Medication Nation

The Washington Post published a review of the recently published book, The Cult of Pharmacology by Richard DeGrandpre. DeGrandpre presents a pretty provocative premise:

Why isn’t Nicorette gum a street drug? The Food and Drug Administration considers nicotine highly addictive. Tobacco companies seem to share this view when they manipulate the level of nicotine in cigarettes. But the gum, which packs a goodly dose of nicotine, appeals to almost no one. While we’re at it, if nicotine dependence is what stands in the way of quitting, why do patched smokers — their brains well-supplied with the substance — still crave the next drag?

If these questions have an answer, it is that addiction is not a simple matter of chemical and receptor. Habit, ritual, social context and the means of delivery all affect how the brain processes a drug and how we experience it. As a result, drug research is replete with paradox.

Psychoactive compounds, he writes, function “as mere stimuli, with more or less the same, potentially great, powers as other stimuli one experiences and gives meaning to.” DeGrandpre derides a set of beliefs that he groups under the infelicitous name “pharmacologicalism.” This false ideology, he writes, holds that “drugs contain potentialities that lie within the drug’s chemical structure . . . and when taken into the body, these potentialities take hold of and transform both brain and behavior.” According to DeGrandpre, drugs do not work in any consistent, predictable way — and we’ve been brainwashed if we think that they do.

The prevailing ideology, DeGrandpre argues, has another, equally insidious side. It causes us to attribute different powers to substances that are effectively identical. We demonize cocaine, a natural stimulant, but sanctify its synthetic counterpart, Ritalin. This benefits the “medicopharmaceutical industrial complex,” which favors what can be patented and profited from. Ultimately, our confused beliefs lead to forms of social control, causing us to drug our children with stimulants while imprisoning consenting adults for taking nearly identical substances such as crystal meth.

The reviewer writes a thoughtful and effective critique of DeGrandpre’s arguments:

The problem with DeGrandpre’s argument is that he, more than his imagined opponents, ignores context. The findings of behavioral pharmacology are not unique; in medicine, environment often modifies physiology. Interferon, a medication used to treat certain cancers, causes depression, but it does so less in people who have social supports and more in patients who have had past depressive episodes. To show that the response is multifactorial hardly invalidates the claim that the drug triggers mood disorders.

Expectancy is powerful. Acupuncture is effective in pain relief. But so is sham acupuncture — using shallow needles inserted at random points. Pain responds to placebos. It does not follow that pain lacks anatomical roots or that the use of aspirin for pain management amounts to a conspiracy.

Our drug policies, arising from puritanical moralizing as much as from the needs of corporations, are often irrational. Still, not every choice is without foundation. Like cocaine, Ritalin modulates dopamine transport in the brain. But schoolchildren who take Ritalin by mouth generally experience no high and develop no craving, while snorting cocaine famously does cause a rush. And crystal meth’s minor chemical distinction — it is water soluble and therefore easy to inject — makes a major practical, and addictive, difference. That we allow Ritalin to be prescribed suggests that, as a nation, we pay attention both to drugs’ chemical properties and to their customary usage — hardly a sign of ideological rigidity.

It’s too bad he throws in the drug policy statement. The suggestion that the motivations for U.S. drug policy are two-faceted and wholly insidious reveals his own ideology.

One thought on “Medication Nation

  1. Author comments in reply to Kramer’s review sent to the Wash Post:It is Peter Kramer’s privilege to love or hate my book (“Medication Nation”; review of The Cult of Pharmacology, January 14), or to find it fruitful or fruitless. I am dubious, however, of a review that fundamentally misrepresents the thesis of the book. Kramer’s reivew does this by suggesting that I throw the baby out with the bath water, which he says I do by ignoring the powerful effects drugs have. “Medications are not mere symbols. Different substances have different effects,” he complains. To suggest that in the book I ignore drug effects requires one to ignore most of it, including an entire chapter on the powerful and often addictive qualities of once-popular medicines (e.g., the barbiturates or the benzodiazepines). Why would I make such a claim, moreover, given the book’s thesis that drugs present a paradox: they have great powers, yet how these powers manifest themselves in mind and behavior – and society – are not pharmacologically determined.Consider my comparison between Ritalin and cocaine. As Kramer admits, “We demonize cocaine, a natural stimulant, but sanctify its synthetic counterpart, Ritalin.” Indeed we do, and this is just the point: what has gone on in the name of drugs historically is, from a pharmacological point of view, quite hard to explain. For Kramer, this example poses no problem, since “schoolchildren who take Ritalin by mouth generally experience no high and develop no craving, while snorting cocaine famously does cause a rush.” To this kind of reasoning I reply in the book: “As important as this difference may be, it has nothing to do with the inherent pharmacological properties of the drug. The quest for a drug rush from a substance like methamphetamine [or cocaine] is as historically specific as the popular prescribing of Ritalin, and a molecular science of pharmacology offers little in the way of an explanation for either.”Kramer goes on to suggest “We need to develop a humane approach to street-drug use.” It is a bit unsettling to have a reviewer disregard your book’s conclusion and then take it up as his own. Looking at drugs in twentieth-century America I did not conclude, however, as Kramer does, that “we’re muddling along, trying to make what sense we can of medications, licit and banned, that are ever better attuned to the workings of those admittedly complex organs, our brains?” This statement is a historical whitewash. There is a magnificent wealth of scientific and ethnographic information about drugs, the mind, and society, but only a small fraction of this evidence is ever considered. Why? Because it does not fit with the “common-sense” view in America, driven by a cult of pharmacology, that some drugs are angels while others are demons. This is not the conspiracy theory Kramer suggests it is. As I stress in the book, “to suggest an active conspiracy would be to miss a central theme of this history, for the power of the cult of pharmacology to classify drugs as angels and demons stemmed largely from the fact that it was widely embraced. America became the world’s most troubled drug culture not because the government conspired to allow access to drugs to some while denying access to others, but because more than any other nation, it was a full member of the cult — it truly believed.”

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