by Rev. Dr. Marilyn Sewell

A sermon given November 9, 2003

First Unitarian Church

Portland, Oregon

OPENING WORDS

Good morning!

We come this day

To give thanks,

To make confession,

To offer forgiveness, and

To be strengthened in the ideals we would live by.

Years ago when I was training to be a Gestalt therapist, I used to travel to a rural area—actually, to a farm—in Michigan to take part in summer workshops.  It was always an intense time, as you might imagine, and during breaks from the group work, I would often wander down the dusty dirt road beside the farm to seek some quiet time in a country cemetery that had graves going back as far as the 19^th century.  I was reminded of my mortality as I walked among the weathered stones and read their inscriptions, and I thought of the people buried there.  Whole families of them.  Young wives who I expect had died in childbirth.  Multiple deaths from the flu epidemic.  Many families lost children, some more than one, dead of diseases which our children are immune from—or which now would require only a visit to the doctor and a prescription for the right drug.

We now have drugs that are truly miracle drugs.  At the top of the list would be antibiotics, which were in widespread use by the 1940s.  We have anti-hypertensives, which control the high blood pressure that contributes to strokes and heart disease.  We have drugs that markedly reduce the complications from diabetes.  More recently, we have had the brilliant research that has brought us the AIDS cocktail—and turned a death sentence into a controllable disease.  I remember the Sunday when a man here in the congregation who has AIDS said to me, with tears in his eyes—he said, “I was preparing to die.  And now I’m preparing to live.  I’m think I’m going to start a new business.”  Which he did, and which has been a success.  His life has been given back to him because of these new drugs.

So I am saying that we have a lot to be thankful for this morning, and some of that gratitude must surely be given to the drug companies whose research has contributed so much to our health and well-being.  And yet there are serious problems with the drug industry today.  That name itself gives some sense of why there are problems—the drug industry.  Drugs, from which we have benefited so much, are an industry, first and foremost: their mission of bringing returns to the stockholders has far overshadowed their humanitarian role.  Their profits have been exorbitant by any measure.  Every year this industry led the rankings among the Fortune 500 companies, yielding double-digit returns on revenues—over 18% in 2001 and 2002.[1]  The industry, in short, is more profitable than any other industry in the United States.  Even in poor economic times, people will always need medicine.[2] 

We are a nation that has become increasingly drug-dependent.  It is interesting to note that when Medicare was started, there was no drug coverage, because drugs were not a large portion of health care costs.  But between 1994 and 2001, the number of prescriptions swelled to 3.1 billion—a nearly 50% increase.  In nearly the same period, sales climbed from $61 billion to $155 billion.   There are new and better medications out there which account for some of this increase, but much of it has been fueled by the heavy marketing of drugs.  In the last several years, drug costs have been rising by 17-19% a year, far faster than health care in general.  So if such a large chunk of money is going into drugs, what does that mean for the rest of our health-care dollar?  We’ve capped the amount we’re willing to pay for health care, and so funds will be denied somewhere else—largely in prevention.

In drugs, as with other products, Americans are good consumers.  More is better.  And more expensive is better.  And if a condition can be fixed with just a pill, and no life-style changes, even better.  “Americans want their Lipitor,”  (a cholesterol-reducing medication) said David Nash, a physician who works in the arena of policy-making.  “They want to be able to take it on their way to McDonald’s.”

The cover story of the November issue of Time magazine was entitled “Are We Giving Kids Too Many Drugs?”  The article points out that the use of anti-depressants among children and teens increased threefold between 1987 and 1996.  And that use continues to climb, although we really don’t know the long-term effect of these drugs on the developing brain—children are not just little adults: they assimilate drugs differently.  One pharmaceutical trade group claims that up to 10% of all American kids may suffer from some mental illness.  And twice that many have exhibited some symptoms of depression, they say.  ADHD rates are exploding, too.  If all these kids are suddenly sick—and I’m not sure that they are—then we ought to be asking ourselves, “Why?”  What in our culture is making our kids crazy?  And we should ask ourselves if we are over-medicating difficult but “normal” children.

As I said, the cost of drugs is skyrocketing.  Of special concern are the vulnerable elderly, who sometimes cut their pills in half or take their medication every other day, to save money for groceries.  When the safety net is pulled out from under them, poor people often have no alternative at all.  When drug benefits were removed from some disabled people in this state recently, Central City Concerns documented at least 27 deaths as a direct result of that loss.  An estimated 780,000, or 1 out of 5, Oregonians have no coverage for prescription drugs. 

