Marginalia #3

It is astonishing to think that there are pharmaceuticals that can not only extend our lives, but that can eradicate diseases that were once plagues, and even still are in some areas of the world. The technology of drugs and medicine has reached a fever pitch, and with greater understanding of the human genome, we are developing cures by the dozen on a yearly basis, each one more effective than the next. However, not all drugs are created equal, nor have they all been show to have a guaranteed efficacy. Add to that fatal side effects and pharmaceutical technology does not appear quite as good as it initially might have.

The Brafman brothers wrote a book recently that discusses the psychology of human irrationality. While only a short tome weighing in at under two hundred pages, it is well researched and a fascinating look at ourselves as humans. I do not mention it because of the psychology, but rather because of the ancillary statistics cited in a particular discussion within the book. The authors examined the meteoric rise of diagnoses of bipolar disorder between the years of 1994 and 2003. Their purpose was to illustrate how the Pygmalion (taking on positive traits that are assigned to us by others) and Golem (taking on negative traits assigned to us by others) effects, collectively called the “chameleon effect” (Brafman, 2008, p. 100).

Along with the rise in diagnoses for bipolar disorder, there was an increase in prescribing SSRI (selective serotonin reuptake inhibitor) drugs. One such drug was Prozac, which has quite a literary history at this point in time. Nonetheless, there were a statistically significant number of trials performed with Prozac, and the findings were quite interesting. “It turned out that when all the studies were aggregated and all the data meticulously analyzed, SSRIs were no more clinically effective than placebos in making patients – either kids or adults – feel better. That is, sugar pills and Prozac had about the same therapeutic effect” (Brafman, 2008, pp. 96-97).

The book goes on to explain that only three in sixteen children on SSRIs showed positive results. (2008, p. 97). It is quite horrific to think of the effects of the drugs on the human body and the results of such use. In this case, do the negatives outweigh the positives? It appears that way. The SSRI studies were not limited to just Prozac either, although that was a heavily researched drug as it was a forerunner to the current menu of psychotropic drugs. Is the human body powerful enough to resist the intended purpose of a drug if we so choose? Or is it more likely that our understanding of the human psyche is too lacking for technology in medicine to effectively treat mental disorders? Or (an ever controversial question) are mental disorders just a perception that is misunderstood and labeled as deviant?

The question of deviant behavior is an interesting discussion in itself, but it strays too far from the topic at hand. Pharmaceutical companies strive to use technology to be the first to market with a new drug that will cure an incurable disease, or that will prolong life or pleasure, or that will provide some form of cosmetic enhancement or correction for visceral pleasure. Cosmetic and visceral pleasures are important for pharmaceuticals and for the plastic surgery industry.

Plastic surgery has proven to be a great help to people in need of drastic repair to their bodies due to traumatic and extreme injuries, but it has also become a cottage industry for the vain and narcissistic. Fein discusses problems with the costs of technology in medicine and insists that “the underlying issue is that the American system stands alone in its complete commercialization. Healthcare in the United States is a for-profit system, and that’s the heart of the problem” (2008, p. A8).

It is this commercialization that calls into question the ethics of the use of medical technologies. Fein further argues that “‘Researchers calculate that between one[-]fifth and one-third of medical outlays do nothing to improve health.’ That ‘extra’ expense pays for billing, marketing, administration, executive compensation – and, of course, profit” (2008, p. A8). As it turns out, cost control is a big issue in the pharmaceutical industry, but “many of the effective means of controlling costs will be painful for us because of our fascination with technology, [and] the resistance to change will be formidable” (Callahan, 2008, p. 11).

One oft-proposed solution to the growing lack of medical coverage for people in the United States is that of universal health care, which is used heavily in European countries with great success. Callahan’s research found, however, that “an astonishing 40 percent of Americans believe that medical technology can always save their lives” (2008, p. 11). Because of this, it is easy to see why Americans continue to fund new medical technology through the existing insurance systems.

One frightening side-effect of the strong belief in medical technology is the dissolving of two agencies that were responsible for ensuring the safety and ethical use of medical technologies.

“American physicians and medical industry associations… were heavily responsible in the 1980s and 1990s for killing two federal agencies designed to assess medical technology from a scientific and economic perspective. Medical groups opposed them on the grounds that studies of that kind could interfere with the doctor-patient relationship (only they can decide about treatment evidence), and that since life is priceless, any economic assessment would be immoral. Congress, which has never shown much enthusiasm for the control of technology costs, did the actual killing” (Callahan, 2008, pp.10-11).

Did the American people get fair representation and moral protection by the removal of those agencies, or did the medical professionals ensure an unimpeded revenue stream? Was Congress looking out for our best interests by agreeing that human life is so invaluable that to attempt to control the costs of technology that could potentially save it would be wrong or bad for us? Isn’t poor fiscal economic policy bad for us as well? All of these questions are not easy to answer because for all of the bad things, there are a number of good examples of the use of pharmaceutical technology as well.

A drug by the name of Prevora has been extensively studied in Canada and is being considered for use in countries in Europe by 2009 (Symington, 2008, p. 37). The pharmaceutical could effectively remove the risk of major tooth decay in elderly humans. The United States is performing its trials on the drug as well to seek FDA approval and hopefully a release to the U.S marketplace as well. But will it be affordable? Name brand drugs that solve a medical problem are often expensive and sometimes not covered by insurance providers in the United States.

Canada and Europe should have minimal issues with the drug as it will be covered by their universal health care systems (which might require a long wait to see the dentist – a common gripe and misconception by detractors). However, the widespread availability is a good thing for the people of those countries who will have access to it. So we can easily see that a properly researched pharmaceutical with proven efficacy can be a great boon to us, but there are mitigating factors to that success, and there are other issues of economy and morality that surround the marketing and sales of the drugs. It is possible that a large portion of individuals will still consider them to be a “good thing”, but I believe that the issues of pricing and availability need to be revisited and redesigned to provide more good for a greater number of people in the United States.


  • Anonymous (2008). Reports from Georgetown University advance knowledge in health and society. Health and Medicine Week (June 9, 2008), 1575.
  • Brafman, O. and Brafman, R. (2008). Sway: The irresistible pull of irrational behavior. New York: Doubleday.
  • Callahan, D. (2008). Curbing medical costs. America, 198(8), 9-12.
  • Fein, L. (2008). If the health of the nation were really an issue. Forward, 111(31693), A8.
  • Symington, J. M. and Perry, O.R. (2008). Breaking new ground in preventive dental care: The story of the Prevora antibacterial tooth coating for root caries reduction in older patients. Oral Health, 98(3), 37-53.