Wednesday, September 3, 2008

Women vs. Big Pharma

Found at The Agitator

Dr. Hamilton Wright

Women vs. Big Pharma

Thursday, August 21st, 2008

Ladies’ Home Journal stirs the pot in this excerpt, which follows after this one.

Pharmacies became a target of the female-dominated temperance movement because regulating their wares was a way to secure some of that elusive legal protection for women and children. In 1892, Ladies’ Home Journal editor Edward Bok barred patent-medicine advertising from the publication. Over the next several years, he published numerous pieces revealing the true ingredients of many patent medicines and explicitly called the WCTU to action. In 1904, Bok declared that Doctor Pierce’s Favorite Prescription, a favorite patent preparation of pregnant women, contained not only alcohol and opium, but also the potentially deadly plant extract digitalis—too late, it tuned out: Pierce had changed his formula since the magazine secured its sample. After losing a $200,000 lawsuit, the Journal hired lawyer-cum-journalist Mark Sullivan to help continue Bok’s crusade in a more law-savvy, less financially dangerous manner.

Sullivan delivered, contributing to exposés on unethical patent-medicine business practices. One Washington journalist made a career of securing testimonials from senators and representatives, charging companies $75 for the former and the relatively cut-rate $40 for the latter. Sullivan also helped Bok uncover the brisk business in supposedly confidential letters from female nostrum users, which, along with the writers’ addresses, traded hands by the thousands among patent-medicine companies—and anyone else who was willing to pay for them. When companies wrote these women back—after employees had giggled over their missives’ “spicy” parts—they frequently answered with a form letter, and sometimes with the wrong medication. “The medicines are put up by young girls who are constantly making mistakes and sending men’s remedies to women, and vice versa,” Sullivan writes in a 1906 story. “They can’t do otherwise because they have to send out a certain number of treatments in a given time.”

As such pieces galvanized women against the industry, Jane Addams, the legendary Chicago suffrage and anti-war activist, campaigned for a ban on common patent-medicine ingredient cocaine, which passed in her hometown in 1904. In 1905, muckraking journalist Samuel Hopkins Adams published an 11-part investigative series in Collier’s Weekly exposing much of the patent-medicine industry as fraudulent. Upton Sinclair’s The Jungle followed soon after, helping convince President Theodore Roosevelt and the American public that a law regulating both drugs and food was needed. Historian James Harvey Young describes the coalition that got the Pure Food and Drug Act of 1906 through Congress as made up of “agricultural chemists, State food and drug officials, women’s club members, the medical profession, sympathetic journalists, [and] the reform wing of business.” The Equal Suffrage League, the General Federation of Women’s Clubs, and the WCTU were all involved.


Women’s groups that supported the Pure Food and Drugs Act were concerned with protecting consumers from adulterated products. The American Pharmaceutical Association, however, didn’t have such untainted motivations.

Public opposition to patent medicines came at a time when American drug use was declining, after a peak in the 1890s. It was the corruption of the industry, as exposed in the Collier’s investigation, that was the most troubling drug issue for most Americans. Big Pharma was happy to play along. It was in its clear interest to have its intoxicants marketed through doctors rather than through unregulated pharmacies: It would disassociate its products from patent medicines and help crush competition from smaller firms. In 1903, the American Pharmaceutical Association had already proposed legislation that would make the sale of cocaine, opiates, and chloral hydrate illegal without a prescription. Congress implemented the law in the District of Columbia, and a few state legislatures followed suit.

In 1905, Congress banned opium imports and prohibited the drug’s use in the Philippines. Opium smokers quickly switched to morphine, heroin, and cocaine, which were still legal. In opium, politicos had found an issue that they could use to win favor with China in opposition to Europe, which had violently forced opium into Chinese lungs as a method of commercial subjugation. Allying with China against opium was a useful foreign-policy tool, though it wasn’t especially interesting to Americans back home.

