Prompt: 1.    How have pharmaceutical companies influenced the way we understand

Prompt:
1.    How have pharmaceutical companies influenced the way we
understand health in the US and other parts of the world? Who benefits and who
pays the price for this way of understanding? How might alternative ways of
understanding health lead to greater well-being for more people?
This is what I have so far.
A man
goes to his pharmacy and asks the technician at the counter for something for
his cough.
The
technician looks around and see that they are out of cough syrup.
“One moment sir,
let me ask the pharmacist what we can do.”
The pharmacist thinks
for a moment and gets a bottle of mag citrate and rings up the man.
Once the man is out of
earshot, the confused technician asks the pharmacist, “How in the world is
that going to help his cough?”
The
pharmacist replies, “Trust me, he’ll be too afraid to cough now.”
-Unknown
Author
Pharmaceutical companies have influenced the way we
understand health in the US globally because they have redefined “health” as we
have come to know it systemically. The goal of health which has been set is,
“to uncover more hidden patients among the apparently healthy” (Drugs for Life
pg. 114). The goal is to create chronic dependence on pharmaceutical therapies
which alleviate and treat risk factors of disease as opposed to treating
disease as in acute manifestations and utilize healthy lifestyle changes for
the frontlines of risk factor management. The pharmaceutical companies benefit
while the one who pays the price is, “the man who walks into the pharmacy” or
to the doctor, or to the urgent care center. It is the common man who seeks
medical care who pays the price for this way of understanding health. This joke
aside from being funny, shows the nature of health as being not something to
directly alleviate a health problem or concern but to cover up a symptom which
does not even address the root of the problem. The man is seeking something for
his cough. Well, why is he coughing? Does he have a viral illness, COPD,
bronchitis, cystic fibrosis, asthma? None of these questions are addressed by
the pharmacist. Now, this being a joke and certainly not an evidence-based
source to cite, it only tracts so far. But the joke symbolizes a universal
understanding of how we have come to understand health, which is, to take
medication to lower risk of possibly having complications of disease before
signs or symptoms are manifested in an individual. This concept which has been
created by pharmaceutical companies through clinical research trials and
advertising has become the standard of how the US and other parts of the world
approach health. Alternative ways of understanding health include a shift
toward preventative frameworks that embrace education and healthy lifestyle
changes to lower personal risk factors, as well as alternative approaches that
focus on treating the health of the whole person as opposed to just markers for
disease.
These are my unorganized thoughts and citations:
1.    How have pharmaceutical companies influenced the way we
understand health in the US and other parts of the world? Who benefits and who
pays the price for this way of understanding? How might alternative ways of
understanding health lead to greater well-being for more people?
By producing drugs based on chronic
dependence and redefining the necessity for drug based intervention
preventative framework. The pharma companies benefit with large profits and
people with low health literacy pay the price figuratively and literally. By
looking at health based on non-drug preventative focus that is aimed at public
health initiatives and improving health literacy individuals can improve their
health overall and reduce reliance on medications. Over time this could shift
big pharma’s aims away from disease focused chronic dependance medication
production.
Reducing unnecessary medications to
lower patient health cost
Do they need the medication really
Empowering individuals to live
healthier lives and understand choices that majorly impact their health and put
them at risk for chronic disease.
This article addresses the offshoring of clinical trials
to middle- and low-income countries
and the complicated ways in which they have become
integral to public health and
quality of care in these contexts. Clinical trials are
social institutions, and the question of
whether to carry them out, where and how is a political
one. These politics bear the stamp
of a patterned set of practices inherent to the
pharmaceutical industry as it has evolved in
North America and elsewhere—I specifically have in mind
the history of research among
minorities and so-called cooperative patients and
professional guinea pigs, and the power
the industry exerts over
evidence-making and drug regulatory policy
The new clinical trial environments that CROs help to tailor are
adaptable, mobile and,
to some extent, parasitic. They insert themselves in ongoing and
unresolved conflicts over
market reforms and the role of public institutions in local societies. At
any given moment
they can move somewhere else. National health and regulatory experts have
high stakes
in attracting clinical trial investments to their countries and keeping
them there. These
experts play a key role in shaping the public’s understanding of clinical
trials—their benefit
to patients and to public health systems more generally. To get an
on-the-ground understanding
of the offshoring of clinical trials, I carried out a comparative
ethnographic inquiry
in two of the fastest growing regions for clinical trials (Latin America
and Eastern Europe),
working with trial coordinators, study monitors and local investigators in
these regions and
where, to some extent, clinical research plays an increasingly important
(though generally
under-acknowledged) role in
public health services provisioning
So, what drives the demand for larger pools of human subjects? First, as I
mentioned earlier,
simply the sheer number of trials being run. The advent of blockbuster
drugs with sales of
over a billion dollars annually has led to the profitable ‘me-too drugs’
business. With minimal
pharmacological alteration, these drugs build on or mimic blockbuster
drugs and are
not especially innovative5. Second, to satisfy US regulatory demands, increasingly large
numbers of patients must be included in clinical trials to prove long-term
safety, especially
of drugs designed to be widely prescribed. Third, some drug
categories—like antihypertensives
to control blood pressure and statins to control cholesterol—are expanding
dramatically
as new compounds are developed. Competition to get drugs approved and
marketed
steps up the search for subjects. Fourth, there is significant growth in
the number of new
chemical entities—patents are inundating the United States Patent Office
for compounds
that have yet to undergo clinical
testing (CenterWatch, 2005).
