Published on Forbes and Apple News
There’s little question that we have been suckered into taking far more medicine than we actually require.
But let’s face it – we want to be suckered. We ask for it, we demand it, and we get it. Pharma companies are enablers, but they are not all-powerful overlords forcing us to gag down statins and painkillers against our will.
The demand for medicine long predates the modern pharmaceutical firm, which has existed for maybe 80 years. The Materia Medica, by contrast, can be traced back more than 3000 years. Of the over 5000 therapeutic uses described in Dioscorides’ 16th century version, probably no more than a dozen have any objective therapeutic value.
If early physicians realized the worthlessness of their remedies, they mostly kept their opinions to themselves. But scientific reasoning began creeping into medical training in the 18th century, and by the early 19th century, many educated physicians became therapeutic nihilists, dubious of the efficacy of any medical intervention. Although scientific methods led to accurate descriptions of diseases and to reliable methods of diagnosis and prognosis, they rarely created cures, least of all by drugs. No less an authority than the physician-poet-jurist Oliver Wendell Holmes declared that
I firmly believe that if the whole material medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind—and all the worse for the fishes.
And that
…if anybody got well under my care, it must have been in virtue of the rough‐and‐tumble constitution which emerges from the struggle for life in the street gutters, rather than the aid of my prescriptions
Needless to say, learned opinion did not reduce the demand for drugs. The vacuum created by therapeutic nihilism was quickly filled by homeopathy, osteopathy, Thompsonism and eclecticism. If you are dismayed by the behavior of pharma companies today, let’s note that Thompson’s campaign to take medicine back from snotty over-educated elites cured no one – but did make Thompson a wealthy man.
This equilibrium of learned nihilism and ignorant quackery might have persisted indefinitely, if not for the development of germ theory in the 1870s. By the 1880s, its application led to the development of vaccines to prevent infectious diseases (which caused over 75% of deaths), and to the creation of anti-sera to cure them. The first chemotherapy for a bacterial infection – what we now call an antibiotic – was developed in 1909.
From The antibiotic resistome: the nexus of chemical and genetic diversity.
These drugs worked. Case fatality rates for hitherto untreatable diseases plummeted. Families saw their loved ones – in particular, their children – rescued from certain death by these miraculous concoctions. Drugs were transformed from placebos, and the doctors who dispensed them were transformed from hapless providers of sympathy into god-like entities, healers whose powers defeated the grave.
Medicine became pharmacology (and surgery). We expect and demand a pill to ease our ailments. If one doctor refuses antibiotics for our sniffles, or opioids for our backaches, we go and find another one who will write the desired script.
Pharma companies are just meeting a demand. But unlike earlier eras, their drugs rarely harm and often work. That’s meaningful progress, and a true benefit to mankind.
What has not progressed is our relationship with medicine. For most of us, pill taking has become a sacrament, an act of faith and a declaration that one accepts the medicalization of unease. Big Pharma has only what power we grant it. Once we decide we are unwilling to pay $100K for cancer drugs that mostly don’t work, its power will wane and become that of just another public utility.