"Big Pharma" & Privilege
June 8, 2015 7:00 AM   Subscribe

Do I think the pharmaceutical industry is corrupt? You bet I do. You know what else is corrupt that you’re not talking about when you say “Big Pharma?” The state governments in places refusing to reform medicaid so that poor adults are still going without medical insurance. I had a friend break her foot recently who didn’t want to have to go to the ER, because it was too expensive and she had no health insurance. The fact that medical insurance is so damned expensive that, before Obamacare, I could not afford to pay for it, I couldn’t afford to get diagnosed to prove I was disabled, and I went years suffering with absolutely no treatment at all while going into extreme debt every time I had a medical emergency, which with my diseases happens pretty often.
posted by Kitteh (39 comments total) 22 users marked this as a favorite
 
when I hear the words “Big Pharma” I stop listening, because I assume it’s going to be filled with a bunch of unscientific nonsense.

It's a very accurate assumption.

There's something about Facebook that seems to strengthen the tendency towards the Dunning-Kruger Effect in many people.
posted by Dodecadermaldenticles at 7:12 AM on June 8, 2015 [12 favorites]


The author's main point is that you, who are not a doctor, and even if you are you are not the personal physician of any given disabled person, have absolutely no idea what is going on inside another person's body and have no right to offer unsolicited medical advice or draw conclusions about that person's willpower, intelligence, or soul. This message is true, and it is important, and it should be disseminated everywhere, and it is something that even the most sensitive among us need to be reminded of every once in a while.

But-- and this is a big but (because I like big buts and I cannot lie)-- the author's only objection to the phrase "Big Pharma" is because it's often bandied about by the sorts of unscientific, judgment-spewing jerks who most need to hear her message. She does not object at all to its connotations or its denotations, only to those who like to use the phrase.

I ask what's intrinsically wrong with saying "Big Pharma" as a moniker for the for-profit medical industry, in line with "Big Oil" or "Big Tobacco"? Let's unpack the pull quote:
Do I think the pharmaceutical industry is corrupt? You bet I do. You know what else is corrupt that you’re not talking about when you say “Big Pharma?” The state governments in places refusing to reform medicaid so that poor adults are still going without medical insurance.
Yes, you're absolutely right. And who is funding the campaigns of those Medicaid-blocking politicians and pulling their puppet strings? Why, it's the for-profit medical industry, Big Pharma! Around and around we go!

To discard a useful phrase just because of its associations with people you rightfully dislike is self-defeating.
posted by Faint of Butt at 7:40 AM on June 8, 2015 [22 favorites]


I hadn't heard that the pharmaceutical industry was lobbying against state medicaid expansion, do you have a link on that so I can read more?
posted by Drinky Die at 7:48 AM on June 8, 2015 [2 favorites]


Drinky Die, I am trying to find one but a lot of my Google results are of the "frothing at the mouth/states' rights" sort. I'll keep looking.
posted by Kitteh at 7:54 AM on June 8, 2015


AFAIK, it's mostly "Big Hospital" and "Big Insurance" that lobby against better insurance and single payer. Big Pharma is mostly concerned with patents and subsidies, though they also lobby to avoid anything that could lower medication spending, like coordinated buying between heath systems and the like.
posted by Monday, stony Monday at 8:04 AM on June 8, 2015 [6 favorites]


> To discard a useful phrase just because of its associations with people you rightfully dislike is self-defeating.

