The Societization of Medicine or the Medicalization of Society?

This book presents a challenge to general historians of the United States. For some time, historians of medicine have been situating developments in biomedicine in a social and cultural context. Andrea Tone now points out, more overtly than most scholars, how the general culture itself interacted with technical developments in medical pharmacology.

To make her case for the historical impact of the minor tranquilizers ("tranks"), Tone invokes the idea of consumerism. Miltown and successor chemicals constituted either a departure from medicalization or a new version of it. The difference was that the widespread use of tranks was driven, not by doctors—nor, initially, even by drug firms—but by consumers.

Several recent books have described how pharmaceutical manufacturers attempted to create and shape markets—most notably Marcia Angell, The Truth about Drug Companies: How They Deceive Us and What to Do About It (2004). Tone takes a leaf from Michael Schudson, however, and instead centers on consumer demand rather than marketing tactics. Tone in her emphasis thus departs from another recent book, David Herzberg's Happy Pills in America: From Miltown to Prozac (2009). Herzberg tells the same story as Tone, but with a focus on the cultural history of the tranquilizers and especially on the interactions of tranquilizer history with advertising, politics, gender, and ideas of the self.

Tone, for her part, emphasizes how consumer demand led pharmaceutical firms to aggressive marketing and to manipulating prescribing physicians. It is true, writes Tone, that there was significant demand for penicillin and other miracle drugs of the mid–twentieth-century decades. But the demand for tranquilizers was a phenomenon in itself, even as it served as the model for marketers in the late twentieth century.

Tone makes her argument, as does Herzberg, by constructing a powerful narrative—illustrating well the continuing effectiveness of telling a story about the past. Tone draws on parts of a large historical literature about the ways in which physicians tried to deal with neurotics or "the worried well" in the nineteenth and early twentieth centuries. Given an unregulated free market, people medicated themselves with various chemicals that they hoped would make them feel better. Barbiturates constituted a substantial part of this market, but they increasingly became tied to nonmedical use and, by the 1920s–1940s, became drugs of abuse along with the opiates and other legally forbidden substances. By World War II, informed Americans were aware of "the barbiturate crisis" caused by widespread employment of these very dangerous substances (p. 26).

Tone's main narrative begins with the advent of amphetamines in the 1930s, a story now detailed in Nicholas Rasmussen's On Speed: The Many Lives of Amphetamines (2008). But, again, even the amphetamines only set the stage for the first revolutionary tranquilizer: Miltown.

Miltown appeared in 1955, although a Czech refugee in Britain, Frank Berger, had discovered it five years earlier. Before that, while he was working with penicillin, Berger tested mephenesin on mice. The mice became relaxed but stayed alert. This substance had promise for use as a relaxant in surgery and other areas of medicine. Tone, however, pictures it differently: "for the first time . . . a drug's capacity to tranquilize had been singled out as an attribute worth testing and discussing in a pharmaceutical journal" (p. 36).

In 1949, Berger became director of medical research at a small U.S. drug firm, Wallace Laboratories, a subsidiary of a company famous for "Carter's Little Liver Pills." Wallace Labs was looking for possible patentable but "ethical" drugs. In 1950, Berger and a colleague chose a mephenesin relative, meprobamate, for trial with mice and monkeys. Meanwhile, some psychiatric clinicians working with very ill patients reported that mephenesin, the original drug, had had a calming effect on those patients.

In 1951, there was another complication: a new U.S. law had created a broad category for drugs that could be dispensed only on prescription, thus helping protect people from indiscriminate self...