Your Call Is Important To Us

by Penny, Laura

  There are two main things, beyond the expense and trampling of civil liberties, about the War on Some Drugs that bother me. First, that anti-drug crusaders tend to be hopped up on pills, liquor, God, or their own righteous zeal. My favorite example of this is the infamous 1970 photo of Nixon and Elvis, after the pill-popping president made the pill-gobbling rock god an unofficial deputy in the War on Some Drugs. Second, the War on Some Drugs is largely a war on the poor. The cartels have lawyers and bodyguards and havens to protect themselves from justice. The minor players and users do not. Some drugs are classier than others, but the abjectness of the drug user’s condition, and the force of prohibition against them, is dependent on the class of the user, not on the effects of the substance itself. Woe betide the collared crackhead from Any Ghetto, who can look forward to a stint in prison. Would that he, like Noelle Bush or Rush Limbaugh, had the resources for revolving-door rehab.

  I have tried several of the Some Drugs, the operative word being tried. I drew my line in the sand at hard drugs like crack and H, but I have certainly inhaled—and popped, guzzled, snorted, and swallowed. My life didn’t go straight to hell, and I encountered most of these substances, controlled and uncontrolled, in stolid middle-class surroundings. I didn’t care much for most of them, but was glad that I had given them a whirl and seen what all the fuss was about. I was never arrested or assaulted or violently ill or driven spontaneously mad. The only drug that has ever made me feel truly wretched is alcohol, the universal solvent of North American good times. I suspect this reflects the drug experience of the vast majority—try a smidge of this and that at a party—but it’s the recovering celebs, shattered junkies, brain-dead Phish followers, and ladies who drive home with a body stuck on the front of their cars that you hear about when you hear about drug use. Nobody gives you an honest warning, like that coke may make you an asshole, or that E may cause you to hug total strangers and dance to lousy music.

  The only illegal drug I liked, and continue to like, is pot. We have been on the verge of decriminalizing small amounts of marijuana for personal use up here in Soviet Canuckistan for the past couple of years, but have yet to do so. Canada did pass a medical marijuana law in 2001, and set up a contract with a company called Prairie Plant Systems to establish a pot farm in Flin Flon, Manitoba, to provide marijuana for patients who meet the stringent guidelines, and to provide pot for medical research. The January 2005 stats from the Office of Cannabis Medical Access, the agency that administers the program, show that about eight hundred patients are legally allowed to smoke pot, and five hundred patients are allowed to grow a little for their personal use. Critics of the program argue that there isn’t sufficient scientific evidence that medical marijuana works. This canard has also been used by U.S. federal drug warriors when meddling with Compassion Clubs in the states that allow medical use of marijuana. While smoking anything does damage the lungs, people have turned to the kind bud for thousands of years to soothe pain, aid sleep, and stimulate the appetite. You cannot overdose on it, unlike many pharmaceuticals. As far as I’m concerned, if it’s good enough for Queen Victoria’s cramps, then it’s fine for you and me, too. It’s all well and good to want to keep pot away from the wee developing spuds, but you have to be a merciless puritan to insist we should deny the anodyne charms of a benign weed to the palsied, the cancerous, the seizing, and the wasting away.

  Of course, it’s not just the puritans who are keeping the ganja down. Big Pharma is also a player. The Partnership for a Drug-Free America, the nonprofit organization that produced some of the anti-drug ads I referred to earlier, is the beneficiary of hundreds of thousands of dollars in donations from tobacco companies, alcohol companies, and the most generous donors of all, pharmaceutical companies. Drug companies contribute about half the money that goes into making Partnership for a Drug-Free America ads. Big Pharma is happy to whip up a batch of Marinol, its own saleable form of THC, but they don’t want you frying your sweet little egg of a brain with that amateur shit from the street. They want you to take the good drugs—the patented, prescribed fruits of Big Pharma.

