Corporate Pushers

If tomorrow, by some miracle, every source of illegally grown or manufactured drug were cut off, the U. S. would scarcely feel any withdrawal symptoms, nor would the current drug-abuse epidemic be ended. The sad truth is that our most sophisticated and profitable pushers are the nation's largest pharmaceutical corporations. Somehow, these companies remain almost unnoticed in the intense and well-publicized debate about the causes of the drug epidemic. Each year, the legal drug industry unconcernedly devotes hundreds of millions of dollars to producing a supply of psychotropic drugs--including barbiturates, tranquilizers and amphetamines--in gross excess of any conceivable legitimate medical need. These "mind" drugs are easily available to practically anyone. The same companies go a step further by creating a demand for their products with a slick advertising campaign seemingly designed to persuade every American that it's medically and socially acceptable to shield himself chemically against all the ordinary emotional hazards of life. I see little chance of making significant progress in fighting such propaganda until we recognize these corporate drug pushers as its source and translate that recognition into mass public pressure against them.

We have become numbed to the television commercials that are the most visible example of the companies' crusade to legitimize the casual use of drugs. Day after day, we're told by the country's "electronic hypochondriac," as former FCC Commissioner Thomas Houser labeled television, that drugs are an instant answer to whatever worries, annoys or disturbs us. Dr. Mitchell S. Rosenthal, director of the Phoenix drug-rehabilitation program in New York City, testified at a Senate hearing on the subject that, "While everyone deplores the misuse of psychoactive drugs by young people, a major industry with practically unlimited access to the mass media has been convincing the American people, young and old alike, that drugs effect instant and significant changes, that indeed they work 'miracles' such as making a 'boring woman' exciting to a husband so that he proclaims her 'a new woman."

True, the aspirins, Bufferins, Anacins, energizers, blood fortifiers (yes, Geritol is a drug) and vitamins you see extolled on the screen dozens of times in an evening don't pose any immediate health hazard to their users. But that's due to their mild strength. In fact, a series of Food and Drug Administration tests has shown that widely used energizers pick you up about as much as does a cup and a half of coffee. At the other end of the spectrum, you can relax just as effectively with any placebo as you can by taking a popular sedative. Even children, who should be watching ads warning of the dangers of drugs, are not spared the constant commercial message on morning kiddie shows that they, too, can pop a pill--a vitamin pill--and feel better fast. Almost unbelievably, three drug companies alone spent $19,000,000 in 1970 urging the kids to get with it. Several recent studies have concluded that children raised by parents who regularly take their medicine in capsules are three to ten times more likely to become drug abusers than are children whose parents don't. What multiple might we expect from children who themselves become accustomed to swallowing the capsules at the age of eight? We might as well allow television advertisements for candy cigarettes on the grounds that candy isn't harmful, and then wonder why our pleas against smoking have so little effect on youngsters.

Besides TV, drug companies use print advertisements in special-interest publications as an especially effective promotional tactic. As much as one billion dollars annually is being spent on a major attack against our resistance to drug use. This effort is aimed exclusively at the nation's 200,000 practicing doctors. In every issue of dozens of medical journals--several of them delivered without subscription charge and paid for entirely by advertising--the pages are laced with ads designed to persuade the physician to prescribe psychotropics for almost every imaginable ailment, anxiety and depression. The idea seems to be that if the doctor's diagnosis does not definitely indicate a specific treatment other than psychotropics, then that must be the treatment. Of course, the layman who received one of the 225,000,000 prescriptions for psychotropic drugs last year is almost certainly unaware that this kind of campaign exists. In the absurd history of these ads, doctors have been urged to consider tranquilizers for women who get depressed at the thought of stacks of dishes to wash every night, as anti-anxiety agents for children afraid of the dark or for military families worried about the father's impending departure. Now, remember that these are dangerous and potentially addictive drugs approved by the Government for treatment of significant mental disorders traceable to pathological causes. In theory, the advertisements must (continued on page 210) Corporate Pushers(continued from page 142) meet FDA standards to this effect, but they generally slip past the Federal obstacle without much difficulty. The fine print at the bottom of the page lists the warnings, side effects and hazards of addiction, which, in the case of the barbiturates, can be more severe than with the opiates. Even assuming the doctors waded through the columns of details, and remembered them, the propaganda would achieve its desired result: making the psychotropics seem an unextraordinary presence. At Senate hearings before a subcommittee of the Small Business Committee chaired by Senator Gaylord Nelson, the Wisconsin Democrat was told that most general practitioners--who prescribe 70 percent of the psychotropics--and even most psychiatrists--who account for another 20 percent--know little or nothing about pharmacology. They are almost as helpless in weighing the scientific basis for the claims made in the ads. And the unbiased, scientific sources of information they do have tend to be financially dependent on the drug companies, as in the case of the medical journals, and are therefore drowned in a sea of specious, misleading Madison Avenue hucksterism. But the ads really speak best for themselves about their philosophy and technique. Here are a couple of examples that illustrate how our corporate drug pushers would have our medical profession view the psychotropics.

