For this installment of Top of the heap we spoke to Elizabeth Watkins, Dean of the Graduate Division and Professor of the History of Health Sciences at the University of California, San Francisco.
David Healy, Pharmageddon (University of California Press, 2012)
Pharmageddon is a searing indictment of the pharmaceuticalization of American health care. David Healy decries the practices of the pharmaceutical industry, American laws and policies that encouraged the growth of Big Pharma, and the medical profession that allowed itself to be duped and co-opted by Big Pharma. He attributes the current state of affairs to three developments since the 1950s: changes in the system of drug patenting, which gave rise to blockbuster drug production and marketing; the classification of certain medications as prescription-only, making doctors the initial consumers to whom massive amounts of advertising are directed; and the appropriation of controlled trials by the pharmaceutical industry, resulting in the debasement of so-called evidence-based medicine. While there have been dozens of books published in the past decade on the problems caused by the pharmaceutical industry, Pharmageddon tackles broader issues of the medical-industrial-academic complex. While others have railed against ghostwriting of medical journal articles and the free pens, lunches, and golf vacations provided to doctors by drug companies, Healy exposes the defects in the foundation of the whole system of drug development, approval, marketing, prescription, and usage. His explanation of the flawed system of evidence-based medicine – from the concealment of raw data, to the publication of skewed interpretations of selected data, to the issuance of treatment guidelines by professional organizations that hamstring the practice of medicine by individual doctors – is masterful.
Dominique A. Tobbell, Pills, Power, and Policy: The Struggle for Drug Reform in Cold War America and Its Consequences (University of California Press, 2011)
Pills, Power, and Policy locates the history of pharmaceutical politics in the larger context of American society during the Cold War, especially the history of business, the history of higher education, and the history of medicine. More specifically, it examines the history of government efforts, dating back to the 1950s, to regulate drug development, drug distribution, and drug pricing and the pharmaceutical industry’s mostly successful efforts to resist these reforms or to influence them to suit its own interests. The book describes how the pharmaceutical industry forged intellectual and economic alliances with physicians and researchers at academic medical centers and how this industrial-academic complex wielded its influence over pharmaceutical policy in the second half of the 20th and into the 21st century. Dominique Tobbell argues that the industry’s co-optation of physicians, scientists, and government officials was “mutually conceived and mutually beneficial” in that the common intellectual, political, and financial interests of drug companies, academic institutions, and the medical profession structured the drug industry’s relationship with the federal government and restricted legislative reform of pharmaceutical policy.
Robert N. Proctor, Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition (University of California Press, 2011)
Golden Holocaust is an exposé of how the tobacco industry and its partners (e.g., advertising agencies, public relations firm, lawyers) made smoking an integral part of human culture, society, economics, and politics, how they conspired to deny the dangers of smoking, and how they perpetuated this fraud and deception for half a century. Based on the on-line archive of more than 60 million pages of documents released by the tobacco industry in response to subpoenas, the book is truly a tour de force. Robert Proctor has marshaled his immense talents as a historian of science and as a writer, so that in spite of its daunting length (over 700 pages), the book is a convincing polemic and a compelling read. To describe Golden Holocaust as comprehensive and thorough would almost be an understatement. Proctor leaves no stone unturned, no list incomplete, no argument unsubstantiated. The wealth of detail serves to reinforce his thesis; it also provides a fascinating historical tour through the material culture of American and European life in the 20th century.
Nancy Langston, Toxic Bodies: Hormone Disruptors and the Legacy of DES (Yale University Press, 2010)
Toxic Bodies tells the compelling story of the development and uses of diethylstilbestrol (DES) and other hormone disruptors in medicine and agriculture, their wide distribution throughout the ecosystem, and their devastating effects on human bodies. Drawing on a wealth of primary documents and secondary sources, Nancy Langston argues that important lessons must be learned from the DES story. First, the parallels between DES and other endocrine disruptors lay bare the importance of acknowledging the significance of animal experiments for human health, the porosity of boundaries between the natural and the synthetic, the risks of low levels of exposure to chemicals, and the influence of the environment on the developing fetus. Second, and more generally, DES reveals the danger of using scientific uncertainty to justify regulatory inaction. Industry-sponsored research was designed to communicate controversy and contributed to the failure of the FDA to appropriately regulate the use of DES. Finally, progress must not be allowed to trump precaution; enthusiasm for medical and agricultural application of technologies must be tempered by regulations to protect public health and the environment. Langston wields history as a tool for advocacy and encourages fellow scholars to provide counter narratives to those told by powerful industries. Toxic Bodies presents a powerful argument against unrestrained market forces and in favor of strong and effective federal regulation of American industry. Although neoliberals might not be persuaded, I certainly was.
Elizabeth Watkins, PhD, is Dean of the Graduate Division, Vice Chancellor of Student Academic Affairs, and Professor of History of Health Sciences at the University of California, San Francisco. She earned her BA degree in biology and her PhD degree in history of science, both at Harvard University. She is the author of On the Pill: A Social History of Oral Contraceptives and The Estrogen Elixir: A History of Hormone Replacement Therapy in America and co-editor of Medicating Modern America: A History of Prescription Drugs and Prescribed: Writing, Filling, Using, and Abusing the Prescription in Modern America. She has also published articles on the history of birth control, the history of male menopause and testosterone, and the history of stress. Her work has been funded by the National Endowment for the Humanities, the NIH/National Library of Medicine, the National Academy of Education, the National Science Foundation, and the University of California President’s Research Fellowship in the Humanities. She continues to supervise PhD students who are writing dissertations on the history of health sciences at UCSF.
Image: Thorazine advertisement, 1962; Psychosomatics, Vol. 3, No. 2. Source.