Overdosed America (40 page)

Since leaving
medical practice to research and write about these issues, I have found problems far more profound than I ever suspected—and I have found far more opportunity for Americans to improve their health as well. I am still a physician and want to do my best to help people achieve better health and a sense of well-being. So what can we do?

Ultimately, the issue is not the quality of our medical science, but the political context in which American medicine unfolds. The overwhelming power that the drug and other medical industries now wield over American politics, science, and health care has created an imbalance between corporate goals and public interest that is no longer self-correcting. In fact, it has become resistant to correction. If democracy is to be more than a ritual dance choreographed by powerful corporations in this postindustrial “information age,” government must actively protect the integrity of the information on which we rely to guide our personal and political choices. As individuals we have the opportunity to reclaim responsibility for much of our health through intelligent lifestyle decisions and informed use of medical care. As citizens we must demand that our government restore the balance between public health and corporate profits, so that the drug, medical-device, and other medical industries can only achieve their goals by effectively and efficiently maximizing Americans’ health. Needless to say, these industries, as well as many doctors whose high-priced specialty services would not be needed in such high volume in a more efficient health care system, will do everything possible to prevent reform, as they have so successfully done in the past.

Courageous leadership is urgently needed to redirect American health care—not unlike the leadership provided by
President Teddy Roosevelt
a century ago when the enormously concentrated power of the railroad, steel, and oil “combines” similarly threatened the public’s interests. Government needs to be re-empowered, and a good place to start might be public hearings that investigate the commercial distortion of our medical knowledge. The first “case” might be an investigation of the process by which Celebrex and Vioxx, two drugs of very limited clinical value, have become blockbusters in the United States
but not in the rest of the world
(nearly 80 percent of all sales occur in the United States). Such hearings could publicly review the unprocessed data from the manufacturers’ own studies that have been submitted to the FDA; expose the discrepancies between these data and the articles that reported the “scientific evidence” about the two drugs, published in our two most respected medical journals; inform the public about the financial ties between each of the four authors of the clinical practice guidelines issued by the American College of Rheumatology in 2000, which recommended the use of these drugs, and at least one of the manufacturers of Celebrex and Vioxx; show that in 2001 (when these drugs were becoming established as the standard of care) they were the
two most heavily advertised
to the public and two of the most heavily marketed to doctors; show how drug company–funded continuing education has persuaded doctors to prescribe these drugs; show how the FDA has known this whole story since February 2001 and, despite issuing Warning Letters to the manufacturers of both Celebrex and Vioxx about false and misleading marketing, has not effectively corrected doctors’ and the public’s erroneous beliefs about the true clinical value of these drugs; and, finally, show how all these tactics were masterfully orchestrated to produce
$5.3 billion of COX-2 inhibitor sales
in the United States in 2003.

Public hearings investigating the commercial bias in the 2001 update of the cholesterol guidelines would be similarly revealing. The public has the right to know that the recommendations that guide their medical care are not nearly as “evidence based” as they claim to be; that many of the references cited to support key recommendations do not provide that support; that the directions of the estimations and extrapolations presented in the guidelines tend to justify the use of more statin drugs; and that these guidelines are driving up sales of cholesterol-lowering statin drugs while diverting doctors’ and the public’s attention away from far more effective and far less expensive ways to prevent heart disease.

This brings me
to the end of my story. I hope that I have answered Mrs. Francis’s question about why I chose to leave my practice to write this book, and that I have helped to improve the health of more people than I might have otherwise. I also hope that in sharing what I have learned about the distortion of our medical knowledge with hardworking colleagues I will have inspired some to become more critical consumers of scientific evidence and the recommendations of “thought leaders” on the payroll of the drug and other medical industries.

I will have succeeded in my task if I have motivated some readers to be more regular about exercise, adopt a healthier diet, stop smoking, and think more critically about the relationship between their own needs and goals and those that are externally imposed by the push of the market. My greatest hope is that this book will inspire readers to consider the responsibility of citizenship in this time of excessive medical profiteering and corporate influence, and to take up one of the most important challenges of our time: high-quality health care for all based on the translation of well-ordered science into accurate, unbiased medical information.

