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A Pound of Cure
The multibillion-dollar pharmaceutical industry has successfully addressed a myriad of illnesses and inconveniences—but how much is too much?
By William Kanapaux

When’s the last time you heard, “An apple a day keeps the doctor away?” Why worry about that when you can slurp down a few chili dogs and pop the purple pill called Nexium?

Think technology and chances are that the first thing to pop into your head won’t be prescription drugs. But there’s no question that the pharmaceutical industry is a key player when it comes to shaping the technological landscape. Last year alone, drugmakers spent $32 billion on U.S.-based research and development. That’s a lot of chemistry.

It’s no secret that modern medicine pushes drugs on us at every turn. On TV, in magazines and at doctor’s offices, American consumers face an onslaught of advertising. There’s Singular for asthma, Zoloft for anxiety and depression, Vioxx to keep seniors active and Viagra to assist aging Don Juans.

Without a doubt, these medicines serve a useful function. But now that science has conquered a vast majority of previous threats—polio and smallpox come to mind—an army of well-paid lab coats have turned their attention to more specific disorders and more precise ways of dealing with them. In the process, it has changed our expectations about medicine’s ability to control what ails us.

Last month’s column on artificial intelligence included a prediction by futurist Ray Kurzweil that in the not-so-distant future, nanobots would sit at our nerve endings, ready to engage each of us in a virtual world of our choosing. While the concept may seem far-fetched, a slightly modified version of this already exists in the plethora of pharmaceutical products available to change our mood.

A recent issue of New York magazine sang the praises of the emerging pill- popping culture of hip urbanites. Mood- altering pills that were originally designed to treat debilitating disorders are now being passed around like breath mints. Stressed out over an upcoming presentation? Take a Paxil. Scared of flying? Thank God for Xanax.

What gets lost in the rush to self- medicate is the threat of side effects. These can get nasty. Problems with Paxil, for instance, have prompted a number of class-action lawsuits that claim the drug is addictive and causes suicidal behavior. In June, both the United States and Britain issued dire warnings about prescribing the drug to patients under 18.

But these kinds of complications are merely speed bumps to an industry that sold $400 billion worth of drugs worldwide last year.

It’s a high-stakes game. Drug companies and biotechnology firms say they spend on average $800 million to develop a successful drug. And only 22 percent of drugs that are tested on humans ever make it to market.

In the process, the pharmaceutical industry sits in the driver’s seat when it comes to shaping our health-care system. The industry’s U.S. research budget is larger than that of the National Institutes of Health, putting it in control of the medical-research agenda. This means some questions don’t get answered, while others get asked over and over until they eventually yield the desired results.

On the front end, you take pills the doc prescribes, pay lip service to the sorts of things that would help prevent the condition or lessen its severity and hold out until the body fails and the only answer is expensive medical technologies on the back end.

The ongoing upsurge in type 2 diabetes is a great example of this, a true clash between modern life and evolution. Clearly, the human body wasn’t designed for processed foods full of refined sugars and saturated fats, nor for a life spent sitting at a desk, in a car and on a couch in front of a TV. About 17 million Americans now have diabetes, a 50 percent increase since 1990.

Fortunately, we have a drug for that. About 15 of them in fact, with 24 new ones currently under development. In 2002, Americans spent $7.3 billion on diabetes treatments.

The downside to treating disease through pharmaceutical concoctions is an overreliance on drugs—versus an emphasis on prevention—and unrealistic expectations for a cure. According to the Pharmaceutical Researchers and Manufacturers of America, the “cure” for diabetes would involve receiving a new pancreas or a mechanical equivalent. Neither is an option yet.

Still, there’s no question that the drug industry has made some astounding advances and continues to push the envelope when it comes to understanding treatments and possible cures for disease.

The biotech firm Genentech has a drug now on fast-track review at the Food and Drug Administration that has shown surprising promise in extending the lives of patients with rapidly spreading colon cancer. Called Avastin, the antibody chokes off the blood supply to cancer tumors. If successful, it would be an important step toward achieving a cure for cancer.

And just last week, AIDS researchers published a paper in the journal Science announcing that they have discovered how a rare antibody detects HIV-infected cells—which disguise themselves as normal cells—and neutralizes them. The team is hoping the discovery will lead to an HIV vaccine, a breakthrough that would turn the tide on a virus infecting 40 million people across the globe.

But in the other cases you have to ask, how much is too much of a good thing? Is it really worth spending $800 million developing a drug to prevent stroke when studies have found that 100 milligrams of aspirin at bedtime will achieve the same thing?

The answer could very well be yes, but in the absence of real debate, the marketplace decides. And when the drug industry finds itself sitting on a blockbuster drug that can earn billions a year, the debate pretty much ends with the balance sheet. The current king of the drug world is Pfizer’s anti-cholesterol drug Lipitor, which alone generates a whopping $8 billion a year.

Along with the rapid growth in pharmaceuticals has come the ability for new technology to develop drugs that are more precisely targeted and to develop them more quickly—at least in theory. When the SARS virus broke out across the globe earlier this year, it took researchers only six days to sequence its genome. To actually develop a vaccine or specific treatment for the virus will still take years and hundreds of millions of dollars, but the drug industry now is using the equivalent of lasers rather than the sledgehammers of a few decades ago.

Even so, drugs can offer our frail bodies only so much protection. In the days of air travel, one wily virus could wipe out a significant portion of the world’s population before researchers even begin to develop a response. In many ways, SARS served as a wake-up call to that reality, even if the virus itself seems to have fizzled for now.

It’s too easy to jump on the moral high horse and say that people should change their habits and lifestyle before running to the medicine cabinet. It’s a tough world, perhaps tougher than it’s ever been. Technology has made our lives more fast-paced and stressful, so why shouldn’t a person seek out a high-tech solution for the modern world’s ills? As long as we keep these advances in perspective, it could very well be the only way to get by.

See you at the pharmacy.

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