This is part 3 of Laurie Oakley’s series on Pharmaceutical Rape.
In our society
We learn a social script in which a “good patient” obeys the orders of doctors as authority figures. The ideal patient is a passive patient, subordinate to the physician. We are expected to relate to doctors as experts whose judgment we should trust when being prescribed medication. Because of drug industry influence, this everyday scenario invites pharmaceutical violation. Thus a pharmaceutical rape culture exists that fosters widespread harms to individuals. In those instances where a patient ends up recognizing that something has gone wrong, he or she will often place full blame on the doctor without recognizing that entire systems of individuals are ultimately responsible for the damage, with participants in those systems remaining far removed from the consequences of their actions. Only rarely does a victim of this kind of offense see the inside of a courtroom. Lawyers who represent the giant pharmaceutical companies will then scrutinize a victim’s traits and behaviors in an attempt to prove personal factors such as poor health habits or an individual’s own underlying illness are responsible for the condition.
Between 1999 and 2004, the heavily marketed pain reliever, Vioxx (rofecoxib), caused an estimated 88,000 heart attacks and strokes, with an estimated 38,000 deaths. After the drug was withdrawn from the market in 2004, lawsuits by patients and their families against the drug manufacturer, Merck, were beginning to pile up. One of the plaintiffs was the wife of Jamie Gregg:
“Jamie Gregg, a 32-year-old construction worker from Katy, Tex., and father of three boys, had just reported for a job at Houston’s Hobby Airport when he collapsed, apparently from a heart attack.
“He was rushed to the hospital, where a medical team saved his life. But his brain had been deprived of oxygen for so long that Mr. Gregg is now in a nursing home in Lufkin, Tex., fed through a tube, unable to move more than his head or to utter more than a few syllables[…]
“Mr. Gregg, who had undergone a series of back surgeries, had been taking a high dosage of Vioxx, 50 milligrams a day, for four years to treat back pain. So the day after Mrs. Gregg heard that Vioxx was being withdrawn from the market, she walked into the offices of Goforth Lewis Sanford, a law firm in Houston. That firm, along with W. Mark Lanier, a prominent Houston plain-tiffs’ lawyer, are now preparing a lawsuit against Merck.
“‘[Vioxx] has got to be the reason,’ she said[…]
“But the plaintiffs’ lawyers face a big obstacle in convincing juries that a person’s heart attack or stroke was caused by Vioxx, because many people suffer such attacks for many reasons[…]
“Thomas B. Moore, a Los Angeles lawyer who represents pharmaceutical companies in such matters, although not Merck in this case, predicted that even the estimate by Dr. Graham of the F.D.A. that the drug caused more than 27,000 deaths and heart attacks would not help plaintiffs win cases. “‘The problem is that David Graham can’t name one of them,” Mr. Moore said. “He can’t name one of those 27,000.'”
—The New York Times. November 14, 2004
It is no remedy for pharmaceutical companies to pay out large settlements in instances where survivors are able to prove injuries were caused by medications that were prescribed with undisclosed risks. Since the problem lies in a culture that trusts in doctors who prescribe medicines to fix health problems while patients remain largely passive and dependent, one solution is to look at pharmaceutical injuries, in part, as a product of this authoritarian/passive relationship and to begin by addressing it at a personal as well as cultural level.
Social conditioning through direct to consumer advertising firmly establishes this pharmaceutical rape culture. When individuals are daily encouraged to “talk to your doctor,” the implicit message is that the starting point for good health is regular visits to a doctor who will prescribe medications to be taken regularly. Accustomed to turning to pharmaceuticals for what ails us, we have all but forgotten that all medicines are poisons which pose risks of harm, even when instances are rare.
The mother of three-year-old, Brianna Maya, was advised by a pediatrician to give her daughter the over-the-counter medicine, Children’s Motrin (Ibuprofen), for a fever and cough. The girl developed a rash but since her mother was not aware that this was a side-effect, she continued giving her daughter the medicine. As ABC News reported:
“Over the next few days, a fine rash on her body and mild redness around her eyes morphed into something insidious: a rare, painful and potentially fatal skin reaction that burned and blistered her body inside and out, blinded her in one eye and left her fighting for her life in a burn unit 1,000 miles from home.
“‘It was like something you see in a science fiction movie,’ said her mother, Alicia E. Maya Donaldson, 34, an assistant professor of social work at the University of Tennessee at Martin, as she recalled how her daughter looked at the time[…]”
“Brianna, now 13, has spent the last decade living the painful aftermath of SJS/Tens: She has undergone repeated eye surgeries and suffered recurrent eye and lung infections. Last summer, she developed seizures stemming from oxygen-deprivation during the worst of her illness. One of the ironies is that doctors have had difficulty controlling her seizures because anti-seizure drugs can trigger Stevens-Johnson syndrome. Because of vaginal scar-ring, “she will never be able to have normal sexual relations or bear children,” her mother said[…]”
Dr. Bernard Cohen, director of pediatric dermatology at Johns Hopkins Medical Institutions in Baltimore, reminds us:
“All drugs have risks, whether they’re topical, oral or intravenous, The patient takes some risk, the nurse-practitioner or physician prescribing it takes some risk. Sometimes pharmaceutical companies are at fault.” In the case of Stevens-Johnson syndrome, “this is one where everybody should take some responsibility for it.”