In their defense, the pharmaceutical companies point out that bringing a new drug to market is a lengthy and expensive process, taking 12 to 15 years and somewhere between $200 million and $800 million dollars.  The drug industry upped its spending on research by close to 70% from 1990 to 2001.  The problem is that the number of new drugs approved by the Food and Drug Administration stayed about the same—around 30 per year.  And a sizable number of these were not new cures for serious diseases—they were questionable “improvements” which allowed drug companies to extend their patents on drugs for another 7 years.  (Also, it must be said that much of the real research and development is done by the National Institute of Health, and paid for by our tax dollars.)

Since only around 22% of drugs brought to the market in the last two decades were genuinely innovative, and the generic drug makers could not be held off forever, the pharmaceutical companies decided to use that tried-and-true method of raising their profits—marketing.  The biggest companies spend two to three times as much on marketing and administration as they do on research. 

Marketing to physicians is not a new phenomenon.  But it may be reaching new heights.  Consider this scene.  About two dozen doctors gather for cocktails and dinner at the Plaza Hotel in New York, guests of a pharmaceutical company that has brought them together ostensibly to solicit their “advice” and “feedback” on the treatment of depression.  The doctors don’t have to rush home after dinner.  Forest Laboratories treats them to an overnight stay at the Plaza, where even the least desirable rooms—those without views of Central Park—cost about $250 a night.  Saturday morning the doctors are treated to a free breakfast and then they participate in a four-hour discussion about depression, which can be treated by Forest’s best-selling drug, Celexa.  A free lunch follows, after which each doctor is given a token of appreciation, a check for $500.  Ethical guidelines allow physicians to accept gifts only in the “general range of  $100,” but doctors who are deemed “advisers” can accept honoraria and travel perks.”[3] 

Another form of marketing that has exploded in the last few years is direct advertising.  I’m sure you’ve seen the TV ads and the full-page ads in popular magazines.  A couple runs on the beach; a grandfather helps his grandson swing a baseball bat; an Olympic gold medal winner laces up her ice skates; a former U.S senator discusses erectile dysfunction.  The FDA used to require a detailed listing of all the risks of a particular drug, but in 1997, the agency issued new guidelines that relaxed the rules.  With direct advertising, patients can find out for themselves which drugs are available, without having to rely on the advice of their doctors.  Spending on advertising shot from $1.1 billion dollars a year to $2.5 billion in 2001.  The cost is, of course, passed on to consumers.

Are these ads effective?  Let me give you an example.  Schering-Plough went all out for its allergy drug called Claritin in 1998.  The company paid out an unprecedented $136 million dollars on ads, and sales skyrocketed 35%, to $3.5 billion dollars.  A pretty good return on investment.

We can now, of course, order drugs on line. At least once a week, a woman named Regina sends me an e-mail offering generic Viagra, at a greatly reduced price. I could even get a free sample, she says.  I’m not sure how this Regina got my name, nor why she thinks I need this product, but there you have it.  All I had to do is to fill in a form, which will go to a Board-certified physician, who will write me a prescription, and then I pay my money.  All done in minutes. I never actually opened this bit of spam until I began to work on this sermon, but then I did, and looking under “product information” was very interesting.  I found that Regina wanted to be sure that I understood that Viagra doesn’t work unless a man is sexually excited.  She warned me about that at least 7 times in about a single page of text.  Remember, she said, “Viagra is not an aphrodisiac.  It doesn’t help unless the man is excited.”  OK, already, I thought. I get it.  She told me how Viagra works, and then issued a few simple warnings.  She said if I take the medication after a high-fat meal, such as a cheeseburger and fries, it might take a little longer for the medicine to work.  Hey, I can deal with that.  She said to ask my doctor if my heart is healthy enough for sexual activity.   I wondered:  does she mean emotionally or physically?  In the next paragraph, I was warned that Viagra is not for newborns or children.  Wow, I’m glad she mentioned that!  I was all ready to send a package to my 3-year-old grandson.  She went on to talk about possible side effects like headache, flushing of the face, upset stomach, and death.  Death?  That’s fairly serious.   If I have heart problems—there she goes again with the heart problems—I should consult my doctor.  My real doctor, mind you—not the doctor that gave me the prescription.  And I should call the doctor also, my real doctor, if I have an erection that lasts over four hours, because that could cause permanent damage to . . . That could cause permanent damage.

