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Allen Frances

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Fighting the Wrong War on Drugs

Posted: 08/28/2012 8:10 am

Since Richard Nixon was President, we have been fighting a drug war we can't possibly win. Meanwhile, we have barely begun to fight a different drug war we couldn't possibly lose.

The losing battle is against illegal drugs. Interdiction has been as big a bust as Prohibition of alcohol in the 1930s. Occasionally arresting a drug kingpin or confiscating a few million of dollars worth of contraband heroin or cocaine makes for a nice headline, but doesn't stop the flow.

The beneficiaries of our war on drugs have been the cartels and the narco-terrorists; the casualties are the failing states they can buy or bully. The Mexican government is fighting what amounts to an undeclared civil war against cartels armed to the teeth and flowing with money -- both from north of the border. We have unwittingly created a terrific business model for the drug dealers and a disaster for the states where they deal.

That other drug war, which we couldn't possibly lose, is against the excessive use of legal drugs that is promoted by our own pharmaceutical companies. Astounding fact: prescription drugs are now responsible for more accidental overdoses and deaths than street drugs. Polypharmacy is rampant and uncontrolled with military personnel , the elderly, and children particularly vulnerable to its risks. Michael Jackson is just the most high profile poster victim of this growing epidemic of legal drug abuse. The drug cocktails are sometimes prescribed by dangerous high-flying doctors, sometimes by multiple doctors who just aren't aware of each other's existence, and prescription drugs are also widely available for purchase on the street.

There is not one cause of this mess, and there won't be one cure. Doctors, drug companies, patients, politicians and our fragmented health care system are all to blame. But the elephant in the room is Big Pharma. It has hijacked the practice of medicine, using its enormous profits to unduly influence physicians, physician groups, academics, consumer advocacy groups, the Internet, the press and the government. Misleading 'disease mongering' promotional programs saturate the media with direct-to-consumer drug advertising that is illegal everywhere else in the world except New Zealand and the developing nations.

The result: a ridiculously high proportion of our people have come to rely on antidepressants, antipsychotics, anti-anxiety agents, sleeping pills, and pain meds. Psychiatric meds are among the very top best sellers for the drug companies -- over $16 billion for antipsychotics; almost $12 billion on antidepressants, and more than $7 billion for ADHD drugs. One in five Americans takes a psychiatric drug, one in five women is on an antidepressant.

Seventy percent of these pills are prescribed by primary care doctors with little training in their proper use, under intense pressure from drug salespeople and misled patients, after rushed seven minute appointments and subject to no systematic auditing.

The free market in drug salesmanship has led to promiscuous drug use, needless side effects and wasted resources -- a kind of societal overdose.

The Government has unwittingly aided and abetted Pharma. The cash-strapped FDA is beholden to industry for funding.

And it gets worse. Big Pharma all too often also goes illegal to push even more product. The multi-billion dollar criminal and civil penalties recently levied on several different drug companies provide clear evidence of the pervasive extent of drug company wrongdoing -- but have not been big enough to deter it. A billion dollars must seem like chump change -- just the cost of doing business.

Pretty bleak. But if we ever had the political will to begin it, we couldn't possibly lose a war to tame the dangerous use of legal drugs. The solutions are crystal clear and a cinch to implement -- if we were really determined to solve the problem:

1) Sharply restrict drug company marketing and lobbying. Pharma now spends almost twice as much money pushing drug sales as on research -- we would have better medicines and less legal drug abuse if this were reversed.

2) Make the punishments for marketing malfeasance much more of a deterrent to underhanded drug pushing. This could be done by levying much bigger mega-fines on the companies; by also holding the executives personally responsible and perhaps by reducing the period of product patent protection.

3) Develop a computerized real-time national system to identify and prevent polypharmacy. Credit card companies can abort a suspicious $100 transaction before the fact. Why can't we apply the same technology preemptively to prevent a patient from collecting potentially lethal pills?

4) Doctor's prescribing habits need to be closely monitored to correct or eject the Dr. Feelgoods.

5) It would greatly improve the quality of our health care system and greatly reduce its costs if all doctors, professional associations, consumer groups, and politicians were prevented from accepting drug company funding. Do drug companies really need this much 'free speech'? It makes no sense to have The Food and Drug Administration funded by drug companies.

