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Essay: The Altered Human Is Already Here
April 6, 2004
By JAMES GORMAN
In the popular imagination, the technologically altered
human being is a cross between RoboCop and the Borg.
The hardware that would make such a mating of humans,
silicon chips and assorted weaponry a reality is,
unfortunately, still on back order.
Many people, however, have already made a different kind of
leap into the posthuman future.
Their jump is biochemical, mediated by proton-pump
inhibitors, serotonin boosters and other drugs that have
become permanent additives to many human bloodstreams.
Over the past half century, health-conscious, well-insured,
educated people in the United States and in other wealthy
countries have come to take being medicated for granted.
More people shift to the pill-taking life every year, to
the delight of pharmaceutical manufacturers. Indeed, drug
sales suggest how willing people are to pursue better
living through chemistry.
Last year retail drug sales worldwide were $317 billion. In
the United States alone, consumers spent $163 billion on
drugs. In North America, the use of drugs that affect the
central nervous system, antidepressants and others,
increased 17 percent. No group has escaped. Last week the
Centers for Disease Control and Prevention reported that 10
million children took prescription medication for three
months or longer in 2002, and preschoolers, another study
found, are now the fastest growing group of children
receiving antidepressants.
This is a social change on the same order as the advent of
computers, but one that is taking place inside the human
body. Just 50 years ago, according to a report by IMS
Health, a company that tracks the pharmaceutical industry,
the two biggest-selling over-the-counter drugs were
Bufferin and Geritol. The prescription drug business was
tiny. In 1954, according to IMS, Johnson & Johnson had $204
million in revenue. Now it is about $36 billion. In 1954,
Merck took in $1.5 million in drug sales; in 2002, that
figure was $52 billion.
To look at it in another way, Americans take so many drugs
that some researchers - Dr. Christian G. Daughton of the
Environmental Protection Agency's National Exposure
Research Laboratory in Las Vegas, for example - are worried
about the effects on the environment. What does it mean if
the sewers run rich with Zoloft? Or to be more precise,
what might happen to fish eggs if the rivers soak up waste
water with discarded and excreted pharmaceuticals and
personal care products, like shampoo?
No one has the answer yet, but the idea that what runs
through our collective bloodstream is a potential
environmental hazard makes you look at your medicine
cabinet in a different way.
In short, while the Six Million Dollar Man is still a
fantasy, Pharmaceutical Man is already here, and largely
unnoticed. Swallowing a pill at a business lunch is likely
to elicit little curiosity. A high-powered executive who
did not have blood pressure or cholesterol problems might
be suspect. There are concerns about the widespread use of
antidepressants, but they do not seem to have affected
sales.
In fact, the group of antidepressants that includes Zoloft
is the third biggest class of pharmaceuticals by sales in
the United States, totaling $11 billion in 2003.
Drugs in the top two categories - statins to reduce
cholesterol levels and proton pump inhibitors to prevent
heartburn, gastritis, ulcers and other digestive problems -
had sales of about $14 billion and $13 billion,
respectively.
Critics of the national medicine cabinet have noted that
behaviors and physiological changes that were once simply
aspects of life - menopause, the inability to keep still as
a child, baldness, decreasing potency in old men - have
been medicalized, turned into syndromes or diseases.
Dr. Thomas Szasz, a psychiatrist who in the 1960's defined
himself as far outside the mainstream by arguing that
mental illness was a myth, recently wrote a book called
"Pharmacracy," about the invasive rule of medicine as it
defines our lives.
Last fall, the President's Council on Bioethics issued a
report called "Beyond Therapy: Biotechnology and the
Pursuit of Happiness." The report included material on
genetics and embryo selection, but it also addressed
performance enhancement and behavioral drugs. One of its
concerns was the way everything in life becomes a medical
problem.
When new technologies, including drugs, come through
doctors, the report said, many aspects of life become
medicalized, raising concerns that "the pursuit of
happiness and self-perfection would become part of the
doctor's business."
The report also cataloged "other aspects of human life that
formerly had little to do with doctors and hospitals:
childbirth, infertility, sexual mores and practices,
aspects of criminal behavior, alcoholism, abnormal
behavior, anxiety, stress, dementia, old age, death, grief
and mourning."
