Free Pharmageddon by David Healy Page A

another set of consumer goods at the mall, conflict with the reality of diseases that shorten and compromise lives. People with diabetes are taught to prick the side of their fingers to get blood samples because the disease brings a risk of blindness and they may need the pulp of their fingers to remain touch-sensitive—good care does not deny these possibilities or put them in the small print of an advertisement. Medicine aims at a myriad of adjustments, with as much assistance as possible from technology, in order to cope with the frailties of the human body and mind; it aims at producing as much health as possible out of mankind's most debilitating afflictions. 1 This is quite a different project than the enhancements health products offer.
    At the heart of medicine is an act of care by doctors who talk, look, listen, and do something for patients who come to a clinic acutely ill with an abdominal problem, a heart attack, or a broken limb, or druginduced injury where every patient is different and care necessarily has to reflect this. While today's rhetoric is more and more about personalized medicine, the practice of dispensing health products has moved increasingly to standardized screenings for risk factors with treatments like the statins, or drugs for osteoporosis, nervous problems, or blood sugar control that clinical trials suggest in many cases are at least as likely to harm us as to help—a practice that is as far from caring as it is possible to get.
    Generations of revolutionaries have talked about the alienation market forces and industrialization produce, the loss of jobs and skills, of values and ways of life, but many of us in the economically developed world have seen our material circumstances improve and have shrugged. Why should we expect anything less than comparable improvements in medical care—especially as we seem to hear of ever more medical breakthroughs in the media?
    There are a few reasons why things are different now. One is that drugs and other services in the medical market physically act on the stuff of which we are made and may reconfigure us quite dramatically in ways we are not told about. Unlike short courses of antibiotics, which do not substantially change us, chronic courses of treatments aimed at managing risk factors do change us. Whether it be a cholesterollowering statin, an anti-inflammatory such as Celebrex, a treatment for osteoporosis such as Actonel, or a psychotropic cocktail, these drugs do not just have the action we are told about but often have much greater effects throughout the body than the one the company markets, potentially leading to an increased risk of dementia in the case of Vioxx and Celebrex, an enduring susceptibility to heart attacks in the case of Fosamax and Actonel, or changes in our ability to make love in the case of Paxil, Cymbalta, or Zoloft. Beyond these specific problems, the indiscriminate actions of many of these drugs on our physical constitution quite probably alter both our susceptibility to various diseases and our personalities too in subtle ways.
    A second reason things are different now is that unlike other industrial processes, many of which have led to tangible benefits, the logic of healthcare marketing may block real benefits. Companies initially attempted to play down the evidence that ulcers were linked to a bacterium that could be eliminated, because this information wasn't good for business. They have similarly been extraordinarily successful at replacing older generations of antibiotics, psychotropic drugs, and anti-inflammatories with less effective and more hazardous agents such as Celebrex, Prozac, and Cipro. As a result some of us are now dying earlier than we should, and many more are suffering needlessly. By taking us away from productive work any premature deaths and incapacity come at a cost to the economy, and so it is in the interest of all of us to pay attention to the medical care each of us gets.
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