Medicating Modern America: Prescription Drugs in History (review)

Few topics in the history of medicine present as many facets for study as drugs do. Our medicines can—and do—function not just as curative agents but as scientific and economic commodities, cultural icons, and instruments of hope or despair. Because of their central role in medicine, they shape research agendas and funding, and sometimes the very definition of diseases and the shape of medical practice. And they provoke endless questions about commercial, professional, and personal power and accountability. The eight essays in Medicating Modern America provide rich, multilayered histories of a representative sample of modern prescription drugs: antibiotics, mood stabilizers, stimulants, oral contraceptives, hormone replacements, statins, tranquilizers, and Viagra.

The editors have chosen to group the essays according to the era of the drugs' origins rather than by drug class or targeted disease. Thus the antibiotics, mood stabilizers, and hormone replacements developed before 1945 compose the first section. Oral contraceptives, minor tranquilizers, and the amphetamine drugs used to treat juvenile hyperactivity represent postwar drug innovation and marketing. And two relative newcomers, the cholesterol-lowering statins and the impotence drug Viagra, complete the volume. This excellent strategy allows a fuller appreciation of how the uses and expectations of different drugs change with time and experience. The contributors have provided fresh perspectives on older drugs and welcome new information about more recent drugs, in all cases giving readers thorough and nuanced accounts of the drugs' "life cycles."

A short review can only note some highlights: Robert Bud's insightful essay examines how professional and cultural presentations of antibiotics have "re-branded" these drugs in the current era of emerging resistant diseases. David Healy explores the emergence of the term "mood stabilizer" to describe drugs used to control manic symptoms (e.g., lithium) and their use in conjunction with the recent vogue of "bipolar disorder." Elizabeth Watkins's chapter on hormone replacement therapy draws on her earlier work but also on a cache of 4,500 responses to a 1986 Saturday Evening Post reader survey, to demonstrate the wide spectrum of attitudes and practices regarding hormone replacement therapy among menopausal women.

Suzanne White Junod examines the challenges faced by physicians and regulators during the 1970s as they sought to effectively communicate information about the risks of blood clots with oral contraceptive use. Their efforts, she notes, exposed consumers for the first time to the idea that drugs were not merely "safe" or "unsafe" but had benefits offset by certain risks. Ilina Singh's chapter on the drug treatment of Attention Deficit-Hyperactivity Disorder (ADHD) is especially welcome: despite increased prescribing of the stimulant drugs methylphenidate (Ritalin) and amphetamine for ADHD in recent decades, little has been written about their history, mostly because the drug industry's primary sources are often difficult to access. Singh traces the history through drug advertisements instead, showing that such ads played on older associations between "problem boys" (the "classic" disruptive ADHD children) and their problematic mothers. Andrea Tone's excellent "Tranquilizers on Trial" follows the minor tranquilizers (e.g., Miltown and Valium) from their discovery in the 1950s through their rapid diffusion into medical practice, to their eventual political and cultural discrediting, deftly situating the popular and controversial drugs within the medical, commercial, and cultural shifts of the 1950s, '60s, and '70s.

In the final section, Jeremy Greene uses the story of the first cholesterol-lowering drug, Merck's lovastatin (Mevacor) to examine the ways in which drug discovery, clinical trials, industry marketing, and public health campaigns have interacted since 1980 to redefine the boundaries of "normal" and "abnormal" cholesterol levels. In her history of Viagra, Jennifer Fishman places its development squarely within a shifting diagnostic context in which the psychological disorder of "impotence" became the medical problem called "erectile dysfunction." [End Page 971...