We have come to a critical juncture, and our future depends on our willingness to act on our country’s highest ideals. In this sense, the health we seek for ourselves, for our families, and for all Americans is a metaphor for something greater even than physical well-being: wholeness and connectedness that extend beyond the narrow confines of the biomedical-commercial paradigm of medicine.

Aronowitz, Robert A.,
Making Sense of Illness: Science, Society, and Disease.
Cambridge, U.K.: Cambridge University Press, 1998.

Barkow, Jerome H., Leda Cosmonides, and John Tooby.
The Adapted Mind: Evolutionary Psychology and the Generation of Culture.
New York and Oxford: Oxford University Press, 1992.

Benson, Herbert, M.D., with Marg Stark.
Timeless Healing: The Power and Biology of Belief.
New York: Scribner, 1996.

Berger, Peter L., and Thomas Luckman.
The Social Construction of Reality: A Treatise in the Sociology of Knowledge.
New York: Anchor Books, Doubleday, 1967.

Bok, Derek.
Universities in the Marketplace: The Commercialization of Higher Education.
Princeton and Oxford: The Princeton University Press, 2003.

Brown, James Robert.
Who Rules in Science: An Opinionated Guide to the Wars.
Cambridge and London: Harvard University Press, 2001.

Callahan, Daniel.
False Hopes: Why America’s Quest for Perfect Health Is a Recipe for Failure.
New York: Simon & Schuster, 1998.

Capra, Fritjof.
The Turning Point: Science, Society and the Rising Culture.
New York: Simon & Schuster, 1982.

Collins, Chuck, Betsy Leondar-Wright, and Holly Sklar.
Shifting Fortunes: The Perils of the Growing American Wealth Gap.
Boston: United for a Fair Economy, 1992.

Dacher, Elliot S., M.D.
Whole Healing: A Step-By-Step Program to Reclaim your Power to Heal.
New York: A Dutton Book, Penguin, 1996.

Dubos, René.
Mirage of Health: Utopias, Progress, and Biological Change.
New York: Harper and Brothers, 1959; reissued, New Brunswick and London: Rutgers University Press, 1987.

———
Pasteur and Modern Science.
New York: Anchor Books, Doubleday & Company, 1960.

Fabrega, Horacio, Jr.
Evolution of Sickness and Healing.
Berkeley and Los Angeles: University of California Press, 1997.

Farmer, Paul.
Infections and Inequalities: The Modern Plagues.
Berkeley, Los Angeles, London: University of California Press, 1999.

Fukayama, Francis.
Our Posthuman Future: Consequences of the Biotechnology Revolution.
New York: Farrar, Straus and Giroux, 2002.

Garrett, Laurie.
Betrayal of Trust: The Collapse of Global Public Health.
New York: Hyperion, 2000.

Golinski, Jan.
Making Natural Knowledge: Constructivism and the History of Science.
Cambridge and New York: Cambridge University Press, 1998.

Good, Byron J.
Medicine, Rationality and Experience: An Anthropological Perspective.
The Lewis Henry Morgan Lectures: 1990. Cambridge, U.K.: Cambridge University Press, 1994.

Greenberg, Daniel S.
Science, Money and Politics: Political Triumph and Ethical Erosion.
Chicago and London: The University of Chicago Press, 2001.

Hack, Susan,
Evidence and Inquiry: Toward Reconstruction in Epistemology.
Oxford and Medford, Mass.: Blackwell Publishers Ltd., 1993.

Hacking, Ian.
The Social Construction of What?
Cambridge and London: Harvard University Press, 1999.

Hahn, Robert A.
Sickness and Healing: An Anthropological Perspective.
New Haven and London: Yale University Press, 1995.

Hilts, Philip J.
Protecting America’s Health: The FDA, Business and One Hundred Years of Regulation.
New York: Alfred A. Knopf, 2003.

Health & Health Care 2010: The Forecast, the Challenge.
Roy Amara et al., Institute for the Future for the Robert Wood Johnson Foundation. San Francisco: Jossey-Bass Publishers, 2000.

Kass, Leon R., M.D.
Life, Liberty and the Defense of Dignity: The Challenge of Bioethics.
San Francisco: Encounter Books, 2002.

Kitcher, Philip.
Science, Truth and Democracy.
New York: Oxford University Press, 2001.

