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In them we trust

They say that all research is ‘me-search’, and indeed, there is something of a paradox behind my interests in medicine, which I view with gratitude and mistrust in equal measure. Modern medicine has saved my life twice, for which I am obviously eternally grateful. It is indeed spectacular when faced with an emergency or critical illness. However, my family and I have also witnessed harm from medical procedures: ‘never events’ in hospital; unsafe and irresponsible prescribing of medicines; and severe reactions to medical devices, drugs and interventions. Looking back, the seeds of my journey were also sewn over 20 years ago, as a mature undergraduate student at university, when I discovered the history of medicine. Inspired by an engaging professor, my interest soon developed into passion, as I became absorbed with questions about the evolution of ideas, medical practice and celebrated discoveries. Concurrently, I also agonised over a historical landscape scattered with ethical challenges, tragedies and abuses.

My interests eventually developed into a masters dissertation, which explored the ways in which chemical and pharmaceutical companies exploited the power of medico-scientific knowledge to market disinfectants and deliberately provoke fear of germs in the home. Focusing on the 1950s and 1960s, it showed how companies manipulated increasing public trust in doctors and deference to science, to buttress fears of infection and disease from household surfaces, bodily processes and food preparation. Re-reading the dissertation nearly 20 years later, during the coronavirus crisis (as we currently sanitise and ‘distance’ ourselves from all that we love – albeit from a virus and not bacteria) the notion that we might avoid disease by certain ‘protective behaviours’ seemed strangely germane.  

Historical landscapes



I went on to explore the lives of British housewives in my PhD, which investigated possible causes of depression and anxiety (or ‘neuroses’ as it was known then) in post-war married women. I was soon drawn into the shady world of 1950s psychiatry, which was emerging slowly from the horrors of prefrontal leucotomy, electroconvulsive therapy and hypnotic barbiturates, into what was considered to be a new dawn of discovery and ‘antipsychotic’ drugs. The discovery of chlorpromazine (marketed in Britain as Largactil) was critical to the foundation of psychopharmacology, since it led to the synthesis of other antidepressant drugs and anxiolytics (for example, the monoamine oxidase inhibitors, tricyclics and benzodiazepines). These new drugs were broadly not appropriate for treating those with mild or moderate symptoms, but pharmaceutical companies recognised that increasing numbers of people were seeking medical advice for ‘neurotic’ disorders and began research into this new and lucrative market. In the United States, meprobamate (marketed as Miltown) became the most popular drug prescribed in primary care – in Britain, prescriptions for the same drug (marketed as ‘Equanil’) rose sharply in the early 1960s. The first of the benzodiazepine range, ‘Librium’, soon overtook prescriptions of Equanil/Miltown. Three months after it was approved, it became the most prescribed tranquiliser in the United States. These medications were increasingly prescribed for a huge range of non-specific emotional disorders. Although studies in the early 1960s suggested there was a risk of dependence from benzodiazepines, they continued to be prescribed widely throughout the 1970s, leading to problems of misuse and dependence. Commentators in the BMJ raised concerns about the motives and marketing techniques used by pharmaceutical companies; similarly, general practitioners complained about the mountains of drug promotional material sent to their surgeries. Concerns were elevated by the thalidomide tragedy – advertisements for Distaval (brand name for thalidomide) were still in print as late as November 1961, only one month before it was withdrawn.

The European trade name for chlorpromazine – Largactil – meant exactly: ‘large action’, and this was evident in promotional adverts for the drug, targeted at a wide range of individuals. It was described as ‘highly versatile and established for use in general medicine, psychiatry, geriatrics, paediatrics, anaesthesia, neurology and obstetrics’. Largactil was marketed for use in all individuals, from infancy to old age. While many of these drugs were aimed at the ‘desperate housewife’, pharmaceutical companies also exploited the overworked businessman, with drugs prescribed primarily for gastritis and duodenal ulcers, which contained a ‘hidden’ tranquiliser. As I have written about in my second book, during the 1960s, these drugs were promoted widely to men suffering from stress-related indigestion and gastritis. 

Current concerns

The misuse of, and addiction to benzodiazepines continued through the following decades. An increasing number of new benzodiazepines have been released in the European market, and it is now suggested that over a quarter of a million people in England are likely to be taking dependency-forming medication beyond the recommended time scales. Since the early 1990s, some psychiatrists have raised warnings about the increased tendency to attempt or complete suicide while taking SSRI antidepressants – a claim that has caused much controversy but is nonetheless supported by recent evidence . More than 76 million antidepressants were dispensed in the community during the year 2018-19 – a 23% rise on the year 2015-16. More recent data suggests a continuing upward trajectory due to the psychological impact of the Covid-19 crisis in 2020. Most worryingly, antidepressant prescriptions for children aged between 12 and 17, more than doubled between 2005 and 2017. 

