Land of the Medicated

This article is from the archive of The New York Sun before the launch of its new website in 2022. The Sun has neither altered nor updated such articles but will seek to correct any errors, mis-categorizations or other problems introduced during transfer.

The New York Sun

It’s not particularly difficult to write and sell a primer on the evils of the pharmaceutical industry. Scads of anti-Pharma books catalog the sins of Merck and Pfizer like so many theses nailed to the pharmacy door. And popular culture has already cast drug makers as scheming and murderous; they’re the wife-killers in “The Fugitive,” wife and child-killers in this year’s “The Constant Gardener,” and soul-sucking suits in the best seller “Indecision.”


Happily, Greg Critser’s “Generation Rx” (Houghton Mifflin, 290 pages, $24.95), is more ambitious than most. While he is content to blame Merck for societal woes big and small, his is a tale of transformation rather than degeneration. “Generation Rx” is the story of how the fuddy-duddy pharmaceutical industry became a slick marketing machine, how the middle-class American became a pill-popping chemistry experiment, and how the neighborhood drugstore turned into a consumer’s playground.


This book is full of questionable claims, but the fact of America’s burgeoning medicine cabinet is not among them. The average number of annual prescriptions per person in 1993 was seven; in 2004 it was 12. What’s driven this scaling up of legal drug use, Mr. Critser writes, is a potent cocktail of deregulation, cheap generic drugs, and the marriage of meds and marketing.


Mr. Critser is at his best relating the industry’s decade warming up to the American airwaves. It wasn’t just regulation that held them back before the days of Viagra Super Bowl sponsorships, he explains, but their own squeamish paternalism. To yesteryear’s execs, “the thought of advertising a drug to anyone but physicians – and even then in very low-key ways – was vulgar.”


When industry heads finally agreed to start airing television spots, they found it was insanely profitable. Eight and a half million Americans annually request and receive a prescription for a specific drug after seeing a television advertisement.


Once pills were being pitched next to cars and cosmetics, Pharma’s execs were free to unleash their collective creativity on finding new and better ways to sell well-being. They formed ostensibly independent patient groups, like the American Infertility Association, and nudged members toward the drug of the month. They started, in Mr. Critser’s words, “talking tribe” – cultivating a herd of patients who identified with the brands Pharma was building. Pat Kelly, president of U.S. pharmaceuticals for Pfizer, encouraged his reps to lead Americans “into the camp of increased life expectancy.” He wanted consumers to feel that they were literally buying time.


As long as Pharma delivered, they were. But with so many leaning on blockbusters, breakdowns could rock the industry. Mr. Critser traces the widely publicized scandals that have plagued pharmaceutical companies, including the revelation that certain painkillers markedly increase the likelihood of heart disease for some people, back to the p.r. machine. “It became difficult to tell where pharma ended and where independent medicine stood,” he writes.


Patients want to engage in self-care, but they have no way to assess the state of the safety information they’re getting. The FDA and major pharmaceutical companies trade heads every so often; physicians accept free trips to the tropics in exchange for churning out questionable advice; pharmaceutical companies sponsor medical literature and patient groups. Objective information is hard to find.


Mr. Critser isn’t above the odd paragraph of alarmist rhetoric (as when he pities Gen Xers for their “over-pharmaceuticalized worldview”), but he keeps the book from drowning in anti-Pharma asceticism. “We want to live, not die with a grapefruit-sized neoplasm on our face,” he explains. In other words, drugs are good. So is information about them. And the question of how to enjoy the pharmacological bounty of Merck and Pfizer, without relying on them for straight answers about the poisons they’re hawking, is unanswerable.


The book’s major weakness is Mr. Critser’s cultural diagnoses. He blames our collective desire to live longer and feel better on the performance-based “work culture of millennial America,” in which we are literally working ourselves to death. But you don’t need to be pushing an 80-hour workweek to want more weeks to live, and Americans don’t need Pfizer to tell them that less pain is a good thing. It seems just as likely that skyrocketing Viagra sales are born of a timeless, and laudable, drive for self-improvement.


Still, Mr. Critser is right to suggest that patients and physicians alike need to be more proactive in seeking information. It is much easier to decry the depravity of a multibillion dollar industry than read widely, and act cautiously, when stuffing our bodies with chemical compounds. But “simply blaming Uncle Pharma just isn’t enough anymore,” Mr. Critser concludes. His entertaining book is a bit of sugar that may help that bitter message go down.



Ms. Howley is an assistant editor at Reason magazine.


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