Opinion: Where addiction and tragedy can confuse issues

It is a sad story

I just read an article posted on LinkedIn titled, Opioids, My Mom's Death, and Why People Trust Science Less and the human side of the story is very sad, however, the additional narrative is opinion, conjecture, suspect and unfortunate.

There is a conflation of issues along with unresolved conflicts that need to be separated before this article tagged as an Editor’s Pick, Healthcare and Pharmaceutical are taken in without questioning or review.

Separate the issues

Walking back the issues, there is grief at a mother’s death, addiction to pain-killers that came as a result of prophylaxis for osteoporosis, estrangement, and then the machinations of the pharmaceutical industrial complex, known as Big-Pharma.

There is no doubt that Big-Pharma, Big-Tobacco, Big-Oil, Big-Manufacturing, Big-Agriculture and Big-Anything have a lot to answer for about their products and the effects of the production and use of those products on people, on the environment, and everything that makes for the wellbeing of our common humanity, but that is addressing the symptom.

The fundamentals would always be down to the individual, their personality and their experiences in how persuadable they are and this is not to castigate the strength of character of anyone, but missing that point would allow for drawing the wrong conclusions.

Scientific advancement has done wonders

For instance, it is thanks to the contributions of scientific research and medicine that I am alive today, having at one time been at death’s door with a prognosis of 5 weeks to live if my physiology could not tolerate and respond to the regimen of therapy I was being prescribed.

At the lowest point, I was in such unbearable pain that if not for the need to monitor my vitals, I would have been anaesthetised to manage the stress of it. Before I was admitted to the hospital, I was on Tramadol, then on the day I was admitted, I was given a morphine skin patch that had to be taken off after two days because I could not keep my food down and from then on, I was put on Oxycontin and Paracetamol with Codeine.

Whilst it appeared to manage the pain, when a deep biopsy was done on the fungating tumours under the sole of my left foot, 7 shots of local anaesthetic did very little to deaden to the pain. I simply bit on a think piece of a folded napkin as they prodded the anger in my foot.

Managing pain alone

On leaving the hospital, I was prescribed a list of pain and nausea management drugs that I was concerned about the cumulative soporific effects of the drugs. In addition to the earlier prescribed drugs, I was given a Fentanyl patch and that dosage was doubled when I reported that I was still in very much pain. That was when the equilibrium for my pain management was reached, I was not as pre-occupied with the pain as I took in 7 sessions of chemotherapy and the cancer lesions healed.

Whilst the lesions had gone and all the necrotised skin had been removed to reveal fresh skin, I was still in pain into the 4^th month of my diagnosis, then the pain began to subside. One Sunday, the patch fell off my skin, I did not know until then that a patch retainer film could be worn to keep the patch in place. Until the effects of the new patch kicked in, I was in such pain I began to laugh almost into delirium, but that produced endorphins to ease the pain. My friend thought I was going crazy, but I knew what I was doing.

Coming off pain killers

The pain of cancer is in another realm, it cannot be explained, the therapy for chronic pain has addictive qualities too. When the pain had gone, I could not just take off the patch, I had to wean myself off it, this is where the mind and the will come to play. Addiction has much of its roots in the psyche first than in its palliative effects. The palliative which is in itself a kind of comfort has to be consciously managed.

In my case, it took another 2 months to come completely off the patch and other pain medication. With the patch, I cut it in half and left it on for longer, each patch dosage halved and left on for much longer until my body could do without the drug.

Then, we all have innate tendencies to addiction and some people might be able to avoid addiction. There was another instance where a change in drug regimen meant I could not sleep, the first suggestion was to put me on sleeping medication, however, I thought of working a plan to take my pills at a certain time and avoid completely drug-induced sleep. I could see the dangers of becoming dependent on sleeping pills.

Addiction is first personal

Going back to the purpose of writing this blog, addiction has social, emotional, economic, relationship and physical consequences. In my view, addiction is not just to drugs or the abuse of drugs, alcohol, it could be sex, it could be religion or any other activity. The person and people around that person suffer, and that is very sad.

Regardless of what brought on the addiction, it is always first a personal struggle, what other factors contribute to it does not take away from how the person might have succumbed to addiction. Whether we fail to be better informed of the debilitating side-effects of a drug does not take away from the balance between efficacy and damage.

Apportion rightly

The science would suggest a drug can do something, most drugs have to recoup research and development costs and it unfortunate that some people put the profit motive well and above the welfare of patients and customers – that is commerce, we cannot avoid it.

It is, however, a long stretch to conflate personal tragedy, addiction, the science and the commerce into one clickable title of Opioids, My Mom's Death, and Why People Trust Science Less and draw the conclusions in the piece without properly assuming personal responsibility on the one hand and understanding that every individual has a unique physiology that adapts to medication in different ways which could influence the mind too.

I recall my doctor saying they could treat my condition but it depended on my physiology to tolerate the medical regimen. I lost a friend to a similar condition because his physiology did not have the capacity to tolerate the regimen of chemotherapy.

