Words & Artwork by: Emma Parkinson

Since their invention approximately three and a half thousand years ago, pills have become a common component of day-to-day life. Pharmaceutical companies rake in extraordinary profits from the population’s poor health, rarely sparking controversy unless they overstep their boundaries (such as the infamous Martin Shkreli, who hiked up the price of a popular HIV medication by five thousand percent). But how many pills is the population consuming, and for what reasons? Are they always the right ones? And who is more likely to take them? The most common pills prescribed to the British public are contraceptives, anti-depressants, and sleeping aids. Focusing on these three areas, I ask the following questions:

Does your sex influence how many pills you take – and what are the side effects?

When the contraceptive pill was first introduced in the 1960s, it was seen as a landmark event in the women’s liberation movement. Sex could be explored without the fear of unwanted pregnancy. Women had control over their bodies! The NHS widely encourage the use of the pill as a long-term contraceptive. It’s easy to take, doesn’t involve any invasive procedure (unlike the IUD or implant), and if taken correctly, is more than 99% effective at preventing pregnancy. If taken correctly.

Everyone’s relationship with the pill is different. For many it’s ideal. A perfectly regulated, twenty-eight-day cycle. For some it causes horrendous skin problems. For others it causes irregular bleeding and spotting. In some cases, it can cause blood clots and seizures, even leading to death. The results of a 10 year long Danish study published in 2016 found that women on the combined pill were 24% more likely to be prescribed anti-depressants, and this risk only increased for teenagers aged 15 to 19, who were 80% more likely. However, look on the NHS’ online list of side effects, and you won’t find ‘Depression’ listed.

People with vaginas are typically only fertile for six days of the month, whereas people with penises are fertile every day of the year. Trials for a male pill are moving forward, although it may be another 10 years before we see fully reversible male contraception hit the market. And then, even if it does, a UK survey by Anglia Rushkin University found that 42% of its respondents, male and female, wouldn’t trust men to remember to take a pill. ‘Natural’ contraception apps, based around ideas of natural family planning, are becoming increasingly popular to a generation who are giving up artificial contraceptives. However, while this method can again be useful to those who use it correctly, the NHS are sceptical about its reliability. So, people with vaginas are caught in a difficult situation. If it’s easier to continue with a product with dubious side effects rather than trust your sexual partner/s, should the medical community be doing more to develop products that allows everyone comfort as well as control?

SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-noradrenaline reuptake inhibitors) are used to stabilise low mood. Health professionals do not claim that they ‘cure’ mental health disorders, but they act as a much-needed life vest to many people suffering. Therapists are few and far between, with many people suffering from poor mental health facing either a lengthy waiting list, or overwhelmingly expensive treatment. For those in need, anti-depressants are a lifeline.

According to a report by the CDC in 2017, women are twice as likely to be prescribed anti-depressants than men, with 16.5% of women they surveyed taking the drug, compared to under 9% of men. This supports evidence that women are nearly twice as likely to develop depression than men, due to a variety of factors, many of which boil down to biological differences. And as mentioned previously, taking oral contraception also increases your chances of being prescribed anti-depressants.

It’s worth mentioning that environmental elements are as much to blame as biological ones, be it increased workload whilst maintaining jobs and looking after children, a higher risk of sexual harassment or assault, issues with body confidence, gender bias – the list goes on. But this is not to suggest that depression doesn’t affect men just as much. Suicide is the largest killer of men under the age of 45 in the UK, so should we not expect to see a higher use of anti-depressants in males? Do women feel more encouraged to discuss their mood with a professional? Or do the side effects, such as decreased libido and erectile dysfunction put men in this age group off? Arguably these side-effects only further benefit the pharmaceutical industry, as Viagra is readily available to help alleviate symptoms. But no such remedy is as accessible for women suffering a loss of sex drive.

More harmful, and potentially dangerous, side effects can be noticed in SSRI use by older people. In their 2011 study, the British Medical Journal found that SSRIs were closely associated with an increase in all-cause mortality – including falls, strokes, and epileptic fits. If this is the case, does it mean that different SSRIs should be developed for elderly people, to protect them from potential harm, or that GPs should prescribe an alternative?

An article by The Times recently noted that ‘One in 10 women — presumably at their wits’ end — have broken up with a partner due to snoring’. As humorous as it may sound, women may have some cause to gripe at the sound of their peacefully sleeping partner. According to the 2002 NSF Sleep in America poll, more women than men experience symptoms of insomnia (63% vs. 54%). The NCHS found in their 2010 study that more adult women (5.0%) used prescription sleep aids than adult men (3.1%). While sleepless nights aren’t often seen as cause for alarm, frequent lack of sleep can cause adverse effects on your physical and mental health. Sleeping pills are one of the most commonly prescribed drugs in the UK and USA.

