Pharmatopia -- An Urban Island
by Martin Overby
Have you ever wanted to be stranded on a deserted island? What makes that daydream so seductive? The sun and sea of course come instantly to mind. But perhaps equally enticing is the notion that our existence would be constrained within very primitive boundaries. Rush hour swapped for a bit of fishing - who wouldn’t be interested? Unfortunately there just aren’t enough islands to go around for the 6 to 7 billion of us living on Earth. To cope, some have taken a chemical step back from their frenetic lifestyles. As the pace of life intensified in the late 20th Century, psychoactive drugs were developed to deal with the stresses of ‘modern’ life. The baby boom generation considers this hyper-activity to be normal. Our minds, bodies and psyche are walking a tightrope and it’s not surprising we need something to steady the horizon. The hippies used to say ‘Turn On, and Drop Out’. Now a generation later, they are the first in line to ‘Turn Up and Pay Out’ whatever it takes to manage their mental health successfully.
The use of drugs to deal with emotional pain goes back to the Sumerians (4000 BC). One drug in particular has had many names starting with hul gil (plant of joy). The Egyptians called it Thebacium. The Cyprians cultivated it. The Greeks (including Hippocrates; of the ‘Hippocratic Oath’) and the Romans documented its usage. The Arabs traded with it for Asian spices. In Europe, during the Middle Ages, it was accepted by some and shunned by others as decadent. Paracelcus (1520’s ) mixed the drug with brandy to make the remedy known as Laudanum. The Germans refined the drug into Morphine and further into Heroin. Hero-in was made by Bayer, the inventor of Aspir-in, which became the first successful ‘blockbuster’ drug of the modern era.
A Dark Tale
Probing the commercial side of modern pharmacology uncovers a dark tale. The first big commercial push for a drug was pursued in an effort to stem an international balance of payments problem. The British Empire was heavily indebted to the Chinese for all the tea they had been importing and they were literally short on the silver to pay for it. Utilising the British Empire’s imperial assets, the East India Company grew opium in Colonial India and then sold it to the Chinese. The British induced and fought two wars to ensure that they had ‘open’ access to the Chinese markets for opium. No consideration was given to the effect of opium on the Chinese, which was one reason the Chinese Dynasties resisted the opening of China. They found the British military power irresistible, and consequently gave up land territories including Hong Kong in pursuit of peace. All this for a cup of tea! (Does this alter your view of those ‘evil’ Taliban poppy farmers when you learn that the British Crown’s monopoly set the whole ball rolling? ‘They sow the wind and reap the whirlwind’) The modern pharmacological industry doesn’t openly behave like this, yet from its inception has always been a commercial enterprise looking for profits. Today it presents itself as a humanitarian industry, yet that dark seam of unbridled commercialism surfaces from time to time.
Without a doubt the modern drugs industry has had more success than failure. Commerce, rather than the medical arts, determines which direction the industry takes. If there is a chemical method of managing a disease, such as a stomach ulcer, the industry prefers to fill prescription after prescription with a patented anti-ulcer drug, rather than cure the stomach ulcer, with a single cheap course of antibiotics. Managing the disease creates a revenue stream for the drug company, whereas a single course of antibiotics is a one off treatment. The same logic is applied to other medical ailments, from heart disease to hyperactive kids. Advertising and dispensation of drugs are the inseparable twins of a profitable drugs business that relies on the daily use of any and many drugs to manage health. Healthcare is one of the largest sectors in the global economy and it’s growing. Therefore we must be aware of the forces that drive the prescription drugs industry.
We identified at the beginning the problem of dealing with the stresses of modern living and our search for an escape from pressure. After the eventual downfall of Opium based drugs, the search was on for new ‘patentable’ drugs to deal with the same issues. Drugs like Prozac alter the blood chemistry and keep the natural hormone Serotonin circulating ( it causes the sensation of satiety) but doesn’t address the root problem. It sidesteps the problem ( stress or depression ) chemically, and provides large profits for its makers. Prozac was approved by the FDA (1987) after a number of studies involving less than 300 patients ( total ) using the drug for 6 weeks or less. The drug is now on prescription to more than 31 million people (2007) and it is estimated that at least 60% stay on the drug long term. (There has never been a long term study about the use of Prozac or other drugs of its type.) It is prescribed for symptoms as wide ranging as grief and obesity. 31 million people can’t be wrong – can they? I wouldn’t like to say. But an interesting study by Essex University in England found that 30 minutes walking in the countryside reduced feelings of depression for 71% of those participating. There’s an easy prescription!
Life has changed dramatically in the last 50 years. Urban living is becoming the norm globally. Most people commute to work, school and recreation. Free time generally involves computer use or television. It seems that half the world (the advanced ‘First’ world ) is looking for ‘easy living’ and that half are the ones needing psychological medication. The ones who can’t afford it ( the simple ‘Third’ world ) don’t seem to have the same mental health problems. This isn’t a Luddite argument for setting the clocks back, but it does call into question why we have these problems – when some parts of the world don’t seem to. We define health as a balance or state of well-being free from disease that uses our capabilities to function in society and meets the ordinary needs of life. We use food as fuel, but drugs are not a fuel to keep us functioning. Drugs alter how the machine works – they change the balance. There are many lives now that don’t balance without drugs. There are two extremes on the drug use spectrum: no drugs or always drugs - The primitive man or Aldous Huxley’s “Brave New World”. As with many things in life – the median is where we function best. That means that drugs have a place, and yet we should beware if they have a preponderant place in our lives.
Use or Abuse?
We can’t expect drugs to bring about a lasting change in our lives, they are employed to a purpose, not a change of being. If we are not happy with who we are ( our being ) we need to recognise that ‘ being’ is a separate issue. The fine boundary between use and abuse of prescription drugs hinges on that. A prescription that one can give without a medical degree is to simplify our lives a bit and perhaps go for a regular walk. We’ll probably be amazed how things seem different after a course of that treatment. But we still might hanker after that desert island in the sun.
1. Prozac Nation by Elizabeth Wurtzel
2. Big Pharma by Jack Law
3. The Cult of Pharmacology by Richard DeGrandpre
4. Better than Prozac by Samuel Barondes
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