I just finished reading Methland by Nick Reding. While the book focuses on the relationship between methamphetamines and the socioeconomic disintegration of rural areas*, this section about the interplay between lobbying and the failure to develop and produce an amphetamine that has decongestant activity but doesn't raise heart rate or possess addictive side effects was truly shocking (italics mine):
Mirror imaging is a process whereby a chemical's molecular structure is reversed, moving, for example, electrons from the bottom of a certain ring to the top, and vice versa. Pseudoephedrine, ephedrine, and methamphetamine are already near mirror images of one another. To make meth from ephedrine, it is necessary to remove a single oxygen atom from the outer electron ring. Thus ephedrine and methamphetamine not only look the same under a mass spectrometer, but both dilate the alveoli in the lungs and shrink blood vessels in the nose-hence ephedrine's use as a decongestant while raising blood pressure and releasing adrenaline. The key difference is that meth, unlike ephedrine, prompts wide-scale releases of the neurotransmitters dopamine and epinephrine.What the 1997 tests at the University of North Texas showed was that, at least in lab animals, mirror-image pseudoephedrine was equally as effective as regular pseudoephedrine as a decongestant. Unlike regular pseudo, however, the mirror-image version didn't cause any side effects to the central nervous system, such as high blood pressure and a racing heart: the common "buzz" that one associates with cold medicine. Better yet for Warner-Lambert, mirror-image pseudoephedrine could only be synthesized into mirror-image methamphetamine, which, according to the Oregonian, had no stimulant effects and could not then be made into regular meth.
...If the cold pills with additives or, particularly, the mirror-image pseudoephedrine had come to market, the effect may well have been enormous. Were the U.S. cold medicine market, the largest in the world, suddenly dependent on any new form of pseudoephedrine, it stands to reason that the nine factories that provide all the planet's pseudo would have begun producing large amounts of the new meth-resistant drug. This in turn would have drastically reduced the amount of meth-ready chemicals available to the DTOs [drug trafficking organizations]. Either drug could have effectively accomplished what Gene Haislip and DEA had five times been unable to achieve between 1984 and 1996.
Instead, by the time Pfizer bought Warner-Lambert in 2000, all research into a cold-medicine alternative ceased. Why should Pfizer worry about DEA when its predecessor had had such an easy time lobbying Congress?
Leaving aside the meth addiction issues, a lot of people can't use amphetamine-based decongestants. For some, they can cause irregular heartbeat and momentary cessation of activity--your heart stops beating. Typically, this is viewed a substandard healthcare outcome.
Other people are very sensitive to the effects of amphetamines. I happen to be one of those people. If I take something with pseudoephedrine, my heart races a million miles an hour (ok, not really, but my resting rate streaks to around ~120 beats per minute). Nyquil is a complete nightmare. If I take it before I go to bed, the 'downer' wears off at around 4am, and I wake up with my heart racing, drenched in sweat. Then it wears off... at about the time I have to wake up. I'm also exhausted. (I couldn't never do crank--I think my heart would give out).
So the idea that lobbyists successfully killed the adoption of a better amphetamine that would not only have damaged the meth trade, but also would increase treatment options for people is galling.
According to Reding, who was the legislator who defended the legal marketing of addictive amphetamines? Orrin Fucking Hatch.
Brilliant.
*For some reason, it is far easier to convince people that the rural meth epidemic has to do with social and economic disintegration than the crack and heroin epidemics do. For some reason, we seem to think that has to do with morality. Post-racial America, my ass.
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Mike -
As it is, getting decongestants with REAL pseudoephedrine instead of the phenylephrine is becoming ridiculously difficult. Phenylephrine doesn't work nearly as well, but was rushed through as a replacement before the ink dried on the studies that showed it wasn't working very well.
I'd be delighted to see a decent decongestant without the stimulant effect. I'd even pay a bit more!
As someone with both high blood pressure and bad nasal allergies, this is fucking infuriating. I have to suffer with a stuffy nose every spring to avoid elevating my BP any higher than it already is. I'd love to have something that I could take for my stuffed up nose that won't cause my heart to explode.
Oh, well. Guess I'll just continue not giving pharmaceutical companies any of my money for OTC decongestants, then.
I'm gathering that the lobbyists in question are from pharmaceutical companies -- which leaves the question of what their incentive would be for blocking what appears to be a highly marketable product.
From corporate point of view, I can see why Pfizer would scuttle it. Sure, there's a great public benefit to be gained by changing the formula; however, if the lobbying can keep the government off of you, why take on the costs of reformulation, clinical trials, FDA approval, etc? As a mindless money-making machine, the savings are significant, especially when compared to utilizing an established lobbying relationship.
As a human being, it still makes me want to beat them about the head and shoulders with a stick, though.
I just wanted to say thanks for typing up this quote. I borrowed it for a post on some of the errors in the chemistry explanation. I credit you here.