It's not really all that useful if it's used almost entirely by (and as a dog-whistle to) people who are at best ignorant and at worst assholes. Like, "states' rights" is a useful phrase, except it's been thoroughly poisoned by decades of racists, so people who are not racists have to find other ways to talk about rights that should belong to states. It's not that difficult, and I have confidence we can do the same in finding ways to talk about the destructive and corrosive forces that drive our medical systems.
posted by rtha at 8:14 AM on June 8, 2015 [21 favorites]


I dunno, I and my other disabled friends use the phrase Big Pharma all the time (as well as give each other a constant stream of well-meaning unsolicited bad advice ("Did you hear that medicine you're on causes cancer in lemurs?" "No, but I did read on Facebook where the medicine bottles they give you at the pharmacy leach toxins into your capsules!")), but maybe it's different when it comes from in the family, so to speak?
posted by mittens at 8:20 AM on June 8, 2015 [3 favorites]


I posted this because I found it very interesting and not a little unfamiliar in terms of what people will tell you in terms of your mental health or illness. "You have anxiety/depression/etc? Oh, that sucks! But instead of taking a ^insert medication^, have you thought about yoga/whatever diet/something holistic instead?? It's way more natural for you than ^insert medication^!"

I have been battling for years against taking anything for my anxiety because I didn't want to be medicated like everyone else (what a jerk thing for me to think as well) and also I was embarrassed, but I'd rather be happier and not tearing myself to shreds internally all the time, so I have said, "Yes, yoga or whatever is great, but it doesn't fix the problem, so I'd rather have the meds."
posted by Kitteh at 8:23 AM on June 8, 2015 [8 favorites]


I think people who have angina or brain tumors or anything get "helpful" unsolicited advice about herbs and yoga etc.

What fascinates me is how adamant the writer is that she has real physical illness not mental goddammit. Even her psychiatric problems, she wants to be very clear, are caused by physical things.

But by making such a big point about this, isn't she playing into the 'privileging' of 'real, medical' illness over psychiatric/social unwellness? Of course everything she has is purely physical folks, but surely there exist people out there who have psychosomatic ailments? One rarely hears from them, but studies tell us they make up a huge proportion of patients in general medical practice. They aren't 'faking' and their symptoms are real. They just happen not to be from a physical cause. She seems to want to be very very precise in differentiating herself from these others so she can claim the privilege of 'real' illness, not merely 'mental'.

As for not being allowed to say 'Big Pharma' because, well, she needs meds and thus I am belittling her plight. Well, we all need food to survive. Thus we can never talk about Big Food/agribusiness?
posted by kevinsp8 at 8:39 AM on June 8, 2015 [12 favorites]


I think "Big Pharma" is a phrase that its users think is shaming the pharmaceutical industry but is most often used to shame individuals with disabilities, chronic illness, and mental illness. (I realize those three categories overlap.) It's used most often, in my experience, to indicate that people who use medications, especially medications for mental health condition or chronic pain, are deluded sheep who can't see through the marketing hype.
posted by jaguar at 8:48 AM on June 8, 2015 [19 favorites]


I'm not aligned (to say the least!) with big pharma or for-profit medicine. In 18 years of practice, I can say I can't think of a single disabled person with chronic pain, for whom the system hasn't utterly failed to meet the needs. As the human being that the system thrusts forward to look the suffering person in the eye, it makes me want to quit medicine.

It's not that pain pills don't have their role, it's just that there's really good quality medical literature that their role in preserving function is remarkably limited, maybe 30% of chronic pain can be mitigated by opiates at any dose. Given that most people with chronic pain are already on some opiate regimen within a short period of time, that modality is pretty much exhausted quickly. And everyone in allopathic medicine gets paid by having quick visits and selling you pills. Discussions and support surrounding nutrition, sleep, exercise, alternative/complementary medicine, and mental health are long, expensive, and produce very slow results and are simply not paid for, despite these being the only areas where there is ground to be gained. I could buy myself a yacht increasing your OxyContin dose by 20 mg every month and your life would never get much better, and you'd have more hospitalizations and ER visits, or I could spend time discussing with you how your self assessment of your pain would improve almost 40% by figuring out how to get you to sleep well at night, and if I do too much of that I have to lay off staff.

