Sicko, which looks at the same story from another angle. He suggests that if the insurance industry should disappear overnight, a lot of people in this country would be a lot happier, maybe even as happy as the people in France or England. One of the big questions he and I have both arrived at is "How are we treating our own?" Watching Sicko, it struck me that ever since 9/11 and Katrina, it's our own country that feels like a third-world country. It's our country's people the folks at the top (the increasingly rewarded haves) are leaving behind in their haste -- to do what? Give a handful of corporate players a few more millions of dollars? (And why? To affirm the limitless potential of the American Dream? So they can buy a bigger SUV and a third home, at the expense of their workers and shareholders and the people who helped them become who they are?) Michael Moore makes the point that it may behoove those in power, which include many of those who are being paid in one way or another by the pharmaceutical industry, to keep the general populace in a state of fear, poverty, and ignorance; a confident, rich, smart populace is much harder to govern.

I am cynical enough to agree, although I think the aphorism's conclusion may be false. I look at the level of discourse in European countries like Germany and France: on television, you see responsible people engaging in a high level of debate about the issues of the day, not these Fox "News"-show shouting matches that take place between the commentators and their "guests."

Okay, this will look like a tangent, but bear with me. The other day, my daughter and I were cleaning the window on our front door. I had some spray window cleaner, and she wanted to help me wash and wipe the window. So I warned her, "When you're working with stuff like window cleaners, don't breathe in the mist when you spray it. Be sure to keep it out of your body, and don't get a lot on your hands, either. Because," I added for emphasis, "it's made for stuff; it is not made for people."

More and more I'm seeing this distinction and it is a useful one. You can learn something about the intent of the makers of something by how willing they are to ensure its safety for the people who use or depend on it. Every day we read about a new study that proves that processed lunch meats cause cancer, or that people who use a greater variety of chemicals to clean their houses have more respiratory illnesses and cancers, that lead is in our toys and lipsticks, or that prescription drugs can have disastrous side effects either when used alone or in combination with other drugs. Or that our earlier assumptions about everyone's health (like the advice to take an aspirin a day) were flawed and further research has not borne them out.

I believe that many of our health issues today stem from the way corporations are guided by money, not people. Factory farms feed the animals growth hormones and antibiotics to improve yield and suppress disease and end up introducing more profound imbalances into the animals' and humans' natural ecologies. A friend was talking with a vet the other day who bought a dairy that was transitioning to organic. The dairy is now fully organic and the vet said to my friend, "I can't believe how healthy all the animals are now." Because organics aren't just about a new market or a new opportunity but are about sustaining and contributing to the health of the organisms involved.

That's why I'm writing and working on this stuff. Because I still believe in people, in doing for people, in making life better for people. Because if all I am on this planet to do is get mine and get rich before I die, what is the point? There has to be more to it that money and toys and having more than the next guy. But sometimes you wouldn't know it to look at the companies that are supposed to be in the business of helping people recover from illness and disease.

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