There are many reasons why women can find it particularly difficult to sleep. Biologically, hormonal changes throughout the month can affect the release of melatonin, the body’s natural sleep hormone. Work related anxiety is the largest environmental factor, with many concerned about economic security. Long working hours, a NMW (national minimum wage) which can rarely be argued to be conducive to a comfortable way of living, and a gender pay gap accentuated by inaccessibility to work for new mothers, single mothers, and pregnant women, are all issues far larger than those solved by a single pill before bed. Like the predecessors on this list, sleeping pills have a long list of side effects ranging from mild annoyances to critical dangers. At one end of the spectrum, you may experience drowsiness the day after, and function a little slower than you would normally. At the other end, studies show that older patients – who suffer worst from sleep disorders – are up to sixty percent more likely to develop Alzheimer’s and dementia. A 2007 study by Kripke of the Viterbi Center also found evidence of sleeping pills exasperating symptoms of depression – although no doubt this could be solved by another prescription (see ‘SSRIs’).

What is the pharmaceutical industry doing about it?

The pill, or indeed hormonal contraceptives generally, haven’t been developed further because there’s been no real need. The general formula of the combined pill hasn’t changed much in the last sixty years, with the exception of a decrease in the amount of hormones used in the 1970s. And why should they? Contraception is a basic health need, and as long as nothing rivals its ease of access and use, the pill will still be in demand. Woman aren’t faced with the choice of finding the most satisfactory option, but rather the least dissatisfactory one. Why develop a new form of contraception, at the expense of millions, if not billions, when you can sell the mild benefits of the one you already have?

In the US, where pharmaceutical companies are allowed to advertise prescription drugs to the general public, this is particularly obvious. TV commercials for contraceptive pills that - stop acne, limit your periods to four times a year and improve ‘moodiness’, turn contraception into a fashionable commodity, rather than a basic need. In the UK this is slightly more subtle. Girls from as young as 14 may find themselves being prescribed the pill for skin conditions, and women are suggested the pill as a way to manage their poor mood. While it’s true that the aforementioned conditions may often be caused by hormone imbalance, the demand for the pill in these other areas creates less incentive for pharma companies to develop it further as a contraceptive and limit its harmful side effects. Thus, it could be seen that the mild benefits of the pill, regardless of their relevance to its original purpose, are what’s holding us back.

As more people become aware of their mental health, the demand for anti-depressants increases. In fact, they were the area with the largest increase in prescription items in 2016. The NHS spent £266.6m on the drugs, however this is actually a decrease from spendings in 2003. Interestingly, anti-depressants have almost halved in price, despite the increased demand. Is it kindness and empathy which has sparked this drop? Unlikely. As the drugs are now out of patent, more companies are able to cash in. There’s no doubt that this accessibility is a huge benefit to many. But does this enable practitioners and their patients to side-step the lengthy and more expensive routes of CBT (cognitive behavioural therapy) or psychodynamic therapy? At what point does accessibility to quick solutions inhibit full recovery?

Arguably, the worst side effect of sleeping pills is their addictiveness. Still, it ensures that they remain in demand, even though the longer you take them for, the more likely they are to have a serious impact on your health. Interestingly, as well as having side effects, it could be argued that the very function of sleeping pills is a side effect in itself. Most over the counter pills are renovations of antihistamines. The oldest sleeping drugs were originally prescribed as anti-anxiety (such as the famed benzodiazepines). So while contraceptive pills have been appropriated in many areas as a lifestyle drug, many sleeping pills are appropriations in themselves. There’s no doubt that this method of practise is endlessly profitable, as countless drugs list drowsiness as a side-effect – who knows how long it’ll be before we see paracetamol being marketed to help with sleep? However, with homeopathic remedies such as CBD oil on the rise, we might also argue that these pills might find themselves redundant. But don’t worry. Luckily for them, the prohibition of stronger marijuana by-products in the UK and the majority of the US means that their shelf life isn’t likely to end anytime soon.

What can we do about it?

There is no doubt that pills provide much needed support to people in need. In many cases they’re the only viable solution for age-old problems. But this enables pharmaceutical companies to become lazy, neglecting to service the users of its products to the best of their ability. This is particularly harmful to women and the elderly, who in the majority of cases, are not provided with suitable alternatives, should the side-effects of the pills on the market have a detrimental effect on their overall health. Pharmaceutical companies have managed to avoid coming under scrutiny for this so far, but why should they? Perhaps it’s time that we start demanding more from those who supposedly care about our health.

Words & Artwork by: Emma Parkinson