The responsibility of addiction remains a personal thing, the responsibility for being properly informed lies within the person, their medical support, the pharmaceutical companies and the science that balances efficacy with possible side-effects, with the hope that efficacy outweighs side-effects.

I am sorry, the writer lost his mother to addiction, but if we are to trust science less because of the conflicts of interest between treatment and commerce, we would all die sooner in more misery and pain with respite or comfort. That is why these issues need to be treated completely separately even if they are linked in a personal tragedy.

Blockbuster snake-oil anti-depressant drugs

Does everything on the bus

I remember riding on those big yellow buses with black stripes in Lagos decades ago where a woman with snake-oil remedies would peddle her wares in front of the bus with humour and fallacy bordering on being cajoled.

Gbogbonse (Yoruba - Translating to does everything or cures all) was supposed to do everything from dealing with tooth decay to making you of extremely amorous interest to the opposite sex.

In what looks like a game show, certain passengers on the bus offered to assist in revealing the instant qualities of the medicines, between the comical and the downright bizarre people opened their wallets and parted with cash for those wraps of powdered substance.

It could all well have been a con job; you had no receipts or recourse to challenge the efficacy of your snake-oil drug if it did not do everything.

Since no one knew any better, it all really looked like a replay of a story I read in secondary school about con-men who sold charcoal as sugar for tea in a village and made loads of money.

Snake-oil anti-depressants

So when I heard that anti-depressants are very much like catch-all remedies with snake-oil potency and have very little effect, I really was not surprised.

The substance of the study was that the reviewers took all research material, especially the unpublished ones (which probably show that we are being sold shit) and analysed all the results with the conclusion that only those who are really very ill need be prescribed anti-depressants.

It would appear these block-buster snake-oil mental drugs which have made Big-Pharma exceedingly rich are very much like being sold charcoal as sugar for tea.

In fact, it appears the placebos also give a commensurate therapeutic effect leading some experts to question the full sincerity of Big-Pharma when it comes to conducting clinical and drug research on drugs that their viability and stock price values depend on.

I have no time, have a pill

I can very well understand why these drugs have gained prominence, the doctors have no time to analyse the issues and causes of depression which require extensive therapy, so stick a pill in the hands of anyone who cannot maintain a smile for more than a second.

Before we come to the conclusion that these drugs do not work at all, they might just be the required Gbogbonse the doctor ordered for some, leaving Big-Pharma laughing all the way to the bank anyhow.

It makes the whole matter ever so depressing – meanwhile, the deafening cacophony continues to sound like - kerching! kerching!!

The Pfizer Drug Trial

A leaked report

There is a need to follow-up on the blog I wrote about Humanitarian Pfizer before a number of points I raised are misconstrued and misinterpreted.

Nowhere was I commending Kano State for refusing to have children vaccinated, rather, I was highlighting the fact that their refusal must have been as a result of the experience they had with Pfizer and the supposed unapproved and illegal drug trials that took place.

Apparently, there was a report completed five years ago which is still confidential and under wraps that details to a greater extent how papers were forged granting access to this demographic and the possibility that no drugs were tested on some the children presumably affected.

The problem here is that the report has not been released to public scrutiny and what we know of it is due to some unauthorised leakages and no official has necessarily corroborated what has been relayed from that report, however, we now have names and titles of the Nigerian personnel who believe they were first cajoled and then kept in the dark about what Pfizer was up to.

Panel Faults Pfizer in '96 Clinical Trial In Nigeria - washingtonpost.com - Thanks to Snazzy for the link.

Hence what we really have to go on in the public domain is the detail covered by the news in terms of the new court case filed a few days ago where the numbers and the events seem to be at variance with the yet confidential report - the truth will out.

The bane of intellectual blind-sidedness

I also refuse to be challenged from the emotive perspective that if I had children, I would not have refused their testing for polio and the consequent necessary vaccination.

The commentator speaks from the comfort of an educated pedestal without appreciating the composition of the said demographic not having been deceived into offering children for trialling an unproven and untried drug in the midst of a seeming pandemic; all in the guise that they were being helped and this was approved by both the government and supported by the WHO.

The people affected in Kano State were attended to in a field hospital and probably not knowledgeable or literate enough to appreciate what was being done or attempted on their children and after The Washington Post blew this rotten exercise wide open in 2000; 4 years after the said events, it was only an expected human reaction to resist any Western medicine offers for mass immunisation in the light of such previous cajoling, deception and betrayal of trust.

Pfizer in the courts

Pfizer would contend that they obtained verbal consent of the parents when they should have only gone ahead with informed consent, a higher standard of ethical probity as required in the West.

It would appear Pfizer once had a statement about the drug tests in Nigeria, but that article can no more be found on Pfizer's site. In all, 4 court cases have been through the US courts and they have mainly been dismissed on grounds of forum non conveniens, basically, issues of jurisdiction rather than substantive misgivings on the merits of the case.

At least, Pfizer has waived possible statute of limitation problems, which means this case might run for years till some sort of resolution is reached.

