Stay Tuned/Drugged Out

[23 February 2007:] I can no longer remember what inspired me to write this rant, but I do vaguely remember the amound of commentary it drew. Some of the things people picked on were actual mistakes, others were matters of viewpoint. In March 1998 I did a round of updates to these pages (that's when the "Hindsight" sections first came into existence), and rather than alter the wording of the original essay, I added all the changes, reflections, et cetera, at the end. As of February 2007, I find that I have a few more things to say, and this latest round of updates has been added at the very bottom, after the March 1998 set.

It would be in your best interest to read the whole thing before you decide to send nasty mail, as you will look very foolish if you choose to gripe to me about something I have since recanted.

I note, as I sit with my reference guide to prescription drugs in one hand and my little black book of URLs in the other, that most of the really big drug manufacturers either have no web sites, or have web sites which focus on portions of their business other than pillmaking.

There's a reason for this.

The tide of public opinion has shifted for and against drug manufacturers so many times since the days of the snake-oil salesman that you can't really blame them for wanting to keep a low profile. Besides, the things drug manufacturers make most of the $$$ from aren't advertised to the public. They're advertised to doctors.

The first major wave of anti-drug sentiment in this country was probably the great patent medicine backlash. Fueled by the exposés of a national magazine, the resulting cleanup eventually led to the founding of the Food and Drug Administration.

The fifties was a time of great trust in drug companies; this was the Age of Miracles and a little pill could do anything. The sixties were a time, believe it or not, of distrust; yes, lots of drugs were being taken, but not the kind the Big Drug Establishment was selling. The seventies saw a partial return to the Age of Miracles, but somewhere after that, an odd thing happened: the pendulum didn't swing back.

Like so many things in the last ten years or so, what used to be an either/or has fractured, dichotomized and/or balkanized; we now have many different schools of thought, each with its own identity and creed, and they all hate each other.

This is an improvement?

You either believe in taking pharmaceuticals for everything that ails you, or you believe in homeopathic remedies, or you believe in home remedies and herbal cures, or you believe in complete abstinence from anything that looks even vaguely like medication.

As ever, the middle ground has been forgotten.

I used to be firmly rock-solid rabidly against Prozac. (Let's not single out one company. This goes for Zoloft and other such drugs as well.) I didn't see any point in this drug whatsoever. My attitude toward depression was: cheer the **** up! If something's bothering you that you can fix, fix it. If you can't, ignore it for a while and go outside and play. It's an attitude that's served me well.

It didn't really hit me that this attitude, while useful to me, was not necessarily applicable to everyone else on the planet. Until an otherwise sensible relative started taking antidepressants. I indicated my dismay verbally and at some length. She informed me that one, usually her depression didn't have a specific cause that she could fix, and, two, that she had been unable to function normally before going on the drug.

So I have backed off somewhat. I now agree that there are some people for whom Prozac serves a legitimate purpose. But I continue to maintain that the drug is overprescribed, and that it is overprescribed because:
1. it's an easy fix
2. it's a low-risk prescription - not many interactions/bad effects
3. it's trendy (what, you thought doctors were immune to faddism?)
4. it produces rapid and visible short-term results
5. it makes patients easier to cope with
6. its manufacturer is spending beaucoup bucks to keep it that way.

Prozac is one of those drugs that's a wet dream for drug companies; it treats many different conditions, all of which have hard-to-trace symptoms, many of which will be strongly affected anyway by the change in the patient's mental state. Oh, and it requires constant refills. Geez, if this were the early 1900's, what would distinguish it from "Columbina's Amazing Wonder Tonic"?

By now any doctor who is reading this is probably gnashing his or her teeth, and I admit I'm being deliberately inflammatory.

But really, even you doctors have to admit that some of the people who are being given Prozac would do better with psychiatric consultation (I also dislike psychiatrists - see below - but in this case they are the lesser of two evils. At least they attempt to talk through and solve the problem, not slap a drug Band-Aid on it).

And don't give me the one about Prozac being used to "facilitate" interaction with a psychiatrist. Not that I disagree exactly - I agree that with some patients, you have to give them something to calm them down, or you'll never even be able to start the conversation successfully. But it strikes me that antidepressants are being prescribed a lot these days as a substitute for psychiatry, not as an adjunct to it.

