Part 3
Most pills start their life as a vast amount of powder in an industrial-sized stainless steel container. The powder is a mixture of the active ingredient, a light lubricant to help the powder move around during the manufacturing process, neutral filler to bulk out the powder so the pills can be a suitable size but without too much of the active ingredient, and finally a binding agent to keep the different ingredients of the powder together. After mixing, the powder goes into a steel heat dryer, which heats it to about 120° Fahrenheit to evaporate any moisture.
Below the dryer, a machine consisting of a rotating steel ring and a multitude of small pill-sized presses spins into action. Each press comes down precisely as it reaches the right point, and scoops off a little of the mixed powder from a tray where the dryer has first deposited it. Once it passes the tray, the press pushes down hydraulically into the mold with a pressure of about eight thousand pounds. At the same time, a press with equal pressure pushes up from the bottom of the mold, so that the pills are molded in the middle of sixteen thousand pounds of pressure, so much pressure that the ten thousand or so grains of powder which make up the average pill are compacted into a single solid object. This process presses five thousand pills per minute. It happens so fast that the machine appears only as a blur to the unaided human eye.
Every fifteen minutes, five pills are tested. Five pills out of seventy-five thousand. A machine measures how hard they are by smashing them and recording the pressure it took. Another machine checks their color to make sure it matches the desired palette. If the manufacturer has included an identifying stamp on the bottom or top of the pill during the pressing process, the stamp is checked for legibility.
Each hour, or once approximately three hundred-thousand pills have been pressed, a worker loads them by hand into another industrial-sized machine (in an industrial plant, all machines are industrial-sized) resembling a tumble dryer for clothes, but twenty times the size. The drum tumbles the pills and a mister sprays a mixture of water, coloring, and shellac[36] onto them. This misted coating ensures that the pills don't crumble back into the powder they were made from, helps to conceal the possibly unpleasant taste of the active ingredient from the eventual consumer, and finally allows the pill to dissolve slower inside of your stomach so that whatever medical effect it is supposed to have can be more effective over time. The misting is so fine – to prevent over-wetting – and there are so many pills that it takes about forty minutes to complete the coating process. Once the mister has finished, a worker opens the tumbler and inspects a handful of pills out of the hundreds of thousands in there, mainly checking their appearance.
A tube in the bottom of the tumbling unit opens and the weight of the pills leads them down the tube, where a machine weighs them. After weighing, it counts them and moves them into different lines, where they will make their way to bottles. Another machine at the end of each line counts the number of pills that are to go in each bottle, and dumps them in, filling the bottle up.
As the bottles fill, they are pushed off the line onto a conveyer belt that leads them to the packaging machine. A final machine places a child-proof cap on the top of each bottle and screws it on. Humans then place each bottle into a box for distribution to doctors and pharmacies, or to regular supermarkets and convenience stores if they’re not made of any controlled substance.
They check only a few hundred pills from the beginning to the end of the process, and at no point in this process do they check the individual pills for efficacy. It’s not out of negligence on the part of the manufacturer; it simply can’t be done. Billions of pills are made each month around the world, and there are just too many to test. And yet, there are many phases of the process where a contaminant could be introduced. Not an intentional contaminant – that would be exceedingly difficult because most pharmaceutical factories search employees as they enter the plant, and because machines handle most of the process, giving few opportunities for potentially malicious human hands.
But perhaps the powder doesn’t mix just right in one one-thousandth of one percent of a certain day’s mixture. Nobody meant for it to happen, but only a tiny percentage of pills are tested, and that tiny percentage is unlikely to have been located anywhere near the other tiny percentage which was affected by the imperfect mixture.
Maybe it never happens. All of the machines are very precise, and the process has been continually refined over many decades. Pharmaceutical companies have a powerful financial incentive to ensure that it never happens, because a hundred-million dollar lawsuit is very upsetting for anyone. It must happen sometimes, though; the whole process can’t always be perfect, even if it can be perfect most of the time, down to the tenth decimal point. Perhaps it happens to two pills out of ten million, or out of a hundred billion.
For the most part, nobody would ever notice. As an example, although we aren’t talking about ibuprofen here, the recommended dose of ibuprofen for adults is two at a time, every four hours, up to four times a day. If one of those two ibuprofen out of eight daily ibuprofen was reduced in effectiveness by half, or two-thirds, would anyone notice? Your aches might be slightly less soothed, but you wouldn’t think anything in particular of it. You might not even notice, because your body is tricking you with the placebo effect, so you feel fine anyway. Good for you.
Some medicines affect the state of your mind, though, perhaps by hampering the signals your amygdala sends, and if those pills aren’t as effective as they should be, then maybe some of the signals are going to get through. However, because it’s not possible to have someone suffering from an overactive amygdala testing each pill to see if it works, it isn’t done.
And so the very rare less effective pills make their way all the way through the manufacturing, testing, and packaging process. They make it to a pharmacy. Someone fills their prescription, and when they get home the bottle with the NorCorp label is placed into their medicine cabinet in the bathroom. Maybe the name on the bottle is ‘O.R. WELL.’ Maybe it’s not. It is, though, in this case. The bottle may have a hundred pills or more inside it to begin with, and the few ineffective pills may have settled to the bottom because they weigh slightly more due to the improper distribution of the ingredients, so that person may use nearly a hundred pills out of the bottle before suffering any ill effects.