One might argue that any extension of medicine should be
welcome. The prevention of heart attacks is obviously a
worthy effort. Antidepressants can ease anguish, which for
many people who take them is overwhelming. In many
countries of the world, people would jump at the chance to
worry about having too much medicine; they don't have
nearly enough of it.
Yet some of the new miracles of the pharmaceutical industry
are not intended to save lives, but to improve and prolong
them.
Ana-Maria V. Zaugg vice president of corporate strategic
planning for IMS Health, said that there were two streams
of change in pharmaceutical research and use. Acute care is
giving way to chronic or preventive care - managing
cholesterol levels rather than treating heart attacks, for
example. At the same time, disease treatment is being
extended to treatment whose goal is to increase well-being.
Drugs for baldness, incontinence, sexual performance and
the effects of menopause may be included in the latter
category. Both trends are expected to increase, Ms. Zaugg
said.
Some areas that she is confident will grow are drugs to
improve male sexual performance, anti-Alzheimer's drugs,
and drugs for incontinence and osteoporosis. If new
psychostimulants and anti-obesity drugs appear in the
future, she said, they will quickly take off. Compounds
that increase intelligence and greatly improve memory will
undoubtedly be best-sellers as well.
Whether or not the growing use of drugs has altered our
essential humanity, there is now almost no bodily system
that cannot be adjusted by them. Blood, respiration, the
nervous system, hormonal regulation, muscles and bones, the
cardiovascular system, reproduction, sexuality - drugs are
available to nudge them all in one direction or the other.
It is not unusual for someone to begin the day with a
cocktail of antidepressants, statins and blood pressure
medications.
The result does not yet seem to be the epidemic of dull,
well-managed emotionless humanity that some forecasters
have worried about. For instance, among professionals in
journalism and publishing in the New York metropolitan
area, who no doubt take as much Zoloft per capita as anyone
on the planet, it is no small trick to find someone who is
either calm or happy.
Perhaps in the future, stronger drugs will produce the
well-sedated zombies that will make the streets of Times
Square disturbingly docile and well mannered, but it has
not happened yet.
There are concrete results of the medicated life, however.
Dr. Isaac Schiff, chief of obstetrics and gynecology at
Massachusetts General Hospital in Boston, said he found
that "most people, men and women who are in their 50's, are
taking something every day."
He added, "One of the reasons is that our life expectancy
has changed dramatically. Our whole concept of aging is
very different."
Dr. Schiff said that many people in their 40's and 50's
"are now taking medication to prevent diseases in their
70's."
In the case of osteoporosis, for example, the point of
taking medication at age 50 is to prevent a hip fracture at
age 75 or 80.
What that means for medicine is that as old problems
recede, new ones arise. Dr. Neal L. Benowitz, professor of
medicine and chief of clinical pharmacology at the
University of California at San Francisco, said that
doctors had seen a shift in "what you can expect to die
from." There are fewer deaths from heart attack, he said,
and more from congestive heart failure, cancer and
Alzheimer's.
One problem, of course, is that it is the well-off and the
well educated who are most likely to take advantage of the
many drugs available. Another is that need can be
manufactured by advertising.
Even children know from television that if you are sad and
worried, there is a pill for you. If you have heartburn
there is a pill for you. It is a lot harder to find out
that there are other ways to feel better, physically and
emotionally, than taking drugs.
By and large, however, the pharmaceutical road is paved
with pretty good intentions. The president's report
addressed "the pursuit of happiness." A similar report on
the dangers of computers and other hard technology might
have a different subtitle - the pursuit of power, perhaps.
Even the dystopian fantasies of cyborgs and the
overmedicated are fundamentally different. Drugs are an
easy way to contentment and the absence of pain - even if
they are ultimately unsatisfying. Hardware is something
else. It enhances the senses, increases strength, adds
weapons. As a cyborg, you can be your own telescope, your
own computer, your own gun.
It may not be so bad that the pharmaceutical human is
arriving first.
http://www.nytimes.com/2004/04/06/health/06BODY.html?ex=1082384818&ei=1&en=dea3a59b50b13570
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