Demand, Reward — Profit

I’ve said elsewhere that our vision of politics is being corrupted by a well-meaning but misguided epistemology of compassion: increasingly, we consider the person or group demanding a right to be the most trustworthy source of information about whether they deserve it. Anyone aggrieved, we think, must really be suffering grief, and since suffering is the worst thing and cruel is the worst we can be, justice is served when the law — that is, judges — fast-track the claims of the aggrieved and grant them instant — that is, legislature-circumventing — relief.

This is pretty transparently a medical way of viewing social relations. But our big medical brains are wired into big therapeutic hearts. And so what is happening in ‘politics’, which is actually the evacuation of politics by law on the one hand and desire on the other, is happening in medicine itself :

Once a condition has been “authenticated,” it’s only a matter of time before Big Pharma steps in with a treatment. Armed with such “objective” fMRI evidence that fibromyalgia is a bona fide condition, Pfizer undertook a series of clinical studies that showed that some patients with fibromyalgia did experience at least partial relief of symptoms with Lyrica. (On a scale of 1 to 10, the fibromyalgia patients achieved an average reduction in symptoms of 2, whereas the controls given placebo had a 1 point reduction.)

As the result of these studies, in 2007, the FDA approved the use of Lyrica for the treatment of fibromyalgia. (Since the approval in 2007, it has been estimated that worldwide sales of Lyrica have increased 30 percent, to well over $2 billion annually.) Without making specific claims about what fibromyalgia is or how Lyrica works, Pfizer, on its Web site , states that “recent research suggests that changes in the central nervous system may be responsible for the chronic pain that comes with fibromyalgia.” It adds that nerve damage may occur because of an infection or injury.

[ . . . ] What isn’t mentioned on the Pfizer’s fibromyalgia Web site is that Lyrica has been approved in Europe for the treatment of generalized anxiety . Lyrica was shown to be effective in providing relief of both emotional symptoms, such as depressive symptoms and panic, as well as physical symptoms, including headaches and muscle aches. Yes, another way of thinking about the benefit of Lyrica is that it helps relieve the muscle aches and pains associated with generalized anxiety and that these may be the same aches and pains as described by patients diagnosed with fibromyalgia. (Without objective lab studies, this distinction is impossible to make.)

The pharmaceutical industry has an absolutely vested interest in the huge profits to be won from treating ‘generalized anxiety’ and any other cry of pain, regardless of how mysterious or relative is the cause. Illnesses are no longer the issue; symptoms settle all. We are beginning not to care about being sick so long as we suffer no symptoms, trained, as we now have been for some time, to know that it’s perfectly normal to be sick, one way or the other. Nobody is the picture of perfect health. Where the logic of equality is applied to sickness, and the logic of individuality is applied to health, there the triumph of the therapeutic is to be found. It’s possible to view this, of course, as the consequence of a ‘secularization’ of original sin, but such a formulation misses the way in which this therapeutic view relates intimately in the lives of many to an essentially religious, if nondoctrinaire, outlook.

But we’re not finished yet. Be not surprised that our view of medicine, correlative as it is with our view of law and rights, circles back to deal politics another blow:

both the Blue Dogs and members of the New Democratic Coalition want to make sure the public plan isn’t based on Medicare rules; they want the plan to pay for itself and operate under the same guidelines as private plans.

But more-liberal members want a more expansive — and expensive — plan. During the closed-door session Tuesday, Rep. Brian Baird (D-Wash.) told colleagues that any bill should include mental health and dental insurance.

Elizabeth Edwards, among others, have been on about this for years now. Add the pathos and persistence of the mental-health lobby to our whole cultural picture of what ‘mental’ and what ‘health’ mean, and it’s hard to imagine how that radical an expansion of coverage wouldn’t make it into a Democratic package. It’s also hard to imagine a more ominous and imposing development than the transformation of the mental-health market into an arm of the pharmaceutical industry bankrolled and protected by the post-Obama federal government. Big Pharma has a vested interest in comprehensive government regulation , too, you know — the better to squeeze out competition, get institutionalized with an unkillable monster of market share, and permanently hedge, by way of unremittant lobbying and revolving-doorism, against market risk or corporate accountability. If people are looking for a useful political talking point in the debate about the future of health care and the totality of government control, I’d suggest this one. But caution: criticizing the idea that we should do whatever it takes to minimize the discomfort of all Americans is hazardous to your health.