A Case Study in Corruption

excerpted from the book

How to Overthrow the Government

by Arianna Huffington

ReganBooks, 2000, paper

p149

THE WAR ON DRUGS AND THE DRUG INDUSTRY'S WAR ON US

For an object lesson in how money has corrupted the political process-changing and even endangering our lives-just look in your medicine cabinet.

The tentacles of the pharmaceutical industry have nearly every aspect of our public policy in their vice grip: from the health care choices we are offered to the way we treat the troubled souls among us; from the government's much publicized war on illegal drugs to the shadowy battle the legal drug giants are waging to make their moodaltering products an integral part of American life; from the public leaders they pay for endorsements to the public policy they pay to influence.

MONEY > PUBLIC POLICY

Let's start with the money that drug companies are pouring into both political parties. In the last election cycle, according to the Center for Responsive Politics, pharmaceutical manufacturers and wholesalers ponied up to candidates, PACs, and party committees over $9.5 million (that includes soft and hard money-it doesn't matter to the drug makers, just as long as it's absorbed into the system). On top of this, the entire pharmaceutical and health products industry spent nearly $150 million on lobbying in 1997 and 1998, the highest total of any interest group and more than was spent on lobbying by the defense industry and labor unions combined. They know that contributing to politicians is simply a good business investment. Which is why they are investing so much more. Prozac's manufacturer, Eli Lilly, went from zero dollars in 1992 to over $787,000 in the last election cycle. "We do it because we think we have to participate in the political process," says Lilly spokesmanJeffNewton. "They are important institutions, basically, and that's why we do it."

ANTIDEPRESSANTS > CHILDREN

What kind of return are the drug companies getting on their investment? Let's just say they're beating the Dow. First of all, they've bought the benign neglect of our political leaders over the legal drugging of America, starting with our children, who were prescribed antidepressants 1,664,000 times in 1998.

This is despite the fact that no antidepressant-Prozac, Zoloft, Paxil, or Luvox-has been approved by the Food and Drug Administration for pediatric use. Luvox was approved by the FDA in 1997 for the treatment of obsessivecompulsive disorders (OCD) in children, but not for the treatment of depression.

So the question is, why are we trusting the drugmakers? The manufacturer of Luvox, Solvay, declares it "safe and effective." Yet the Physicians' Desk Reference reports that during controlled clinical trials 4 percent of children on the drug developed manic reactions. Another clinical trial found that Prozac, America's most popular antidepressant, caused mania in 6 percent of the children studied. "I have no doubt that Prozac can cause or contribute to violence and suicide," Dr. Peter Breggin, the author of Reclaiming Our Children and Talking Back to Prozac, told me. "And manic psychosis can lead to violence."

Another example: Even though the National Institutes of Health reported that "there is no current, validated diagnostic test" for Attention Deficit Hyperactivity Disorder, that has not stopped the makers of Ritalin from pushing the drug to three-quarters of the children diagnosed with ADHD in 1996, up 20 percent since 1989. At the same time, the percentage of those receiving psychotherapy dropped from 40 percent to 2 5 percent.

"The age range for being treated for ADHD has gone down as people think these medications are relatively safe and effective," says Richard Todd, psychiatrist at Washington University in St. Louis. "This is a very important developmental period. The effects of medications on these processes are not well understood."

Such is the crass, bottom-line approach of most health care providers, who prefer relatively cheap drugs to costly therapy. But they also speak to our lazy culture's inclination to medicate problems rather than confront them. "Settling for Ritalin says we prefer to locate our children's problems in their brains rather than in their lives," says Dr. Lawrence Diller, author of Running on Ritalin.

Dr. Leon Eisenberg of the Harvard Medical School described the Prozac/Luvox family of antidepressants as "potent medications that change nerve transmission." "What happens," he asks, "after two to three years of that?" No one knows. But even mildly skeptical voices from within the medical community are routinely ignored as if they were attacks on scientific progress itself.