What are the political prospects of my twin proposals -- to begin the winnable war against the over-use of legal drugs and to drop the losing war against illegal drugs? You guessed it -- zero and zero. The first will be doomed by Pharma's political punch; the latter by the irrational victory of hope and ideology over experience.

This post is part of the HuffPost Shadow Conventions 2012, a series spotlighting three issues that are not being discussed at the national GOP and Democratic conventions: The Drug War, Poverty in America, and Money in Politics.

HuffPost Live will be taking a comprehensive look at America's failed war on drugs August 28th and September 4th from 12-4 pm ET and 6-10 pm ET. Click here to check it out -- and join the conversation.

Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.

 
 
 
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Since Richard Nixon was President, we have been fighting a drug war we can't possibly win. Meanwhile, we have barely begun to fight a different drug war we couldn't possibly lose. The losing battle i...
Since Richard Nixon was President, we have been fighting a drug war we can't possibly win. Meanwhile, we have barely begun to fight a different drug war we couldn't possibly lose. The losing battle i...
 
 
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10:36 PM on 09/10/2012
I met the man once (Frances) and he bled out arrogance like all other men and women in his position on all subjects matter related to mental health and public health. He is no hero. He is just a monster who feels guilty about his sins and wants to clear his conscience before he dies. But, he does not want to have to apologize or admit his wrongs about anything he or his colleagues did. He just wanted to swoop in as the academic rebel hero to criticize the things he built and used to love (well love the money and prestige it gave him).

That is the United States of America's plutocratic system in a nutshell. One good act coming out at the end of a life of sordidness, sadism and sickening actions. But, once an evil fraud always to some degree an evil fraud. At least I am European and never had to experience parents drugging me "out of love". But, my fortune will never be that of their victims and their students' victims.
10:33 PM on 09/10/2012
I think it is extremely strange that Frances of all times to come out and speak up is doing so now. That is, now that he is at the academic emeritus part of his career. After he has finished getting and lazing about in the largest portions of money and fame he reached out for during his career span. When it is convenient and most profitable for Allen Frances. Instead of when he was a lead administrator and player in the psychiatry scene.

The truth of the matter is that he, Joseph Biederman, BF Skinner (remember Skinnerian conditioning and "Beyond Freedom and Dignity") and many, many others have led the path for retardation in untold numbers of children through their advocacy of psychiatric behaviorism which as protocol has children at young ages sent off to institutional schools where their nervous systems suffer from non-organic failure to thrive related forms of mental retardation and learning disabilities as they sit in "class rooms" staring at blank walls while drugged out on several hundred milligrams of anti-psychotics. They have made it so that institutional settings continue to take in people even after De-institutionalization occurred and to continue working on their record of beating and raping vulnerables.

