A Social History of Medicines in the Twentieth Century: To Be Taken Three Times a Day (review)

John Crellin's aim in this book is to take the oft-told story of the introduction of new medicines in the twentieth century beyond the saga of medical progress, to the more complicated level of the impact of sociocultural factors on the use of drugs. To that end, interactions between physicians, pharmacists, the pharmaceutical industry, government, and society at large are explored in a search for explanations of trends in medical prescribing and lay self-care.

Although the book's title specifies the twentieth century, there is a comprehensive "prelude" chapter that surveys the 1600–1900 period to provide context for the dramatic advances of later years. Also largely context-setting is the chapter that follows, a discussion of the popularity of "medicines for weakness" during the first half of the twentieth century, in which self- dosing with tonics is treated in connection with both professional and popular anxiety over autointoxication, acidosis, and other supposed debilitating syndromes.

The remainder of the book focuses on the flood of new medications onto the market from the 1930s onward, the rise of prescription-only drugs and their enhancement of the gate-keeping authority of physicians, and the eventual erosion of professional authority as the untoward effects of new remedies became better known and as doctors were perceived to overprescribe pharmaceuticals (particularly psychoactive ones). There is also attention to other factors promoting the holistic revolt of the 1970s and the shift from physician paternalism toward patient autonomy. Finally, the resurgence of alternative medicine is considered as a force in reshaping popular attitudes toward drugs and lay choices of treatment options. Crellin nicely outlines the cycle from self-medication in the early 1900s to reliance on prescribed pharmaceuticals in the mid-1900s, to the return to self-prescribing and self-dosing with the flourishing of herbal remedies in the closing years of the century. Influences on patient compliance with prescribed treatments, the growing status of pharmacists as drug experts, and physicians' loss of decision-making power with the rise of managed care are among still other themes running through the narrative.

Crellin's conclusion proposes a "new therapeutics," one that will resolve historic patterns of patient discontent by urging restraint in prescribing, mending the splintering of care associated with specialization, and pursuing other reforms within conventional medicine while also incorporating elements of complementary and alternative practice that can be shown to have value.

The book is thoroughly researched and extensively documented with references to medical, pharmaceutical, and popular literature. But the story also draws heavily on oral history: the author teaches at Memorial University of Newfoundland, and the recollections of numerous Newfoundlanders are cited throughout the text in support of arguments (the islanders were particularly susceptible to promotions for tonic medications, one learns, because of their long history of high levels of tuberculosis and scurvy). Another appealing feature is the inclusion of cartoons, advertisements, and other supplemental materials to illustrate key points. To be sure, most of the components of this survey will be familiar to medical historians, but they have not previously been so attentively interwoven into a unified narrative.