—ABC News, June 3, 2011
The drug manufacturer in Brianna Maya’s case was ordered to pay her family $10 million for her injuries because the label on over-the-counter Children’s Motrin had not warned of this rare but life-threatening condition. Stevens-Johnson syndrome had been a known risk, fully acknowledged by the drug company; the prescription version of Children’s Motrin had always carried a warning. Yet when the risks are this rare, safety information is brushed aside.
The cultural tendency to focus only on a drug’s benefits has been set in place by pharmaceutical companies and reinforced by the medical establishment; this denial of potential risks prevents patients from being able to make an informed choice. While many of us benefit from “safe” medications, children like Brianna (and her family) pay the horrendous consequences alone.
Pharmaceutical rape culture
A pharmaceutical rape culture is a culture in which iatrogenic harms are pervasive and normalized due to societal attitudes about medicine and health care. It is a complex set of beliefs that tolerates the commercialization of healthcare and supports everyday harms in medical and mental health care settings. It is a society where harm is only acknowledged as rare, yet is accepted as necessary, and inevitable. In a pharmaceutical rape culture, doctors and patients unknowingly trust what are oftentimes pseudo-scientific facts put forth by drug makers about drug safety. Both doctors and patients end up disbelieving the reality of the adverse events they see, and instead believe alternate explanations for such events. A pharmaceutical rape culture condones widespread medical harms that are rooted in reckless practices within the industry-government-medical trade alliance because multiple societal systems are involved in producing, reproducing, and disseminating “information” about pharmaceutical products. This “information” sat-urates the public and reinforces that alliance.
A veteran’s story
Jeremy Brooking was a U.S. Marine who, after surviving a sniper attack in Iraq, was sent to Camp Lejeune, NC, to recover. It was then, he says, that the real battle began. News correspondent, Bob Segall of Indianapolis, reported in April of 2014:
“The battle Brooking is talking about is an addiction to pain killers. Military doctors prescribed him 22 different medications – many of them powerful narcotics like Oxycontin and Hydrocodone – to numb his chest pain. A VA hospital gave Brooking 43 pills a day. That’s nearly 1,300 pills a month. More than 15,000 pills a year. A 1-month supply of medication filled a plastic grocery bag.
“‘I lost three years of my life where I barely remember anything,’ he said. ‘I’d sleep 23 out of 24 hours of the day because of those pills. It destroyed our family. It really destroyed me.’”
His wife, Tia, who witnessed him turning into a different person, decided to consult with medical staff at the VA to inquire about alternative treatment options.
“The doctor said ‘Your husband is never going to get better. This is how he’s always going to be.’ And I said ‘What can I do?’ And he said ‘I can write you any prescription you want. Tell me what you want, and I’ll write it.’ He said ‘I’m in the business of writing prescriptions.’ I remember him saying that, and I said ‘I don’t want prescriptions. I want him to get better,” she recalls, shaking her head. “It was horrible. Sometimes […] when I got home, I thought he was going to be dead.”
Jeremy Brookings did eventually break free from his addiction to narcotics after he gave up on the VA’s pain program and found a doctor willing to try other options. But thousands of returning veterans have lost the quality of their lives, while many others have died, as a result of the prescribing practices at the VA.
Dr. Pamela Gray, a VA Medical Center doctor in Hampton, Va., from 2008 to 2010, advocated for alternatives to the routine practice of prescribing narcotics but was told to stop by VA Administrators:
“I was told by the department chair of internal medicine to think twice about not prescribing these narcotics,” the doctor said. “I was ordered to write these drugs or be fired. I was ordered, as a physician with 25 years of experience, by a non-physician to do something that was medically incorrect. That is an intolerable position.”
Gray recalled a severe shortage of qualified pain specialists within the VA yet the idea of creating pain management programs was rejected by supervisors. Treatments other than the prescribing of narcotics were not a cost effective option for the VA so doctors continued to over-prescribe.
—WTHR 13 Indiana’s News Leader. April, 2013
An attitude about patients that places primary value on what treatments or procedures can be employed for reimbursement or compensation. Reducing the patient to a commodity with value being limited to financial usefulness.
Many in our communities, from the most vulnerable children to military veterans, end up experiencing serious medical consequences and unacknowledged suffering after trusting a doctor’s advice. This is a literal type of rape that is downplayed by medical practitioners, regulators, and the entire healthcare systems that are charged with our care.