So, I put it out there. Frances and his cronies in the name of capitalism in Psychiatry have directly and indirectly abused millions and millions of American children. Not to mention the adults that they hurt, as well.
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rduryea
09:52 AM on 09/07/2012
The practices of the FDA accepting the safety trials of prescription drugs paid for by Big Pharma due to lack of funds by FDA. To accept big pharma's tests on drugs they manufacture? Data and designs can be designed to MAKE an outcome statistically significant for " safety" when it is not. Make the laws like bar owners having licenses not to sell liquor to underage drinkers. If caught lose their license period. If Big Pharma of license production risks those studies may ALWAYS reflect a longitudinal study as to the effects of a proposed drug and not find out later like Vioxin or Nicotine in Tobbacco Industry whose KNOWN harmful effects remained hidden for profit. Go after the CEO's of BIG PHARMA for profitting at the risk of a person's health or results in death of a loved one for falsely reporting risks. Let the CEO's be civily responsible to family members effected. If these new drugs are so safe then why the disclaimers shown longer than the product themselves? A TV big pharma ad of a woman picking apples when narrator speaking of death and coma risk???? It's like allowing irradiated meats change the skull and cross bone symbol of irradiated meat to a flower symbol ( FDA approved) ..because no one was buying!
05:02 PM on 09/03/2012
All drugs should be leaglized what buissnes is it of the goverment to tell me wat i can smocke or do. Also if all drugs where leaglized the entire underground market will go away there would be less killings in the united states in mexico. Oh and by the way the goverment could just make the tax really high and image how mutch money tht would bring to the econmy--- just a thought.
09:05 PM on 09/02/2012
legalize weed.. people could grow there own cure all .. Make The oil in"RUN FROM THE CURE" full version on youj tube , THIS IS NOT HEMPOIL YOU BUY IN STORES THATS MADE FROM SEEDS.. big pharma knows that wont work... There's a few2 holes in your ideas. ( great artcle though).#1 - Big Pharma owns politicians,, They get huge contributions to leave big pharma alone.. Even the DEA Chief ( DEA = Drug Enforcement Agency,) wont say whats worse heroin or marijuana.. The truth is.. On the drug war facts website. "ZERO PEOPLE HAVE DIED FROM MARIJUANA,, people are curing cancer in 3 months with it #2 - PROHIBITION OF ALCOHOL HAD NOTHING TO DO WITH DOING WHATS BEST FOR PEOPLE.. It shows how much power big oil . At that time Standard Oil has on politicians.. It stomped out Henry Fords plans for clean sustainable fuels. "ETHANOL" yep when Henry Ford Gave up his clean dream. Prohibition was lifted.. He even developed hemp fuel.. and hemp body cars,, VERY TOUGH AND LITE
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Todd D Lawn care
11:00 PM on 09/02/2012
dude, if weed oil cured cancer you'd know about it, big pharma couldn't hide it, anyone can make it. I'm all for legalization, but lets not get swept up in far left propaganda. It's equal to the far right propaganda against the pro choice crowd. the problem is science can disprove your hypothesis.
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Rational Voice
A voice of reason in a world gone insane
07:08 PM on 09/07/2012
You should start paying attention. There are several plant-based foods that we commonly consume that are good at fighting cancers. Cannabis is proving to be one of the best... hmmm, your government doesn't want you to live too long (and become a burden to the social saftey programs), and big-harma corporations have a vested interest in pushing THEIR poisons... I wonder why we haven't heard more of the truth?? [Sarcastic, rhetorical question]

Sadly, there is no money in 'curing' things.
Genders
Love, Tolerance, Enlightenment
08:33 PM on 09/02/2012
Right you are.

Pot prohibition is crime against humanity

Prohibition criminals thrive, Our CIA floods our streets with drugs bad drugs like heroin, to finance wars that are illegal.

Meanwhile, Pharma drugs go on the market with company testing and no followup.

Legalize pot, save millions of lives.
07:28 PM on 09/02/2012
There are many issues with the way that Pharmaceuticals are manufactured and marketed. Study results are ghost written by company employees, then signed by academics, then used to gain approval by the FDA. This was one of the issues that was touched on by the recent settlement against Glaxo.

The issue of withdrawal from SSRI and benzos are completely denied by regulators and manufacturers, leaving patients to seek out anecdotal and community information. This lack of official information leads patients to either accept a new diagnosis and a new prescription, or defy their doctor's orders and attempt withdrawal on their own. Both courses of action result in lower outcomes for the patient. They either find themselves on the downward spiral of diagnoses/poly drugging, or become non compliant.

The pharmaceutical companies have two mandates, earn profits and produce good medicines. The balance has shifted too far towards earning profits, and too far away from producing effective medicines. We shouldn't seek to punish companies, but rather move the balance more towards the care of patients. Since the companies seem to be intransigent in their stance that their procedures do not need to be changed, punitive fines may be the only way to change their behavior.
04:06 AM on 09/03/2012
SSRI and Benzos are closely watched by nursing facilities etc as required by law not so for regular folks. Plus add to it the fact that different drugs require different techniques to help the person during withdrawls. The best place I have seen yet is in Michigan you go they put you out for 2 weeks to let you get through the withdrawls etc... so when you are awakened you are clean and your body isn't throwing you for a loop. But alas they won't do it. But I don't blame the drug companies I blame the docs for writing the scrips and the pts for abusing them. If your 20 yrs old and you have to pop pills theres a problem.
06:27 PM on 09/02/2012
Cannabis
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jeb50
Retired.
02:14 PM on 09/02/2012
Am I the only one who has watched these drug commercials and realized the side effects can be worse than the problem you want to solve.
04:38 PM on 09/02/2012
Some people would rather risk a .05% chance of a heart attack than live life in debilitating pain, or they'd rather take laxatives and keep tic-tacs in their pocket then have to wear adult diapers at the age of fifty.