Diller described three candidates for ADHD diagnosis: four-year-old Stevie and his two younger sisters, all of whom get dropped off for preschool at 7 A.M. by their dad and are picked up at 5:30 P.M. by their mom "if she isn't running late." Stevie is overly aggressive, and his parents, whose own marriage is troubled, are desperate, demanding a fix: prescription drugs. Is there really a consensus that this is a medical problem?

DRUGS > SHOOTINGS

On April 20, 1999, Dylan Klebold and his friend Eric Harris walked into their high school in Littleton, Colorado, and opened fire on their classmates, killing twelve students and a teacher before turning their guns on themselves. Buried in the saturation coverage of the Littleton massacre was the finding that traces of Luvox were found in Harris's bloodstream. The presence of Luvox, the coroner said, "does not change the cause and manner of death." Well, of course not-he died of a selfinflicted gunshot wound. But did the presence of Luvox change the cause and manner of Eric's life?

Mania is defined as "a form of psychosis characterized by exalted feelings, delusions of grandeur . . . and overproduction of ideas." That pretty much describes Harris's Web site. "My belief," he wrote, "is that if I say something, it goes. I am the law. If you don't like it, you die." This should have troubled any doctor who was following Harris after he was put on Luvox. Or was Harris one of the tens of thousands of children cavalierly put on antidepressants without either a proper psychiatric evaluation or any ongoing monitoring of side effects?

The news that Harris had been on Luvox came on the heels of the revelation the previous summer that Kip Kinkel, the Oregon school shooter, had been on Prozac. Later, Anthony "T. J." Solomon, the Conyers, Georgia, school shooter, took Ritalin the morning of the shooting. Solomon is facing trial for wounding six students just weeks after the Columbine killings; Kinkel was sentenced to 111 years in prison after killing his parents and two schoolchildren and wounding twenty-two others. Kinkel and Solomon were only fifteen at the time. The antidepressants clearly did not exorcise these teenagers' demons. The question is, did they embolden them?

"I have testified as a medical expert," Dr. Breggin says, "in three teenage cases of murder and attempted murder in which antidepressants were implicated in playing a role.

In one case a sixteen-year-old committed murder and tried to set off multiple bombs at the same time. The comparisons with Littleton are obvious and ominous."

At a congressional hearing on media violence last spring, we were reminded that 95 percent of children are never involved in a violent crime. Most children whose parents own guns do not steal them; most children who watch Natural Born Killers do not go on shooting rampages; and most children on antidepressants do not kill their schoolmates. But while there is constant coverage about the dangers of guns and media violence, there is no debate about the dangers of antidepressants to the brains of our most vulnerable children, no campaign to examine kids for mood-altering legal drugs in their bloodstream the same way as they are examined for illegal drugs and alcohol.

In the aftermath of the Littleton massacre, President Clinton proposed new laws to restrict the marketing of guns to children, and hosted a conference to examine the entertainment industry's marketing of violence to children. But no one planned a conference or introduced laws to deal with the third problem-the marketing of moodaltering prescription drugs for children.

DRUG MONEY > PRESIDENTIAL SEAL OF APPROVAL

Quite the opposite. Weeks after Littleton, a high-profile White House conference on mental health was held, presided over by the vice president and Mrs. Gore. The conference was hyped as "historic" but turned out to be mostly a cheerleading session for drug manufacturers, with Tipper pumping her fists and giving the thumbs-up from the stage.

It was striking that at a time when, following the rash of school shooting tragedies, parents and communities were being called upon to get more involved in the lives of their children, the conference managed to trace all behavioral and emotional problems to the biochemistry of the brain. Dr. Harold Koplewicz, director of New York University's Child Studies Center, went so far as to say that it was an "antiquated way of thinking" to blame "inadequate parenting and bad childhood traumas" for depression. And the First Lady, who not long ago told the world that it takes a village to properly raise children, backed him up, as if a well-stocked drugstore in the village center was good enough.

Even after Koplewicz blamed the wave of school violence on "depression or other mental health problems" that had been left untreated, no one at the conference challenged the good doctor by reminding him of Harris, Kinkel, or Solomon, who had all been treated. "Both plenar,v sessions," said Sally Zinman, director of the California Network of Mental Health Clients, "were an infomercial for drugs. There was absolutely no mention of the potential risks."

