Risky Business

From Gk. pharmakeutikos, from pharmakeus “preparer of drugs, poisoner,” from pharmakon “medicine, drug, poison, charm, spell, enchantment.”

As the ancient Greeks saw it, drugs, poisons, spells and enchantments were all in the same family. Over the centuries, science separated useful treatments from the occult relatives, but injected and ingested chemicals have always retained a mystical ability to inspire faith and hope.  Because we now live in a world of non-stop, sophisticated, and ubiquitous marketing of drugs to healthy people, faith and hope have to be tempered by some healthy skepticism about the products being pushed by the new shamans.

Seeking expanded markets for drugs

Drugs companies do much superb work and save lives of people who are desperately ill. Without them, our children would die of simple infections and surgery would be, at best, unsafe and very painful.  But beyond the pharmaceutical laboratories stretch marketing departments, an enormous sales force, and corporate board rooms that seek expanded markets. Television, magazine and newspaper ads show sincere, dedicated researchers seeking cures for debilitating diseases, but the primary goal of advertising is to convince doctors to prescribe the company’s drugs. Direct advertising to consumers enlists the general public in the task.

The project is wildly successful. In 1993, around the time marketing drugs directly to consumers became legal, patients filled 2 billion prescriptions for medications. By 2003, after a population increase of only thirteen per cent, the prescription rate was up 70 per cent to 3.4 billion, or 11.8 prescriptions medications a year for every man, woman and child in the country.

Expanding disease definitions expands markets

Dig into the pharmaceutical company culture and you will find policies that push expansion of disease definitions to include more and more people who are not actually sick. Drug marketing highlights selected risk factors for future illness, and converts them into “diseases” in their own right, to be measured by tests and managed by drugs. Examples? Cholesterol levels and bone density measurements. High cholesterol and osteoporosis are not diseases since they do not impair functioning and cause no symptoms. Among many other factors, they are simply correlated with illnesses that appear later – heart attacks and fractured bones.

Other risk factors such as inactivity and poor diet – the ones unresponsive to drug magic – fade in importance as marketers seek to convince potential customers that the risk factor that responds to drugs is the primary cause of a potential illness. Scratch the surface of “awareness campaigns” and you are very likely to find drug companies behind them, ready with easily packaged solutions for the problems they’ve brought to your attention.

Keep track of the ads you see, and you’ll notice other “illnesses:” depression, anxiety, pain, sexual “dysfunction,” gas, bloating and other non-specific stomach ailments. Some people suffer significant medical problems in these arenas, but the marketing is aimed at the far larger numbers who have minor and temporary complaints that fix themselves, or can be fixed by facing problems and adjusting lifestyles. The blossoming Type II diabetes epidemic is a great new opportunity for pharmaceutical marketing of drugs – the focus will be on controlling blood sugar rather than on the weight control, diet and exercise needed to prevent the disease.

The molding of the therapeutic mindset by the drug industry

Most doctors report that they are not influenced by marketing, even if they attend industry-sponsored seminars and meetings set in luxurious vacation spots, or meet with drug company representatives who dispense free samples. But there is a much more insidious and effective corporate influence on physicians: the molding of the therapeutic mindset by continuing education. The pharmaceutical industry recruits influential physicians in respected academic institutions to oversee the studies that get new drugs through an arduous approval process. Results are reported in prestigious medical journals, under the authorship of highly respected investigators. Nothing but pure scientific interest appears to motivate the research.

But pharmaceutical sponsorship produces gray areas: reports are very often written by drug company employees who extract results from data provided by the researchers; negative results sometimes escape reporting; statistics have a way of making very modest results look impressive, especially to consumers reading the simplified translations drug companies provide as press releases.

Doctors rely on a constant stream of reports of advances by medical researchers to chart the best course of treatment for their patients. Like consumers, they need good information untainted by commerce. Professional journals now require publication of their author’s affiliations with pharmaceutical companies along with any articles involving the company’s products. This is a step toward much needed transparency. Other steps have to come from the audience. More than ever we need to be educated and to be aware of fear tactics and manipulation.

Statistics color perceptions

A good, educational starting point is a rudimentary understanding of statistics, because the benefits of drugs must outweigh their risks to justify treatment of any condition. The use of “relative” numbers to inflate trivial differences in risks and benefits is psychologically misleading and happens all the time. Reporting something as a 33% or 50 % improvement in risk may only mean the difference between one and two or three cases in the 100 people studied over however many years the study ran.
Vast numbers of people, including children, take daily medicines that target behaviors and moods, or single risk factors for a disease. Based on short term studies, the drugs appear safe. But there are no long term studies yet to guide us in this new era of perpetual drug use aimed at optimizing behavior and preventing disease.

Be wary; ask what statistics really mean, and pay attention to drug-free ways of preventing disease and modifying behavior.

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