The reported adverse events they mention in the commercials are not necessarily side effects. Sometimes even a true placebo will have a statistically significant number of incidents of a particular adverse event. The clinical trials are thorough and well developed, and they want to be sure consumers know the possible adverse experiences they could have with the drug.

Of course, my favorite by far is still Roche's Xenical- "Gas with oily, rectal discharge; frequent and urgent bowel movements and the inability to control them." That was pure comedic fodder. Even now, years later I can't help but giggle every time I think about it.
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jeb50
Retired.
05:30 PM on 09/02/2012
Yes, I remember the Xenical ads. Placebos may have a psychological adverse effect, my uncle who is a pharmacist told me, but physically they do nothing to the body. Ironically positive psychological effect is the reason for them. And clinical trials are not always as good as you may think. Many drugs have been fast tracked then later recalled.
04:10 AM on 09/03/2012
Yeah my aunt was one of those 0.05% she wasn't in debilitating pain either. And you must work with or for a drug company because if its listed its a side affect and adverse reaction are the same thing!
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sunbeltvoter
Teapublican Evangelical Cults ARE The Problem
06:33 PM on 09/02/2012
I like the TV ad for one pill where they list the side effects: "MAY cause drowisiness." Uh hello, this is an ad for a sleeping pill. I always thought it would be fraud to advertise and sell it if it does NOT cause drowsiness. LOL
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jeb50
Retired.
11:09 PM on 09/02/2012
:LOL. Great one!
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HUFFPOST SUPER USER
USA FIRST1
01:47 PM on 09/02/2012
Good start to a good story.
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mkelch
Know or listen to those that know.
12:31 PM on 09/02/2012
I was hoping for an argument that makes sense. Drug use should not be a criminal offense. If the government feels the need to intervene it should be through treatment. Every year 15% of those addicted to drugs (including alcohol) decide that they want to stop. It would cost substantially less in ruined lived and wasted taxpayer dollars if we focused our resources on helping them. Law enforcement needs to get out of the drug business all-together.
curmugin
You kids stay off my lawn.
04:47 PM on 09/02/2012
You make and miss the good professors point. You seem to mean well. But. Appropriate regulation is part of any solution and is only marginally related to the law enforcement problem. Utopian anarchy where evrybody acts nice and we all help each other be better and that mean ol' government is held at bay by the power of love has not proven very effective. Current regulation is based on the supply-side free-market philosophy that has bollixed every policy from agriculture to education and beyond. Maybe focus on that.
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mkelch
Know or listen to those that know.
10:45 PM on 09/02/2012
I do not believe there is anything utopian about my suggestion. There is a substantial body of research that agrees - http://www.rand.org/multi/dprc.html
03:50 AM on 09/03/2012
The problem with your theory and the study is basically.... a drug addict won't quit until they are ready I could quote my lovely alcohol adled biologicals who informed their 3 children that we were " greedy lil bastards and they will quit when they are ready" 15% is an extemley low number. I went into the medical profession thinking I would "help" what a joke. Addicts are manipulative, will lie on you in a second and act like we owe them something. So I say stop throwing money at them quit giving them the ammo they need to manipulate the system and hold them accountable PEFRIOD!
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aacme
My micro-bio is on a strict need-to-know basis.
09:00 AM on 09/02/2012
"The Government has unwittingly aided and abetted Pharma. The cash-strapped FDA is beholden to industry for funding."
"Unwittingly" is kind to the point of absurdity. In the Republican Paradise we call 21st Century America, the system designed by the founders and outlined in the Constitution no longer exists. Government by lobbyist was not envisioned in the 18th Century, but in post-Republican- Revolutionary America, that is the system. Bribery is not just not against the law, it is the law. The entire system runs on illicit money, vying both to divvy up the licit, taxpayers money, and to shape laws abetting the sale of dangerous but "legal" drugs, start wars nobody wins for no reason, allow Wall Street to run the biggest casino on the planet, and in general enable anything any hustler thinkshe can make a buck at, regardless of who gets screwed in the process The 21st Century US is a Gangster Republic.