I read in the paper last week about Prozac's manufacturers applying to the FDA for permission to market peppermint-flavored Prozac in dosages designed for children.

In a perfect world, this idea would be so ridiculous as to be its own satire - something where, if I made it up, no one would believe me.

Let me quote the Boston Globe: "If young people are suffering - and showing it through antisocial behavior, school failures, or suicide threats - who can deny treating them with the best available combination of psychotherapy and drugs?"

Well, to begin with, who's to say what is normal and what is not? From my point of view, a kid who is Pollyanna all through adolescence is as much a medical oddity as one who wants to slit his wrists the whole time. Being cheerful is not always the desirable thing, you know.

Second, gee, isn't it so much easier to dose the kids than to actually fix the problems? If you took ten minutes out of each day to listen to the kids - even if it's only to allow them a vent for steam ... if we devoted some energy to fixing some of the things in this country that make adolescence miserable, like maybe some real schools and some honesty about sex and a little reassurance that our society does give a damn about them ... but no, just drug 'em, that'll shut them up. Why not? It works for Mom and Dad.

Third, I worry that it won't be "psychotherapy and drugs." Just drugs. See above. (Interesting question: is it easier to claw money for Prozac or money for a psychiatrist out of an insurance company?)

Fourth, at this point my basic distrust of all kinds of psychiatric treatment kicks in. I need to explain this. I'm not a "normal" person. I have all sorts of deviances in various directions. I don't know any "normal" people. I suspect if I did, I wouldn't spend time with them; I'd think they were boring.

I worry that psychiatrists have a baseline standard of "normal" which they try to shoehorn people into, and which very few people - including the psychiatrists themselves - would be able to meet.

This is paranoid of me - I admit it! - but the medical profession does not have a long history of enlightenment on the subject - throwing people in asylums for any behavior that was not approved of by the minority doing the committing. Even today, Massachusetts has an involuntary committment law which is constantly abused and allows a period of up to ten days before the decision of the committing authority has to be placed under review. That's a long ten days if you're in a "facility" and you have no business being there. Don't tell me that we've cleaned up our act.

Oh, boy, am I ever rambling. OK. Let's change the focus a little here. I've fired at the drug makers many times already for selling-at-any-cost; it's been beaten to death now and I'll stop. Allow me to fire at you, the buying public, for a little while.

Since I've already offended everyone in the free world with my views so far in this screed, I'll go out even further on a limb and say that as a nation, we depend upon prescription and over-the-counter drugs too much.

No, I'm not endorsing homeopathic medicine or anything else flaky like that. I'm advocating the same things I always am: awareness and common sense. If you have a headache, figure out what caused it. If it's bright sunlight, get your sunglasses; if it's muscle pain, fix the muscle, not the headache. If it's sinus congestion, you can open those passages by inhaling steam. A nap works wonders.

(OK, I admit it: one of my favorite remedies - on the occasions when I really need the headache to go away right now this minute - is to drink some strong coffee. Stimulants do the trick. I happen to get fewer bad effects from a coffee than a couple of aspirin - yes, it's true - but other people would see it the other way round, and anyway it's a tossup which is worse for you. My point in the paragraph above - that sometimes it's better to figure out what's causing the headache and treat that - stands, despite the fact that on occasion I get just as impatient with a headache as everyone else.)

I'm not saying I never take drugs or go to doctors - that would be just as bad as the other extreme - but I generally do it only when it becomes clear that the problem will not go away just by treating my body well and waiting a little while. A cold will go away if you keep your nose clear and endure. A serious throat infection may not. Cancer certainly will not.

I guess the greater problem is that people are showing a lack of willingness to pay attention to their own bodies. It's so much easier to go down to the drugstore and get a quick fix. And then, when you do go to the drugstore, half the time you don't realize what you're buying.

(Example: cough drops. They're candy. They work because they either soothe the throat (pectin) or because of a counter-irritant (menthol). Read the packages if you don't believe me. And buy a roll of Life Savers, it's cheaper. Wild cherry if you're of the pectin school, wintergreen if you're in the other camp.)

