Monday, January 14, 2008

The Shame of Consumer Health In America by Norman Markowitz

In the early 20th century, the great progressive journalist Lincoln Steffens put together a collection of articles that he had written about urban political corruption into a book he called "The Shame of the Cities." I thought of that that title today as I both read H-Labor, a very valuable scholarly website in which students of labor history and allied subjects exchange information and the New York Times.

First a writer on H-Labor cited an earlier NYT article to note that OHSA had refused to process 93% of occupational health and safety violations that they found to be "willful" between 1882 and 2002 of of the cases they did prosecute, the cumulative fines were 106 million and prison sentences less than 30 years as compared with 750 million in fines and 256 prison years cumulatively for EPA violations(both OSHA and the EPA were established in the same year, 1970).

The EPA has been notorious for its non enforcement of environmental protections but OHSA, whose penalties for serious violations of occupational health and safety were at the beginning very lax and have not been seriously upgraded, has become something of a dead letter. Since OHSA was the most important labor victory won by the trade union movement in the post WWII era (if only by default, since laws like Taft-Hartley especially and Landrum Griffin were major defeats and the organized labor movement has been ineffective in preventing the export of capital and jobs from the United States and in maintaining its numbers in the labor force) what has happened to OHSA is an example of what has happened to organized labor since the Reagan victory in 1980 gave the Republican right an influence over U.S. politics that it had not had since the 1920s.

While workers are being physically and psychologically damaged by conditions in the workplace without serious protection from OHSA, the Pharmaceutical Industry, regulated in principle since the establishment of the Pure Food and Drug Laws in the administration of Theodore Roosevelt, continues to charge twice as much for prescription drugs as private pharmaceutical firms in countries with universal health care system (since they must sell the drugs to public sector agencies) and also create a situation in the United States in which Americans take twice as many prescription drugs as people in other developed countries. The power of pharmaceutical corporations is so great (along with the general power of corporate capitalists in the U.S) that they have for years been advertising prescription drugs on television and encouraging viewers to contact their doctors about the drugs (the only serious "regulation" involved is that they must state the side effects of the drugs, which they do at the end of the commercial, as rapidly as they can). Drugs for male potency, psychological depression, and chronic physical pain are are the leaders in TV medical commercials, but there are also commercials for "restless leg syndrome" and other "diseases" that most people had never heard of or knew were diseases. As people age, all sorts of minor physical discomforts and pains develop along with a greater propensity for serious ailments. Large numbers of people, myself included, are also mild hypochondriacs, worrying from time to time that some of these minor discomforts may be major illnesses.

Like the patent medicine purveyors of the late 19th century, before the passage of the pure food and drug laws, the pharmaceuticals are tapping this "consumer market" with both diseases and remedies. In this case, the disease, which some doctors believe is not a real disease, is called fibromyalgia, which strikes middle aged women primarily and causes pain, dizziness, weight gain. The FDA has accepted the disease, as have many doctors and Pfizer is now marketing a drug for it. While this disease may in reality exist, and is actually a better case in my opinion than others which are now routinely advertised by the pharmaceuticals, doctors who are critical note that while the symptoms are real, they are also general. There is no clear test for the illness and no environmental explanation for it, save increased stress and anxiety often connected to economic and social problems. Pain, fatigue, dizziness, ringing in the ears, are also general symptoms. Furthermore, the drugs that are being marketed for this disease are related to popular anti-depressants, as other companies begin to come into the market with drugs to challenge Pfizer.

The issue here is profit, not science or health. If these drugs do help people more than they are hurt (as other prescribed painkillers are not) this will be essentially a matter of luck. Making the workplace safe, and the home and the larger society less stressful is the foundation of a public health policy. Preventive care is always both more effective and more cost effective than drugs for chronic conditions which relive symptoms but do not make people healthy.

In the U.S. we have a national health system to develop (we are now more than half a century behind most of the rest of the developed world) we have a labor movement to make healthy so that it can defend the occupational health and safety of American workers. We have the resources to do both. What we need is the political organization and commitment to do both.

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