For an understand of this, read the novels and notebooks of the philosophical guru of 21st Century right-wing America, Ayn Rand.
This is no accident. If there is a book that says it's ok, it's a Philosophy. That the Philosopher is stone crazy is a subjective view, one not shared by her right-wing acolytes, who either share her craziness, or use it as cover.
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realitytrumpsbull
Two 'alves of coconut!
07:49 AM on 09/02/2012
How about promoting sobriety? Instead of 'fighting' the 'war on drugs', to the tune of billions of avoidable tax dollars per year, bring the education, not only about illegal drugs, but legal ones also. If you're trying to live a good life for yourself, family, etc., sobriety's largely where it's at. Why voluntarily put yourself in an altered mental state, where it's anybody's guess if you really know what's going on around you, or a diminished physical state, where you will not really be able to be and go and do and fully enjoy life, nor will your body be able to resist stress and disease? So, why slam smack, why pound coke up your nose, or live your days in a purple haze, or concantenated drinking binges? Yet, despite all the counter-indications of overmedication by whatever means, people do it, and then they do it again, and, somewhere in there, needs to come the discussion of basic personal freedom and liberty: If you want to get high, by all means. Just, please don't operate equipment on the highway(or elsewhere) afterwards. Drugs by prescription under direct physician's supervision, that's one thing, and it's typically short-term, to address life-threatening conditions. Most other use is either hypochondriacal, possibly profit-driven, or recreational. You can take enough medications to solve all your worldly problems permanently, but it's not recommended, because the effects are permanent.
07:24 AM on 09/02/2012
A missing discussion piece in this very good article is the collusion of the psychiatric and pyscho-therapeutic community with Big Pharma, and the DSM manuals. More and more human behaviours are being defined as mental health disorders, and the treatment of the defined disorders (especially by pyschiatrists) is now pharmacological. Take a drug, we'll re-order your brain chemistry and make your behaviour acceptable, trust us, we know best.
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realitytrumpsbull
Two 'alves of coconut!
07:56 AM on 09/02/2012
Good point. There is also the dreaded Overdiagnosis Disorder Syndrome Complex, a system of institutional disease by which people in lab coats and business suits and corner offices think they can use the magical prescription bottle to cure the world at-large of all its problems....
curmugin
You kids stay off my lawn.
05:06 PM on 09/02/2012
More likes diagnosis by the incompetant syndrome. School staff and parents and CNAs reading a diagnostics manual they can't possibly interprete and demanding treatment for behavior they don't understand and disorders that are not present. The pharma industry is allowed to take advantage of that ignorance. Well meaning people might start with insisting on a proper diagnosis.
expattam
I remain confused
01:16 PM on 09/02/2012
Agreed. I've been depressed, as has everyone. I have also suffered very acute depression. The difference is clear. I see so many people who have a tough time for a while and immediately go get on drugs, often two different types (anti-depressant and anti-anxiety).

The one thing I would add to your thoughts is the media and their portrayal of how we all should live. Need to lose a few pounds so you look like ______ ? Take a few pills to suppress your appetite. Want to have sex like you were 25 again? Take a little blue pill everyday, so you can be spontaneous. Not out in the park frolicking with your kids? Don't bother eating better, or doing yoga, or exercising, Just take a pill so you can be a good parent again, like you see on all those shows. You too can be a beautiful person... trust us.

Proud to be #1
01:43 PM on 09/02/2012
California Ed
Did you ever watch daytime television. Every other ad is for drugs, they describe symptoms we all have (like gypsies with a crystal ball.) Watch it long enough and you will become a hypocondriac. They won't be happy til we become a bunch of zombies. In a field where there is so much money involved your kept under constant pressure and the price is really human life.
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Carl Caroli
I just don't understand people
06:19 AM on 09/02/2012
Lobbyists. They are the problem. They buy our representatives. They write our legislation. They profit.