Although temperance advocates included drugs in their condemnation of insobriety, booze remained a much bigger public-health concern among most progressives. Reliable estimates put the number of drug addicts at only around half a million nationwide, out of a total population of under 100 million. In 1910, President William Howard Taft told Congress that cocaine was “the most dangerous drug in America,” but attempts to push comprehensive drug prohibition through went nowhere. So drug opponents took a more modest approach. Hamilton Wright, the U.S. Opium Commissioner, led the effort, with the press as his able assistant. A 5,000-word profile of Wright published in the New York Times in March 1911 begins, “Read this paragraph and gasp.”

“Of all the nations of the world,” Dr. Hamilton Wright, who knows more of the subject than any other living man, told me the other day, “the United States consumes most habit-forming drugs per capita. Opium, the most pernicious drug known to humanity, is surrounded, in this country, with far fewer safeguards than any other nation in Europe fences it with. China now guards it with much greater care than we do; Japan preserves her people from it far more intelligently than we do ours, who can buy it, in almost any form, in every tenth one of our drug stores. Our physicians use it recklessly in remedies and thus become responsible for making numberless ‘dope fiends,’ and in uncounted nostrums offered everywhere for sale it figures, in habit-forming quantities without restriction.”

Elsewhere in the piece, the Times, perhaps the first to militarize drug-policy debate, calls Wright’s effort a “battle with the evil” and suggests that “it is to be devoutly hoped” that he prevails. As with many of today’s drug epidemics, it took the media to alert the citizenry that there was one. “Few people realize how serious the opium habit has become in the United States,” the story maintains. “Ask most men where most opium is used and they will answer, ‘China,’ without the slightest hesitation; but the fact is definitely otherwise. Our per capita consumption equals and probably exceeds that of the dragon empire, and there the habit is being intelligently killed, while here it is increasing with so great a speed that we may well stand startled at the contemplation of its spread.”

Wright proposed going after the pharmaceutical industry. “As a result of the illicit traffic in these drugs the pharmaceutical profession in this country has lost much of its dignity,” he told the reporter, “and this is fully justified by facts; the medical profession must include within its ranks a multitude of arrant knaves, the greater number of them, possibly, themselves victims of the drug and robbed by it of all sense of their responsibility to their patients and society.”

But Big Pharma would make that strategy problematic.

Wright’s plan was to limit narcotic sales to licensed, monitored pharmacies, which could deal only with patients with prescriptions. He refused to compromise with the pharmaceutical industry, which sought to use his legislation only to put smaller vendors of patent medicines out of business. His bill died in House committees in 1911, 1912, and 1913, blocked by Big Pharma.

Wright, a State Department official, had better luck internationally. In 1906, at Wright’s urging, Roosevelt called for an international convention on drugs. Underscoring China’s interest in the issue, it was held in Shanghai in 1909, with a follow-up conference—this one with treaty-making authority—taking place two years later. The Hague Opium Convention, the beginning of the international antidrug effort, was contentious, because many of the 13 participating countries benefited from the opium trade. Nonetheless, Wright succeeded in getting participants to pledge to pass laws regulating opium, morphine, heroin, and cocaine—thus obligating Congress to enact his own legislation.

Despite the international mandate, Wright was still stymied at home. Secretary of State William Jennings Bryan, a fervent prohibitionist, convinced Wright to sit down with the drug lobby. A few compromises later, the legislation was finally moving. Marijuana, then still known as cannabis, was excluded from the plan. So was chloral, a sedative popular at the time but almost unheard of today. (Mary Todd Lincoln took it for insomnia, though it was supplanted in the 20th century by Quaaludes, Benzedrine, and other depressants. Anna Nicole Smith’s death, however, was reportedly the result of chloral-and-Benzedrine cocktail.) Pharmaceutical bookkeeping requirements were standardized and simplified so the reform wouldn’t be costly to major firms. The large companies didn’t want an overly complicated system of paperwork, but they weren’t opposed to regulation per se—after all, it impacted smaller, undiversified companies the most.

The labeling regulations of the Pure Food and Drug Act had already dented the business of the once-secretive patent-medicine vendors. Now their profits from soon-to-be-regulated drugs would be vulnerable to investigation. Big Pharma was winning.

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