The Richest Man in Town

Or, The Spectacle of Medicine’s Debasement by Big Pharma

Let’s talk about the richest man in town. No, this isn’t another George Bailey post. I’m referring, obviously, to your local optometrist. We all know he has the biggest mansion around. Can’t turn on the TV without seeing yet another commercial for bifocals hectoring you about your poor vision. Goodness, sometimes they don’t even wait for the commercial break – half the news coverage these days seems to be about the unparalleled benefits of transition lenses, and you can’t watch late night shows for five minutes without hearing about the need to mandate reading glasses. And don’t even get me started on those smoke-filled, back-room Washington deals – we all know LensCrafters are really the ones running DC these days. That’s how they get all those prescription lenses into public kindergarten; kids are where the real money is. Get ‘em squinting young, and they’re hooked for life.

I am, of course, joking. I hope your local optometrist does well (allow me to break stride for a Henny Youngman classic: a little old man was hit by a car, and while waiting for an ambulance, the policeman tucks a blanket under the guy's chin and asks, ''Are you comfortable?'' The man replies, ''I make a nice living''). Odds are he isn’t running the town. Why bring it up?

Longtime readers will remember my enthusiasm for former New York Times reporter Alan Schwarz’s book ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic. In this post, I talked about the driving force of Schwarz’s narrative, Dr. Conners’ transformation from the inventor of ADHD treatment to its most outspoken critic. Another fascinating thread in Schwarz’s book is the degree to which Big Pharma corrupted every aspect of the ADHD discussion from the earliest days, blatantly buying off the most prominent academics, even staging psy-ops using unwitting parents (at the 29 minute mark in this incredible PBS footage, aired in the days before pharma bought off all the networks, you can see parents discover, in real time, that the ‘grassroots’ movement they thought they were a part of is actually a front for a pharma company).  

As Schwarz shows, there are two go-to lines that the drug companies hammer into all the corrupt doctors they have working as their spokesmen. The first is deployed when faced with real tough questions, based on undeniable statistics, about the dramatic rise in ADHD stimulant prescription use. Isn’t ADHD somewhat overdiagnosed?, a concerned parent or teacher might ask, looking out at row after row of zombiefied faces. “ADHD is both overdiagnosed and underdiagnosed,” the drug shill will reply. This means that, yes, 40% of a given classroom might be on Ritalin, which is rather higher than the research-suggested 1-2% rate of ADHD in this age group… but among that unmedicated 60% there’s probably a little cherub or two struggling with their math worksheet who would really benefit from a good drugging. Oddly, for all the times these glorified drug reps repeat the “both overdiagnosed and underdiagnosed” line, they never seem to work up too much of a sweat trying to decrease that overdiagnosis rate…

The second go-to line beloved by Big Pharma in the ADHD conversation is that stimulant medicine is “just like eye glasses, it helps you focus.” Read Schwarz’s account of the people deploying this line since the 1980s (it’s in the old PBS documentary above, too!) and try not to let your own eyes roll out of your head, or you’ll need more than an optometrist’s help.

I thought maybe after Schwarz’s book they’d come up with a new routine, but no… just yesterday, over at the Free Press, they ran a story on America’s adderall addiction, and here is an actual quote, from a real doctor, who has to find a way to live with himself every day:

He compares having ADHD to blurred vision. “You could spend your life with it, but think how much more you could get done with glasses. The medicine is the glasses.”

Now, unlike some far better people than myself – think Prof Twenge arguing in good faith with the Washington Post editorial board over the dangers of screen time – I am beyond engaging seriously with this thoughtless talking point. However, if you are less cynical than I am and need actual arguments to demonstrate why cocaine may be different from a contact lens, here, via Dr. Malone, is a good faith effort from an Israeli scientist to illustrate “how far the eyeglasses metaphor is from the clinical reality and the scientific evidence regarding ADHD and stimulant medications.”

Me, I lost my argumentative goodwill with Big Pharma shills around the time of the Covid vaccine mandate, so let me offer an alternative approach. Next time someone tries to tell you that mind-altering pharmaceuticals are on par with your Warby Parkers, ask them if their glasses get them high. Other questions you might ask them to ponder: how high do they think rates of nearsightedness would jump if you could get addicted to your wire frames? Is their local optometrist Pablo Escobar? Do the makers of reading glasses spend hundreds of millions of dollars lobbying congress every year? Can you turn on a TV without seeing an ad for tortoise shell rims?  Are college kids with perfect vision making back alley deals for a fifth pair of spectacles?  

You get the picture. Try to encourage them to think not about the similarities between glasses and street drugs, but about the rather salient differences.

Oh, and since we were just talking about Carl Reiner this week, I can’t finish without mentioning the one very real, documented, serious side effect that is posed by wearing glasses (the list for Ritalin is a bit longer…) – as so bravely demonstrated by Mr Reiner himself in the comedy classic, The Jerk.

Thank you for reading, don’t fall for silly talking points, and have a wonderful rest of your day!