  Perhaps the only thing as distasteful as the drugs-are-bad ads are the obliviously chirpy drugs-are-good ones. In keeping with the general ad creep, ads for drugs have increased and spread into more media. Such up-with-pharma ads are a recent innovation. In 1997, the Federal Trade Commission decided to allow more direct-to-consumer (DTC) advertising of prescription drugs, and pharmaceutical companies now spend more than $2.7 billion a year shilling their pills. The only Western nations that permit such advertising are New Zealand and the United States. The Canadian government is trying to decide whether or not to allow DTC ads, but this is an utterly moot point, given that most Canadians watch oodles of American television, and I have seen “ask your doctor” ads run on Canadian television for months without any Health Canada crackdown.

  I’ll return to the topic of DTC advertising, but first, it is important to note just how big Big Pharma is. Tech, schmech—the savvy investor has known for many moons that pharmaceuticals are the solid bets. A friend of mine made sweet returns on his modest investments throughout the bubble’s bust, when everyone else’s portfolios were tanking. I never saw him read the financial section. He preferred Baudelaire and haiku. When I asked him what his secret was, he summed it up succinctly: drugs. Ah yes, grasshopper, drugs, the answer to so many questions. Pitted skin? Bad mood? Going bald? Getting limp? Nothing that a little Accutane, Paxil, Rogaine, and Viagra can’t fix.

  Those are just the lifestyle pills you’ll see on television and in magazines. The Valley of the Dolls stretches far deeper and wider than that. There are all the disease-specific pills: the heart and cholesterol pills people pop to fend off the nation’s number one killer, cardiovascular disease; and the AIDS cocktails, and varying hellacious regimes of cancer drugs. Then there’s the galaxy of painkillers and sleep-inducing elixirs, and all the psychiatric drugs that have yet to achieve the marquee status of Prozac. Then there is the gastrointestinal superstar, Prilosec, an acid-reflux remedy that has spawned a spin-off for the related pain of esophageal erosions, Nexium. And let us not forget the arthritis blockbusters like Celebrex and its recalled fellow, Vioxx, which brings me to another vast pharmaceutical category: drugs for the ravages of old age. While other cultures venerate their elders and treat them as sages, we excel at keeping our old fogies stoned. Chances are, the most pixilated pill-poppin’ rave kid is strung out on only half as many chemicals as your average golden-ager. The majority—more than 80 percent—of seniors take prescription drugs. They also take more prescription drugs than younger people. Over 40 percent report using more than three prescription drugs.

  The downside of all of these miraculous pills are that they don’t come cheap. Health care costs have ballooned all over the industrialized world, and pharmaceutical costs are part of that massive swelling. The United States, the globe’s leader in health expenditures, spent about 15 percent of its GDP on health care in 2002, according to the Organization for Economic Cooperation and Development (OECD). In dollars, that’s over $1 trillion, more than double what it was in 1985. Part of this can be blamed on inflation, but a larger share is due to expensive new technologies, the growing needs of an aging population, and the increased price and usage of prescription drugs. The 2004 OECD report notes that costs for prescription drugs grew twice as fast as other health care costs, driving up the overall total.

  The Kaiser Foundation did a breakdown of the three factors driving rising drug spending from 1997 to 2002, finding that 42 percent of the increase was due to more drug sales. This is a trend that has been going on for a long time. From 1980 to 2002, prescription drug use tripled. Newer, more expensive brand-name drugs replacing older, more inexpensive ones accounted for another 34 percent of the increase. Price hikes accounted for the other 25 percent. This trinity of increased sales, spiffy new products, and higher prices may be tough on Grandma, but it is fantastic for pharmaceutical companies. From 1995 to 2002, Big P
harma was by far the most profitable sector listed in the Fortune 500. In 2003, they slid to third, behind oil and banking, who had blockbuster years. But big Big Pharma profits are another long trend. The prescription drug industry has enjoyed profit margins two and three times as hefty as those of other industries over the past twenty years. To give you some sense of the gap between Big Pharma and other sectors, consider this: In 2002, which wasn’t even the best year of their reign, Big Pharma’s profits exceeded the total profits of the other 490 companies on the Fortune 500.