One place you will find them is in the complaint filed in the Superior Court of California by the estate of Brynn Hartman, wife of comedian Phil Hartman, who killed her husband and herself while on Zoloft. "Although none of the drug manufacturers will admit it," read the complaint,

"these drugs pose an unreasonable risk of violent and suicidal behavior for a small percentage of patients. They can also cause a condition known as 'emotional blunting,' or disinhibition." Hartman's estate sued Zoloft's manufacturer, Pfizer, as well as the doctor who allegedly gave her a sample package of the drug without a proper diagnosis. To settle the case, Pfizer agreed to provide a $100,000 college fund for the Hartmans' children, Sean and Birgen. "Our principal goal in pursuing the case," said plaintiffs' attorney Andy Vickery, "was to let them know this wasn't really their mom that did this." Pfizer is also being sued in Kansas by the family of a thirteen-year-old boy who hanged himself while on Zoloft. The trial is set to start inJuly.

But the White House conference organizers seemed intent on avoiding all the tough questions while engaging in insidious hyperbole. The promotional literature stated that "13.7 million of the nation's children have a diagnosable mental illness." When I asked Mrs. Gore's press secretary how the conference came up with this number, she referred me to the White House press offfice, which in turn referred me to the Health and Human Services Department, which sent me to the American Psychiatric Association and its director of research, Dr. Harold Pincus. The problem is that Dr. Pincus had never heard of this number. It turns out that it is based on a Florida Mental Health Institute study that states that the upper limit of an estimate of "youth with any diagnosable disorder" is 20 percent. Yet despite repeated warnings in the study that we don't have the ability to project national rates, this number was quickly and conveniently treated as gospel by conference organizers and by members of Congress, who set national health policy and readily cash drug industry checks.

If one in five children in this country is mentally ill, it is time to declare a national emergency. But this is true only in the addled brains of those who lump serious mental illnesses like schizophrenia with the garden-variety depression that comes with being awkward and fourteen.

It is particularly disturbing when drugs are used to keep so-called mentally ill children docile, as occurred in California's foster care and group home system, where children were given antidepressants in dosages that psychiatric experts said could cause irreversible harm. Or in Michigan's Medicaid system, where 57 percent of children aged three or younger diagnosed with attention deficit disorder were taking drugs for it, while only 27 percent were being treated with therapy.

How come no one at the conference mentioned that these little panaceas might actually cause harm? Because, as Dr. Breggin put it, "The drug companies call the tune. The problem with this biochemical model is that by blaming the brain of the child, even for commonplace sadness and anxiety, we take parents, teachers, politicians, and all of society off the hook for the widespread suffering of our children."

Some politicians, including Rep. Sheila Jackson Lee (D-Tex.), who led the Children's Mental Health breakout session at the conference, did not let themselves off the hook. "My focus," she told me, "has been not on drug therapy but on how children can be made whole. I've seen the changes that happen when you put your hands around a troubled child by providing a nurturing environment. In our session we talked about mentoring, and about not coming in and telling parents what to do, but engaging them in a plan for their child."

But the overwhelming impression the White House conference left was that of the Clintons and the Gores endorsing a purely pharmacological view of humanity. The conference was supposed to "burst myths" about mental illness, but it never got to the truth behind the myths: that human beings consist of a soul as well as a brain. And there will never be a drug to cure a troubled soul.

DRUG COMPANIES > DAMAGE CONTROL

Buying politicians' silence and seal of approval is one thing. But sometimes it's not enough-not with a world of potential new customers out there.

So when President Clinton called on pharmaceutical companies in 1997 to test all drugs likely to be prescribed for children, Lilly signed up Leo Burnett of Chicago, the ad agency handling Reebok and McDonald's, to target consumers directly. The company sent its spokespeople out to radio shows to debate its critics (myself included) with measured talk of Lilly's "partnership with the academic community," "peer review medical journals," and the need to establish "whether the benefits outweigh the risks." Guess which side they came down on.

