Who Needs Religion When We Have Pharma

Is a sin really a sin if a drug makes it go away?

Dr. Ostacher and I last wrote together on Sensible Medicine asking why we treat Zoloft and Ritalin so differently? It is a pleasure to collaborate with him again. We here at Sensible Medicine are a bit obsessed with the seven deadly sins. We first reworked them in our discussion of churnalism. Here we suggest that, thanks to pharma, maybe the sins are not that deadly anymore.

Religion is dying. Whether that observation was made by Nietzsche, Time Magazine, or John Lennon, the reason has never been agreed upon. Some hypothesize it is the rise of the enlightenment science, capitalism, or the general decline of Western Civilization. We have a more convincing argument. Religion is dying because of the rise of modern pharmaceuticals.

Among other things, religion helps humanity manage the seven deadly sins: pride, greed, wrath, envy, lust, gluttony, and sloth. Depending on the religion, man is offered counsel on how to refrain from sin or forgiveness after the fact. But what if the sinner need not repent? What if we can treat the desire to sin? Rather than damnation, a person can go to the pharmacy.

Medicine now offers a means to avoid sin. Why engage with religion (or psychiatry’s religion – psychotherapy) when a daily pill or weekly injection can assuage temptation? All that is necessary is reinterpreting the sin as a diagnosis, with an associated ICD-10 code, and setting big-pharma to work and the problem. 

Our medical solutions to the Seven Deadlies:

1. Gluttony

For decades, we have worked to perfect the treatment for the effect of gluttony (and sloth) in drugs for type II DM, hypertension, and hypercholesterolemia. Now, however, we have treatment for the sin itself, the GLP1- RAs. An entire pint of ice cream at midnight in the blue light of the freezer? No thank you, a spoonful is more than enough when a daily Rybelsus or weekly Ozempic prescribed.

2. Sloth

Sloth may be straight laziness but it might also be inattention masquerading as idleness. A young person might “fail to give close attention to details or make careless mistakes” and have “trouble holding attention on tasks or play activities.” He or she might “not seem to listen when spoken to directly” or “not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace.” Clearly this looks to classmates, coworkers, and clergy like sloth. Can we recommend a daily stimulant, Ritalin perhaps? Adderall is in shortage, so it will have to do.

3. Lust

Here is an easy one. Without even setting out to eradicate lust or understand its physiology we developed antiandrogens and GNRH antagonists and lust was gone. By creating beta blockers, SSRIs, and all the other medications that decrease libido, cause erectile dysfunction, or delayed orgasm, our species has been relieved of temptation. 

4. Wrath

The FDA recently approved brexpiprazole for agitation in dementia, which, according to the company’s press release, treats “gesturing, profanity, shouting, shoving, and hitting.” The FDA seems to agree with these effects. It won’t be long before the company convinces us to broaden the indication in order to eradicate this (literally) deadly sin.

5. Envy

Envy “kills more Sardinians than malaria.” But with income inequality growing and some people living in climate change induced hellscapes while others living in locales that have (so far) been spared, this sin can only become more widespread. The fact that oxytocin decreases envy between romantic partners might suggest a promising area of important inquiry. Until that vein is explored, we have made unintentional progress. With about one in eight people in the US being on an antidepressant, (and the majority of these people being on SSRIs), we might have made a lot of people just not care. 

6. Greed

Capitalism runs on our desire to want more. Can 21st century pharma treat greed? We might not be there yet but it seems like we are getting close. A side effect of the  dopamine agonists pramipexole and ropinirole and the dopamine partial agonist aripiprazole is to increase greed in the form of compulsive shopping and pathologic gambling. So we can’t be far off from doing the opposite, can we? Naltrexone does help treat gambling addiction. Of course, gambling is as much about thrill as it is about greed, so maybe all we are lacking is a brilliantly designed, deceptive RCT. (Suggestions for getting a protocol through our IRBs are welcome.)

7. Pride

We might not even need to address this one as pride’s publicist has been so successful that June has already been renamed Pride Month. Pride parades have eclipsed St. Patrick’s Day parades as the most enjoyable ones in any big city. 

However, if we want to be thorough, a pharmacologic solution to pride has been proposed by those who tout psychedelics as the solution to all of humanity’s problems. If ego dissolution can be obtained with psilocybin, this sin may not be long for the world. 

Religions have had, in some cases, thousands of years to rid the world of the deadly sins without success. Is it not time to give pharmaceuticals a try? Love the sinner, not the sin, say some, but we say why not love the sinner who no longer cares to sin. The world has surely changed since sins were first conceptualized as being within the control of the mind or heart or soul of the individual. In much of the world, we live with great abundance and safety, but temptations may never have been as great as now.. If the sin (or at least the drive to sin) can be removed with treatment, perhaps we’ve been thinking about sin the wrong way. We have evidence that asking God to remove a compulsion is ineffective. Maybe, for a small co-pay, we could do better.

The photo accompanying this post is by Pedro Lima from Unsplash.