Jay Cohen believes he knows what went wrong in Michael Hope's life.
Hope, 56, sits in his home in the San Gabriel Valley and tries to use his brain, an effort of tortuous frustration for a former quick-thinking business executive. Not only does he suffer from constant muscle pain throughout his body, but also from the anguish of short-term memory loss and the inability to command words in simple conversation. When he finally gives up on the word he is trying to think of and attempts a substitute, he has forgotten not only what he has been trying to say, but what the entire conversation was about.
The reason for his Job-like travails? Not a dread disease or an exotic virus from Africa. After years of tests and consultations with doctors, chemists and others, Hope believes he suffers from overdoses of the drug Lipitor, the top-selling prescription drug in America today and a member of the family of drugs--called statins--that are hailed as lifesavers for reducing cholesterol.
Hope took the drug for four years. The dosage was just 10 milligrams per day, the standard dose recommended by the pharmaceutical company. So what's the problem?
The standard dose is the problem, says Cohen, an activist physician and author who has picked a fight with the powerful pharmaceutical industry. Lipitor should have been available in doses of 5 milligrams or even 2.5 milligrams, Cohen says, but he doesn't believe the problem is confined to Lipitor. It also is true for many prescription medicines today, Cohen argues in "Over Dose," his 2001 book that points fingers at people in the medical profession. Standard doses are damaging lives and are linked to the deaths of thousands of Americans each year, he says. Precise numbers aren't known, but Cohen cites a 1998 article in the Journal of the American Medical Assn. that said prescription drugs cause more than 2.2 million severe medical reactions in hospitals and could kill more than 100,000 people a year.
"We have a huge problem with side effects, year after year, decade after decade," Cohen says. "Every family is affected by it. I don't know how many people have told me that their parents didn't die of disease; they died of drugs. The problem is solvable if we just pay attention to it."
Jay Cohen is slight and bookish, a 58-year-old single father who looks like an accountant, not an agitator. His fashionable rustic home blends into a Del Mar hillside and rests on some of the most expensive dirt in California. Prominent among the large light-filled rooms is a study that is book-deep and organized, pointing to a systematic fellow who might develop a rash if his glasses weren't where he left them.
The uncommon breadth of the man is apparent as he proudly shows off his garden, with its splashes of color that would flatter a Costa Rica travel brochure. When he endured his own severe medical afflictions that effectively ended his medical practice in the 1990s, he turned horticulture into therapy and taught himself about tropical plants.
To Cohen, pharmacology is like collecting baseball cards: He does it for fun. However, his dedication is the glitter-eyed intensity of a door-to-door evangelist.
It all started with Prozac. When the drug was introduced in the U.S. in 1988, it held the promise of a new era of depression management--at a starting dose of 20 milligrams. Cohen and many other physicians started using it as a welcome tool to help angst-ridden patients, prescribing it in the recommended strength. But then, several of Cohen's patients started crawling the walls.
The loud-bang imprint on Cohen's mind was from a female patient in her early 30s who suffered from mild chronic depression. "I gave her the recommended dose," he says. "In three days she was psychotic--totally psychotic. But when I stopped the drug, she recovered in a few days." So Cohen lowered her dose, eventually to 5 milligrams, and she did fine. He also lowered dosages for other patients, in some cases by having them dissolve the pill in liquid and drink it over three or four days. It worked, and they got better.
Seeking to understand the experience, Cohen found data that showed Prozac to be effective in much lower doses even before it was released at 20 milligrams. "I found research that shocked me. I thought, 'Wait a minute! If you don't give me the information to do my job right, how can I protect my patients?' I took that very personally."