It's not that it's patients' depression and anxiety and trauma history are causing chronic pain, it's that they sure as shit affect pain perception and disability and this is what is almost universally not being addressed. But no one's going to pay me to go down that path, and frustrated uncomfortable people who once walked out of a doctor's office with some pills that made them feel better within hours aren't going to go back to the doctor who wanted to talk about their childhood and told them to eat right and exercise. And on that rare occasion where a person does feel that they want to work with me in the manner that is supported by good medical science, there is zero institutional support. Mental health is so scarce and hard to access, gym memberships aren't a medical necessity, nutritionists are few and far between, and my time is doled out in 15 minute increments when I'd really like to spend an hour. Fuck, a lot of the time where I work, what would make biggest difference is safe and stable housing. How do you do that in a medical context?

And this doesn't even touch upon the fact that for every one person with a genuine chronically painful condition that comes into my office, there's ten 20somethings who are drug seeking and it's not always easy to separate them out and I've taken care of too many teenagers with overdoses and opioid addicted newborns to not be profoundly concerned about my impact on this problem.

Yes, I am sympathetic to and listen to my suffering patients and understand that I don't really understand their experience. But I have literally given up my life to help the chronically suffering and I have nearly 2 decades of experience, I keep up with the literature obsessively, and I'm being consulted for some kind of expertise. I've seen few helped and many harmed. I consciously avoid pressure from drug companies and am relatively resistant to the financial pressures of medicine. And still, I am here to say that this is a fucking unrewarding thing to be in the middle of every day and I think it is likely I'm going to leave the practice of medicine one day because of it.
posted by Slarty Bartfast at 8:50 AM on June 8, 2015 [66 favorites]


I know plenty of smart, well-intentioned folks that rail against Big Pharma. I mean, I've railed against Big Pharma, but the unfortunate part is that a lot of times those conversations end with a sort of pernicious (explicit or implicit) "Western Medicine is all crooks. You're Ms Gullible McGullibleson for believing that anyone involved in the medical/pharmaceutical industry has your best interests at heart. My best-friend's sister's boyfriend knows this girl that knows this guy that cured his bipolar disorder with juice cleanses and acupuncture. Obviously, if you can't treat your chronic depression with a vegan smoothies and yoga, then the problem is your close-minded attitude and the fact that you don't want to be happy." Which 1) Heh and 2) I've been there and heard it and it's pretty much the least helpful thing ever. Like, it's awesome that you believe so strongly in the power of back massages and positive thinking, but depression means I'm pretty much incapable of positive thinking right now.
posted by thivaia at 8:55 AM on June 8, 2015 [8 favorites]


I think people who have angina or brain tumors or anything get "helpful" unsolicited advice about herbs and yoga etc.

Oh goodness yes, everyone gets this no matter what their problem is. "Oh, my great-aunt once had a sucking axe wound. She found that vitamin pills were helpful. Have you tried that?" "My cousin's homeopath has a great solution for that -- just don't pull out the axe until you get there, it's part of the adjustment process."
posted by pie ninja at 8:57 AM on June 8, 2015 [3 favorites]


Yeah, a friend with MS just posted a message she received from an acquaintance telling her she didn't have MS, she obviously was just allergic to mold.
posted by jaguar at 9:01 AM on June 8, 2015 [3 favorites]


I don't see how Big Pharma anymore (after years of overuse and repetition) is any more useful than saying "The Man" or "Big Gubmint" or "Black Helicopters" or "The Illuminati" or "The American Way." It's a signal that anyone can tune out at will because it's become agitprop white noise.

I also loathe the use of "doing some actual shadow work" and "releasing issues" in the Facebook quote pulled by the writer in the OP -- whatever the hell that means. As Slarty Bartfast alludes above, there is almost no support from insurers or anyone else for solid mental health or other treatment that falls under the specious category of "wellness" that doesn't involve a 15-minute monthly appointment at the end of which you get handed a script or a pill sample and sent on your way. What people mean when they say "shadow work" is basically "super-expensive weekly or daily therapy that insurance would never cover and that only I and my friends and family swimming in time and money have the privilege to afford."

