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Tuesday 2 October 2012

Professor Allen Frances : Fighting the Wrong War On Drugs - Coutesy of Psychology Today website


Fighting the Wrong War On Drugs

Taming the pharmaceutical companies, undercutting the cartels
Published on August 28, 2012 by Allen J. Frances, M.D. in DSM5 in Distress

Since Richard Nixon was President, we have been fighting a drug war we can't possibly win. Meanwhile, we have barely begun to fight a different drug war we couldn't possibly lose.
The losing battle is against illegal drugs. Interdiction has been as big a bust as Prohibition of alcohol in the 1930s. Occasionally arresting a drug kingpin or confiscating a few million of dollars worth of contraband heroin or cocaine makes for a nice headline, but doesn't stop the flow.

The beneficiaries of our war on drugs have been the cartels and the narco-terrorists; the casualties are the failing states they can buy or bully. The Mexican government is fighting what amounts to an undeclared civil war against cartels armed to the teeth and flowing with money -- both from north of the border. We have unwittingly created a terrific business model for the drug dealers and a disaster for the states where they deal.
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That other drug war, which we couldn't possibly lose, is against the excessive use of legal drugs that is promoted by our own pharmaceutical companies. Astounding fact: prescription drugs are now responsible for more accidental overdoses and deaths than street drugs.

Polypharmacy is rampant and uncontrolled with military personnel , the elderly, and children particularly vulnerable to its risks. Michael Jackson is just the most high profile poster victim of this growing epidemic of legal drug abuse. The drug cocktails are sometimes prescribed by dangerous high-flying doctors, sometimes by multiple doctors who just aren't aware of each other's existence, and prescription drugs are also widely available for purchase on the street.

There is not one cause of this mess, and there won't be one cure. Doctors, drug companies, patients, politicians and our fragmented health care system are all to blame. But the elephant in the room is Big Pharma. It has hijacked the practice of medicine, using its enormous profits to unduly influence physicians, physician groups, academics, consumer advocacy groups, the Internet, the press and the government. Misleading 'disease mongering' promotional programs saturate the media with direct-to-consumer drug advertising that is illegal everywhere else in the world except New Zealand and the developing nations.

The result: a ridiculously high proportion of our people have come to rely on antidepressants, antipsychotics, anti-anxiety agents, sleeping pills, and pain meds. Psychiatric meds are among the very top best sellers for the drug companies—over $16 billion for antipsychotics; almost $12 billion on antidepressants, and more than $7 billion for ADHD drugs. One in five Americans takes a psychiatric drug, one in five women is on an antidepressant.
Seventy percent of these pills are prescribed by primary care doctors with little training in their proper use, under intense pressure from drug salespeople and misled patients, after rushed seven minute appointments and subject to no systematic auditing.

The free market in drug salesmanship has led to promiscuous drug use, needless side effects and wasted resources—a kind of societal overdose.

The Government has unwittingly aided and abetted Pharma. The cash-strapped FDA is beholden to industry for funding.
And it gets worse. Big Pharma all too often also goes illegal to push even more product. The multi-billion dollar criminal and civil penalties recently levied on several different drug companies provide clear evidence of the pervasive extent of drug company wrongdoing—but have not been big enough to deter it. A billion dollars must seem like chump change—just the cost of doing business.

Pretty bleak. But if we ever had the political will to begin it, we couldn't possibly lose a war to tame the dangerous use of legal drugs. The solutions are crystal clear and a cinch to implement—if we were really determined to solve the problem:

1) Sharply restrict drug company marketing and lobbying. Pharma now spends almost twice as much money pushing drug sales as on research—we would have better medicines and less legal drug abuse if this were reversed.

2) Make the punishments for marketing malfeasance much more of a deterrent to underhanded drug pushing. This could be done by levying much bigger mega-fines on the companies; by also holding the executives personally responsible and perhaps by reducing the period of product patent protection.

3) Develop a computerized real-time national system to identify and prevent polypharmacy. Credit card companies can abort a suspicious $100 transaction before the fact. Why can't we apply the same technology preemptively to prevent a patient from collecting potentially lethal pills?

4) Doctor's prescribing habits need to be closely monitored to correct or eject the Dr. Feelgoods.

5) It would greatly improve the quality of our health care system and greatly reduce its costs if all doctors, professional associations, consumer groups, and politicians were prevented from accepting drug company funding. Do drug companies really need this much 'free speech'? It makes no sense to have The Food and Drug Administration funded by drug companies.
What are the political prospects of my twin proposals—to begin the winable war against the over-use of legal drugs and to drop the losing war against illegal drugs?
You guessed it—zero and zero. The first will be doomed by Pharma's political punch; the latter by the irrational victory of hope and ideology over experience.

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