You think I'm being petty again, huh? OK. Big example this time. Drug called butorphanol. Opioid analgesic. A synthetic opiate. A narcotic. It's addictive, get it? The non-generic name for it is Stadol NS (the NS is for "nasal spray"; there's also an injected form). To make a long story short, people are getting addicted to this stuff (it's being sold as a painkiller for occasional use, for severe headache sufferers) - they're supposed to take it now and again, and they're buying a bottle a week.

Admittedly, the manufacturer (my least favorite company of the moment, Bristol-Myers Squibb) has shown a history of lobbying the FDA for a lenient classification of this stuff - my nurse's guide doesn't show it on any of the "potential for abuse" schedules, although the Boston Globe seems to think it is - but in this case, you know what? I can't really hold a grudge against them.

Because, frankly, if you take an opiate for your headache (which is a little like going after a mosquito with an elephant gun) and you didn't take the time to read up on it or even ask the doctor what he was prescribing for you, then I have little or no sympathy. I expect you to know what you put in your body. Period. That means knowing about what you eat, knowing about what drugs you take, everything. You can eat healthy, eat junk, whatever, but pay attention.

Yes, that means you have to go read a book about this stuff or two. It won't hurt you, it may even help you. And if you are being exploited, by your doctor or your drug company, it will give you the weapons to beat them.

This has been a very long rant. I want to make it clear that I know a number of good doctors, some of whom even agree with me about the overuse of drugs in this culture, and in general I have a lot of respect for what is, at its core, a very demanding profession.

I also tend to sometimes spout off without getting all the information. If you know that I'm misstating, oversimplifying, or in any other way omitting a part of the picture here, please write me and I'll try to fix it.

I have no such apologies for the drug companies. Since Sandoz and Ciba-Geigy merged last year, and Roche just bought two or three more companies in medical markets, I am not encouraged ... they just get bigger and bigger. As I said at the very beginning, most of them don't have web sites and are not easy to fuss at directly, by mail or on the phone, since prescription drugs, unlike OTC ones, don't usually have "customer response" phone numbers.

Paradoxically enough, though, Eli Lilly, makers of Prozac, have both. Perhaps you should connect to their site, search on "Prozac," and read some of the testimonials ... it'll provide a nice counterweight to the material I've subjected you to here.

The first comments I got actually arrived before I "published" the article on 2 june 97, from someone here at HQ who edited it for me. Those corrections, primarily a clarification in the section on caffeine vs. aspirin for headaches, actually made it into the article. It was pointed out to me (gently) that not everyone would consider caffeine more innocuous than aspirin, and I agree ... in retrospect.

A day or so later, I got some very articulate emails from an old friend, and I have quoted her in the following comments, with her permission.

On the cough drop section, in addition to pointing out that menthol is the essential oil in peppermint, not wintergreen (yeah, I know, but I like wintergreen better), she says:

"I looked it up: Essential oil of peppermint is an antiseptic [....] Essential oil of eucalyptus is also an antiseptic, but is an antibiotic as well, which is why it's more powerful. Essential oil of thyme is even more powerful. If you look on the back of a bottle of Listerine, you'll see it contains thymol (essential oil of thyme), eucalyptol, and (if you get the mint flavor) menthol. [...]

"Lest you rebut by saying there's not much essential oil of eucalyptus in a cough drop - it doesn't take much. Essential oils are highly concentrated and highly volatile. [...]

"In general, any hard candy is going to help a cough regardless of flavor because a) they cause you to produce extra saliva to lubricate the throat and b) the swallowing you have to do because of all that saliva is going to jostle the sinuses, which will help any post-nasal drip that might be causing the cough. But don't write off all cough drops as expensive hard candy. Some are, but many have extra value to them."

Well, I agree with the last paragraph, about producing extra saliva and all that. I think that's really what I meant when I talked about the "soothing" of pectin - sorry, I must have been lapsing into ad-speak at the time.

As for the essential oils, color me dubious. The tiny amount in most cough drops is sufficient, I think, to have counterirritant value - try seeing how little cinammon oil it takes to make your tongue sting - but I don't think there's enough of it to be useful as an antiseptic/antibacterial. I think the primary antiseptic activity in Listerine would almost have to come from the alcohol content.

Some cough drops are more useful than others, I agree, but after spending an afternoon poring over bags of cough drops at the drugstore, I conclude that most of them are not far removed from the candy counter.

