The U.S. has 5% of the world’s population, but consumes 50% of its pharmaceuticals and 80% of its painkillers. Why do we have such an alarming appetite for prescription drugs?
That’s the question at the heart of American Addict, a documentary by Gregory A. Smith, M.D., and filmmaker Sasha Knezev. The answer, according to the team’s research, is multifaceted and troubling, but it boils down to this: Pharmaceuticals are big business.
“We’ve been conditioned to think there is a pill for everything,” says Knezev, “and we have such a cultural pattern of fast living — being incredibly busy with our jobs and with our lives — that we seek a quick fix without looking at the overall detriment to our long-term health or what it does to our minds.”
As a result, “70% of Americans are on some type of prescription drug,” Knezev says. That helps bring the nation’s top pharmaceutical companies a combined annual revenue of between $300 and $400 billion, he says. “That’s more money than the gross domestic product of two-thirds of the world’s countries.”
The film seeks to show that this eagerness to keep the profits coming has led to disturbing trends in marketing, lobbying and in interlocking relationships between pharmaceutical companies and doctors, media, government officials and regulatory agencies. It has also helped inspire a prescription drug abuse epidemic, the filmmakers say. In short, Dr. Smith says, “The general health of the public is being trumped by big business.”
And the issues aren’t going away, Dr. Smith says. A sequel, American Addict 2, is in the works and scheduled for a fall 2014 release. It will look at a host of new concerns, including possible links between mass shootings and psychotropic drugs, and a “hot new market” — drugs for children ages four and under, even anti-anxiety medications, he says. “I would love to make an American Addict 3 showing that it’s gotten better and why,” Dr. Smith says, “but I really don’t think it’s going to get better before it gets a lot worse, unfortunately.”
The U.S. Prescription Drug Abuse Story
Dr. Smith’s interest in prescription drug overuse grew out of his work as a chronic pain and addiction specialist. “I was tired of seeing people die unnecessarily,” he says. He was in the middle of writing a book about the subject, also to be called American Addict, when he became acquainted with Knezev, a narrative filmmaker. “One day he was telling me about prescription pills,” Knezev remembers, “the epidemic and how wild it was — and I said, ‘Well, why don’t you make a movie about it?’” Dr. Smith put the book on hold for the moment (it will be released later this year), and the two joined forces to create American Addict, with Knezev directing, writing and co-producing and Dr. Smith acting as executive producer and co-writer. The film made the festival circuit in 2012 and went into release in 2013. It can be seen on Netflix, Amazon and iTunes. The pair decided early on not to do a traditional voice-over documentary, but to assemble authoritative voices on the subject and let them tell the story. The result is powerful. One by one, researchers, doctors (including Dr. Smith), government officials, congressmen, attorneys, law enforcement agents and others share their piece of the puzzle. What emerges is a portrait of a health care industry that is prioritizing profits rather than people.
A key part of the equation, the film maintains, is the pharmaceutical lobby, the most powerful in Washington. Then-Congressman Dennis Kucinich is one of those who appears in the film. He notes that the pharmaceutical lobby has more members than Congress and spends hundreds of millions per year on its efforts, which have enormous economic and political impact. To help ensure the 2003 passage of the prescription drug subsidy called Medicare Part D during the Bush administration, for example, the lobby spent $116 million, he says. But, he explains, drug companies realized an $8 billion profit as a result. Part D, he says, gave the pharmaceutical industry the ability to name its price for pharmaceuticals, get it and have the government pay for it.
Lest the film be dismissed as a knock on Republicans, it should be noted that the current administration also gets called out: In 2008, President Obama received more money from the pharmaceutical lobby than any other candidate, and his current medical overhaul is described by the film’s experts as leaving Big Pharma firmly in charge.
An “Eye-Opening” View into Big Pharma
The decision to look at the politics of addiction rather than addiction itself was an intentional one, Knezev explains. “I said, ‘Let’s investigate, go deep and let’s make it political. Let’s dig down the rabbit hole and see how far it goes.’ And we did.”
What they discovered, Knezev says, “is very eye-opening to the viewer because they really see how it literally goes from the top. That’s not a metaphor. … There is this entire medical, pharmacological industrial complex, and its tentacles are so vast and stretched across so many different areas.” For example, the film notes that pharmaceutical company money goes to fund universities, research, clinical trials, doctors, politicians, even the FDA. And advertising dollars bring billions to media. “We’re only one of two countries that allow direct-to-consumer advertising,” Dr. Smith says. “It’s us and New Zealand. And there’s a reason for that. Other countries realize it’s a bad practice.” Research shows that it makes people seek out drugs they would not normally request and may not need, he explains, and “it can also create an issue where medical problems are created for a pill that’s on the market.”
Light at the End of the Pharmaceutical Tunnel
Creating the film was an education for both members of the team. “Plenty of things surprised me,” Dr. Smith says, but the biggest was what he considers to be inappropriate relationships between the FDA and big pharmaceutical companies. “And I don’t mean everybody; I mean a few key individuals. I’ve reiterated that there are a lot of good people who work at the FDA and the big pharmaceutical companies.” One problem, he says, is that the work of lower level employees is sometimes overridden by upper management.
That’s what happened recently with a drug called Zohydro, he says. An FDA advisory committee researched the drug and voted overwhelmingly against it, citing its extreme potency, lack of anti-tampering features, and potential for abuse, but it was approved anyway, sparking a national outcry.
Despite the discouraging discoveries, Dr. Smith sees light at the end of the tunnel. “I’m an optimist. I wouldn’t be putting in this kind of energy if I didn’t believe” change is possible, he says. Even the Zohydro decision had a silver lining. The FDA recently decided not to approve another even more potent drug. “I totally believe that’s because of the backlash over Zohydro,” he says. “So it does make a difference. People have power when they speak in unison.”
Be Proactive About Your Own Health Care
Response to the film, both Dr. Smith and Knezev say, has been overwhelmingly positive. “The most rewarding by far is just the response from people,” Dr. Smith says. “I’ve had so many emails and Facebook notifications, tweets, etc., from people all over the world just saying, ‘Thank you, we didn’t know this.’” The film’s website, www.AmericanAddictTheMovie.com, allows visitors to share their own stories, some of which will undoubtedly make it into the second film, Knezev says. “We’re getting 20-30 emails every day,” he says. To some detractors who say the film downplays the many benefits of medication, Knezev says, “We’re not against medication. There is obviously some great medication. But there is a point where you can’t be taking daily medication for every ailment.”
In the film, Dr. Smith tells the story of his mother, whose doctor tried to give her a prescription for Prozac during a routine checkup not long after the death of her husband of 45 years. “I’m not depressed,” she told the doctor. “I’m just sad.” Too often, Dr. Smith says, when people have a problem the first response from the medical community is “here’s a pill for it.” Despite all the pills, the film notes that the U.S. is well behind the rest of the industrialized world in terms of population health, in people’s satisfaction with the health care system, and in cost control. The solution, both Dr. Smith and Knezev believe, is for people to get involved in their own health care and inspire change from the ground up. “People need to be proactive; they need to educate themselves,” Knezev says. That includes paying attention to the marketing all around them that seeks to convince them they have a problem only a pill can fix and to keep in mind that drug makers “don’t want you to stop. They want a lifelong customer.”
Each person should also keep a copy of their own medical records, Dr. Smith says, and ask their doctors if nonmedical alternatives exist to treat their conditions. “We talk about this in the first film,” Knezev says. “If the first thing your doctor wants to do is prescribe you pills when you say you have a problem, then you need to find another doctor.”