Greg Critser’sGeneration Rx: How Prescription Drugs Are Altering American Lives, Minds, and Bodies chronicles a woeful tale that will be familiar to those who have been following, with mingled horror and amazement, the development of the stripped-down, bottom-line-only corporate-crony capitulation-capitalism of the last few decades. Whether the subject is fast food or Enron economics, the environment or foreign policy, media monopolization or disaster relief, we seem to be enmeshed in an accelerating entropic process where the federal agencies and regulatory systems once created to protect the public interest have mutated into adjuncts and accessories of profligate profiteers and manipulative marketers, for whom the mental health of a child, the rustle of leaves in an old growth forest, the oil deposits beneath the deserts of a sovereign nation, or the tragic displacement of an urban population represents jackpots of spinning dollar signs. Pasadena-based Critser is the author of Fatland: How Americans Became the Fattest People in the World, looking at the devolution of the U.S. diet and its deleterious effects on health; his work belongs to a new entertainment genre, fueled by the success of Fast Food Nation and Michael Moore’s films. In what is surely a sign of the times, such works convert the stalking of a passive and pathetically misinformed populace into a new spectator sport for liberal handwringers.
A significant proportion of Generation Rx — perhaps too much of it — unfolds as a straightforward business story, in which we witness Big Pharma, at first tentatively and then with increasing euphoria, slough off its old fuddy-duddy ambiance and traditional restraints to embrace what the author calls a promotional “bacchanal,” today spending $12 billion a year, “between $8,000 and $15,000 annually per physician to sell its wares.” The direct payola that doctors receive from this scheme — from pens and notebooks to cash payments, trips and visits from sexy young sales reps dispensing back rubs, suggesting a “pharmaceutical lap dance” more than “an old-fashioned sales call” — puts the record industry to shame. This transformation of corporate culture co-evolved with the pharmaceutical companies’ influence on the FDA and other government agencies, getting rid of or creatively circumventing old restrictions that slowed drug development and prevented “direct to consumer” marketing of prescription drugs until the early 1990s.
Key to this transformation, notes Critser, was the tearing down of the “old church-and-state divisions between marketing and science.” As in other areas across the corporate culture — such as the dot-com realm or the imaginative use of energy futures mastered by Enron — marketing quickly became the driving force behind the industry, determining the creation and description of new drugs, which had to be “instant successes” to justify the huge investment behind them. As a president of GlaxoSmithKline noted, the only drugs worth developing had to have potential markets of $180 million or more a year. Drugs yielding less than $50 million a year “would be crazy. It would cost us more than that to develop them.” Marketing created a new “pharmaceutical paradigm,” where the pills were no longer just about curing disease but about delivering “products and services that add to the quality of life .?.?. In some cases, we are replacing a disease state with a healthy state,” enthused another Glaxo functionary.
What this has led to, in practice, is an extraordinary proliferation of new and revamped physical and psychological conditions. As Michel Foucault realized, once you have defined a new condition, you can create new techniques and technologies to treat and exploit it. Obviously, the most profitable conditions for drug companies are chronic ones, where maintenance of a “healthy state” requires daily doses of their proffered panacea for “irritable bowel syndrome,” or “persistent anxiety.” The story of Ritalin and attention deficit disorder (ADD) is an extraordinary case in point. Studies of the stimulant pointed to its ability to increase the concentration spans of children and improve their performance in school. In 1980, the Diagnostic and Statistical Manual of Mental Disorders, the standard reference manual for psychiatrists, listed ADD for the first time. Although “there has never been a consensus about what causes the disorder,” Ritalin was seen as the treatment. “The drug thus became the diagnosis,” Critser writes. The author realizes that the new pharmaceutical model perfectly supports our manically driven work culture, depending on a compressing or limited focusing of consciousness rather than independence of action and imaginative thought. “We cannot afford diversity of personality,” he notes, “at least when it affects performance in a narrow range of work-related activity.”
During the 1950s and 1960s, a battle was fought by two models of the human mind. The Freudian and Jungian psychoanalytic depth-chart of the psyche, with its repressed unconscious dimensions requiring a conscious mediation to reach a state of health, was pitted against the medicalized model, in which mental disturbances expressed genetic and physiological factors, best treated by antidepressants and other mood-altering pharmaceuticals. As Generation Rxmakes abundantly clear, our society opted for the medicalized model in a big way, but this may have been due to expedience and ease rather than scientific rigor. While psychoanalysis often intensifies the patients’ consciousness of their plight, current psychiatric practice aims at medicating patients to succeed in a society that may, in itself, be deeply unhealthy — and some of the most popular antidepressants can cause akathisia, a state of restless irritation, occasionally leading to sudden suicide.
Larger signs of our societal illness include the disregard of the environment, the competitive and greed-based behavior enforced by corporate culture, and a system that supports the dissemination of new and barely tested chemicals to treat a panoply of conditions, without much regard for long-term consequences. If psychoanalysis offered a kind of cultural shamanism, exploring the process of individuation in dreams and unconscious hints, the pharmacological mania of current decades might be considered a kind of sorcery, in which the language of science and marketing is utilized to rob individuals of their agency by turning them into chronic sufferers. If, as the Pharmaceutical Marketing Congress put it, “The message is part of the medicine,” then the antidote might be found in a different kind of message, one that sees the individual as fundamentally healthy, and our institutions as dangerously sick.
Daniel Pinchbeck is the autho ofBreaking Open the Head: A Psychedelic Journey Into the Heart of Contemporary Shamanism.
GENERATION RX: HOW PRESCRIPTION DRUGS ARE ALTERING AMERICAN LIVES, MINDS, AND BODIES | By GREG CRITSER | Houghton Mifflin | 308 pages | $25 hardcover