Pill pushing has inevitability in the best of all possible worlds. It brings good and bad. It reflects the free enterprise that built the modern world. The bonanza of effective medication that capitalism produced seen besides the insignificant output of communist Russia and its satellites gives some measure of its effectiveness. Besides drugs that have radically improved the ability to fight infection and resist heart disease, the drug manufacturers (Big Pharma) have produced many failures such as thalidomide. Failure we expect, but even after learning of them manufacturers continued to promote the dangerous substances with marketing no less effective than that they devoted to the best validated of their merchandise. Understandably the dominant meme, “profit or perish”, dictates that response. To optimise the benefit Big Pharma can bring, society has to exercise careful restraint on free enterprise. Sadly, a successful combination takes time to develop. Restraint necessarily lags behind the enterprise that needs control. Many victims of thalidomide still wait for their promised compensation.
I entered psychiatry when Big Pharma delivered a marvellous boon, chlorpromazine, a drug that rapidly calmed the agitated insane. I watched it transform the lunatic asylum. For a while I shared the hope that drugs would overcome schizophrenia, but learned to accept that they do no more than make life easier for patient and carer. Then came the the mood lifters and the mood downers in a flood that besotted a generation. Big Pharma grew exponentially until it dwarfed the dye industry that founded it. I watched as the diagnostic net of psychiatry expanded to encompass the population, young and old, and justify flooding it with medication. What conclusion should we reach about illnesses that increase parallel with an enormous increase in their treatment?
In the 1990s I encountered more and more cases of medication-induced mental disorder. Many publications document the increase in medical poisoning: neuroleptic toxicity, the serotonin syndrome, akathisia and the like. I watch psychiatrists deliver enormous doses to patients, who become worse. Instead of recognising error, with lop-sided reason the therapists take deterioration to justify giving even more of the same. Once well-known as reprehensible, the combined use of many drugs, polypharmacy, has become routine. I encountered relatives, who had tried every means to persuade psychiatrists that the treatment made their family member worse before finally resorting in frustration to the courts. One set of parents even mustered a support group that demonstrated outside Parliament. I have not seen a single appeal to reason succeed. The psychiatrists, overwhelmed with admissions to hospital and eager to discharge patients as soon as possible through the revolving door, instead of letting their victims go hung on tenaciously to their revealed failure. The challenge to their authority, or the criticism of their acumen, made them the more determined to continue. The memes of their group hold them in thrall. They maintain their hold on their victims using powers of compulsion conferred by compliant legislators.
Tuke
July 21, 2012 5:22 pmIt is easy to believe that regulation is the answer to problematic drugs. If a company produces a drug that has bad side effects our immediate reaction is to call for government regulation, without considering that the presence of a vast, expensive, inefficient, bureaucratic government regulatory structure might cause or at least contribute to problems in the pharmaceutical industry.
Consider, for example, a company seeking to develop and market a totally new antidepressant. The cost of research would be high, but the likelihood of government restriction on and opposition to a new product would be higher still. It might therefore be safer to modify an old drug slightly (attracting less regulatory attention) and put the money which would have gone into researching the new drug into promoting the variant of the old drug.
This might allow the company to make money more safely, but it inhibits development of new products.
It is common for people to perceive government regulation (in just about anything) as a solution when it might be a fundamental problem.
David Bell
July 25, 2012 6:50 pmBureaucratic regulation can stultify, but with pharmaceuticals the record has been one of regulation neglected rather than over-zealous enforcement. The FDA in the United States did not reveal the raised incidence of suicide evident in the data submitted to it by manufacturers until forced by legal action. The FDA in Australia has taken an even more lenient attitude. The courts have had a far more retardant effect on the potential of manufacturers to provide drugs for the relief of suffering. To be precise, the harm has come from the opportunistic use of the courts by litigants pursuing the prospect of compensation. The endless claims of birth defects due to Bendectin, a drug used to relieve the nausea of pregnancy, forced its manufacturer to withdraw it despite its repeatedly proven harmlessness. Nobody contested its benefit. The courts would deliver justice more readily were they to take effective means to prevent unfounded vexatious claims.
As for copy-cat drugs, they appeared long before governments beefed up the regulation of pharmaceutical manufacturers. Their invention allows other companies to enter a lucrative market. And has the lure of profit really promoted new products? Perhaps none at all. A surgeon and an anaesthetist began the revolution in drug management of mental illness by noticing the effect of chlorpromazine. Geigy hung on to the first effective antidepressant, reluctant to market it until well after clinicians proved its effectiveness. Basic research by earnest scientists still brings about the real advances. But about one matter we can certainly agree. Government regulation does not produce advances. Communist Russia demonstrated that only too well.
Tuke
July 26, 2012 6:03 pmAlthough new drugs might be a product of individual creative effort, the fact that so many effective medications are widely available in Western society can only be explained as a result of the free enterprise system.
A recent bureaucratic initiative from Canberra is to take the analgesic, Di-Gesic (combined paracetemol and dextro-propoxyphene), off the market on the basis of it causing cardiac harm.
A patient with chronic pain following spinal fracture in a fall viewed the exclusion of this product with concern and wrote to the medical committee responsible for banning the drug with a request for advice on an alternative preparation. In keeping with the best government tradition, there was no reply.
General practitioners and pharmacists could not advise alternatives compatible with the patient’s physical limitations. None had encountered the cardiac effects for which the product is to be removed from the market. On the contrary, they said many patients had used it successfully with relief and without ill effect. It appears that a useful pain relieving drug is to be lost to consumers at a time when many media reports say chronic pain is a major health problem.
David Bell
July 26, 2012 9:20 pmI agree. I know of other drugs taken off the market to the disadvantage of ill people, thioradazine in particular.
Tuke
July 27, 2012 3:53 pmHere are a couple more examples of withdrawal of useful pharmaceutical products: Promazine, an antipsychotic related to Largactil (chlorpromazine) but without the latter’s risk of obstructive jaundice, was taken off the Australian market in the 1970s because relative lack of use by medical practitioners made its maintenance uneconomic for the manufacturer.
The same applied to an effective vaccination against shingles (Xostavax), even though shingles affects many older Australians annually, with a significant death rate. This product was on the Australian market briefly and disappeared almost at once. Perhaps its demise in Australia was because it was expensive, not funded by government, and older Australians (who would benefit most) are not much in favour with the present health authorities.
The withdrawal of Melleril, an effective antipsychotic, was puzzling to many psychiatrists who had prescribed it for large numbers of patients in moderate dosage without ill effects.