I'd love to do extensive "shadow work" on excavating myself. I don't have the expertise. I also don't have the money or the time during the workweek to spend on someone who does have the expertise. That pretty much goes for any of the other pricey modalities that well-meaning people mention as crucial preventative wellness interventions but which are for many people these days impossible luxuries: yoga, nutritionists, acupuncture, Reiki, pilates, physical therapy, gym memberships, on and on ad infinitum. I seriously doubt I'm alone in this. My own employer pushes great-sounding wellness workshops, with the catch that you have to pay $350-500 per session out of pocket to join them. I don't know anyone who has the kind of spare cash to put toward something like that.
posted by blucevalo at 9:09 AM on June 8, 2015 [6 favorites]


Yeah, I can't stand people who give unsolicited medical recommendations without any context.

Ask your doctor if Humira is right for you.
posted by RobotVoodooPower at 9:43 AM on June 8, 2015 [2 favorites]


"agitprop white noise."

I think I have a new ambient music project and I think I have its name!
posted by symbioid at 9:59 AM on June 8, 2015 [3 favorites]


I don't know. Obviously, it's terrible to give anyone else unsolicited medical advice, and the post she's responding to was really obnoxious. But I do feel like pharmaceutical money distorts the practice of healthcare in the US, and that makes it hard for me to make good decisions about my own care. I have at various times felt pressured by doctors to take drugs that I wasn't sure that I needed, and I've sometimes felt like my concerns about side effects were being dismissed or minimized. I feel like drugs are the go-to solution to every problem, and sometimes I'm not sure they're the best solution for me. I'm very lucky to have good insurance, and in that sense this very much is a product of privilege, but I do feel like it's easier for me to get meds than to get support for making lifestyle changes. I get that she might share these concerns but doesn't think I should use the phrase "Big Pharma." And I mean, I take her point, but I do think that the pharmaceutical industry is part of the problem and that I'm not wrong to be a little suspicious of it, even as I realize that pharmaceuticals have vastly improved my own life and those of a lot of other people.
posted by ArbitraryAndCapricious at 10:09 AM on June 8, 2015 [5 favorites]


What is considered a reasonable or an excessive profit margin in business? Found an article claiming Big Pharma makes about 30% profit margins (and another saying 10-40% depending on company) and I'm wondering if this is outrageous or about what you'd expect of a healthy industry.
posted by maryr at 10:30 AM on June 8, 2015


It's not that it's patients' depression and anxiety and trauma history are causing chronic pain, it's that they sure as shit affect pain perception and disability and this is what is almost universally not being addressed.

Not just not being addressed, but patients' own doctors often treat illness as imagined or at least exaggerated because of the emotional state or mental health history of the patient, worsening the mental health of the patient and feeding back into the mental health - physical health feedback cycle:

I have been at this so long and have heard it’s all in my head so many times from friends, strangers, doctors, and loved ones that, despite having a ridiculously long list of diagnosis and more specialists than I care to admit to, I still sometimes genuinely worry that I’m a hypochondriac. Or worse, maybe I’m suffering from what used to be called Munchhausen’s… Maybe I just want attention. The worst part of this phenomena? I’m not the only chronically ill person who struggles with this.

The sensationalist reporting that goes on around mental-physical health connections is also extremely harmful to chronically ill patients.

nutrition, sleep, exercise, alternative/complementary medicine, and mental health are long, expensive, and produce very slow results and are simply not paid for, despite these being the only areas where there is ground to be gained.

