Medicating Modern America: Prescription Drugs in History (review)

The exponential growth of the pharmaceutical industry in the second half of the twentieth century has been a significant international phenomenon offering a rich area for exploration by historians from many disciplines, including those of science, technology, medicine, and business. However, understanding the developments in health care and medical knowledge and their application in society stretches the subject more widely still, as is evidenced by the three themes common to the eight chapters in this book. As noted by the coeditors, Andrea Tone and Elizabeth Siegel Watkins, these themes are the construction of diseases and treatments, the shifting boundaries between the definitions of normal and abnormal, and the way in which medical information about drugs and diseases has been communicated to patients and consumers so that drugs have been incorporated into popular culture. This sets the agenda for the contributors, each of whom analyzes the evolution of one drug or class of drugs and in so doing illustrates how perceptions changed over time.

Robert Bud’s chapter recaps the discovery and development of penicillin and the antibiotics of the first and second generation. He employs the concept of the “brand” to encompass their use and sometimes abuse, their impact, and their image. In the second chapter, David Healy argues that the use of the term mood-stabilizers for some of the drugs prescribed to treat psychiatric disorders dates only from the 1980s. Over two decades, however, it has led to what he characterizes as a “folly,” namely the construction of bipolar disorder, with widespread diagnoses of its incidence. Elizabeth Siegel Watkins explores some forty years of hormone-replacement therapy, concluding that despite the availability of and access to much more information by the end of the period, uncertainties about and ambivalence toward the treatment continue in the medical profession as well as among consumers. While there have been many studies of the development and use of the contraceptive pill, Suzanne White Junod’s approach examines the development of knowledge about the risks of taking the pill, particularly for older women and smokers and the way in which that knowledge was conveyed to those at risk. Communication in the shape of advertising is at the center of Ilina Singh’s detailed analysis of the developing uses of stimulant drugs, including Ritalin.

The tranquilizers, “drugs for anxiety,” are the focus of coeditor Andrea Tone’s chapter. She suggests that the minor tranquilizers of the 1950s revolutionized how prescription medicines were perceived and used, paving the way not only for the widespread consumption of Roche’s Librium and Valium but also for other later lifestyle drugs. The notion of the creation of treatable conditions is a recurring theme and features strongly in Jeremy A. Greene’s chapter on cholesterol and the statins. He illustrates how the boundaries between what was seen as abnormal and what as pathological in terms of high cholesterol were shifted over time and played a significant part in creating high cholesterol as a treatable condition in itself. Finally, in a study of what is generally considered to be the first significant lifestyle drug, Jennifer R. Fishman discusses Viagra. She argues that the scientific and cultural perception of “erectile dysfunction” established the potential for a market for a drug such as Viagra. Thus, when Pfizer found in the clinical trials of sildenafil (for angina pectoris) that participants reported unanticipated effects, the corporation moved swiftly to develop the drug to meet the market for “erectile dysfunction.”

The brief summaries above cannot fully convey the richness of analysis and illustration of the studies which make up this book. At the heart of the explorations is the complexity of the relationships between illness, the medical profession, the pharmaceutical industry, technology, and patients, and how these have changed over half a century or so. Even that is a simplification of the complexity, given regulatory interventions, consumer pressure groups, the use of the media, and a multiplicity of different agendas. This collection clearly...