Saturday's Interview. "Pharmacomania" and the Cult of Medicine: Our Dangerous Liaisons
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Drug abuse can be harmful to your health... Why the title "Pharmacofolie"?
"The idea was to question our relationship with medication through several themes. I wanted to talk about our drug addiction at a time when the very idea of medication is causing divisions. I also wanted to show what history teaches us about this relationship, since, as far back as we can look in evolution, we always find signs of medication. Medicine is co-evolved in all societies, in all species, even in the most primitive beings."
What led us to this madness?
"Medicine, symbolically, has coevolved with us. We can't find a homo genus, whether it's homo sapiens or Neanderthals, that didn't function without a medicinal strategy. There's a slow evolution that means that, ultimately, we find ourselves unable to do anything other than integrate medicine as a technical object, as something that accompanies us. Man has come to integrate this with his own singularities, that is to say, his obsession with technology, with improvement... Thus, medicine has found itself in this evolutionary race with many other objects. We have, therefore, reached a paroxysmal point, in a world invaded by medicines, like other technological developments."
You also address the issue of transhumanism, this belief in the ability of drugs to improve us?
"There's this temptation in our species to want to be better than well. I question this desire, how our treatments can potentially improve us. When you delve into the literature, you see that there are a lot of fantasies. The superman who would be generated by medication is much more complex than it seems."
Hasn't the pharmaceutical industry contributed to this "pharmacomania" by pushing for consumption?
"Indeed, there has been a very clear shift over the decades from what was, one might say, intellectually understandable and conceivable at the outset. That is to say, an industry that must exist for this virtuous idea of improving health. It is accepted that there can be profits because every industry is intended to make profits. But, in the end, we see that the bulk of this industry's efforts are aimed at making people who are already relatively well better. However, if we look at the level of global distress, we could say that, for example, the fight against AIDS, against malaria, should be ultra-priority fights compared to other considerations."
You also say that this is a subject specific to rich countries?
"There's something very introspective about being able to worry about our health, about having the time to do so. That is to say, health has never been a top priority in our developed societies as much as it is today. Medication is the symbol of this. It's a symbolic object of our fears of death. Through medication, there's always the possibility of being able to postpone death, even if it's very utopian. Beyond its therapeutic effects, medication is also a strategy for channeling our fears."
Drug Madness: “Watching ourselves function and questioning our excesses”
How to get out of this “pharmacomania”?
"We must recognize that there was undoubtedly a need to experiment with excesses in order to become more reasonable later on. We can regret, however, that we needed to move towards overconsumption in order to succeed, at a given moment, in observing ourselves functioning and questioning our excesses. We are still in situations where we have elderly people who reach 70-80 years old with a list of around fifteen medications. Does that still make sense? We find traces of drugs in the waters and this raises real questions in terms of pollution. So, was it necessary to go that far?
Should we consider care differently?
"I don't know, but, in any case, it is certain that we are reaching an age where we can ask ourselves, 'Can we now enter an era of deprescribing that is, in fact, an era of rationalization?' We can say it pragmatically: we reevaluate things, we stop overprescribing, we consider, for example, a general practitioner consultation from which we would leave with advice and not necessarily with medication. We can succeed in rethinking care in this way. We can rebuild our expectations, divert our obsessions a little by telling ourselves that for a large number of cases, ultimately, the overall 'primum non nocere' (first, do no harm), that is to say, not just centered on the individual, can be therapeutic abstinence or a therapeutic choice for a limited period."
A word about TikTok and its influencer “prescribers”?
"It's quite disconcerting to think that TikTok is becoming a sort of pharmacist or general practitioner who is able to give you advice, with people behind it who obviously have no qualifications. So, that's it. And it's quite terrifying. A 'pharmacomania', in other words."
Mental health is not exempt from excesses?
"There are definitely excesses on the psychotropic side. There are several classes of medications that are potentially problematic, and in particular, one that we know well: the benzodiazepine family. Benzodiazepines are our anxiolytic treatments. Their widespread use is a problem that is not unique to France, but is nonetheless particularly French. Initially, these treatments were intended to be given for a limited period because we know that long-term problems of tolerance and dependence arise. Anxiolytics are normally prescribed for three months, and hypnotics for four weeks. However, we see patients taking them for years, even several decades. We have exceeded all codes of good use. With benzodiazepines, we are typically in a state of "pharmacomania."
You mention the golden age of medicine in the 1970s and 1980s. Are practices still changing?
"We're returning to a sort of age of reason, particularly with the deprescribing policy. We were in a golden age from the 1970s to the 1990s. In the immediate post-war period, there was industrial growth and many drugs were developed. Today, we're moving back a little from that model. This is particularly the case with antibiotics, but also psychotropic drugs. Now, we're also starting to ask ourselves the question of the ecology of drugs."
Public policies, for essentially budgetary reasons, encourage us to consume fewer medications and to do more prevention.
"Telling us that we need fewer medications for economic or ecological reasons is, in my opinion, a false argument. This is being proposed to us simply because there's no more money. But regardless, I'd say, this is the goal we need to move towards. In any case, it's rational to say that we need to move towards fewer prescriptions. This has benefits for patients. The issue of drug-induced iatrogenesis (all the adverse effects caused by taking one or more medications) remains a colossal problem."
(*) Directorate of Research, Studies, Evaluation and Statistics (DREES)
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