This is absolutely true, but whenever it's reported in the news, the very long time periods and often laughably small effect sizes get left out*. And the the cause and effect is typically confused in the article - so if meditation is the cure, the patient must have the disease because they were stressed. It just reinforces not-sick people's belief that sick people are making themselves that way. It also unrealistically raises the hopes of chronically ill people. No matter how much a chronically ill person focuses on nutrition, sleep, exercise, alternative/complementary medicine, and mental health, a normal life isn't going to pop out. The kinds of improvements are "when lying in bed in excruciating pain, I no longer want to commit suicide" or "I understand the difference between too sick to go to the grocery store and too sick to go to work" or "I'm in pain today, but it's not bad enough to keep me from doing my easiest physio exercises."

*In this "successful" migraine and meditation study, patients generally spent more time meditating than the time their migraines were reduced by, for example.
posted by congen at 10:40 AM on June 8, 2015 [8 favorites]


In 18 years of practice, I can say I can't think of a single disabled person with chronic pain, for whom the system hasn't utterly failed to meet the needs.

I love the term "pain management" -- it just doesn't exist. I see it everyday with my disabled grandmother. I am in Canada, but it's no different here. People have no idea what it means for someone to be in that condition. The system was not made by people in that very condition; hence it cannot properly respond to it.

It is bad enough when doctors want follow up appointments to drag someone from one place to another and then the person spends a week in excruciating agony just to settle down from that ordeal.

But then people with no clue offer the vitamin, meditation, and other insulting quackery advice as if that were some alternative. I really try not to get angry at their arrogant naïveté, but it's tough.

The answer is in medicine, but that will only happen when researchers and the medical community grasp what pain is. It is a life-draining plague where getting up is a soul-crushing challenge. It is not enough to see patients in pain: you have to somehow ride that wavelength before the right treatment can ever be found.

While sedation is not the answer, neither is pushing herbal remedies you find in KFC batter. Sure, pharmaceutical companies are out to make a buck, but so are their detractors. I just want something that heals the source of the pain.
posted by Alexandra Kitty at 10:45 AM on June 8, 2015 [3 favorites]


I can't speak to the social experience of "invisible" disability in English-speaking countries other than USA-Canada. But in most of the western EU and Israel, I've not received the blame-the-victim-you're-succumbing-to-capitalist-industrial-modernity-indoctrination for using Evidence Based Medicine. Except Germany, the founding home of homeopathy and some other vitalism woo. Even there, it was the well-intentioned "have you ALSO tried woo X?", not "if you tried ONLY woo and it failed, it's because you were a non-compliant patient/chose to be ill". Also, the US is the only place where my non-xianity was blamed for my illnesses.
The Big Pharma/Evidence Based Medicine label as weapon to further condemn immiserated human objects of capitalist rent-seeking is disgusting.
posted by Dreidl at 11:36 AM on June 8, 2015 [1 favorite]


See also.
posted by congen at 1:12 PM on June 8, 2015


Yeah, I can't stand people who give unsolicited medical recommendations without any context.

Ask your doctor if Humira is right for you.


I get that you're just being funny, but Humira is the wonder drug that gave me my life back. I went from wondering if I would need to drop out of grad school and ultimately go on disability to finishing grad school and now successfully working full time at the demanding career that I had always dreamed of. Not because of meditation or yoga or the paleo diet or the power of positive thinking. But because I give myself a shot in the belly once a week. Sometimes there is a magic pill, or shot, that makes things better. I am so incredibly grateful to Big Pharma.
posted by hydropsyche at 1:40 PM on June 8, 2015 [3 favorites]


My experiences with family and friends suffering chronic pain reinforce Slarty Bartfast's comment. All of them have had to develop their own techniques for relieving their pain, even if they were following the doctor's regimen for treating an underlying condition. The ones who took opiates are no longer with us.

Pharmaceutical companies make some wonderfully useful products, certainly. But they're 40% of the healthcare industry by market cap, so it makes no sense to leave them out when speaking critically about healthcare. They are Big. They move mountains and shape discourse.

