March 05

Can We Really Trust Prescription Drugs?

By Stephen Hanks

   "I'll tell you why America has a drug problem,” begins a riff of the legendary comedian and satirist George Carlin. And before the audience can think his routine will be a commentary on illegal hallucinogens, Carlin careens into another track. “Everybody has access to drugs because there are so many DRUG stores. Every three or four blocks, there’s a big sign—DRUGS. Open all night—DRUGS. We deliver—DRUGS. Cut rate—DRUGS. It’s the biggest thing on their signs: cosmetics, sundries—DRUGS! It’s no accident that our country is so drug-oriented. The drug companies got us that way and they want to keep us that way. It all starts with that little colored aspirin for children.”
   While such a cogent commentary would be relevant today given the most recent headlines about the dangers of some prescription drugs, Carlin first performed his drug routine in 1970—35 years ago. Carlin’s comedic observations have always been ahead of the curve; it’s a shame he turned out to be prescient on the subject of pharmaceutical drug use in America.
   Our society’s relationship with prescription drugs is at a crossroads. When the anti-inflammatory Vioxx was pulled from the market last September and fears were expressed about the potential heart-damaging side effects of other Cox-2 inhibitors such as Celebrex and Bextra, it sent shudders through the hearts of people who were using those drugs to treat arthritis and pain. And the concern over anti-inflammatories, which came on the heels of worry about the side effects of antidepressants, may just be the tip of the iceberg.
   The next titanic class of drugs to be sunk could be the cholesterol-lowering drugs called statins. One such drug, Baycol, was withdrawn from the market in 2001, and the Food and Drug Administration (FDA) raised a red flag in January when it voted against recommending the over-the-counter sale of Mevacor. As you read this, lawyers throughout the country are developing thousands of cases against the companies which produce statins because of side effects that have damaged muscles, livers and kidneys only a few months after people start taking the drug.
   This is what has the public dazed and confused about prescription drugs: If you take a drug for one health problem will it cause another even worse problem? But the questions don’t stop there. Which drugs are safe to take together? Which drugs cause nutrient depletion in the body? Are doctors equipped with the information they need to advise patients properly? Just watch one of those TV ads pushing a drug, where half the time is spent on dangers and disclaimers, and you understand how confusing—almost scary—it all is.
   This is not to say we should live in total fear of prescription drugs, many of which have helped millions of people during the last century. Antibiotics are the closest thing to a miracle drug as has ever been developed. The problem is that we’ve become a society in love with magic pills and potions that can supposedly cure all ills, and corporate drug companies are only too happy to cater to our every whim and capitalize on every health fear.
   Just reading the statistics is enough to make you reach for the aspirin bottle. According to the Los Angeles Times, a total of 3.5 billion prescriptions—medicating 129 million Americans—were filled last year. That averages out to almost a dozen prescriptions filled for each of the country’s 290 million citizens, and more than 40% are taking at least one prescription drug every day.
   But here are the even more depressing stats: According to the nonprofit Citizen’s Health Research Group (CHRG), each year roughly 1.5 million people are admitted to the hospital due to adverse reactions to drugs and of those, about 100,000 die. What causes the adverse reactions? The CHRG cited seven reasons, including: the prescribing of a drug for a “disease” caused by the adverse reaction to another drug; prescribing two drugs that are safe on their own, but harmful when linked together; and dangerously high doses of one drug or two drugs within the same class.
   So how did we find ourselves in this poisonous pharmaceutical soup? Actually, everyone is to
blame—the government, the health agencies, the drug companies, the doctors and even we patients—for succumbing to two of the seven deadly sins: greed and sloth.
   Out front in the greed parade is the drug industry, whose lust for profit knows no bounds. Drug industry revenue in the US tops $231 billion annually and in 2001, with the economy reeling after 9/11 and corporate profits tumbling, drug companies on the Fortune 500 saw their profits jump by 33% over the previous year.
   How did they do it? Overpricing and massive promotion. Only a small fraction of new drugs—usually hyped as “breakthroughs”—represent an improvement over products already on the market. Then multibillion dollar advertising campaigns seduce the public into buying more and more drugs, and at higher prices. The drug industry claims the revenue supports research and development, but it actually spends just 1 out of every 5 dollars on research.
   Why is the pharmaceutical industry more profitable than any other US industry? Because it has the most powerful lobby in Washington. Such influence has created major conflict of interest issues involving the FDA and the National Institutes of Health (NIH), two organizations entrusted with protecting our health and safety.
   The problems with the FDA are so far-reaching it would take a complete overhaul of the agency to fix them. Aside from the decades-old technology they use to evaluate drug safety and their soft drug-monitoring policies, the FDA is just too cozy with the drug companies for our comfort. A large percentage of the FDA’s funding comes from “user fees” paid by the drug companies who seek the agency’s permission to market new drugs.
   “The FDA and the drug industry are kind of like the parents of the drug and they decide what happens with a drug,” Wayne Ray, an epidemiologist who consults for the agency, told USA Today last year. “But they aren’t looking at things impartially. We need a watchdog to protect the public.”
   Congress is now doggedly watching the NIH, an agency American doctors rely on for advice
and guidance on drug safety. Last year, Congressional hearings revealed that many NIH doctors and researchers paid to study the safety and effectiveness of drugs were also on the payrolls of the companies marketing the drugs. One prominent NIH executive endorsed the controversial cholesterol drug Crestor while accepting consulting fees from four companies developing cholesterol medications— including the maker of Crestor.
   The drug companies and their enablers at the health organizations have fostered this misguided philosophy: A few deaths caused by prescription drugs are offset by the thousands of people who are helped. That’s like the military saying it’s okay to take out an enemy building if only a few hundred civilians die. Such collateral damage is totally unacceptable. Is that hopelessly idealistic? Perhaps, but to paraphrase Atticus Finch, the lawyer from the great novel To Kill a Mockingbird, such a health policy should not be seen as an ideal, it should be a living, breathing reality.
   So, who is responsible for the sin of sloth? The blame for that lies with us—the consumers of prescription drugs. Until people stop seeking magic medications to avoid working on lifestyle changes, and until people stop badgering doctors into giving them prescriptions as if they were free samples of candy, then the drug companies will keep feeding us medicines that aren’t always good for us.
   Can we really trust prescription drugs? Yes, but we must become more vigilant about understanding what we put into our bodies and about seeking the safe and cost-effective alternatives to questionable drugs. They are out there. You just have to want to find them.

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