In early 1971, two-page spreads began appearing for Serentil, a powerful phenothiazine drug manufactured by Sandoz and approved for use in serious mental disorders, including schizophrenia. Side effects can include drowsiness, dizziness, nausea, vomiting, rash and a host of cardiovascular ailments. (Though no causal relationship had been demonstrated, said the fine print in the ad, "several sudden and unexpected deaths apparently due to cardiac arrest have occurred in patients ... while taking the drug.") The background for most of the two pages was a plain, green jigsaw puzzle with one piece missing. Looking out from the hole was the face of an anguished woman. The bold headline was: "For the anxiety that comes from not fitting in." Below that, the text said that Serentil was "suggested for this type of patient: The newcomer in town who can't make friends. The organization man who can't adjust to altered status within his company. The woman who can't get along with her new daughter-in-law. The executive who can't accept retirement." Presumably, by emphasizing the word can't and stating that a "disordered personality" frequently finds these situations intolerable, Sandoz figured it was protected from charges of exploiting everyday anxiety situations as new mental illnesses. It was wrong. The suggestions in this particular ad were too preposterous even for the normally pliant FDA, which demanded a retraction. Dutifully, Sandoz complied, after the damage was done. It had made claims it knew weren't justified from a medical standpoint. Doctors read them and then, months later, saw a retraction that admitted a mistake.

The FDA rarely asks for retractions, generally preferring to let even some of the most colossal medical nonsense stand unchallenged. Not a murmur was heard about a series of ads that Aldous Huxley would surely have included in Brave New World--if he'd imagined them. The three-page ads, for Ritalin, an energizer manufactured by CIBA, announced to physicians that a brand-new mental illness had been discovered: "Environmental Depression." One installment in the series dealt with "Noises: A New Social Problem"; another, with "Tie-Up: The Transportation Problem"; yet another, with "Brownout: No Power to the People." In this one, it was explained that environmental depression may be "often expressed [by the patient] as listlessness ... complaints of tiredness." Patients who suffer from E. D., the doctor was advised, "may not complain specifically of being depressed. More likely they will complain of tiredness, early-morning awakening, poor appetite, lethargy, or vague aches and pains which have no detectable organic basis." What, then, are the specific causes of E. D., as understood by CIBA? "Air conditioners are turned down, or off. Lights dim. Transportation slows down, or stops--usually in a long hot summer. This is when comfort, conveniences and productivity suffer. So does the emotional outlook of some individuals. Already frustrated by the constant din around them, helpless in the face of situations they can't control, and faced with the daily exposure to bad news and crises, they fall prey to a phenomenon of the times--one that may overwhelm the patient and may cause symptoms of mild depression to occur more frequently." By the standard of being mildly depressed from brownouts, bad news and crises, is there anyone who shouldn't be taking Ritalin? As the ad says, "Ritalin will not help all depressed patients faced with environmental problems, and it certainly won't change those problems or an individual's response to them. But Ritalin can improve outlook ... help get your patients moving again."

I should say it can. It is addictive if used excessively, and during withdrawal, says the fine print in the ad, "effects of chronic overactivity can be unmasked." Get them moving again!