That they make some useful products doesn't excuse them for the horrible things they do. To the extent that they have participated in stonewalling medical marijuana research and legislation, they have removed patient choice in treating their own pain, and at worst caused deaths.
posted by RobotVoodooPower at 2:18 PM on June 8, 2015 [4 favorites]


"That they make some useful products doesn't excuse them for the horrible things they do."
Indeed.

I'm tired of these conversations cherry picking the foofiest "anti-pharma" weirdos that can be found on the net and then using them to stifle the kind of SERIOUS FUCKING OUTRAGE that should be had over the bullshit being pulled by the pharmaceutical industry. Yes they do a great deal of good. The fact that some priest has helped many poor people and changed real lives in real ways does not mean their acts of abuse should be excused?

I think you can appreciate the good done AND ALSO call foul on the bullshit. And pharma is NOT the only way to treat many illnesses- the fact that our go to healing modalities that are accessible on insurance weigh heavily on pharmaceuticals and surgery is not actually because evidence proves dietary changes, exercise, and emotional/social wellness are useless- it's because the market is loaded and altered. Shit for that matter addressing poverty is an actual medical issue- there is so much evidence based health research that could be made accessible to people but everything is skewed toward permitting known health hazards to flourish in our communities in a way that is very hard for individuals to go against the grain, and then treat once we make our citizens ill.

I think trying to turn this into an "us" against "them" makes us all lose out. There is need for evidence based healthy lifestyle promotion AND treatments of many different types (that INCLUDE but are not limited to pharmaceuticals) to be accessible to people.

And if the sane people give up diligent work on preventative and restorative lifestyle and environmental factors that cause or heal diseases- the only people left to give info to the public will be quacks or well intentioned but undereducated "believers" who don't know what they're doing. We need actual medical professionals to be educated and knowledgeable about multifacted methods of disease treatment.
posted by xarnop at 3:57 PM on June 8, 2015 [4 favorites]


I think of medical "professionals" as industrial workers. As in "take this vat of pills and dump into that batch of bodies. Repeat."
posted by telstar at 4:10 PM on June 8, 2015 [1 favorite]


The problem here is that the proportion (maybe 30% or so) of people with chronic pain for whom opioids work are difficult to sort out from those who won't be helped and those who will be harmed. Addiction isn't the issue here: you are not going to create a new addiction in a person over 40 who has never had one 99% of the time. But you won't know if the person previously had an addiction because of the shame and fear of being untreated that accompanies it and you won't know if the person is faking and already addicted in large part because of the way we criminalize and mistreat addicted people as well.

At least 75% of recreational opioid users *never* get their drugs from doctors at all.

But we try to prevent opioid addiction by demonizing the chronic pain patients for whom opioids *do* work and by telling them they should be doing yoga and meditating and not benefiting from opioids and thereby providing an excuse for doctors to be allowed to prescribe opioids.

Those chronic pain patients are not the main source of the drugs— the source is generally acute pain patients who have the stuff lying around. Why? Because doctors write huge prescriptions for people not at risk of addiction with acute pain after surgery or dentistry so they don't have to deal with refills, just in case. And those people keep them around just in case because they know how hard it can sometimes be to get the drugs. Then, some kids find them.

We've got to recognize that addiction isn't caused by drugs and that prevention therefore involves dealing with why people take drugs and reducing drug related harm, not targeting supply.

We shouldn't make life even more difficult for people in chronic pain with the aim of preventing addiction because it won't do so.
posted by Maias at 4:29 PM on June 8, 2015 [4 favorites]


Anyone else hear Robert Evans?
"Do I think the pharmaceutical industry is corrupt? You bet I do. Did I nail Mia Farrow? Damn right."

Seriously, waaay too many people feel ok about dening another person's pain. But the big problem (man, I feel like a broken record repeating this concept) is systemic.
We're systemically blinded.

What I like, what I really enjoy *'casm* from the VA is listening to people in the healthcare system trying to tell people who are tougher than gunmetal that they need to suck it up.

