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Monday, July 11, 2011

Rx Manipulation - How Crazy Is This?

What if the love of money has caused a worldwide health epidemic that since 2004 has been responsible for far more years of lost potential life than all accidents from falls, firearms, drownings, fires, and nonmedication poisonings combined? Just what if we are caught in the middle of a terrible conspiracy?

David P. Phillips, Ph.D., a professor of sociology at the University of California at San Diego, analyzed all death certificates filed in the United States between 1983 and 2004. He noted in a study (2008) that over two decades the rate of deaths from prescription and over-the-counter drugs was "not only increasing steeply, but at an accelerating rate."

Phillips said it is impossible to know from the information on a death certificate who is to blame for the death. Some blame, he says, might lie with the doctor, the nurse, or the pharmacist. "Someone is at fault," he says, "but it's unclear who." (Melody Petersen, "Pain Killers," Men's Health, January 31 2011)

Who is the "someone" most at fault for the death and destruction? Could it be whom we least expect?

Let's just speculate: Could illness could be manipulated for capital gain?

What if an industry's marketing practices help glamorize and normalize the public use of prescription medication, even working in tandem with promotion to doctors? And, what if this manipulation involves payments to doctors, self-financed drug studies, politicians for rent, and off-label marketing?

Then, what if the industry practices shape how both patients and doctors understand and relate to disease and treatment?

And last, what if so much money is generated that the entire process feeds itself and allows a few greedy hands to perform ruthless, homicidal work on global proportions?

Several Revelations

Lourdes Salvador says (Mary Ebeling,"Beyond Advertising: The Pharmaceutical Industry's Hidden Marketing Tactics," 2008) that the biggest 10 pharmaceutical companies spent $1.9 billion on promotional events alone in 2000. All pharmaceutical companies spend a whopping $8,290 per doctor to improve their relationship between their sales representatives and the doctor. Add to this, the average family doctor receives 28 visits each week from drug representatives who provide free samples and explain new findings from their company-sponsored drug trials. (Lourdes Salvador, "Multiple Chemical Sensitivity Beleaguered, Part 2: Pharmaceutical Profits,", March 3 2008)

The Economist ("Absence of Evidence: Do Drug Firms Suppress Unfavourable Information About New Products?", November 27 2008) relates that a study in PLoS Medicine, an online journal, confirms what many have suspected and what previous studies have hinted at: drug companies try to spin the results of clinical trials. Lisa Bero of the University of California, San Francisco, and her colleagues found troubling evidence of suppression and manipulation of data in studies published in (or often withheld from) peer-reviewed medical journals.

According to one report ("Pharmaceuticals / Health Products,", 2011), the pharmaceutical and health products industry -- it includes not only drug manufacturers but also dealers of medical products and nutritional and dietary supplements -- is consistently one of the top industries for federal campaign contributions. Pharmaceutical manufacturers are a subset of this industry. It was reported in 2009, that since 2000, the pharmaceutical companies had made more than $125 million in political contributions, giving to both sides of the aisle, but always more to whomever was in power.

Off-label use is the practice of prescribing pharmaceuticals for an unapproved indication or in an unapproved age group, unapproved dose or unapproved form of administration. The United States federal government is aggressively pursuing criminal and civil cases against pharmaceutical companies and their employees for promoting off-label uses of prescription drugs. To date billions of dollars have been won in criminal and civil settlements.

There is no doubt that prescription drugs are readily available and that doctors are prescribing more drugs for more health problems than ever before. Who is primarily at fault for rx drug abuse? I'm sure the answer involves many culprits. I'm not attempting to simplify solutions for such a broad problem in this post. I know the subject cannot be adequately addressed on my editorial blog. Still, we all must weigh the evidence at hand, chart a plan of action, and attack. I have many unanswered questions and many unsettling opinions.

Rates of emergency department (ED) visits* for nonmedical use 
of selected opioid analgesics, by type --- United States, 2004--2008.

Source: Substance Abuse and Mental Health Services Administration (SAMHSA)'s Drug Abuse Warning Network (DAWN), 2004--2008.

A Little Research

Here is some information for those wondering about the nature of the rx beast. ("Emergency Department Visits Involving Nonmedical Use of Selected Prescription Drugs --- United States, 2004--2008," Centers For Disease Control and Prevention, June 18 2010)

"The number of ED (Emergency Department) visits involving nonmedical use of prescription or over-the-counter drugs increased rapidly during 2004--2008, and by 2008 matched the number of ED visits involving illicit drugs. ED visits involving such pharmaceuticals accounted for all of the growth in overall drug misuse/abuse rates during 2004--2008. ED visits involving opioids or benzodiazepines were the largest contributors to the increase in ED visits involving the nonmedical use of prescription or over-the-counter drugs.

"Notably, results from 2008 indicate that in addition to the large increase in visits compared with 2004, peak visit rates for both opioids and benzodiazepines appear to have shifted into the 21--24 and 25--29 years age groups and away from the 30--34 and 35--44 years age groups. As late as 2006, the peak mortality rate for fatal drug overdoses involving opioid analgesics had been in the 35--54 years age group. (Warner M, Chen LJ, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999--2006. NCHS data brief, no 22. Hyattsville, MD: National Center for Health Statistics; 2009.)

"The 5-year increase in ED visit rates reflects, in part, substantial increases in the prescribing of these classes of drugs. (Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiol Drug Safety 2006;15:618--27)

"The increase also might reflect an increase in the rate of nonmedical use of prescription drugs per 1,000 prescriptions, as has been observed for selected opioids. (Dormitzer C. Summary of drug abuse "rates" in the United States. Available at , Accessed June 10, 2010)

"In the 2008 National Survey of Drug Use and Health (NSDUH), 4.6% of persons aged ≥18 years reported past-year nonmedical use of prescription pain relievers, and 2.1% reported nonmedical use of tranquilizers, a category that includes benzodiazepine." (Substance Abuse and Mental Health Services Administration. Results from the 2008 National Survey on Drug Use and Health: national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2009. HHS publication no. SMA 09-4434. Available at, Accessed June 10, 2010)
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