(contd) Let us now turn to the pharmaceutical Industry. In the olden days herbs and potions were used, based on experience, by healers thru the millennia. Gradually and then rapidly, botanical compounds were synthesized, e.g. quinine, digitalis, belladonna, opium and many others and new compounds discovered- to a tremendous benefit of humankind. This went from the monastery garden to sophisticated factories. From individual compounding of drugs to patent medicine for mass usage. Medical drugs then became an industry with research and development of more drugs and retailing. This brought on competition with attendant side-effects. Advertisement, slick and attractive packaging, and the push to sell as much and as soon as possible. It became a free for all requiring regulation and verification of claims and standards of content. "snake oil' had to be checked for snakes and oil. Pressure physicians to prescribe a particular brand with 'incentive' of fully paid 'seminars' at resort areas where a well compensated academic physician touted the authenticity and the miraculousness of a drug. Medical and specialty societies were subsidized by the pharmaceutical and medical device manufacturers. All this was great for the medical profession and the industry but catastrophic for the patient- now called 'consumer' Prices rose rapidly for some one had to pay for all this. Insurance picked up the cost. We will talk about that under "Insurance". Medical representatives went to physician's offices first giving pamphlets then knickknacks then bringing lunches. They then got into clinical research by subsidizing trials involving their products.
As soon as a drug lost its patent and became generic (anyone could make it) variations were introduced to tout of the 'new and improved' to keep up the product at a higher price. involvement int medicine became greater and more entangled. In the 1980's there was a general hue and cry that physicians were not treating 'pain' adequately. It became another'vital sign'. Any thing can be justified by 'studies'. Many came out supporting that and a new specialty was born- Pain Medicine. Pharmaceutical narcotics were touted, specially Opiods. Their sales soared. Both in oral form and as injections. After surgery, now a patient could self inject an opiod pain killer on demand through a clever device.
The 'pain industry' took off. Hundreds of thousands of pills were prescribed for the complaint. All was bliss. Certain companies made a fortune. The drug addicts found an easy source and the drugs themselves created more of them. Enter the pain specialist- to treat pain, both those addicted to the profusely available legal and illegal opiods. It did not matter, everyone was happy. The resulting addiction and accompanying problems were now glaringly visible all around. The pendulum now swung to the other side. Physicians who were blamed for under treating pain were blamed for over treating it. Mandates and regulations as to how, how much, when and what to prescribe came out. Some unethical physicians had made a fortune during the period. But now everyone had to be punished.
The pharmaceutical companies had devised ways to avoid losing control when a product became generic. Some were doing less original research and buying out small companies which were developing products. Prices of life-saving drugs like epi-pen soared for flimsy reasons. The most ingenious think done in advertising was done as 'direct to consumer' advertisement, mostly on TV. The persuasiveness and audacity of these ads is brilliant. To market the drug with indication and then telling the consumer to 'ask your doctor about it'. Not withstanding that these drugs are one of the most expensive in the market, and putting the physician in awkward position. They have one of the strongest lobbies in Washingto. (to be cntd)