Really? Putting out an oil fire in a war zone just not hardcore enough? Just gotta walk off those skin grafts and that shrapnel buddy, here are some pills. Oh, thanks for your service and whatever.

It doesn't seem like the system is broken. It seems like it's purposefully mercenary and designed - as an industry - to obscure genuine care in favor of making money.

I've got no idea how to fix that. Pretty sure sniping at each other doesn't help things. Not sure I care about being considered anyone's buddy or parsing language as a priority before getting something done.
But, as I'm limited in ideas here, my plan is for shit, so maybe this guy knows better the direction things have to go.
Is there some other shorthand for the cause of the trainwreck that is the political/industrial system of healthcare in the U.S.?
I mean it's crazy as a layman to get a straight answer on a lot of topics and medical care is one of them.
posted by Smedleyman at 4:54 PM on June 8, 2015 [2 favorites]


Big Pharma's flu vaccine last year, didn't work. They still made a gazillion bucks for it.

The incentives paid to medical professionals by big pharma, are intended to alter how prescribing. professionals practice medicine.

Often standards of care are altered via recommendations from pharmacy reps who have statistical evidence, that will make their companies more money. They aren't coming by to tell the prescribing professionals their meds are marginal in good effect. They are not going to say the generic is just as good. They are coming over with lunch, maybe a fabulous trip, somewhere.
posted by Oyéah at 7:07 PM on June 8, 2015


> Big Pharma's flu vaccine last year, didn't work. They still made a gazillion bucks for it.

I think you should read something like this before you go making claims like that.

(There are different strains of flu that are dominant each flu season. Making vaccines takes time, so there is a degree of educated guesswork that goes into figuring out which strain(s) to create vaccines for. The entire vaccine market brings in a ton of money, yes.... which adds up to something like 2-3% of the overall pharmaceutical industry.)

Vaccines prevent a huge amount of suffering, death, and lost economic productivity.
posted by rtha at 7:29 PM on June 8, 2015 [8 favorites]


I read the article today regarding the ineffective vaccine. Next years is supposed to be wonderful, just right, knocking out all kinds of flu bugs.

If you are a scientist or work for a pharmaceutical company, or if you are a molecular biologist, or a physician, or Eduardo the Wonder Chicken, we mefites can still speak of Big Pharma, in a safe and polite atmosphere with the utmost regard for one another. I had quite a few very sick, vaccinated friends last year. Some work in medicine and needed the vaccination to work. I just availed myself of a DPT vaccination, and had the typical three day fever, headache, and symptoms of meningitis I always get from the tetanus vaccination. Got the vaccine.
posted by Oyéah at 7:54 PM on June 8, 2015


Big Pharma is a conspiracy term used by the sort of people who told me I didn't need meds for my depression because they weren't 'natural'.
posted by Charlemagne In Sweatpants at 11:05 PM on June 8, 2015 [4 favorites]


I was about to reply that Big Pharma is a conspiracy term also used by people who are troubled when each new antidepressant just seems like a copycat of one before; when major side-effects or inefficacy of older antidepressants aren't revealed by the manufacturer until new ones are available; and when doctors appear to listen to drug reps more than their patients about side-effects.

...but then I went looking for links to that second point, found the first page of Google results was all Dr. Mercola, and gave up.
posted by mittens at 3:57 AM on June 9, 2015


I was about to reply that Big Pharma is a conspiracy term also used by people who are troubled when each new antidepressant just seems like a copycat of one before;

Brain chemistry is subtle, slight changes can make big differences. Finer gradation between drugs can help more people find the best fit possible.

It really gets to me that anti-depressant is the go to type of medication for "why big pharma is bad". They really help lots of people live better lives. They also don't help other people, or sort of help, but the side-effects aren't worth the gains. There's already so much pressure and judgement on people who need the anti-depressants, they don't need more just so you can have one more thing you can say is bad about an industry that has some questionable practices.
posted by Gygesringtone at 6:33 AM on June 9, 2015 [4 favorites]


That would make sense if criticizing the antidepressant industry were just a rhetorical point, a pleasant bit of anti-business to make one feel good, while ignoring, as you say, the pressure and judgment on the folks who need the pills.

