The New York Times - Essay

By JAMES GORMAN

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Last year retail drug sales worldwide were $317 billion. In the United States alone, consumers spent $163 billion on drugs. In North America, the use of drugs that affect the central nervous system, antidepressants and others, increased 17 percent. No group has escaped. Last week the Centers for Disease Control and Prevention reported that 10 million children took prescription medication for three months or longer in 2002, and preschoolers, another study found, are now the fastest growing group of children receiving antidepressants.

This is a social change on the same order as the advent of computers, but one that is taking place inside the human body. Just 50 years ago, according to a report by IMS Health, a company that tracks the pharmaceutical industry, the two biggest-selling over-the-counter drugs were Bufferin and Geritol. The prescription drug business was tiny. In 1954, according to IMS, Johnson & Johnson had $204 million in revenue. Now it is about $36 billion. In 1954, Merck took in $1.5 million in drug sales; in 2002, that figure was $52 billion.

To look at it in another way, Americans take so many drugs that some researchers — Dr. Christian G. Daughton of the Environmental Protection Agency's National Exposure Research Laboratory in Las Vegas, for example — are worried about the effects on the environment. What does it mean if the sewers run rich with Zoloft? Or to be more precise, what might happen to fish eggs if the rivers soak up waste water with discarded and excreted pharmaceuticals and personal care products, like shampoo?

No one has the answer yet, but the idea that what runs through our collective bloodstream is a potential environmental hazard makes you look at your medicine cabinet in a different way.

In short, while the Six Million Dollar Man is still a fantasy, Pharmaceutical Man is already here, and largely unnoticed. Swallowing a pill at a business lunch is likely to elicit little curiosity. A high-powered executive who did not have blood pressure or cholesterol problems might be suspect. There are concerns about the widespread use of antidepressants, but they do not seem to have affected sales.

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Whether or not the growing use of drugs has altered our essential humanity, there is now almost no bodily system that cannot be adjusted by them. Blood, respiration, the nervous system, hormonal regulation, muscles and bones, the cardiovascular system, reproduction, sexuality — drugs are available to nudge them all in one direction or the other. It is not unusual for someone to begin the day with a cocktail of antidepressants, statins and blood pressure medications.

The result does not yet seem to be the epidemic of dull, well-managed emotionless humanity that some forecasters have worried about. For instance, among professionals in journalism and publishing in the New York metropolitan area, who no doubt take as much Zoloft per capita as anyone on the planet, it is no small trick to find someone who is either calm or happy.

Perhaps in the future, stronger drugs will produce the well-sedated zombies that will make the streets of Times Square disturbingly docile and well mannered, but it has not happened yet.

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Even the dystopian fantasies of cyborgs and the overmedicated are fundamentally different. Drugs are an easy way to contentment and the absence of pain — even if they are ultimately unsatisfying. Hardware is something else. It enhances the senses, increases strength, adds weapons. As a cyborg, you can be your own telescope, your own computer, your own gun.

It may not be so bad that the pharmaceutical human is arriving first.