One Nation, Under Medication

There were two great pieces in the NYTimes yesterday about our country's love affair with drugs. The first, entitled "This is Your Country on Drugs" by Carl Elliott, compares the most recent doping scandal in baseball with our culture's penchant for performance-enhancing drugs of every flavor.

College students take Ritalin to improve their academic performance. Musicians take beta blockers to improve their onstage performance. Middle-aged men take Viagra to improve their sexual performance. Shy people take Paxil to improve their social performance. The difference is that if athletes want to get performance-enhancing drugs they go to the black market. If the rest of us want performance-enhancing drugs, we go to our family doctors.
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Perhaps this is the inevitable result of turning our medical system over to the market, where making sick people well is often less profitable than making well people better than well. Procter & Gamble, for example, has decided that the profit margins of its ordinary consumer items like Crest toothpaste and Tide laundry detergent are not nearly as appealing as the enormous profit margins of prescription drugs.

The second, "We Love Them. We Hate Them. We Take Them." by Abigail Zuger, MD, is an account of a doctor's negotiation with her patient around pharmaceuticals, and will sound extraordinarily familiar to anyone who's ever had more than one prescription at a time.

Medical anthropologists have written at length about how medications "commodify" health, fostering the illusion that it is something bought and sold at market. In doctors' offices and in medicine cabinets, though, a reverse process takes place: we all anthropomorphize pills right back from commodities to willful agents of good or evil...

As a woman in my twenties, I have already acquired three long-term prescriptions. One of them (my anti-baby device) I have to explain to any doc who isn't a GYN. They look at me kinda funny, because they want to know why the regular old Ortho Whatever-Cyclen isn't good enough for me. I don't enlighten them. The next one is an anti-malarial pill that I take to control my lupus. Do I need it? Well, no, but it helps my hands stop aching. It improves my performance when knitting and typing and putting on my underwear. It's unclear whether Elliott would consider me a "sick person made well" or a "well person made better than well" by the anti-malarial. The last of my three is an antidepressant that I have never gotten around to weaning myself off of... I've never found a month that I'm willing to give up as I taper off the drug. Elliott probably would have more of a problem with the last one, though it's much more vital to my mental and physical health than the others. So who does get to decide the good drugs from the bad drugs? Obviously, the FDA hasn't been up to the task lately. I don't think Elliott is the one to ask. And Zuger doesn't sound entirely confident about either the drugs or her ability to do without them when caring for her patients.

What about caffeine? If I had to choose, I'd say that the coffee I drink every morning has more of an effect on me than the prescription drugs I'm taking. I know more than one man who changes completely after a pint of beer. So what counts as a "drug" under these analysts' definitions? The jury, I think, is still out.