From Paxil and Prozac to Ritalin and Viagra, Big Pharma is a multibillion-dollar global business. With a court battle that may result in Canada allowing drug companies to target ads directly at ¬consumers, how much of 'selling sickness' are we willing to swallow?

Out here on the fleece-clad West Coast, we like to think our active lifestyles keep us healthy. We exercise more than the rest of Canada, we don’t smoke as much and we live longer. But alongside those cheerful facts is a counterintuitive and alarming one: we are also consuming prescription drugs at an unprecedented rate. If we’re so healthy, why are we ¬popping so many pills?

British Columbians are sophisticated when it comes to health issues. We’re widely read and up-to-date on the latest scientific news. We surf the Internet to discover the latest in natural remedies. But if drug company critics are to be believed, the reason we take so much medication is because – sophisticated or not – we are the victims of a major marketing conspiracy that has persuaded us to buy far more than we need.

Through ¬vigorous marketing, these companies have convinced doctors that it’s in our best interests to prescribe these products. With targeted advertising, drug companies have drilled into our natural anxieties, convincing us we might be sick, scaring us into taking expensive medication for non-existent diseases.

These days, there’s an ill for every pill. Even being at risk of an illness has effectively been branded as having a disease ¬requiring preventive treatment. Hypertension and high ¬cholesterol, both physiological factors contributing to a higher risk of heart failure, are now indelibly branded in the public consciousness as diseases in their own right. Drugs designed to treat them are now the best-selling pills in the world. Health critics such as UBC researcher Barbara Mintzes and University of Victoria pharmaceutical researcher Alan Cassels say this is no ¬coincidence, pointing their fingers directly at aggressive drug company marketing strategies.

Let’s face it: we’re bombarded daily with advertising and health information designed to make us anxious about our well-being. It seems to be effective, if statistics on skyrocketing drug use are anything to go by (see “Drugged Out?”). Is there anyone reading this who hasn’t wondered whether they should be getting their cholesterol or bone density checked? What about Ritalin for the kids? Hormone replacement therapy? Ever asked your doctor about antidepressants for anxiety or PMS? Who hasn’t seen an ad for Viagra?

Prescription drug manufacturers say the concerns raised are nonsense. They’re in the business of making medicines that save many lives and improve the quality of millions of others. Yes, they supply information on their products to doctors. Yes, they try to raise awareness about disease. But consumers are discerning individuals who are entitled to be informed about the diseases they could have and the drugs available to treat them. And prescribing those drugs are doctors who are ostensibly independent medical experts and effective filters of any drug-company bias or propaganda.

Victoria pharmacist Steven Dove also reminds us that it’s thanks to the drug industry that Canadians are living longer. “Pharma-ceutical companies have worked miracles in the last 50 years,” he says. Prescription drugs for cancer, HIV/AIDS, clinical depression and other life-threatening conditions are a boon. Gabriola Island physician Verne Smith makes that point emphatically with a single example: “When I started medicine [in 1958] everyone with Hodgkin’s disease died. Now they mostly don’t.”

Given the breadth of access to health information, do concerns about the heavy-handed marketing of drugs really matter? On the one hand, we’re intelligent human beings who should have freedom of choice in our health care. We’re grown-ups who can make our own decisions, so advertise away; it’s only fair.

Conversely, some argue that the state of our health is an emotional area in which we are highly vulnerable, and playing on that vulnerability with advertising that makes us think we’re sick is unethical and unfair. Only doctors should diagnose illness and prescribe treatment, goes the argument, and those doctors should not be subject to any form of influence by the drug companies.

In the meantime, it’s the patient who is caught in the middle of the debate. Well-¬ informed or not, healthy or unhealthy, he or she simply isn’t in a position to contradict either the drug companies or the family physician.

Noam Smith is a 65-year-old retired marketing executive. He and his wife Sylvia, 61, are well educated and are avid readers of magazines and Internet sites. (Their names have been changed to protect their privacy.) Neither likes the idea of taking drugs and both scorn the pop-a-pill-and-feel-better messages contained in drug advertising. Nonetheless, they are familiar with all the household-name pharmaceutical firms – the Merck Frossts, the Glaxos – and can reel off brand names such as Lipitor, Ritalin and Paxil without hesitation.

Fifteen years ago the only prescription drug on this couple’s radar screen was the occasional dose of penicillin. Today they are painfully familiar with a wide range of medications. Everyone they know takes something. Many of their grandchildren’s friends are on Ritalin and a close friend of their son’s has been on Paxil for several years. Another friend saw an ad for Pfizer’s anti-inflammatory Celebrex in a magazine, touted in the media as a miracle drug in the treatment of arthritis. She tore it out, marched into her doctor’s office and demanded a prescription. He was writing it out before she’d even finished speaking. The majority of their contemporaries, say Noam and Sylvia, take a daily cocktail of meds including beta-blockers for hypertension and cholesterol-lowering drugs. It isn’t necessarily a question of age. Noam’s father is 92 and he doesn’t take any of these drugs.

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