So there is a lot of unneeded treatment
going on, which is another way to think of that nnt. This kind of result is
known as the prevention paradox, in which “many people must take precautions in
order to prevent illness in only a few.”17 pg 113
e uncanny thing about describing the trial
this way is that it implies
that which ten out of one hundred patients
get helped is up to chance, given our knowledge today; the other ten of the
twenty that got better would have gotten better anyway. This is the very point
of randomized control trials: randomly choosing which patients get Plotec and
which get placebo (or a different treatment) is done to ensure that nothing
other than chance and the treatment affect who gets better. This is the type of
fact that clinical trials produce. Treating patients in this way also requires
ensuring that the patients be, in fact, comparable as patients. That is, they must
all have depression in a similar and measurable manner, and their improvement
must also be comparable. Therefore all two hundred en-rolled in the clinical
trial must be treated in a similar manner pg 114
An industry executive stated the goal in
the case of diabetes: “To uncover more hidden patients among the apparently
healthy.” Large trials were increasingly needed “to render visible the
rela-tively small improvements provided in less severe forms.”19 pg 114
The Ameri-can Diabetes Association’s slogan
in 1961 was “Be alert—be tested—be sure—check diabetes.” Greene points out that
the shift toward earlier and earlier diagnosis was driven by the existence of a
therapy to test and theo-ries about how the drug worked, especially when the
drug could serve as a diagnostic tool. The shift was enabled by a different way
of think-ing about the disease: “By equating the linear gradient of
physiological parameters with the temporal progression of disease, the concept of
pre-diabetes invested borderline test results with a sense of
pathophysiologi-cal urgency.”21 Today, a similar shift is happening with
Ritalin and other stimulants whose prescription is being used to diagnose as
well as treat attention-deficit hyperactivity disorder (Adhd): if Ritalin helps
a person, then the person must have Adhd.22 pg 115
Described as a “double shift” by Greene,
illness began to be seen in an
entirely new way.23 Diseases previously
regarded as incurable downward progressions came to be seen as long-term
chronic conditions requiring prediction, surveillance, and chronic treatment.
Preventing those dis-eases from manifesting in the first place emphasized
prediseases and their treatment. Prediseases by definition usually had no felt
symptoms, but as they became treatable they came to be viewed as diseases in
their own right. Prediseases involved large percentages of the population, and
Greene notes that it required the availability of extremely safe drugs that
could be given to hundreds of thousands of patients to make the category of
predisease diseases clinically meaningful 115
lness was redefined by treatment as risk
and health as risk reduc-tion, and the line of treatment was itself determined
by the clinical trials and an associated cost-benefit calculation. And the sum
of these shifts was as controversial as the establishment of randomized control
clinical trials (rct) in the first place. If the rct meant that doctors had to
give up control during the trial and trust the numbers afterward, the emergent
notion of illness as defined by that line was equally troubling precisely because
it was both arbitrary and unsatisfying. Why at this number and not a bit higher
or lower? Why are the numbers usually so round (every-one over thirty should be
on cholesterol-lowering drugs)?25  pg 116
The most meaningful difference between the
two models is in the form of diagnosis, as one move away from Has he got it? to
How much of it does he have?28 Given a continuum of measurements, 116
I have attached three sources. I do not care if you want to add more.
I also need to cite a book called Drugs for Life by Dumit if possible but I can always add that llater.