It is always fun to look into the drug use of the past and make direct comparisons to today. One of the problems with that is that addiction meant something different then than now; another is the assumption there was something we might call Big Pharma back then.
In the nineteenth century addiction was not framed as such a problem as today; in many jurisdictions opiates were readily available and so it did not require illegal activities to sustain a habit. Courtwright’s data looks at the shift of the users of opium, the changing demographic from a respectable middle class cohort using for medical purposes, to a criminal underclass using for fun; and argued that this is when opium prohibition became more of a national concern.
However, the assumption that addicted (or habituated) citizens were considered a huge problem over simplifies the case. Many docs did not see the habit as their concern—it was a personal failing, not a disease—while others were deeply concerned about habituation and the fact that it often was a result of their own prescriptions. (They saw this as a problem for the respectability of the profession). I have analyzed doctors’s records from the nineteenth century and found 25% of prescriptions included some kind of opium based pain killer. But that does not mean they were all addicts. They were, however, all people in pain.
At the same time, the shady vendors you reference (and everybody’s favourite images of patent medicines gone wild) were far from the Big Pharma we have today. The only real big pharma progenitors were mostly German (like Bayer), and they were manufacturing things like phenacetin, a nonopiated pain killer (later found to be carcinogenic) and Aspirin, which filled the anodyne demand and helped to interfere with an opiation of the nation. Bayer also introduced Heroin as a nonaddictive alternative to morphine or opium, and their mistake there was not about willful deception but about different assessment standards than we have today.
The big drug houses in North America like Parke Davis were mostly manufacturing standardized forms of popular preparations that you would normally go to your pharmacy to purchase on prescription. They were not synthesizing new drugs, as the Germans were doing. One notable quality assessment done by Canadian government chemists found these mass produced versions were much more accurately compounded than the ones you’d get from your local pharmacist. In other words they were safer and more reliable (results that seriously ticked off the emerging pharmaceutical profession). (Shameless plug I wrote a book on this).
So vilifying Big Pharma without nuance (which is often the result of the length limits of The Conversation as well I know) is tricky. There is much to learn today about the practices of the past, but I don’t think it is fair to say this is nothing new with Big Pharma. Big Pharma is a much different operation than 113 years ago when your FDA was formed. A better comparison might be with the robber baron rapacious capitalists of the time. Because to them, business and profit were foremost, but they framed it as a national imperative to allow companies to make as much money as they wanted with a little control as possible. And they profited wildly on the backs of their workers. Who then sought pain killers to deal with the effects.
And now that their fraud is coming out Purdu is threatening to declare bankruptcy to avoid having to pay for the clean up of the problems they created!
I agree with Carl (previous commenter).
I would also add that the structure of this article feeds into the alt-med stereotype/conspiracy theory world. I’m no apologist for bad actors. Yet articles like this, without a strong statement that supplements, remedies, etc. have NO requirement to demonstrate effectiveness OR even safety of the products being sold, risk pushing those without knowledge away from effective interventions and toward a land of magical treatments. Many people see Pharma as big bad impersonal corporations that only care for money and the supplement/alt med industry as caring individuals who want only the best for people. Neither of these is true.
We live in a capitalist system that attempts to drive innovation by rewarding those that create and bring to market new products. Being greedy, as abhorrent as it may be, is not a crime. Misrepresentation is another story. It seems clear that Purdue is guilty of this, and that the consequences have damaged and destroyed many, many lives. But the same is true for the many people (e.g. “Dr.” Oz, Joe Mercola, Andrew Wakefield, Gwyyneth Paltrow) who profit mightily by selling popularizing pseudoscience.
I went back and looked through the article and did not see *any* references to ‘alternative/herbal medicines are better than standard treatments,’ nor any references to buying products recommended by Gwyyneth Paltrow. It appears you went off an a tangent there. I think we need to stay on point in this issue, which is that many pharmaceutical companies are profiting from death and addiction, with very little regulation.
Good article, but you lost me at the conclusion when you stated ” … today’s Big Pharma actively schemes to profit off of vulnerable, addicted customers, even while taking steps to ensure that opioid addiction persists.” This is a damning statement that simply does not agree with my experience. Sure, there may be a few bad small players that willingly look the other way or view it as not their problem to address, but it is not a characteristic of “Big Pharma”. There are many, many companies making drugs, and to label the few, greedy, unethical ones as representative of an entire industry is simply misleading.
now vaccines, statins, dietary guidelines
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