The pharmaceutical giant also sent misleading letters to every newspaper in America that ran my column critical of its practice of pushing Prozac on kids. Lilly executive Christina Hendricks was upfront at a drug industry conference in May 1997 about company policy toward anyone who dares be disrespectful of almighty Prozac: "We go after these people with a very serious intent to get them to cease and desist from their activities." Any attack on Prozac is countered as "belittling those suffering from depression."

Lilly's damage-control strategies include settlements that require plaintiff confidentiality, preventing any adverse Prozac side effects from being aired in public. One of the largest occurred in Louisville, Kentucky, where Lilly quietly reached agreement with the families of the victims of a Prozac user who killed eight and wounded twelve in a printing-plant shooting spree. In the trial, the plaintiffs claimed that Lilly had failed to report to the FDA adverse clinical reactions to Prozac. Judge John Potter allowed evidence of a similar case from Lilly's past, when it pleaded guilty in 1985 to criminal charges and paid hundreds of thousands of dollars in fines for concealing from the FDA the fact that patients in Britain had died after taking Oraflex, another Lilly drug.

Eli Lilly did whatever it could to keep the Louisville jury from hearing those details-including misleading the judge. On May 23, 1996, the Kentucky Supreme Court found evidence of bad faith, abuse of process, and possible fraud on the part of Lilly during the trial. A separate investigation by the Kentucky attorney general's office uncovered a secret deal wherein Lilly assured the plaintiffs' silence in exchange for promising to pay them regardless of the verdict. The plaintiffs' lawyer also agreed to settle a number of other cases he had pending against Lilly.

FDA > OVERSIGHT?

In 1997, Lilly ran a three-page Prozac ad in major magazines around the country, from Time to Cosmopolitan. Under a storm cloud that on the second page is magically transformed into a bright sun, the ad informed us, "When you're clinically depressed . . . you may have trouble sleeping. Feel unusually sad or irritable. Find it hard to concentrate. Lose your appetite. Lack energy. Or have trouble feeling pleasure. These are some of the symptoms that can point to depression...."

These are also some of the symptoms that can point to life. Is there anybody on this planet who has never lacked energy, felt sad or irritable, found it hard to concentrate, or had trouble sleeping? Because if there is, I would sure like to meet that perfect specimen.

However, the small print of the ad made for much more interesting reading. The adverse side effects listed under "precautions" range from anxiety (I thought Prozac cz~red anxiety) to suicide (a fail-safe cure for depression, though probably not the one Lilly likes to brag about).

Despite a page chock-a-block with small-print warnings and small-print advice to consult a doctor, the ad is part of Lilly's multimillion-dollar campaign specifically designed to bypass doctors and target consumers directly. Treating life as an illness is bad enough. But treating childhood as a disease is tragic. And what made the timing of the ad campaign so disturbing is that it coincided with the publication of the only large-scale study on the effects of antidepressants on kids, which was then used by Lilly to try and get FDA approval for pediatric use of Prozac. The University of Texas study found that about half of the eight- to eighteen-year-olds improved. But then, so did one third of those on a placebo.

We are in desperate need of more information-not just more clinical studies but more data released to the public about the medical histories of children charged with acts of violence. Following the news about Eric Harris being on Luvox, Rep. Dennis Kucinich (D-Ohio) called for "comprehensive clinical trials by the pharmaceutical companies" to establish "the behavioral effects of antidepressants on our youth." Kucinich has been waging a lonely battle to get the FDA and the Drug Enforcement Administration to conduct "deliberate and thorough" research on Prozac's effects on children before it is approved for their use. Isn't this, after all, why these agencies exist?

This is especially important given Eli Lilly's dissembling on the issue. "Prozac is being studied by Eli Lilly and Co.," F-D-C Reports, which covers the drug industry, disclosed in 1997, "as an antidepressant for use in patients under 18 years of age.... A pre-N.D.A. [New Drug Application] filing was made." This directly contradicted the stance Lilly has assumed for public consumption, denying that it planned an expansion into the children's market.

