Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture

The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture by Richard DeGrandpre, 286 pp, $24.95. Durham, NC, Duke University Press, 2007. ISBN-13 978-0-8223-3881-9. Among the countless forces that shape attitudes toward drugs, science is arguably the least influential. Although irrationality pervades people's use of all substances, from herbal preparations to antibiotics, a singular foolishness imbues the views of mind-altering ones. Unfounded drug decisions can result in substantial costs to the public health. As just one example, the US Food and Drug Administration (FDA) recently decided that all antidepressants should carry a black box warning to the effect that they increase the risk of suicidal thinking and behavior in children and adolescents. The FDA decision was based on what can most charitably be described as inconclusive data. No children or adolescents in the trials at hand actually killed themselves; the slight increase in suicidal thinking and behavior noted in some of the antidepressant trials is of doubtful statistical and clinical significance; and, most pertinent, such behaviors do not foretell actual suicide.1 Thanks in part to this warning and the surrounding publicity, parents have become reluctant to have their children take antidepressants and clinicians reluctant to prescribe them. Numbers of antidepressant prescriptions fell precipitously following the warning, and although the effects are not yet clear, it is possible that morbidity and mortality among children and adolescents will increase. The most troublesome upshot of society's unreasonable approach to drugs is the war on drugs. As Richard DeGrandpre points out in The Cult of Pharmacology, the war on drugs is fueled by misconceptions about the nature of addiction, the danger of prohibited drugs, and the best ways to limit the damage that these drugs do inflict. Most worrisome of all, this war has already been lost several times. The book's basic message is that certain drugs are demonized and others embraced not on the basis of a drug's pharmacological actions or what it actually does mentally or physically but because of the meanings attached to it. What the author calls “angel drugs”—those, like antidepressants, that are considered legitimate and beneficial—are a lot worse than people think, and demon drugs, like cocaine and heroin, he contends, are not actually so bad. The book's other major point—and the one giving rise to its title—is that the “cult of pharmacology” or “pharmacologicalism” is at the root of misconceptions about drugs and society's wrongheaded drug policies. DeGrandpre never clearly defines these terms, but they seem to refer to the beliefs that drugs are uniquely powerful and that their effects come from their pharmacological activity alone. The Cult of Pharmacology states again and again that insufficient attention is paid to context, expectation, and meaning. For example, he asserts that nicotine is not the culprit behind addiction to cigarettes, but rather other attributes of smoking are—the anticipation, the smoking context, and what smokers expect to happen when they quit. As “evidence,” the author points to the fact that not everyone on nicotine replacement stops smoking. The Cult of Pharmacology treads familiar territory, and its main points are inarguable. A small library of books and papers, much of it cited by the author, attests to both the impact of nonpharmacological factors on drug response and the irrationality behind our attitudes toward drugs. Although this information has been around for a long time, it bears repeating. People who should know better, physicians included, continue to approach both medical and recreational drug use with a raft of unfounded biases. Unfortunately, the book has its own irrationality: it's a polemic, not a balanced discussion. The author cites limited research that confirms his opinions but not the vast body of data that do not. Chapter 1 delves into the dangers of Ritalin (methylphenidate). The author writes of its addictiveness and describes it as “nothing less than synthetic cocaine”(p 10). He does not mention the vast literature documenting its usefulness in attention deficit-hyperactivity disorder and the insignificant rate of addiction among those who receive it as treatment. On the other hand, he asserts, cocaine is not as bad as we think: South American Indians have been chewing coca leaves containing small amounts of cocaine for centuries without ill effects. Chapter 2 states that Prozac (fluoxetine) and other selective serotonin-reuptake inhibitors (SSRIs) precipitate “suicide and other forms of violence” (p 49). The author cites pertinent case reports, court documents, and testimony from antidrug advocates but not the considerable evidence that calls this notion into question. In fact, SSRIs and other antidepressants do have drawbacks, but suicide and violence are not among them. The antidepressants' biggest shortcoming is that they do not work very well. In other chapters the author portrays the shifting fortunes of alcohol, heroin, cocaine, and marijuana during the 20th century. He is on firm ground as he describes the forces at play—none of them scientific—that changed the status of these drugs from legal, and in some instances medically sanctioned, to illegal and dangerous. He devotes a good bit of space to the development of tranquilizers, which he sees as medically sanctioned drugs of addiction. Most chapters include detours that are mostly beside the point. Chapter 1, for example, has a good deal about the colonel who headed the US Army's antidrug operations in Columbia and his wife's cocaine addiction and trafficking. Chapter 3 contains an exhaustive account of the FDA's attempts to prove that the tobacco industry deliberately increases the nicotine content of cigarettes. The Cult of Pharmacology delivers important messages about the bias and irrationality behind drug policy and our approach to drug use, messages that both clinicians and the general public should hear. But because these messages come in the form of a polemic loaded with nonsense about the dangers of psychotropic drugs, shaky pharmacology (a constant refrain is that Ritalin and cocaine are one and the same), and misleading use of data, I cannot recommend this book. The only reason a clinician might want to read it is if patients stumble across it and become alarmed or perplexed by what they read. Knowledge of this book's claims and the “data” the author calls on to support them can help reassure patients that, contrary to what they have read, Ritalin has its uses, Prozac does not turn patients into murderers, and nicotine does in fact contribute to the tobacco habit. Back to top Article Information Disclosure: Dr Brown is co-owner and CEO of Clinical Research Centers International, a company that sets up and manages clinical trial sites outside the United States that conduct research for both drug companies and nonprofit entities. References 1. Klein DF. The flawed basis for FDA post-marketing safety decisions: the example of anti-depressants and children. Neuropsychopharmacology. 2006;31:689-69916395296Google ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture

JAMA , Volume 297 (5) – Feb 7, 2007

Loading next page...
 
/lp/american-medical-association/the-cult-of-pharmacology-how-america-became-the-world-s-most-troubled-eX17WiorZJ
Publisher
American Medical Association
Copyright
Copyright © 2007 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.297.5.534
Publisher site
See Article on Publisher Site

Abstract

by Richard DeGrandpre, 286 pp, $24.95. Durham, NC, Duke University Press, 2007. ISBN-13 978-0-8223-3881-9. Among the countless forces that shape attitudes toward drugs, science is arguably the least influential. Although irrationality pervades people's use of all substances, from herbal preparations to antibiotics, a singular foolishness imbues the views of mind-altering ones. Unfounded drug decisions can result in substantial costs to the public health. As just one example, the US Food and Drug Administration (FDA) recently decided that all antidepressants should carry a black box warning to the effect that they increase the risk of suicidal thinking and behavior in children and adolescents. The FDA decision was based on what can most charitably be described as inconclusive data. No children or adolescents in the trials at hand actually killed themselves; the slight increase in suicidal thinking and behavior noted in some of the antidepressant trials is of doubtful statistical and clinical significance; and, most pertinent, such behaviors do not foretell actual suicide.1 Thanks in part to this warning and the surrounding publicity, parents have become reluctant to have their children take antidepressants and clinicians reluctant to prescribe them. Numbers of antidepressant prescriptions fell precipitously following the warning, and although the effects are not yet clear, it is possible that morbidity and mortality among children and adolescents will increase. The most troublesome upshot of society's unreasonable approach to drugs is the war on drugs. As Richard DeGrandpre points out in The Cult of Pharmacology, the war on drugs is fueled by misconceptions about the nature of addiction, the danger of prohibited drugs, and the best ways to limit the damage that these drugs do inflict. Most worrisome of all, this war has already been lost several times. The book's basic message is that certain drugs are demonized and others embraced not on the basis of a drug's pharmacological actions or what it actually does mentally or physically but because of the meanings attached to it. What the author calls “angel drugs”—those, like antidepressants, that are considered legitimate and beneficial—are a lot worse than people think, and demon drugs, like cocaine and heroin, he contends, are not actually so bad. The book's other major point—and the one giving rise to its title—is that the “cult of pharmacology” or “pharmacologicalism” is at the root of misconceptions about drugs and society's wrongheaded drug policies. DeGrandpre never clearly defines these terms, but they seem to refer to the beliefs that drugs are uniquely powerful and that their effects come from their pharmacological activity alone. The Cult of Pharmacology states again and again that insufficient attention is paid to context, expectation, and meaning. For example, he asserts that nicotine is not the culprit behind addiction to cigarettes, but rather other attributes of smoking are—the anticipation, the smoking context, and what smokers expect to happen when they quit. As “evidence,” the author points to the fact that not everyone on nicotine replacement stops smoking. The Cult of Pharmacology treads familiar territory, and its main points are inarguable. A small library of books and papers, much of it cited by the author, attests to both the impact of nonpharmacological factors on drug response and the irrationality