Re my dismissal of homeopathic medicine, she notes:

"It is certainly possible to believe in/use naturopathic/herbal/home remedies and still go to a doctor when necessary. 'When necessary' can mean something very different if you also self-medicate using the other stuff, because you've got a whole different arsenal to use before you bring the doctors in. Andrew Weil talks about that in Spontaneous Healing, actually. Says that too many times in our culture, people go to an allopathic (western medicine) doctor until things get really, really serious - they're dying or something, and then they get desperate and go to a Chinese herbalist. Weil says that really people's approach should be the other way 'round. Allopathy should be used for serious problems and naturopathic/herbal/dietary remedies should be used for everyday difficulties."

Certainly it's possible to use both. One of my points was that in this country a big schism exists - i.e. most people will practice one side of that equation or the other, never both unless they're really at a loss.

Funny that she mentioned Weil. I thought of him at various points when I was writing the essay. Of course, one can hardly avoid him these days. Ah, for the good old days, when he was ingesting every mind-altering substance From Chocolate to Morphine.

As you can tell, I have something of an innate dislike for Dr. Andy, mostly because I feel that he crosses my personal Rubicon in terms of what he thinks can be healed without doctors. Also he tends to use words like "naturopathic" which set off my danger signals. But in this case I agree with him - if you're going to do both, the obvious thing to do is to try the home remedies first, then go to the M.D. if they don't seem to be working. Which is what I said before.

Oh, and several people so far have answered my rhetorical question: it is generally much more difficult to get money for continual psychiatric visits than it is for continual dosages of antidepressants. I rather suspected this.

Oddly enough, I didn't draw any fire for my comments about Prozac.

Drug companies get bigger and bigger; since this rant was written, there have been several more large mergers. There is little which can be done about this alarming trend, except to not buy drugs you don't need. Fortunately, with the high prices these conglomerates can and do charge for drugs, this abstention becomes easier and easier to practice.

First off, on rereading this piece I'm amazed I allowed myself to muddy my own waters as much as I did. While it is true that I have an innate suspicion of both the physical and mental medical professions, and that I believe that this distrust is well-founded (primarily because of what, in a consumer product, would be called "poor quality control") - none of that is really germane, and I believe that it obscured the important point, which was (once again) a plea to be an aware consumer. Know the drug. Look it up on your own. Be prepared to discuss with and even argue with your doctor; and if the doctor doesn't like that, get a different doctor.

Unfortunately, I think I am bucking the tide. Increasingly (and I don't think this can be entirely attributed to my getting older and meaner) it feels to me like consumers don't want to be aware, they don't want to think too hard about what they are buying and ingesting; they just want to be told what to do and what to take and that it will cure what ails them.

I am still appalled by the increasing number of prescription drugs shoved down the mouths of children by parents who apparently cannot be bothered to do actual parenting. Mind you, not all of it is parenting; a great deal of the blame needs to be laid on an increasingly apathetic, underfunded, subpar school system, among other culprits. Point is, a lot of people are falling down on the job and continuing to dose problems instead of attempting to fix them - using the drugs as the answer, rather than a tool to help achieve a realer and better answer. This goes for adults and children alike.

I am also appalled by antibiotics increasingly becoming useless because consumers insist on taking them for things where they are not needed. I am perturbed by the way Viagra and similar products have changed the national discourse. I'm alarmed that antidepressant use has, in some circles, become not just an expectation, but so casual that it's become a pop-culture joke. I am unhappy when I see someone taking a drug for a situational complaint that probably would have been better addressed by changing the conditions that led to the situation in the first place.

This situation has worsened in recent years, and I blame a great deal of it on the lifting of restraints on advertising by drug companies. Letting drug companies advertise directly to consumers is probably one of the worst things that has happened to the social structure of this country in fifty years. (Hell, I don't even approve of the promotional techniques drug companies used inside the medical profession. If I were in charge of the universe, drug companies and lawyers wouldn't be permitted to advertise at all.)

It's fine if the consumer is smart enough to question the advertisements and avoid, "ooh, shiny object" or "disease of the week" syndrome ... but do you have faith in that ability? If I can't successfully convince my peers - whom I believe are smarter than the average bear - to read the backs of OTC cold medicines critically, there is no hope for increasing drug discernment in the mass audience whatsoever.

and now back to our program

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