There's Gold In Them Thar Pills

Commentary by Greg Lewis / WashingtonDispatch.com
February 10, 2004

Within the last several months, three events occurred that have refocused attention on the drug industry and on the fact that it's become the tail that wags the dog of American medicine.

First, Rush Limbaugh copped to a long-term painkiller addiction, took a hiatus from his talk show, and checked himself into rehab. Second, a Republican congress — over the obstreperous naysaying of Teddy Kennedy, who could see the Democratic hegemony built on buying votes via the subsidization of health care dissipating before his bloodshot eyes — passed a prescription drug bill for "seniors." And third, I, along, no doubt, with millions of other Americans, got an e-mail from some yahoo named "n_wallace" whose web host is "supereva.it." The subject of the e-mail was "Killer discounts on Valium, Xanax, Soma, Fioricet and more."

When, rather than send a return e-mail, I tried to access supereva.it, I was without warning shuttled to a porn site, which, given the kind of people likely to respond to the promise of discount prescription psychotropic meds, probably makes sense. I guess I should have been on guard when I saw that this guy wallace had "_" for a middle initial, but what the hell.

It turns out that when Rush talked about having "half his brain tied behind his back" he wasn't kidding. But he's not the first to suffer from this affliction. History is full of powerful people who abused drugs. President John F. Kennedy was taking a stupefying array of mind- and soul-numbing substances, including steroids, thyroid hormones, amphetamines, the painkiller Demerol, the heroin substitute Methadone, Ritalin (which exactly mimics the action of cocaine in the brain), Miltown, Librium, and various sleep aids, including barbiturates.

But while liberals typically defend Kennedy's use of a staggering combination of prescription painkillers and other psychotropic substances, CNN's Paula Zahn was moved to wonder peckishly if Rush Limbaugh's drug use "didn't affect his thinking" in some way. Yes, Paula, it did affect his thinking. It meant that when he was dosed up with Vicodin and Oxycontin he was only seven times as smart as the smartest liberal and not eight times as smart.

The recent congressional debate has focused on prescription drugs, particularly on the issue of the degree to which the government should subsidize the purchase of prescription medications for senior citizens. Politically, it has become virtually impossible to oppose prescription drug benefits for seniors, because doing so would be to risk alienating this very influential bloc of voters. But the history of federal health care legislation is interesting with regard to this issue. Concern for the medical well-being of senior citizens and the socio-economically disadvantaged surfaced legislatively in the 1960s with the Kennedy/Johnson "Great Society" legislation. The original Medicare bill was an amendment to the Social Security Act and was passed in 1965. It focused entirely on what can be termed "face-to-face" medical treatment, including visits to doctors' offices, hospital stays, and surgery.

The first Medicare legislation did not even address the issue of subsidizing the purchase of prescription drugs. The reason? There was no apparent need to do so. The use of drugs to "manage" health was a statistically insignificant portion of medical expenditures at the time, and it wasn't deemed necessary even to consider remuneration for drug expenses.

Since that time there has been an explosion of new medications onto the market. Whole new classes of drugs have appeared based on our rapidly expanding knowledge of human biochemistry and the ways "health" can be "managed" through the artificial disruption of biochemical processes by the use of powerful toxins. Among other things, there have been substances (literally) designed to treat "diseases" and disorders and conditions that were not even blips on the radar screen of allopathic medicine in the 1960s. Drug use — including the rampant and irresponsible overprescription of psychotropic and other medications by physicians — may be the single largest and most important component in the breakdown of law and order and manners that has occurred in the past half century.

It's a classic case of legislation scrambling to keep pace with the times, in this instance, with the explosion of drug-based therapies that has transformed the practice of medicine from a healing enterprise into the ill-advised attempt to discover, often by process of elimination, which combination of powerful toxins might, for the time being, be called upon to "manage" a given patient's symptoms. This process is acted out daily in doctor's offices across the United States. From depression to adult onset diabetes, from high cholesterol to ankylosing spondylitis, physicians wrestle with the difficult issue of "managing" a patient's symptoms, all the while managing to avoid wrestling with their consciences.

So influential and powerful is the drug industry that physicians are now all but out of the loop. Drugs are advertised directly to patients, who can go to their doctors and insist that they be "put on" a specific drug. Physicians, in many cases reduced to the equivalent of streetcorner dealers in a widespread drug trafficking scheme, are normally more than willing to comply. Why not? Their role in diagnosis and treatment has been pretty much reduced to following insurance company and HMO guidelines, and the purchase by their patients of the drugs approved by insurers and HMOs is subsidized, in many cases by the government.

The health care system now functions in such a way that if patients want to choose "alternative" means of treatment, they have to pay for it themselves. There's no real market for medical services, except among those who have the resources and the determination and the understanding to seek treatment other than that subsidized. It's a lot like public education: There is a de facto monopoly that depends for its existence on there being no practical choices among most of those for whom the service is provided.

This means that most people are not able to shop for treatments that might restore their health rather than put them at the mercy of physicians who, often in ignorance, keep on prescribing meds that fill the coffers of the drug companies but don't promote healing. They're basically creating "customers for life" out of normal Americans who get hooked on the product. Indeed, many of the drugs are so highly addictive — this category includes such substances as Ritalin, Xanax, Vicodin, and Paxil, to mention only several of hundreds that are commonly prescribed for otherwise treatable physical, emotional, and behavioral disorders — that it can be wrenchingly painful, even fatal, to try to withdraw from them, and people often choose to stay on them rather than work towards reestablishing their health more naturally.

This is not only detrimental to the health and well-being of patients, it's extremely costly to taxpayers. Since there is no means testing for federally mandated health services subsidies for seniors (it's certainly not "insurance"; "subsidy" is the only accurate descriptor), these moneys are freely distributed to everyone, regardless of income. Means testing would at least begin to reduce costs.

But the cynical point is, Why do we need a prescription drug plan for anyone? You can get these meds so cheaply through internet sources that in the near future there may be no need for the Federal Government to subsidize drug companies. One has to think that this booming black market in controlled substances is somehow to the drug companies' advantage, so timorous are their attempts to control it. The fact that Rush Limbaugh is under investigation for circumventing the federal government/drug company controlled-substance hegemony may say more about the source of the enormous drug problem in this country than it does about a single user's difficulties withstanding the addictive product to whose profitable distribution those two entities are themselves so obviously addicted.