In sickness and in health: the politics of pharmacology

Guest post alert! Here is someone else’s view from elsewhere. Namely, from my good friend and current resident of Damascus, Zachary Manning. Zac is studying Arabic in Syria and may be so kind as to send us occasional musings on things political and economical via an expatriate’s view from “the Arab street.” And now, without further ado, Zachary:

There are a range of them; green crosses, the snake wrapping around some kind of drinking vessel (which are rare to find in the US), the other more western sign is the mortar and pestle (still alive as an anachronism at Walgreens). Some of us used to see them while growing up, George Bailey and Mr. Gower kinda stuff. However, these archaic symbols are still omnipresent in the streets of Damascus.

Whereas the mom and pop, combo soda-fountain-and-pharmacy, is long gone in the states. Now we go to CVS, Walmart, Target, Walgreens, etc, where our neat little package awaits us and we the insured sometimes dole out a co-pay or nothing if we’re one of the lucky ones. For the not so lucky, and by that I’m referring to the ever increasing number of the uninsured, a basic prescription for Tetracycline, whose patent expired in the time of Socrates, can still knock you down a few lattes.That’s the good side of things. Allah forbid you’ve got genital warts or a nasty injury requiring some Limbaugh-esque cocktail of designer painkillers. (We never thought we’d see your picture up on the erotic services portion of Craigslist.)

Again, that’s still a pretty good scenario.We haven’t even dabbled into chronic and terminal illnesses like HIV or cancer, which cost more than most yearly mortgage payments. These costs affect people’s livelihood in unconscionable ways. On the flip side of our medicinal nightmare is Syria. Yes, they are to some extent the Appalachians of the Middle East and have been known to dabble in Deliverance-like behavior before going to Mosque and promulgate the mentality that girls are for babies, boys are for fun. Yes, a 12-year old was driving my city bus the other day in such a fashion as to make me feel a little Keanu Reeves in Speed. Yet in spite of of such “backwardness” they seem a lot more forward thinking than policy makers in the US, especially when it comes to national health care, or at least access to medication. A recent example: I got a lab test. Total cost, $3. The lab was located on the second floor of my building. The results came the same day. I was diagnosed with H1N1. Two blocks away I went to a pharmacist and told him what I had. Kapow, and I mean a serious kapow, I left the store in minutes and spent all of $1 with the medicine I needed.

You can’t get a Q-tip for a $1 in the US. Symptoms more or less abated and under control. In the states, that would have been $100 trip to my Humboldt park doctor who once sent me to an infectious disease expert when I had a hemorrhoid and then I would have had to dole our more cash for the lab fees, medication, etc.

Another example. Some months ago I became significantly ill and went to the state run hospital in Damascus. Think Cook County circa 1980’s crossed with an old-school barbershop. It was quite disorganized and had instruments immersed in aqua-marine barbacide, and most of the staff were smoking. It was scary. BUT, they drew blood and diagnosed me with amoebas, and I left about an hour later. They also gave me a shot in the butt without my consent which was less than ideal but they weren’t charging me anything so I was happy to endure a few discomforts and cultural differences. I was rehydrated and on the road to recovery and was more or less fine by the next day. My prescription of Flagyl was under $2 and aside from turning my urine a brownish color, it worked wonders.

Now to the bad people. The people who own both a Prius and a suburban attack vehicle. Folks who are quick to criticize developing countries easy availability of prescription medications, claim the products lack quality control and create ultra-resistant strains of bacteria ad nauseam. Some of them even point to Canada, where more and more U.S. citizens are trying to get their medications from. In the greater argument of making super-bacteria, look who’s guilty. You needn’t take but a glimpse at our antibiotic fed cattle and beef industry and the super strains of Ecoli that kill people every year in the US. Somehow I just don’t think the global south is the culprit in the rise of superbugs. Staph infections (MRSA specifically) are more or less concentrated in North America, and mainly exist in urban areas in the US, particularly in hospitals. Again, the lobbyists and pharmaceutical companies employ the good old straw man fallacy. Objective data and logic are only to be used when you have a really clever statistician or actuary at hand. While our alleged health and safe access to prescription medicines supposedly informs these policies, it’s not hard to see that such people are thinking more about their bank accounts than our well being in how they continue to justify the absurd cost of medicines.

Another criticism of systems similar to Syria’s is that doctors should be the only ones to prescribe medicine. For common ailments, this just doesn’t make sense. Imagine this scenario, which was true here a few weeks ago when everyone was sick. Most of these people have been going to the same pharmacy for years. They shake hands with the people, they ask about their families, they actually get treated like human beings, not some figure time-stamped on an HMO invoice. Moreover, they know their medical histories and what they’ve taken in the past. It’s actually quite impressive.

I would argue they are better than doctors here. They more or less occupy the role of a nurse practitioner and diagnose common maladies and do some serious detective work from time to time. When everyone seemed to be getting bronchitis last month, local pharmacies new exactly what it was. They had already had 50 people come in with the same symptoms. They used deduction and common sense to know what was going on and factored in experiential knowledge to make educated decisions. If they are wrong it becomes clear rather quickly and they modify the scrips. Few of us like the guinea pig role at the end of the day, and I wouldn’t really equate this process to wild experimentation, but the relationships, even kinship, in these communities offer something the US has completely neglected to see or employ for a long, long time.

Something that has never happened to me in the states. My pharmacist in the old city stopped me on the street and asked how I was doing and gave me his home phone number in case I needed something. That’s the difference between a job and a passion. That’s what happens when you teach putting people before profits.

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About theunlikelyeconomist

theunlikelyeconomist is in the midst of the long slog to attain a PhD in economics.
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