The Cult of Pharmacology: How America Became the World's Most Troubled Drug Culture (review)

Historians of technology will recognize the rejection of technological determinism in Richard DeGrandpre's The Cult of Pharmacology. Without ever using the term, DeGrandpre demonstrates the importance of considering technology within its social contexts. The single biggest factor concerning our troubled drug culture, he argues, is our inability to accurately assess what drugs do to those who use them. In spite of the claim by politicians, scientists, and the media that drugs have innate pharmacological effects, DeGrandpre wants readers to understand that "drug effects" are in fact far more profoundly influenced by the "whole set of beliefs, rituals and expectations [that] have been attached" to them than to the actual drugs themselves (p. 17).

DeGrandpre, whose doctorate is in psychopharmacology, is most successful at demonstrating the flawed logic of what he terms "the cult of pharmacology" in the book's first three chapters. Here, case studies of Ritalin, cocaine, SSRIs, and tobacco enable him to demonstrate the myriad effects of such cultish thinking in American culture. Few may realize that Ritalin and cocaine are pharmacologically identical substances. The "cult" makes it difficult to address such an issue, DeGrandpre argues, given that Ritalin is classified as a "good" drug for enhancing kids' academic performance while cocaine is a "bad" drug that encourages youth addiction and deviance. His coverage of SSRIs allows DeGrandpre to suggest where the cult's power comes from: pharmaceutical companies (Big Pharma as he calls them) have actively covered up stories of horrific reactions (including suicide and murder) among "good drug users," while benefiting from media coverage of "bad drug users" as those using illegal substances. The effect is to dissuade physicians and psychiatrists from closely monitoring prescription drug users for positive and negative effects.

The Cult of Pharmacology has several discussions that will prove especially useful for historians of technology. First, chapter 3 on the Food and Drug Administration's efforts to prove tobacco "addictive" is a fascinating study of where meaning is determined in a technological substance. DeGrandpre's account of the FDA's investigation into cigarettes' addictive properties reveals that nicotine itself was incorrectly classified as addictive due to "cultish" thinking; the agency only pursued the regulation of cigarettes after concluding that nicotine was addictive and discovering that tobacco companies had been enhancing its content for years. DeGrandpre argues, however, that nicotine was never the sole source of addiction (example: there has never been a subset of "patch" addicts). Consumers actually found satisfaction through a decidedly "low tech" marriage of product and ritual (lighting, smelling, socializing), all readily available from the nineteenth-century process overseen by "cigarette girls" rolling out four per minute.

Second, DeGrandpre's brief analysis of the effect of regulations on opiate abuse reveals the importance of looking to the structural factors that enable technologies to have very different meanings across divides of class and race. In the case of opiates, only after therapeutic use declined in the early twentieth century did "addicts" emerge. Prior to this, DeGrandpre argues, white women with status commonly took opiates in elixirs and tonics. The American Medical Association's regulation of the drug market during the Progressive Era resulted in two categories of drug users: those with access to prescriptions for medically necessary mood enhancements and those "addicted" to such enhancements, who were relegated to black markets and back alleys (a divide that continues today).

Third, DeGrandpre understands the science of pharmacology sufficiently to explain how these substances actually work. His efforts thus provide an important foundation for historians who will seek to put the findings in broader cultural context.

Two minor critiques of the text also point to its strengths. It is repetitious: halfway through the book the reader tends to agree that culture must be considered (earlier if she is a practitioner of cultural studies). Yet the very return to this theme, in study after study, leaves one convinced...