Kleinman, Arthur, M.D.
The Illness Narratives: Suffering, Healing and the Human Condition.
New York: Basic Books, 1988.

———
Writing at the Margin: Discourse Between Anthropology and Medicine.
Berkeley and Los Angeles: University of California Press, 1995.

Kuhn, Thomas S.
The Structure of Scientific Revolutions.
Chicago and London: The University of Chicago Press, 1962.

Krause, Elliot A.
Death of the Guilds: Professions, States and the Advances of Capitalism, 1930 to the Present.
New Haven and London: Yale University Press, 1996.

Krimsky, Sheldon.
Science in the Public Interest: Has the Lure of Profits Corrupted Biomedical Research?
Lanham, Md.: Rowman & Littlefield Publishers, Inc., 2003.

Lasch, Christopher.
The Culture of Narcissism.
New York: Warner Books, W. W. Norton & Company, 1979.

Leach, William.
Land of Desire: Merchants, Power and the Rise of a New American Culture.
New York: Vintage Books, Random House, 1993.

Lewontin, Richard.
The Triple Helix: Gene, Organism and Environment.
Cambridge and London: Harvard University Press, 2000.

Love, Susan M., M.D., with Karen Lindsey.
Dr. Susan Love’s Hormone Book: Making Informed Choices about Menopause.
New York: Three Rivers Press, 1997.

McGinn, Colin.
The Mysterious Flame: Conscious Minds in a Material Field.
New York: Basic Books, 1999.

Miller, Matthew.
The 2% Solution: Fixing America’s Problems in Ways Liberals and Conservatives Can Love.
New York: Public Affairs, Perseus Books Group, 2003.

Northrup, Christiane, M.D.
The Wisdom of Menopause: Creating Physical and Emotional Health and Healing During the Change.
New York: Bantom Books, 2001.

Our Bodies, Ourselves, for the New Century: A Book by and for Women.
The Boston Women’s Health Book Collective. Update. New York: A Touchstone Book, Simon & Schuster, 1998.

Panadian, Jacob.
Culture, Religion, and the Self: A Critical Introduction to the Anthropological Study of Religion.
Englewood Cliffs, N.J.: Prentice-Hall, Inc., Simon & Schuster, 1991.

Pearson, Cynthia, et al., The National Women’s Health Network.
The Truth About Hormone Replacement Therapy: How to Break Free from the Medical Myths of Menopause.
Roseville, Calif.: Prima Publishing, Random House, 2002.

Pickstone, John V.
Ways of Knowing: A New History of Science, Technology and Medicine.
Manchester: Manchester University Press; Chicago: The University of Chicago Press, 2001.

Rampton, Sheldon, and John Stauber.
Trust Us, We’re Experts: How Industry Manipulates Science and Gambles with Your Future.
New York: Penguin Putnam, 2001.

Schlosser, Eric.
Fast Food Nation: The Dark Side of the All-American Meal.
New York: Houghton Mifflin Company, 2001.

Searle, John R.
Mind, Language and Society: Philosophy in the Real World.
New York: Basic Books, 1998.

Sen, Amartya.
Development as Freedom.
New York: Anchor Books and Random House, 1999.

Sheridan, Alan.
Michel Foucault: The Will to Truth.
London: Tavistock Publications Ltd., 1980, Routledge, 1990.

Slaughter, Sheila, and Larry L. Leslie.
Academic Capitalism: Politics, Policies and the Entrepreneurial University.
Baltimore and London: The Johns Hopkins University Press, 1997.

Starfield, Barbara.
Primary Care: Balancing Health Needs, Services and Technology.
New York and Oxford: Oxford University Press, 1998.

Starr, Paul.
The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry.
New York: Basic Books, 1982.

Stevens, Rosemary.
American Medicine and the Public Interest: A History of Specialization.
Updated edition. Berkeley, Los Angeles, London: University of California Press, 1998.

Tauber, Alfred I.
Confessions of a Medicine Man: An Essay of Popular Philosophy.
Cambridge and London: A Bradford Book, MIT Press, 1999.

Varela, Francisco J., Evan Thompson, Eleanor Rosch.
The Embodied Mind: Cognitive Science and Human Experience.
Cambridge and London: The MIT Press, 1991.