Free Pharmageddon by David Healy

Acknowledgments
    I have accumulated so many debts it would take an ocean-going liner to accommodate everyone who should be acknowledged. Some of those to whom I am most indebted have been critics, a number of whom over the last decade have held open a forum for debate in which I’ve been able to test and discard ideas. Ocean-going liners have luxuries like showers and bidets. Over the past year I’ve given lectures on the subject matter of this book in several North American settings under the informal title of “The Shower and Bidet Approach to Medical Care,” as well as in Oslo, Uppsala, Bruxelles, Gent, and Milan, and I have Andy Scull, Joel Braslow, Ned Shorter, Cindy Hall, David Antonuccio, Masumi Minaguchi, Tom Ban, and others to thank for this, and much else. Joanna Le Noury, Margaret Harris, Stef Linden, Tony Roberts, and other colleagues in North Wales have helped supply the data for many of these talks.
    It takes a lot to divert an ocean-going liner off course. Not so for a carpenter’s boat like George Oppen’s, where staying within the harbor walls seems advisable. There is a much smaller number of people to whom I owe particular debts who might fit on such a boat. These include Charles Medawar, Andrew Herxheimer, Vera Sharav, Annemarie Mol, Steve Lanes, Kal Applbaum, and Dee Mangin, who will see the beams they have contributed here but may feel they have been monstrously welded to the wrong seams, in which case they more than anyone are likely to turn green at the gills once the boat ventures out beyond the harbor mouth.
    Far from getting outside the harbor, at one point it looked like the boat would never float, but Jonathan Cobb came to the rescue through wonderful editing. Rather magically he showed me how to write the book I thought I’d written. Bev Slopen, my agent, and Hannah Love, my editor, have also had to keep faith through some tricky moments. And finally Sarah, Helen, and Justin have had to put up with a lot, including “sibling” rivalry.

8
    Pharmageddon
    Nothing more
But the sense
Of where we are
    That seeks to find, to rescue
Love to the chill
Upper world, and to speak
    A substantial language
Of Dignity
And of respect.
    â€”George Oppen, “Orpheus”
 
    Medicine as we have known it is at death's door. Real disease brings the specter of death with it, and every medical journey to some extent follows in the steps of Cora into the underworld, leaving Demeter to implore heaven to restore her to some measure of life.
    Over the last quarter of a century, what was medicine has increasingly turned into healthcare, part of a vast global market in healthrelated products. Pharmaceuticals are exemplars of the goods in this modern health products market, but entire services can be packaged and managed as commodities, just as drugs are.
    Only the market can guarantee efficient production, we're told, and we must surrender to it. The industrialization and marketization of healthcare has entailed a gamut of changes similar to those that have been seen in other industries. We see a standardization of care, with practices geared to treating patients in the same way as a service station handles a car that comes in for servicing—albeit with appropriate expressions of concern that wouldn't be necessary with a car. Meanwhile, the labor of taking risks in trials of new drugs has been outsourced to the Third World, Enron-scale scandals with drugs like Vioxx and Zyprexa have erupted, and to sell the products, healthcare advertisers now promise what automobile and shampoo advertisers have promised for years with purchase of their products—an enhanced life.
    The corporate world of today's health services industry is a long way from the clinics in which nurses, doctors, and others working with those who are suffering try, often against the odds, to produce health. Ads for healthcare products that portray patients as vigorous and embracing life, as if drugs were just