"Lilly's proactive approach to media management may be smoothing the way for antidepressants in children," FD-C Reports concluded. Indeed. Lilly representative Dr. Gary Tollefson appeared on National Public Radio earlier that year to tell listeners that adult depression "often begins in children and adolescents."

According to the FDA's Melinda Plaisier, the "FDA's decision to market a new drug is based on the answers to two questions: one, do the results of well-controlled studies provide substantial evidence of effectiveness? and two, do the results show the product is safe under the conditions of use in the proposed labeling? Safe, in this context, means that the benefits of the drug appear to outweigh the risks." If this is the case, shouldn't we demand a much fuller accounting and understanding?

Shockingly, many drugs regularly prescribed to children have been tested only on adults. The Pediatric Pharmacy Advocacy Group reports that approximately 70 percent of the drugs used by children have not been tested on them. Even their labels admit as much: "Safety and effectiveness in pediatric patients have not been established." Nonetheless, these drugs continue to be given to children, while unwitting parents and heedless politicians ignore the unknown and potentially disastrous long-term effects.

The FDA's lax oversight of drug companies has triggered terrible symptoms. Every year, two million Americans are hospitalized for drug side effects. David Lawrence, head of Kaiser Permanente, says that approximately 180,000 patients in hospitals die annually due to errors and complications from using prescription drugs.

"Most errors are not caused by stupidity, incompetence or neglect, but by system failures that allow them to occur," Lawrence said, suggesting that the safety tests done by drug companies are not enough, and that the companies fail to educate physicians and hospital workers on the proper administration of the drugs.

Currently, doctors and hospitals are not even legally required to report patients' drug side effects to the FDA. And even if they were, the agency has approximately eighty employees to monitor more than three thousand prescription drugs. In the past two years, the FDA has banned five drugs that it had previously approved but that it now deems dangerous. Why do we tolerate such lax oversight of a powerful industry that affects life and death?

DRUG COMPANIES > COLLUSION

Politicians aren't the only recipients of the drug companies' largesse-or its coercive clout. Doctors, pharmacists, researchers, and consumers are all targeted for persuasion, both subtle and aggressive. For instance, medical journals are funded predominantly by ads they carry from pharmaceutical companies, while much of the research on drugs is paid for by the drug companies themselves.

And what the pharmaceutical companies can't buy, they manipulate. Amazingly, present laws allow them to pick and choose among drug studies. "The public might be shocked to learn," Dr. Breggin told me, "that the vast majority of studies done for the FDA approval of psychiatric drugs such as Prozac show them to be of no value whatsoever. But the companies are allowed to pick out two often marginally or questionably successful studies as 'proof' that the drugs work." On top of this, there is growing evidence that the drug companies, by sponsoring their own research-as well as offering grants, trips, and other perks-are contaminating the conclusions of these vital studies. Examples abound, such as the three doctors who editorialized in the British Medical Journal that Prozac is not addictive, after participating in an all-expenses-paid symposium in Phoenix sponsored by Eli Lilly. So Prozac is nonaddictive, but desert golf may be.

Some of the legal drug pushers in the employ of Eli Lilly recently found their way to a suburban Washington high school. "They gave out pens and pads and little brochures pushing Prozac to these high school kids," Sidney Wolfe, director of the Public Citizens Health Research Group, said in a groundbreaking but hardly noticed 1997 Nightline show. Everything from fancy dinners to first-class vacations to a lifetime supply of ballpoint pens are doled out by "detail" men and women, as drug sales reps are called, who constitute a formidable grassroots army traveling around the country, leaving a trail of judgment-clouding goodies behind. In the other drug industry, such people are called runners.

Another drug company tactic puts free pens to shame. It's called "drug switching"-doctors and pharmacists induced into substituting one brand of drugs for another. Here's how the scheme works: The major pharmaceutical companies buy up the giant drug management and rating companies, which create preferred drug lists (formularies) for use by insurers and HMOs. If doctors or pharmacists don't choose the "preferred" drugs on the ratings list, the HMO often refuses to reimburse the patient. Moreover, for his refusal to switch to the drugs on the list, the prescriber risks being ejected from the HMO and losing a major source of his income. On the other hand, pharmacists are often given a few dollars as a "bonus"~ynics have another word for it-for choosing the preferred drug. Is your doctor giving you a drug because that's the best one for you? You may never know.