Enough said.  Don’t order drugs over the Internet.  You don’t know what you’re getting, and nobody is responsible for what happens to you if you take these drugs.

One of the greatest sadnesses to me about our health care system is how much of our money goes into treatment and not prevention.  We know, for example, that we can reduce smoking considerably by educating the public.  Yet most health plans will not cover treatment for quitting smoking—they will of course pay for surgery for lung cancer.  We know that obesity is a growing problem, and a real killer.  Drugs have proved dangerous.  But how much big research money going into research on prevention?  And the Race for the Cure, focusing on breast cancer.  I wish it were called “The Race for Prevention.”

How do drug companies decide which drugs to go after?  There are several considerations—certainly they consider the current state of science and their chances for success—but it is chiefly a business decision. They typically do not work on drugs for epidemics like sleeping sickness or malaria that kill millions of people in developing countries. They go after drugs that offer novel approaches for large numbers of people who can afford to pay for health care coverage.  These chosen diseases, at best, would be chronic and serious—chronic enough that people will have to continue the medication indefinitely, and serious enough so that they will be afraid to quit. The ideal drug, in summary, would be one that treats a serious, chronic disease of well-off people.  With baby boomers now aging, more attention is being paid to drugs and procedures that will prolong the appearance, at least, of youth.  Aging in this society is considered serious, and well, of course, is chronic. 

We need to ask ourselves a basic question about health care in this country—is it a privilege, or is it a right?  Think about our Purposes and Principles—the values we uphold here at this church.  Is everyone of inherent worth?  Everyone, of whatever class or color?  Do we understand how truly interdependent we all are?  Do we understand that we need the work of the person cleaning the toilets and picking up the garbage every bit as much—and arguably even more—than we need white collar workers?

To Wall Street, drug companies may just be another business, to be evaluated according to their earnings per share.  But to the people, drugs are much more than a business—they represent comfort and a long life, physical strength and vitality.  We’re not talking about selling hamburgers here—we’re talking about a product that keeps people alive. Though every business should be answerable to the public, the drug industry is answerable in a way other businesses are not.  Without the regulation of drugs, people—especially poor people—will die.  They’re already dying.  Whether the Federal Government does it via Medicare, or the states do it through their buying clout, as Oregon has done, or the HMOs with their formularies, the drug companies are ultimately going to have to live with price controls and lower profits.

There are folks in our social justice program here at the church who have been working on these problems.  The Metropolitan Alliance for the Common Good, better known as MACG, has studied the issues deeply and they are working to organize a state-wide citizens’ dialogue on how to reform the current system.  They would welcome your personal stories and your vision of a health care system that would really work.  Stop by their table in the Parish Hall today and learn more about what this group is doing.  Also the Economic Justice group, or EJAG, will be passing out materials.  Other groups in our social justice program will also be downstairs, including our Peace Action group.  They are planning on meeting with our Senators regard the need to support our troops by ensuring that all our service men and women have adequate equipment, including bullet-proof vests.  If you want to be a part of the group that meets with Senators Wyden or Smith, you can sign up at the Peace Action table downstairs.  And you will also find downstairs our very active environmental group, or Seventh Principle group.  If you would like to become active in any one of these groups, talk to the organizers today, or talk to our social justice director, Kate Lore, who can advise you about our programs. 

Some of you who are visiting today might wonder, why is the minister talking about the pharmaceutical industry?  Isn’t it a little strange for her to be talking about Viagra instead of God?  Well, Unitarian Universalists believe that we have to take some responsibility in bringing about the Kingdom of God on this earth, not in the world to come.  In our vision of the Beloved Community, people who love are the face of God, human hands are the only hands God has to reach out to those in need.  Why do we talk about politics in church?  Why do we talk about economics?  Because these are the powers that determine, in some cases, whether people live or die.  These institutions can give life and hope, or hurt and despair.  Let us always, always, as a religious people, find ourselves on the side of love and hope and justice.  So be it.  Amen. 

PRAYER

Spirit of Life, help us to redefine our values until those values make sense for us, and for the larger world, and then let us live by these values.  Let us walk in the world with love and compassion.  And let us lean into the wind, and help make the changes that need to be made, so that all may be fed, all be housed, all have medical care when sickness comes.  Amen.

BENEDICTION

As you go from this place today, carry with you kindness, kindness to yourself and to all those you meet.  Go in love and go in peace.