Hopefully, there would be a judge ready to hear this case and get to the heart of the matter, it might also require lobbying Congress to come down heavily on rich drug companies that take advantage of helpless, poor and illiterate people to attempt dangerous drug trials outside the purvey of their government and judicial processes.

You only have to do a search on Google for Drug Trials Africa to see how much we in Africa have become a continent of guinea pigs for Big Pharma.

So, once again, in the circumstances, I can understand why the Muslim North in Nigeria were against vaccination, though it was ill-judged and wrong; they definitely were not going to be guinea pigs in another macabre drugs trial - the government had to institute serious confidence re-building measures to get the people to acquiesce to hopefully an honest activity of really saving life with drugs that really do work.

Drug Trial links

Kano Trovafloxacin trial litigation - 4 cases brought in the States since 2001

Nigerians in drug trial take their case to US court - Raufu 326 (7395): 899 -- BMJ

Nigeria: 1996 Drug Trial - Kano State Sues Pfizer for $2.7bn

Good Clinical Practice

London Drug Trial Catastrophe - Collapse of Science and Ethics

Drug Trials

The Constant Gardener

Nigeria's drug trial fears

Researcher received undisclosed payments of 300,000 dollars from Pfizer - unrelated but relevant

Humantarian Pfizer fed Nigerian kids poison drug - allegedly

The devil's work in Africa

The sensationalism of the headlines made us want to cover our heads in shame as we tried to defend what was indefensible.

The Muslim North in Nigeria had refused to allow their children to be vaccinated against polio which in many ways delayed the eradication of polio in Sub-Saharan Africa, in some cases; places that were once clear became vulnerable too.

Anyone who read the by-line in the Scotsman - "Polio vaccination dismissed as devil's work across Africa" would have sniggered; the ignorant savages do not know what is good for them.

With hindsight, there is much to reckon with this refusal, Kano State in Nigeria has just sued Pfizer for a $2.75 billion compensation for using 200 of their children as guinea pigs to test an unapproved drug - Trovan Floxacin - under the guise of humanitarian aid.

Help from the devil

There was an outbreak of measles, cholera and meningitis in 1996; the World Health Organisation and Pfizer offered to help the government with this problem but it transpired that these children were given drugs that lead to complications, deformities and even death.

It would appear some independent research also found some batches of medication to be contaminated, allegedly.

What is quite disturbing about this case if it does get to court and suffer proper judicial scrutiny is that fellow Nigerians might have been party to this rotten exercise whilst the gravitas of the WHO might have given legitimacy to an activity that is completely unethical and utterly beneath contempt.

The might of Big Pharma that Pfizer represents might have hoped to exploit rife corruption in Nigeria so that this almost "eugenics" exercise would not be exposed, someone must have been paid off being privy to what was about to happen to helpless, innocent, frail and trusting little children and their seemingly gullible parents.

Low-level hysteria

Once this rotten activity was discovered, it was no surprise that low-level hysteria was employed by the religious leaders and government to prevent vaccinations from taking place a few years on.

Who was to say another Big Pharma firm would not use the large demographic of deprived Africa to test some drug for the benefit of the more privileged West.

There are many including the rich shareholders of Pfizer who would wish this suit was both frivolous and calumnious, but I would contend that some legal advice must have seen serious merit in this case.

This reeks of the infamous Tuskegee Study of Untreated Syphilis in the Negro Male which ran from 1932 to 1972 in America where poor illiterate black males were denied treatment for syphilis. There are stringent laws guiding medical trials in the West, but with the oaf of Professor Eyitayo Lambo sitting in the Ministry of Health in Nigeria, it is unlikely that he would have been agitated at all by this rotten exercise, though it happened long before he became a minister.

He could not be bothered about the prevalence of sub-standard drugs in Nigerian Teaching Hospitals because the case was not presented directly to him as it was to his predecessor.

Too small a price to pay

$2.75 billion sounds like a high price to pay but no price can be high enough a penalty for subjecting helpless innocent children to deafness, paralysis, brain damage and blindness with drugs that cause such immeasurable misery.

Let us see, with revenue of over $48 billion in 2006 if the price on the head of an African child is worth anything compared to if this exercise had been conducted in the West.

The deception in the guise of humanitarian aid in a very vulnerable situation is just unforgivable, I am all too livid with rage as I now understand the reticence of the people to take on new vaccinations, they were duped, robbed, betrayed and literally killed off for possible block-buster drug success - not only should Kano State be suing Pfizer, Nigeria and Africa as a whole should be scrutinising what other gifts we have been made to ingest in the guise of prophylaxis or therapy when in fact we were guinea pigs in an unconscionably malevolent trial.

Time to dump your Viagra pills down the drain and make sure they are properly flushed away before your toilet bowl thinks it is dysfunctional too.

Addendum:

Read the last paragraph as a metaphor, a reader left this comment - Actually, it is probably a bad idea to dump much Viagra in a toilet. Hormones and psychoactive drugs are starting to show up in the blood of aquatic organisms as well as in many bodies of fresh water in the United States and other industrialized countries. - I would agree, the prospect of seeing marine life cured of erectile dysfunction would be too horrific to countenance. Thanks Don.