This pharmaceutical arm-twisting was evident in the case of Prescription Card Services, the largest and most influential drug rater in the nation, covering 50 million Americans. In its 1993-94 guidelines, PCS informed doctors and pharmacists that Prozac "is no more effective than other antidepressants and is much more expensive." But in its 1995-96 guidelines, the company claimed that Prozac had fewer side effects than the cheaper antidepressants, which were "more toxic."

Was PCS merely suffering from one of those manic mood swings that Prozac is supposed to alleviate? Or did the fact that Lilly acquired PCS in 1994 have something to do with its "objective" medical conclusions? A PCS spokesperson predictably denied a connection. Still, Prozac sales rose 40 percent-from $1.7 billion in 1994 to $2.4 billion in 1996.

"The takeover of PCS by Lilly converted a powerful opponent of Prozac into an ally," charged New York City public advocate Mark Green. And after evidently ingesting some "nonpreferred" FDA truth serum, a former senior official at Lilly who was reluctant to let me use his name (our own version of The Insider) said, "The whole point of buying PCS was to influence the formulary lists and protect Prozac. You make sure your drugs are on the formularies and your competitors' drugs are not. If Lilly bought PCS, there was no way they were going to let Zoloft get ahead of Prozac."

Reports that Lilly was using PCS to promote Prozac were made available to the Federal Trade Commission- which had consent agreements signed by Lilly and PCS that this would not occur. Last year, Lilly got rid of PCS, selling it to Rite Aid, a drugstore chain.

A number of states including California, New York, and ~~rgi~ua are t~ging to address the bad medicine of drug switching. But our well-compensated Congress, once again, has been virtually silent on the issue. Recent attempts to reform managed care and health insurance, such as the Patient Access to Responsible Care Act, the Fair Care for the Uninsured Act, and the Health Care Access and Equity Act, among others, completelyignored the issue of pill-ola. When it comes to legal drugs, our representatives in Washington- pacified by dangerous doses of pharmaceutical cash-would rather switch than fight.

POLITICAL ENDORSEMENTS > PROFITS

One tried-and-true way to influence public of ficials is to buy the services of one. After nearly becoming president of the United States, Bob Dole became a paid spokesman for Pfizer, the maker of Viagra. Pfizer was trying to pump up sales in the wake of flaccid demand (prescriptions falling from one million in May 1998 to 346,000 in October 1998) and bad publicity (130 men dying from Viagra-induced side effects).

But such risks can be smoothed over when you have an underemployed former presidential candidate up your sleeve. To further imply an official endorsement from the corridors of power, Dole's television ad was filmed in a plush offfice before imposing white columns. He positioned the ad as a public service announcement, dismissing concerns over Pfizer's logo appearing on the screen with the improbable excuse that not "many men know that Pfizer makes Viagra."

He even compared his campaign to Betty Ford's fight for breast cancer awareness. As far as I know, no drug company ever paid Betty Ford. Pfizer's chairman, by contrast, not only paid Dole but pompously praised him for making "men's health issues a priority for 1999" and "advocating for Americans with disabilities." (So that's why all those handicapped spots are always taken.)

"It may take a little courage," said Dole in his commercial for Pfizer. But the courage that's needed by our public officials is the courage to turn down lucrative offers from drug companies with self-serving agendas. Dole's protestations have a familiar ring in this era of politicians who feel compelled to comically deny any link between the massive donations they take and the public decisions they make.

LEGAL DRUGS > ILLEGAL DRUGS

...the major pharmaceutical companies are big backers of the Drug War, helping fund both the Partnership for a Drug-Free America and the National Center on Addiction and Substance Abuse, while 17,000 oftheir sales reps distribute information to health care professionals to help them identify drug abuse. Isn't it ironic that the same people who are pushing mood-altering legal drugs should be taking up the challenge of alerting doctors to the dangers of the illegal competition? It's not that they don't want us on drugs-they just want us on theirs.