The pervasive influence of big pharma is not confined exclusively to psychological distress but extends to treatments for a wide range of other conditions, among the most notable: opioid pain relief and drugs for hypertension and high cholesterol. In the United States, the pharmaceutical company Johnson & Johnson was fined $572 million in 2019 for fuelling Oklahoma’s opioid addiction crisis. Oklahoma’s Attorney General claimed the company used misleading information to downplay the risks of opioids and repeatedly ignored warnings by the Federal Government and its own scientific advisors about the dangers of its drugs. He asserted that Johnson & Johnson built its billion-dollar brand out of greed, and on the back of pain and suffering. In 2004, the drug company Merck withdrew its blockbuster arthritis drug Vioxx, because it doubled the risk of heart attacks and strokes. In the UK, a study in 2017 found that almost half of over-65s are taking at least five different drugs a day. The increasing dependence on multiple prescription drugs is known as ‘polypharmacy’ and increases the danger of interactions between different drugs and the risk of frailty in older patients. The debate on statins – one of the most widely prescribed drugs for the older population – has raged for decades. Prescribed to help prevent heart attack and stroke, over 70 million statin prescriptions are dispensed each year in England. Yet studies do not necessarily suggest that lowering cholesterol levels confer any particular benefit.

Most disturbingly, a recent report by the Independent Medicines and Medical Devices Safety Review, ‘First Do No Harm’, described serious harm from three other medical products: Primodos – a hormone-based pregnancy test used in the 1960s and 1970s, which caused miscarriages and birth defects; sodium valproate – an epilepsy treatment that caused birth defects and developmental delay in unborn children; and the pelvic mesh implant for organ prolapse in women, which has been found to cause internal damage, sepsis and chronic pain. The report found that patient’s voices were ignored, and that action was taken too late. The harm caused by these drugs and devices was so serious that the report urged Government to establish a Patient Safety Commissioner to examine patient safety incidents. One of the vaginal mesh products is produced by Johnson & Johnson, who maintain that they have acted responsibly; however, class action is being brought by 300 women against them. In terms of the scale and numbers affected, legal teams rate the vaginal mesh scandal to be on a par with the thalidomide tragedy. 

The pandemic

And so, in a time of crisis, it has been to these pharmaceutical companies that we have turned, to develop and manufacture vaccines for Covid-19. The remarkable speed with which they have risen to the challenge is commendable, and it could be fair to suggest that vaccines offer us one route out of the pandemic. It is certainly true to say that those in priority groups, over 70 years of age and/or with certain pre-existing conditions (and anyone else who would like one), might be well served to take up the vaccine. However, the rhetoric of mass vaccinations for all younger adults and children (for whom the risks from Covid are negligible) is concerning. Some people, who do not consider themselves to be in a priority group, would be more comfortable waiting for longer term safety data; for the trials to finish in 2023; and for the vaccines to be fully licensed instead of authorised for emergency use only. This is not an extreme or ridiculous view, particularly when held by those who have previously experienced harm from medical interventions – and by those who fully support vaccination and are vaccinated against other things. However, given the unhelpful tone of current debates and hysterical cries of ‘antivaxxer’, you might be forgiven for thinking that it is so. Certainly, the discourse of mandatory vaccines and the coercive, exclusionary practices of ‘vaccine passports’ has been unsettling for some, particularly when there is no data to suggest vaccinated individuals cannot still transmit the virus to others, and when it has been shown that the trials were not focused on answering the questions many might assume they were. Many people are also not aware that the vaccine manufacturers are immune from any liability for adverse side-effects or death.

Some of us remember concerns in the recent past with Pandemrix, the vaccine developed for Swine Flu in 2009. Anthony Fauci in the United States, and the Department of Health in the UK, fully supported the Swine Flu vaccination programme and assured the public that Pandemrix was safe, despite ‘various logistical and legal arrangements to shorten the time between recognition of a pandemic virus and the production of a vaccine’. However, a year later, problems emerged with post-market reports of narcolepsy, primarily in children and adolescents. Eight years after the outbreak, information emerged from a lawsuit suggesting that manufacturers and public health officials were aware of serious adverse events from Pandemrix, even before narcolepsy cases were reported. Unsurprisingly, GlaxoSmithKline have not accepted that the association between the vaccine and narcolepsy was causal, but Peter Doshi, associate editor of the BMJ, cautioned that public health officials have a duty to warn the public over possible harms detected through pharmacovigilance. 

