杏吧原创

LET鈥橲 look at some disturbing figures. The use of prescription drugs in the US has soared. In 1993, the average number of prescriptions per person per year was seven; by 2004 it was up to 12 鈥� and rising. That鈥檚 some 3 billion prescriptions and a cost of $180 billion. So is the richest nation also the sickliest? Have the drugs stopped working?

According to journalist Greg Critser, who鈥檚 spent years studying the pharmaceutical industry, the reason is that these drugs (which, remember, require a doctor鈥檚 or healthcare professional鈥檚 authorisation) are now central to the national notion of health.

For John and Jane America, their parents and their kids now see prescription meds as 鈥減artners 鈥� their message about why they work鈥�almost as important as the pill itself鈥�. The public still trusts them despite a proliferation of concerns about the safety of many drugs (COX-2 inhibitors, SSRIs, Ritalin, ACE inhibitors) and their unintended effects on the gut, brain, liver, heart and lungs. For Critser, the irony is that the generation that experimented with drugs is now a generation the drug companies are experimenting with.

颁谤颈迟蝉别谤鈥檚 Generation Rx is the latest addition to a growing pile of books attacking Big Pharma. Like those before him, Critser details the shenanigans of lobbyists, the weakness of the FDA, and the manipulation of public and doctors via direct-to-consumer adverts and off-label prescribing.

But perhaps the strongest and most unusual part of his book describes the US of today as a nation of pharmaceutical tribes. Starting with the Tribe of High-Performance Youth, the use of prescription drugs for depression, attention deficit disorder and a range of other psychiatric and behavioural problems is turning American kids into the most medicated generation ever. Why? Because of their parents鈥� wish that they 鈥減erform well in a society of ever-increasing demands to perform well, nay, superbly鈥�.

This group may constitute the biggest recipients of 鈥渙ff-label鈥� prescribing, where manufacturers encourage doctors to prescribe their drugs for conditions and diseases not covered by the original licence.

Next comes the Middle Years Tribe, or the Tribe of Productivity and Comfort, who take cocktails of antidepressants, painkillers, fat and cholesterol-busters, and libido enhancers. These drugs shore up their 鈥渁bility to produce more and better, and to relieve discomfort, including the discomfort of having to watch what we eat and drink鈥�.

The old also join in the drugs fest as 颁谤颈迟蝉别谤鈥檚 Tribe of High-Performance Ageing. They want both to alleviate the obvious discomforts of ageing and to extend life 鈥� the latter to such an extent that doctors are worried about polypharmacy (the piles of pills our grandmas take, many of which their own doctors will have forgotten prescribing). For the old the prescription medicine chest is at best a very mixed blessing.

This part of the book is the most fascinating and disturbing. A strong drive for medical fixes, for an ever-better quality of life, for being 鈥渕ore鈥�, all make Americans (with the rest of the developed world close behind) willing consumers and thereby colluders with the drug companies. In a new way, Critser has attempted to answer the question implicit in his subtitle: how it is that pills have become key transformers of American bodies and culture.

After all the analysis, Critser is obliged to offer solutions. And he does. First, the fairly obvious litany: reining in Big Pharma with tough government, enforcing transparency on vested interests, improving drug testing and safety feedback, and so on. Again, his societal answers are more telling: stop being consumers of health, get healthy lives, don鈥檛 be part of the off-label experimentation, think about work and health, and set up wellness programmes.

But his biggest point, and one to pursue, comes in his sign-off: 鈥淎mericans and pharma must recognise the mutual intensity, emotionality and deceptiveness of their co-dependence. We need to shed synergy. Only then can we learn where our true interests converge and where they depart. The stakes are high. It鈥檚 your money and your life.鈥