Women are particularly victimized in, and by, these ads. Dr. Robert Seidenberg, clinical professor of psychiatry at the State University of New York, who has studied the ads' contents extensively, wrote last year: "The drug industry openly acknowledges the enslavement of women, as shown in an ad with a woman behind bars made up of brooms and mops. The caption reads: 'You can't set her free but you can help her feel less anxious.' Another one pictures a woman who, we are told, has an M. A. degree, but who now must be content with the P. T. A. and housework. This, we are advised, contributes to her gynecological complaints, which should be treated with drugs." Valium, a tranquilizer that can impair mental alertness, was the suggested drug in the latter case. Dr. Seidenberg wryly noted that a better recommendation by the doctor would be that she use the prescription money "as a down payment on an electric dishwasher, or a more radical change in life style."

Naturally, there is no place for women's liberation in these advertisements. "Anyone sensitive to the issues raised by the women's liberation movement would be angered by the recommendation that this woman should be tranquilized into accepting her life as it is ... by medication usually prescribed by a male physician," Dr. David Lewis, director of the Medical Outpatient Department at the Beth Israel Hospital in Boston, testified at Nelson's Senate hearings on this subject last summer. "As you can see, once daily living is defined as disease, how logical it is for us to attempt to treat that disease. I do not believe that the public's health is well served by such advertising." James Bicket, president of the Academy of the General Practice of Pharmacy, put it even more bluntly, testifying that this type of drug advertising has become, all by itself, "a major public health problem."

With the public so alarmed by the drug epidemic, why has so little been done to remedy the situation? The FDA, which last year declared itself "thunderstruck" by the number of ads that go "way overboard," has little preventive power. It cannot demand preclearance of the ads, and each retraction ordered requires months of legal fights against batteries of industry lawyers. Until recently, the Federal Trade Commission showed no particular interest in cracking down on the invalidity of many of the scientific claims. But the principal responsibility for the deterioration of the situation rests not with the Government, which should not have to act as censor in the first place. The medical profession itself is supposed to be a protector of the public health, and if it lived up to that responsibility, the present situation would never have developed. The profession, especially its supposed leading organization, the American Medical Association, deserves ethical and moral blame for developing a severe drug dependence problem of its own. Apparently for no better reason than money, the A. M. A. publishes even the most aggressively exploitive ads, including those that are patently in violation of the association's own stated policy on drug advertising. There has been no major effort undertaken to unite the profession against the pharmaceutical industry, and anyone suggesting to the A. M. A. that doctors should receive their information on drugs solely from unbiased scientific sources is likely to receive the answer that such a step would mean higher subscription rates for the journal.

Sir William Osler, a famed British physician, once said that "the desire to take medicine is perhaps the greatest feature which distinguishes man from animals." The task of the medical profession, he said, "was educating the masses not to take medicine." The A. M. A. seems not to have heard that little piece of wisdom, and perhaps America's physicians need some education on this point. "Physicians have fallen into a rut and lose sight of alternatives to drug use," Dr. Richard Feinbloom, from Harvard Medical School, testified at Nelson's hearings. "The message we receive is very one-sided. Like the public, we are bombarded with ads for drugs and hear no opposing argument. Our journals and meetings, heavily subsidized by drug companies, are devoid of critical debate on the issues of using psychotropics."

Since the pharmaceutical industry and the medical profession have shown no indication of assuring a balanced message, the Government must act, first by placing an FCC ban on the ads for nonprescription drugs on television, just as liquor and cigarette ads are banned. Failing that, the commission should at least require the networks to provide free air time for public-service ads offering scientific evidence and philosophical arguments against the casual use of these drugs; and it should ban all pill ads from children's programs. Perhaps, also, the time has come for legislation authorizing the FDA to screen the advertisements for psychotropics in medical journals.

These are serious Government interventions, but the consequences of doing nothing about the current laissez-faire attitude toward drug pushing are too great to ignore. Unless we recognize the interconnections between this promotion and today's drug problem, we are going to find ourselves with a crisis of unimaginable proportions by the end of the decade.