  In the early nineties, the industry began to face criticism for the rising cost of drugs from managed care organizations eager to cut their own costs. Big Pharma also has to reckon with a tenacious Gray Power lobby that has all the time in the world to circulate petitions, write angry letters, and call in to talk radio. You can’t find a more tear-jerking photograph than a gaggle of frail seniors taking a bus to Canada to fill their prescriptions. It packs a PR wallop. Those poor dear little grannies shouldn’t be on that bus! If seniors are on a bus en masse, they should be en route to a leaf tour or to hear Wayne Newton playing Branson, enjoying some golden-years leisure, not scrimping on scrips.

  The standard Big Pharma argument against charges of profiteering is that scientific research requires big bucks. Those selective serotonin reuptake inhibitors (SSRIs) aren’t made of pixie dust and moonbeams; it takes years of hard work by millions of geeks in white coats, tormenting countless small mammals, peering into microscopes, and penning lengthy studies to find a new drug. According to the nice people at the Pharmaceutical Researchers and Manufacturers of America, it can cost up to $500 million to bring a drug to market, and only a fraction of all drugs developed ever make it. Another industry figure claims it costs $800 million to create a new drug. Whenever hated topics like price controls and patent monopolies come up, Big Pharma pleads science and implies that less money or shorter patents means less science means fewer miracle cures. We need to pay for our research, they say, and protect that research from competitors who might spirit the miraculous new chemicals away.

  Here’s the rub: Big Pharma doesn’t pick up the tab for all the research that creates the miraculous new chemicals. In fact, when you break it down, research money flows from a variety of sources. Much of it is conducted at public facilities that use taxpayer dollars, courtesy of the National Institutes of Health (NIH). Then there are the ones that come from universities. Then there are chemicals developed in other countries that get patented and introduced in the U.S., like Celexa, a leading SSRI originally developed by the Danish firm H. Lundbeck. A report by Ralph Nader’s advocacy group, Public Citizen, contends that fully 85 percent of the research and development behind the top five drugs of 1995 actually came from taxpayer-funded studies or foreign research.

  Tamoxifen, the breast cancer drug, is a nice example. It began as a British birth control pill in the sixties. The Brits tested it as a breast cancer treatment throughout the seventies and eighties. Money from the American taxpayer funded tons and tons of studies and tests in the nineties, and continues to fund research to this day. A billion-dollar concern called AstraZeneca patented it for sale and pays a wee royalty to the NIH while making millions and millions. Tamoxifen is the most widely prescribed breast cancer drug, and they’re testing it as a preventative measure for at-risk women, even though some studies show that it may cause strokes or other cancers. People pay way more for it in the States than in Canada or in Europe, even though it’s the same drug from the same company with plants all over the globe. And when not making cancer drugs—oh, genius of capitalism!—AstraZeneca manufactures pesticides.

  The Naderites also point to the preponderance of “me-too” drugs, that is, drugs that are a lot like existing popular drugs. Until 1992, there was a way of determining whether or not a drug was truly a revolutionary breakthrough, or simply a variation on a theme, as Paxil and Zoloft are to Prozac. The Food and Drug Administration used to classify all new drugs based on one of three categories. Class A drugs were important therapeutic gains, Class B modest ones, and Class C the copycats that duplicated existing products. The Bush père administration scuttled this classification system at the urging of the pharmaceutical lobby. The lobbyists were pleased about their success, and no wonder: Half the drugs approved between 1982 and 1991 were class C, and 31 percent class B. A measly 16 percent made grade A. It’s not just the Naderites who are fuming, either. The former editor of The New England Journal of Medicine, Dr. Marcia Angell, argues that two-thirds of the new drugs the FDA approves are mere me-toos. If you’re going to brag about the innovation, Big Pharma, how’s about you magic up a cancer cure that doesn’t make other cancer, instead of making Antidepressant Potion Number Nine or Viagra: The Sequel?

