On Speed: The Many Lives of Amphetamine (review)

In recent years, an interdisciplinary field of scholarship has begun to interrogate the history, sociology, and anthropology of specific pharmaceuticals in order to unravel the complex networks that connect biomedical research, clinical practice, science-based policy, and the broader forces of marketing and consumption. Among these works, Nicolas Rasmussen’s On Speed: The Many Lives of Amphetamine stands out as a singularly well-framed and engagingly written case study of the interrelated phenomena of licit and illicit pharmaceutical use in the evolution of drug development, marketing, regulation, and consumption in the late twentieth century.

As the subtitle suggests, amphetamines are a multivalent subject: a therapeutic class seen as prominent “wonder drugs” in the consumer landscape of the 1930s and 1940s that are now perceived as a dangerous group of addictive substances with grave public health consequences. In narrating the colorful and vexing history of amphetamine use in the United States, Rasmussen has therefore chosen a subject that illustrates the difficulty of fixing historical distinctions between legitimate and recreational drugs, between the treatment of disease and the enhancement of performance, and between the marketing goals of pharmaceutical firms and the evidence-based assessment of the potential benefits and harms of a given therapeutic agent.

Though the book’s eight chapters follow a chronological succession that spans the better part of the twentieth century, each chapter focuses on a novel thematic dimension of the problems amphetamines reveal about science and commerce, disease and deviance, and legitimate and illegitimate forms of therapeutics in American society. The book begins by describing the synthesis and initial clinical trials of amphetamine by the twenty-seven-year-old Gordon Alles, an entrepreneurial chemist who injected himself with amphetamine in 1929 in the presence of a doctor friend and who parlayed these experiences into a series of challenging but lucrative agreements with the drug firm Smith, Kline, & French. The second chapter traces out the set of clinical research, marketing, and regulatory networks extending from Smith, Kline, & French through which amphetamine accumulated a set of therapeutic claims to tie it to specific markets—most notably in the treatment of depression—as the high-grossing brand-name drug Benzedrine. Rasmussen here provides a careful description of the interaction of marketing goals and clinical research and the role of imagined markets in the process of drug development in the first half of the twentieth century.

This is followed by an interlude exploring the military evaluation and utilization of amphetamines during World War II as Allied and Axis forces sought pharmaceutical means to fight combat fatigue and potentiate long-distance bombing runs—and exposed thousands of soldiers who would come home to contribute to licit and illicit amphetamine use on the home front. The postwar landscape of amphetamine use is described in a pair of chapters on speed in the emergence of 1950s counterculture—with rich narrative material from jazz musicians and beat poets—and the increased use of amphetamines and other psychoactive drugs in postwar American medicine. Another more pair of chapters focuses on the continued expansion of amphetamine prescription in the 1960s and 1970s despite an emerging literature on amphetamine addiction and its disastrous social and economic consequences. The book concludes with a rapid survey of the recent resurgence of licit amphetamine use—such as the increasing diagnosis of pediatric and adult ADHD—and continued expansion of illicit amphetamine use in spite of a series of policy attempts to limit supply, which have had the paradoxical effect of adding the risks of unregulated black-market drug production to the already-evident risks of the drug itself.

This narrative and analysis are supported by a broad reading of clinical literature and government documents, new archival materials from industry-related researchers, clinicians, and regulators, and some particularly useful documents revealed in the discovery process of pharmaceutical intellectual property lawsuits. Rasmussen has made some important and innovative findings here—perhaps most notably in his...