Big

Big Business. Big Game. Big Mouth. What’s the Big Idea?  Small word, big thoughts. We get the idea and we love / hate big targets like Big Pharma and Big Government.

The concepts are so big we don’t know what to make of them. Our brains are too small. We tend to conflate conspiracies with pharmaceutical companies instead of evidence-based Science and bureaucracy with government rather than an institution designed to serve the people.

During my fifty-three years as a pharmacist I witnessed more than a dozen pharmaceutical companies, including Squibb, Upjohn, Schering, Lederle, Wyeth and Parke-Davis swallowed by larger conglomerates. Big fish got bigger, raking in billions of dollars with me-too drugs, patent shenanigans, data distortion and physician inducements. Research continues to be tilted or withheld. Marketing inflated. Unconscionable profits.

And yet…

The products brought to market are largely the result of rigorous FDA measures including peer-reviewed science after extensive regulatory procedures with double-blind studies including a wide population, special care given for age, demography, race etc… None of this can be said of the other  small pharma establishment of homeopathy, herbs, nutritional supplements and all the shelves of remedies based on anecdotes, testimonials, superstition and old-wives tales (bubbe-meise). It thrives on false hope and nostrums in which the wish is father to the thought.  

The fact is most ailments including rashes, eruptions, mood-swings, inflammations, respiratory symptoms etc.. are self-healing or episodic. Any substance which has a therapeutic effect will necessarily also have side effects and contra-indications. Symptoms come and go. The mysterious brew you took when it disappeared had as much to do with its cure as the color socks you were wearing. One is Science. The other is Nescience.

I am continually amazed how many otherwise enlightened, counter-culture people have unwittingly rejected science in favor of alternative medicine. As if the words Natural and Organic implicitly confer safe and salutary. Opium is of course, natural along with digitalis and strychnine, all far from harmless. I would argue that synthetic is far better than natural because it can be assayed with precision. For a hundred years whole thyroid tablets were marketed by Armour but the active fraction of levo-thyroxine in each batch varied widely. The synthetic version now comes in at least eight strengths enabling the correct dose to be titrated. They are not striking a blow against big anything but in favor of Big gullibility.

The baby has been discarded with the bathwater. Big Pharma is a worthy adversary but the corrective is not the dubious  berry-of-the-month industry. Less costly and more rational would be closer scrutiny of the healthcare protocol. It is not rejection of Flu vaccine for pseudo-scientific reasons. It calls for an engaged participation in health sciences.

To be fair one good reason for OTC products of botanical origin such as Valerian, Ginkgo-Biloba or Saw Palmetto is that Big Pharma won't touch them. The reason being that they are so ancient no exclusive patent can be obtained. Should this give them a free-pass as to purity, safety and efficacy? I think not. 

Take the case of the plant, St. John's wort. It is a natural source of an anti-depressant S.S.R.I. (Selective Serotonin Re-uptake Inhibitor) but one has no way of knowing if one is taking a therapeutic dose, an overdose or no dose at all.  In fact if one wishes to militate against Bigness one might consider the twenty-five billion dollar domestic dietary supplement market which Sen. Orrin Hatch has been pandering for over the past forty years much to the benefit of his son (lobbyist), grandson and son-in-law (family business).

Government is so massive with so many levels of operation it has become the favorite whipping boy of disgruntled voters inflamed by right-wing politicians. It gets attacked for inefficiencies, ponderous regulations, cost over-runs and calloused indifference. Yet much of the problem is due to budget short-falls and on the federal level, politically appointed, ill-equipped department heads whose mission it is to destroy or undermine their office. The Republican agenda has, at its core, the dismantling of government except as it pertains to so-called Defense.

In fact the Federal Government stands as the only institution powerful enough to stand up to unbridled corporate-greed and monopoly Capitalism. Big is necessary to fight Big.

Big government provides us with retirement income (our own money), with healthcare, safe water, air traffic control, breathable air, regulation of medications, subsidized education and housing for the less advantaged, National Parkland, support for the Arts, highway system, first responders and many more public services. It is called Civilization. It may be hard to embrace because it is so big. It’s a Big Deal, the sort of deal our president does not understand.