  The $500 million per drug figure seems awfully generous, too, when you consider the way research is being conducted by a growing clinical trial industry. In 1999, the New York Times ran a couple of deeply creepy investigative reports about cost-cutting and outsourcing in the drug industry. Clinical research has traditionally been the work of academics working under the auspices of universities or teaching hospitals. But academics are not particularly speedy people, and speed is the new watchword in the highly competitive drug-testing market. Consequently, more and more private research companies are conducting clinical trials. Universities have lost about a third of their clinical trials over the past couple of years to other forms of testing. More independent doctors are also performing tests. In 1990, only about four thousand U.S. doctors performed clinical trials for new drugs. By 1997, that number had reached 11,662. Doctors were frequently offered bonuses for signing up enough patients for a trial; one was offered $50,000 if he could round up fourteen guinea pigs for a test of a Merck hypertension drug. Other doctors regularly receive faxes encouraging them to cash in by either running trials or simply recruiting test subjects. The Times investigation also found that many of the doctors running tests had little experience doing so, and often ran studies outside their areas of expertise. And wherever and however the research occurs, drug companies ultimately control which results get published and publicized and which ones get buried.

  Speed isn’t just the watchword for pharmaceutical companies, either. The Food and Drug Administration, which approves all new drugs in the U.S., has picked up its pace. Part of the reason it has picked up the pace is that the industry is paying it to do so. Sick and tired of a balky, underfunded, ponderous drug approval process, industry began paying user fees to get their dope stamped with the federal okay. A 1992 bill called the Pharmaceutical Drug User Fee Act (PDUFA) meant that industry ponied up six-digit fees for every new drug they submitted, in exchange for approval processes that took only six months or a year, rather than two or three years. While the PDUFA has funded more staff at the FDA, and the government hails the program as a success for patients, some critics have argued that the snappier turnaround time for more new drugs may well have something to do with a rise in adverse drug reactions.

  Don’t misunderstand me: Our prodigious appetite for legal drugs is not entirely misguided. Pills sure do beat a poultice or a good bleeding, and they are less invasive and traumatic than surgery. In fact, it is their very convenience that makes us so dependent on them, and that offers grounds for worry. After all, William S. Burroughs described junkies as the ultimate consumers. They’ll pay any price, and they’ll wait for the man, so long as they can get their soma. But God only knows what effects any of the current blockbuster drugs will have in twenty-five years, or in the children of people who take them.

  Oh, sure, you pay the man and you takes your chances, but maybe it’s not the best idea to go swallowing and wallowing in all sorts of relatively new chemicals in a big rush. In the eighties, 233 prescription drugs came to market; in the nineties, that was up to 370, thanks in part to clinical trial and FDA approval times being shortened in the interest of getting drugs to market as quickly as possible. Big Pharma’s line is pretty simple: Callooh callay, o frabjous day
, more people can get their hands on more medicine. This is the same basic argument you hear from the up-with-the-stock-market types. If more people are doing it, and there is increased participation in the market, it must be good. At the risk of pissing on the progress parade, an increased market share is also an increased radius of consequences. If the markets tank now, more people feel it. If a bad drug somehow makes it to market, more people run the risk of taking it. The most recent example of a drug gone wrong is Vioxx, the arthritis blockbuster that Merck withdrew from the market in fall 2004. Clinical trials found, in the euphemese of the press release, “there was an increased relative risk for confirmed cardiovascular events.” If 488,000 Google hits for the phrase “vioxx recall” are any indication, then the class action suit filed against Merck should be a mother. The other big arthritis drugs, such as Celebrex and Bextra, are also being subjected to side-effect scrutiny and the specter of litigation.

  The idea that the people have spoken, and have asked for drugs, glosses over the fact that the people are spoken to before they speak. According to a few estimates, those great Big Pharma research budgets are only half as big as the corresponding advertising and marketing budgets. This brings us back to the pharma ads. There have been prescription drug ads running in newspapers and magazines since the early eighties, but it was not until 1997 that the FTC relaxed standards to allow electronic advertising. Since then, ad spending has mushroomed. In 1991, pharmaceutical manufacturers spent about $50 million on “ask your doctor” advertising. In 2001, they spent $2.7 billion. Big Pharma also spent about 12 billion clams in 2000 on marketing to doctors—in the form of samples, paraphernalia, and junkets to exotic places.