"Why do we have such intense punishment for people who take drugs illegally," Dr. Dean Ornish, clinical professor of medicine at the University of California at San Francisco asks, "while drug companies make billions of dollars in profits every year by selling mood-altering drugs to millions of Americans, including children?"

Dr. Ornish is not the only member of the medical community to note the continuum. Dr. Nadine Lambert, a developmental psychologist at U.C. Berkeley, published a paper in October 1998 concluding that children on Ritalin are three times more likely to develop a taste for cocaine. And a 1995 study in the Archives of General Psychiatry by Nora Volkow found numerous troubling similarities between methylphenidate, the key ingredient of Ritalin, and cocaine. The distribution of Ritalin in the human brain was "almost identical," the peak effects of the drugs occurred at nearly the same time, and the drugs' highs were "almost indistinguishable." "We're dealing with a drug that does have properties very similar to cocaine," she concluded.

In fact, the Drug Enforcement Administration reports increased Ritalin abuse among adolescents, who some times crush it into a powder and snort it-which can lead to heart failure. And it isn't just Ritalin that's abused. The DEA has collected information indicating illicit use of drugs like Prozac by cocaine and heroin users. As Rep. Kucinich, who sits on the Government Oversight Committee, wrote in a letter to the DEA, "The potential for diversion of Prozac to illegal drug users is real and the DEA's role in this decision should not be swept under the rug."

In 1998 our airwaves were filled with anti-drug commercials-paid for in part by the taxpayer. The Offfice of National Drug Control Policy in cooperation with the Partnership for a Drug-Free America and the Ad Council launched a billion-dollar, five-year ad campaign against drugs.

According to drug czar Barry McCaffrey, the project includes a "scientific" component that has as its goal to "try to talk" to "90 percent of the American people four times a week with a scientifically credible anti-drug message." "I think that this phase will be even more effective than the last phase of the campaign," said President Clinton last August in announcing the second year of the ads. "And I think you will see real impacts on the behavior of our young people, and that teen drug use will continue to decline."

"We're enormously proud of it," boasted McCaffrey. "I think we know what we're doing. We've got a real professional group running it for us now. They do this for a living." So at the same time that we are bombarded with hamfisted public service commercials trying to convince the young that it's "uncool" to do drugs, we're being seduced with ads making it very cool to respond to every emotional pain, stress, and discomfort by taking an exotically named pill. As heroin user Heather said on Nightline, "What's the difference between heroin and Prozac? . . . If you live in a neighborhood where you can't afford a therapist who costs $150-an-hour, and you've got brown tar heroin down the street, and you know that's going to make you feel better and get you through another day without killing yourself, that's what you're going to use."

We will never win the war against drugs unless we stop wilfully ignoring the connection between a culture that offers a pill for every ill and a culture that cannot wean itself from illegal drugs. But that will never happen until our political culture weans itself cold turkey from special interest money. In the end, after all, it's all about supply and demand.

DRUG COMPANIES > GOVERNMENT POLICY

Our unwillingness to look at the continuum between illegal drug abuse and legal drug abuse can be traced back to the power of the prescription drug industry, always cloaking its self-interest in language about pharmaceutical research and the public good.

One of the most chilling illustrations of the drug companies' misplaced priorities was the collective silence from the leaders of both parties over the efforts of the drug industry to stop production of inexpensive AIDS drugs in South Africa. The story-involving powerful drug companies, powerless victims of disease, cash-hungry politicians, a hidden army of revolving-door lobbyists, and policies dictated more by profit than public interest-presents an anti-civics lesson on America's broken political system.

Vice President Gore is the cochair of the U.S.-South African Binational Commission, coordinating trade policy between the two countries since 1994. South Africa, suffering an AIDS epidemic that our own surgeon general has compared "to the plague that decimated the population of Europe in the 14th century," passed the Medicines Act in November 1997. The act was intended to make it possible for its infected citizens, many of whom live in extreme poverty, to obtain inexpensive AIDS drugs. "American drug companies want some of the poorest people in the world to pay U.S. market prices for drugs," Rep. Jesse Jackson Jr. (D-Ill.) says. "But AIDS drugs can cost $500 per week-which happens to be the annual per capita income of sub-Saharan Africa."