But it's worse than that. The collision between psychiatry and marketing makes our lives as depressed people harder.

Part of this is just because any disabling condition is immediately going to be minimized by those who do not suffer so (as we read in the original post above), and that modern psychiatric marketing has given our dismissers a great new language to use to judge us. If depression is a "chemical imbalance," with all the simplicity that implies, then what happens when you fail that first round of antidepressants? Or the second? Or the third? Everyone else is being helped by these wonder drugs: Why aren't you? Didn't you see how the woman in the commercial went from black-and-white to color, just by taking this one daily pill? Why is your life still so gray?

I mean, that judgment comes from people listening to big pharma, not people criticizing it.

The popularity of the drugs has some contradictory effects. On the one hand, being able to get them from your GP rather than having to go through a psychiatrist is great. Everyone should have easily available relief from suffering. On the other hand, again, the GP is not necessarily going to have a lot of knowledge of the literature, not a lot of insight into side-effects, and isn't going to be prescribing to you based on a deep clinical knowledge that compares your needs to the profile of the drugs. I don't want to diminish the efforts that GPs go through to help their patients, but you can easily feel sort of lost if your drug causes bad effects, or does not adequately treat your depression, and your GP isn't able to help other than offering to try a different drug. That is a scary place to be, if you've just started these pills, and again, it's a factor of the industry itself, not of criticism of the industry.

That's not to say there's not some point-scoring criticism of the industry out there from people who aren't particularly invested in making sure depressed people are well-supported. But, rather, quite often the criticism comes from those of us who have spent months, years, decades, finding ourselves very much at the mercy of this industry and the cultural effects its marketing has had, and it is okay to be upset by that, and okay to demand change. This criticism, unlike point-scoring, is born of actual concern and sympathy for what depressed people have to live through as they try to find a treatment that keeps them alive and functioning, and is complementary, rather than contradictory, to the criticism that says "please don't replace my pills with woo."
posted by mittens at 7:27 AM on June 9, 2015 [2 favorites]


But, rather, quite often the criticism comes from those of us who have spent months, years, decades, finding ourselves very much at the mercy of this industry and the cultural effects its marketing has had, and it is okay to be upset by that, and okay to demand change.

Absolutely, I agree with everything in your response. There's a lot to be criticized about how drugs are marketed, and I'm always very careful to point out that antidepressants aren't a good choice for everyone, because sometimes either they don't work, or have side-effects as bad or worse than the depression.

I was responding specifically to the idea that releasing variations on the same drug is a practice to be criticized. Without further context that was hard to pick out from the general pattern of dismissing antidepressants as unnecessary or harmful and claiming that Big Pharma's just convinced people they need them. Sorry for assuming a different position than where you were coming from. The issue is just something that's sensitive for me after having been rubbed raw so many times by people who were just looking to score points.
posted by Gygesringtone at 7:57 AM on June 9, 2015 [1 favorite]


The issue is just something that's sensitive for me after having been rubbed raw so many times by people who were just looking to score points.

Which is where I think the author of the linked piece was coming from. Not that the pharmaceutical industry is blameless, just that the phrase "Big Pharma" brings a lot of baggage along with it, and it's important to be aware of that when making more nuanced criticisms of the pharmaceutical and healthcare industries.
posted by jaguar at 8:31 AM on June 9, 2015 [4 favorites]


I really try not to get angry at their arrogant naïveté, but it's tough.

I don't see it as naïveté, just marketing. Mostly they are trying to make a buck, or they believe strongly in someone trying to make a buck. The fact that they're often ignorant about science amplifies their stupidity.
posted by sneebler at 5:50 PM on June 9, 2015


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