Complaints about pharma go way back … to ancient Rome

One hundred years ago, editors of The Journal of the American Medical Association voiced their complaints about “pharmaceutic” problems. In particular, they objected to proprietary remedies (compounds with secret formulas), the inappropriate substitution of one drug for another, counterfeit drugs, and flowery but meaningless names that served only to increase the popularity of a drug.

According to the anonymous editors, these practices were in fact nothing new, but could found in descriptions of the ancient Romans.

Pliny the elder (first century AD) complained that physicians of his time used remedies that had already been prepared, thus saving the time it would take to prepare them. A historian (Ludwig Friedlaender) writes of the Romans: “[O]ften the physicians did not know the exact ingredients of the compounds that they used and should they desire to make up written prescriptions, would be cheated by the salesmen.”

Pharma reps less than totally forthcoming? Hmmm.

In the second century AD, Galen also complained of physicians who used “ready-made” medicines. Both Galen and Pliny believed prescriptions should be carefully prepared by physician’s themselves, or at least under their close supervision. But no. Some doctors simply followed the line of least resistance and abdicated this most important function. Surely this brought harm to both patients and the physicians themselves.

In addition, Galen complained of the “cursed dealers” who simply substituted one drug for another when a drug was out of stock. The editors of 1911 write: “This whole picture of the drug trade in imperial Rome … would read almost like an antedated satire on certain conditions of our time.”

Here, I think, things have improved in 2011.

A rose by any other name …

The editors go on to recall the Roman’s use of arbitrary and appealing names (Ambrosia, Nectarium) instead of descriptive names that provide information about the ingredients. “The promoters evidently knew the satisfying effect on both physician and patients of a long, mystifying foreign name.”

Today we have Lunesta, Sonata, Elavil, Wellbutrin for patients. But at least physicians may know these by the more (presumably) informative names eszopiclone, zaleplon, amitriptyline, buproprion.

Romans also complained of misleading labels: “instantaneous,” “safe,” “sure cure,” “harmless remedy.”

This was still quite prevalent in the early 20th century, especially for snake oil, “quack” medicines. Today you can still find misleading information on the fringes of health care, but it’s actually more common to hear a legally required list of undesirable side-effects quickly recited to the accompaniment of soothing music and images.

The commercialization of medicine

The underlying complaint that the 1911 editors of JAMA lodged against both their contemporaries and the ancient Romans remains true today:

The source of these abuses was just the same in Rome nineteen centuries ago as it is here to-day – greed for money. To use Friedlaender’s words, “Wealth was the genius of the noisy, restless striving which daily filled the streets and palaces; one universal chase after money as the original good, whence were derived rank, respect and honor. The complaint was just that wealth was the sole criterion and the one aim of Rome.”

In 1911 the medical profession complained of the “commercialization” of medicine, contending that this led to abuses in pharmacology and the practice of medicine. The Romans failed to check these abuses, which increased as Rome declined. “[I]f we are to avoid such unfortunate deterioration in our own time, we must not shrink from recognizing and resisting the evils which do so easily beset commercialized ages like those of the first and twentieth centuries A. D.”

If only the editors could have lived to witness the money-driven nature of medicine 100 years later. “The value of history consists largely in the applicability of its lessons to the aftertime,” they advise. Unfortunately, the harmful side-effects of a “greed for money” are one of those lessons we’re doomed to relearn in perpetuity.

Resources:

Image: A Directory

Ancient Problems of Pharmacy and Their Warning, The Journal of the American Medical Association, February 18, 1911, reprinted in Vol 305(7), p 772, February 16, 2011

Ludwig Friedlaender, Roman life and manners under the early Empire