behind our attitudes toward drugs. Although this information has been around for a long time, it bears repeating. People who should know better, physicians included, continue to approach both medical and recreational drug use with a raft of unfounded biases. Unfortunately, the book has its own irrationality: it's a polemic, not a balanced discussion. The author cites limited research that confirms his opinions but not the vast body of data that do not. Chapter 1 delves into the dangers of Ritalin (methylphenidate). The author writes of its addictiveness and describes it as “nothing less than synthetic cocaine”(p 10). He does not mention the vast literature documenting its usefulness in attention deficit-hyperactivity disorder and the insignificant rate of addiction among those who receive it as treatment. On the other hand, he asserts, cocaine is not as bad as we think: South American Indians have been chewing coca leaves containing small amounts of cocaine for centuries without ill effects. Chapter 2 states that Prozac (fluoxetine) and other selective serotonin-reuptake inhibitors (SSRIs) precipitate “suicide and other forms of violence” (p 49). The author cites pertinent case reports, court documents, and testimony from antidrug advocates but not the considerable evidence that calls this notion into question. In fact, SSRIs and other antidepressants do have drawbacks, but suicide and violence are not among them. The antidepressants' biggest shortcoming is that they do not work very well. In other chapters the author portrays the shifting fortunes of alcohol, heroin, cocaine, and marijuana during the 20th century. He is on firm ground as he describes the forces at play—none of them scientific—that changed the status of these drugs from legal, and in some instances medically sanctioned, to illegal and dangerous. He devotes a good bit of space to the development of tranquilizers, which he sees as medically sanctioned drugs of addiction. Most chapters include detours that are mostly beside the point. Chapter 1, for example, has a good deal about the colonel who headed the US Army's antidrug operations in Columbia and his wife's cocaine addiction and trafficking. Chapter 3 contains an exhaustive account of the FDA's attempts to prove that the tobacco industry deliberately increases the nicotine content of cigarettes. The Cult of Pharmacology delivers important messages about the bias and irrationality behind drug policy and our approach to drug use, messages that both clinicians and the general public should hear. But because these messages come in the form of a polemic loaded with nonsense about the dangers of psychotropic drugs, shaky pharmacology (a constant refrain is that Ritalin and cocaine are one and the same), and misleading use of data, I cannot recommend this book. The only reason a clinician might want to read it is if patients stumble across it and become alarmed or perplexed by what they read. Knowledge of this book's claims and the “data” the author calls on to support them can help reassure patients that, contrary to what they have read, Ritalin has its uses, Prozac does not turn patients into murderers, and nicotine does in fact contribute to the tobacco habit. Back to top Article Information Disclosure: Dr Brown is co-owner and CEO of Clinical Research Centers International, a company that sets up and manages clinical trial sites outside the United States that conduct research for both drug companies and nonprofit entities. References 1. Klein DF. The flawed basis for FDA post-marketing safety decisions: the example of anti-depressants and children. Neuropsychopharmacology. 2006;31:689-69916395296Google ScholarCrossref

Journal

JAMAAmerican Medical Association

Published: Feb 7, 2007

References