Three months later, the big international pharmaceutical companies sued South Africa, preventing the law from taking effect, and lobbied for severe trade sanctions to be placed on the country. Among them were the three major AIDSdrug manufacturers, Glaxo Wellcome, Bristol-Myers Squibb, and Pfizer-companies that in 1998 alone made $4.43 billion, $3.64 billion, and $3.35 billion, respectively.

That the drug companies are acting out of pure self interest is not surprising. After all, these are the same companies that, despite making the largest profits of any industry, are eschewing spending research money on the lethal diseases of the poor in favor of antidepressant drugs and designer cures for "lifestyle" maladies such as baldness and toenail fungus. Malaria, which the World Health Organization describes as "closely linked to poverty," has made a fierce comeback in Africa, Latin America, Southwest Asia, and several former Soviet provinces, after nearly being eradicated decades ago. But a survey of the twenty-four largest drug companies found that none of them has an in-house research program on malaria. Meanwhile, U.S. sales of pharmaceutical drugs for pets are approachmg $1 billion annually. The Pharmaceutical Research and Manufacturers of America's boast that they aim to "set every last disease on the path to extinction" may ring hollow, but at least Fluffy will never shed again!

The drug industry's unadulterated self-interest is also governing public policy. Despite two years of complaints from public health groups, Gore remained steadfast on the industry's side until embarrassing public protests at campaign stops forced him to issue anemic defenses of his posltlon.

Who would defend leaving hundreds of thousands to die because lifesaving medicines are priced out of reach? Certainly not the same administration that spared no expense in waging a "humanitarian" war over Kosovo. Or so one would think. But Gore, wedded to a trade policy that is anything but humanitarian, aligned himself with his pharmaceutical donors.

In explanation, the vice president's offfice served up a bureaucratic cocktail of words-to be taken only with an empty head-claiming that it was trying "to help AIDS patients by making sure drug companies maintain profit levels to develop new AIDS medications." But what good are AIDS medications if they can't get to the people with AIDS? It looks as though Gore's vaunted "livability agenda" stops at the suburbs' edge.

Why did Al Gore go to bat for the drug companies and against AIDS patients? One answer lies in the web of Gore aides, friends, advisors, and lobbyists moving seamlessly between his inner circle and the pharmaceutical industry. Among them are Anthony Podesta, a top advisor and close friend of Gore and one of the Pharmaceutical Research and Manufacturers of America's chief lobbyists; Gore's chief domestic policy advisor David Beier, previously the top in-house lobbyist for Genentech; and Peter Knight, Gore's main fund-raiser, who made $120,000 lobbying for Schering-Plough.

Congress was equally paralyzed. In July, the House of Representatives approved the African Growth and OpportunityAct, a bill that liberalizes trade between the U.S. and Africa but contains no protections for AIDS victims- and, in fact, does not even mention the AIDS epidemic. Once again, a "solution" was enacted that completely ignored the problem.

Rep. Jackson introduced a competing bill to prevent the United States from applying sanctions on South Africa and other sub-Saharan nations that are attempting to make AIDS drugs widely available. "It is the better bill," Rep. Tony Hall (D-Ohio) told me at the time, adding that the African Growth and Opportunity Act "put[s] trade above all other humanitarian concerns." But in the end, the Clinton Administration's pressure was too much to overcome, and ninety-eight Democrats supported the Act, pronng once again that in Congress-and America- money speaks louder than the muffled cries of the poor. After all, many of them won't live to see the next election cycle.

But the protesters persisted, and threatened to pursue Gore all the way to the convention. The long-overdue change in the Administration's position is directly traceable to them, and to all the activists who dramatized the consequences of an inhumane trade policy. In September, the U.S. reached an agreement that allowed South Africa to implement its Medicines Act in order "to pursue its much-needed health reforms in the interest of its people." But how many people had to die first?

The power of protest made a difference in the AIDS drug war. Will it make a difference in the war on drugs and the drug industry's war on us?

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