 

Trust and transparency are currently in short supply. Scientists, academics and clinicians with views that compete with the Government narrative are being censored. As Kamran Abbasi, executive editor of the BMJ pointed out recently, ‘Science is being suppressed for political and financial gain. Covid-19 has unleashed state corruption on a grand scale, and it is harmful to public health . . . the pandemic has revealed how the medical-political complex can be manipulated in an emergency – a time when it is even more important to safeguard science’. In a biting critique, he warned that the UK’s pandemic response has relied too heavily on scientists and other government appointees with worrying competing interests, including shareholdings in companies that manufacture Covid-19 diagnostic tests, treatments, and vaccines. Let’s not forget also that the four main vaccine manufacturers have paid billions of dollars in fines for misconduct, including: falsifying data; bribing medical professionals; false claims; promotion of unapproved medical products; and safety violations. Pfizer alone has paid $4,712,210,359 in fines since 2000.  

And finally

Ending this blog where I started, I suppose it has been a unique combination of personal experience and lengthy academic enquiry that has led me to inhabit a place both of respect and suspicion when it comes to medicine and big pharma. My experience, and my instinct as a mother, have taught me that, it is not only perfectly reasonable to ask questions – it is essential. It might also be worth remembering that, as a society, we have grown accustomed to relinquishing responsibility for our own health, in favour of handing it over to the medical profession and the state. Perhaps a compromise would be to embrace medicine with optimism and gratitude (for we benefit from much of it), but to retain the ability to think critically and undertake our own research. Equally important in a frightening health crisis, is to remember that alternative views should be respected and may have been formulated on credible foundations, even if they do not appear to fit with the prevailing narrative.

References and further reading

M Angell, The Truth about Drug Companies: How they deceive us and what to do about it (New York, 2005)

M Fitzpatrick, The Tyranny of Health: Doctors and the Regulation of Lifestyle (Abingdon, 2001)

A Haggett, Desperate Housewives, Neuroses and the Domestic Environment, 1945-1970 (London, 2012)

A Haggett, A History of Male Psychological Disorders in Britain, 1945-1980 (Basingstoke, 2015)

D Healy, The Antidepressant Era (Cambridge MA, 1997)

D Healy, Pharmageddon (Berkeley, 2012)

N Tomes, The Gospel of Germs: Men women and the microbe in American Life (Cambridge MA, 1999)

A Tone, ‘Tranquilisers on trial: psychopharmacology in the age of anxiety’, in A Tone and E Siegel Watkins (eds.), Medicating Modern America (New York, 2007)

 

Links from text above:

James Davies et al., ‘Long-term benzodiazepine and Z-drugs use in England: a survey of general practice’, British Journal of General Practice 67: 622 (2017) 

https://bjgp.org/content/67/662/e609

Suicide risk and SSRIs:

https://jech.bmj.com/content/75/6/523.full

76 million prescriptions for antidepressants:

https://www.chemistanddruggist.co.uk/CD006720/Antidepressants-dispensed-up-almost-a-quarter-in-last-five-years

Rise in antidepressant use in children:

https://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1003215

Opioid crisis and Johnson & Johnson:

https://www.bbc.co.uk/news/business-49452373

Half of all over 65s take at least five drugs a day:

https://www.telegraph.co.uk/news/2017/11/15/half-over-65s-take-least-five-drugs-day/

Report of the Independent Medicines and Medical Devices Safety Review:

https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf

 

The Conversation article on vaginal mesh, Primodos and sodium valproate

https://theconversation.com/after-shocking-medical-scandals-new-patient-safety-champion-can-restore-trust-146250

Peter Doshi, ‘Will covid-19 vaccines save lives? Current trials aren’t designed to tell us’, BMJ, 21 October 2020

https://www.bmj.com/content/371/bmj.m4037

Peter Doshi, ‘Pandemrix vaccine: why was the public not told of early warning signs?’ BMJ, 20 September 2018

https://www.bmj.com/content/362/bmj.k3948.full

Kamran Abassi, ‘Covid-19: politicisation, “corruption,” and suppression of science’, BMJ, 13 November 2020

https://www.bmj.com/content/371/bmj.m4425

Pfizer fines:

https://violationtracker.goodjobsfirst.org/parent/pfizer