New Books in Drugs, Addiction and Recovery

Commercial interests are often understood as impinging upon the ethical norms of medicine. In his new book, Medical Monopoly: Intellectual Property Rights and the Origins of the Modern Pharmaceutical Industry (University of Chicago Press, 2013), Joe Gabriel shows how the modernization of American medicine was bound up in the ownership, manufacture, and marketing of drugs. Gabriel unearths the early history of intellectual property concerns as they entered the domain of medical practice itself. Through his careful marshaling of evidence, he takes readers back to a time when the norms and legal structures of commercial capitalism in the U.S. were just as much at issue as those of the professionalization of medicine. This fascinating book serves as a pointed reminder that the sources of therapeutic rationale are just as much tied to the production and regulation of therapies as the collective decision-making on ethical practice. Along with my previous interview with Jeremy Greene, this discussion will hopefully make accessible a broad perspective on the development of medicine in the 20th century by focusing on its ties to industry. Medical Monopoly charts the history of property rights over medicines at the dawn of the 19th century through World War I. The important broader transition here is that while before the Civil War–at least in medicine–patents were seen as tantamount to granting problematic monopoly, by the end of the 19th century they were understood as the best available regulatory mechanism for preventing more problematic imitation. Whereas patent medicines had previously been linked to quackery, the emergence and rapid expansion of the “ethical” pharmaceutical industry after the Civil War was due to its adherents advocating for more effective regulation of commerce within medicine. Rather than reverting to secrecy, firms began to circulate and publish information on new remedies and the results of studies to physicians. As the explosion of new medicines remained at pace with the boom of consumer goods in the late 19th century, patenting and corporate investment in monopolistic practices became understood as a mechanism to advance the public good. The expansion of laboratory science and norms of chemical manufacturing in the 20th century only bolstered this union further.Medical Monopoly is a fascinating and important read that people interested in medical policy should pay attention to. Learn more about your ad choices. Visit megaphone.fm/adchoicesSupport our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery

Is pain real? Is pain relief a right? Who decides? In Pain: A Political History (Johns Hopkins University Press, 2014),Keith Wailoo investigates how people have interpreted and judged the suffering of others in the US from the mid-1940s to the present. While doctors and patients figure in his story, the primary protagonists are politicians, judges, and ideologues, who variously understood the ambiguities of pain as political problems to be settled in legislatures and in courts of law and public opinion alike. For instance, in the 1940s and 1950s, the “pain complaint” of ailing World War II veterans became the locus of debates about manhood, federal disability benefits, and pharmaceutical interventions. Although physicians faced complex problems about adjudicating the pain of their patients, Wailoo shows that pain was also a deeply cultural problem, especially as new, competing theories of pain emerged to explain not only the experience of suffering, but the character, motives, and rights and responsibilities of the sufferer. In the Reagan administration-era, debates about pain were an index of America’s welfare problem, and in late 20thcentury, controversies over fetal pain and the “ultimate relief” of physician-assisted suicide reflected the polarized landscape of “liberal” and “conservative” positions. The last chapter, “OxyContin Unleashed,” compellingly shows how a de-regulated and pro-business pain policy led to the pain drug boom in a competitive and unstable medical marketplace. Ultimately, Wailoo claims that “we have a cultural problem understanding people’s pain.” Pain shows us how that has taken place throughout our recent history, and challenges us to acknowledge and attend to the way that we politicize the pain of others without regard for their suffering. Learn more about your ad choices. Visit megaphone.fm/adchoicesSupport our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery

Khat, the fresh leaves of the plant Catha edulis, is a mild psycho-stimulant. It has been consumed in Yemen, Ethiopia, Eritrea, Djibouti, Somalia for over one thousand years. Khat consumption is an important part of Yemeni social and political life. During the early part of the twentieth century, Yemeni dockworkers brought khat to Madagascar, where other members of the Malagasy population have adopted its use. In her excellent book Drug Effects: Khat in Biocultural and Socioeconomic Perspective (Left Coast Press, 2012), Lisa L. Gezon, Professor and Chair in the Department of Anthropology, University of West Georgia, analyzes the production and consumption of Khat on the island nation of Madagascar. Taking a cultural, medical, and anthropological approach, Gezon looks at the use of khat in pharmacological, cultural, political, economic and environmental contexts.As a student of plant drugs/medicines/intoxicants, her summary of the manner in which khat’s effects have been mischaracterized by many so called experts has echoes of reefer madness inspired characterizations of cannabis and its users.Like so many drugs, khat is a powerful force in the local economy, and the factors that have allowed khat to provide income for small hold farmers rather than becoming part of a centralized and commercial monoculture are worthy of further analysis. In addition to teaching me about the specifics of khat consumption in Madagascar, the background material provided a great primer on CMA approaches to substance use, as well as on the history, pharmacology and policy surrounding Catha edulis. I have been thinking a great deal about the economic forces that influence the consumption and availability of drugs.There are similarities and differences between poppy production in Afghanistan or the Golden Triangle, cannabis production in the Emerald Triangle, and khat production in Madagascar.The peaceful and widely distributed economic benefits of smallholder farming on Madagascar make this study particularly fascinating. Lisa Gezon was a pleasure to interview, and was very patient with my still developing interviewing skills.Her research included extensive field work as well as research, and the book is almost encyclopedic in its synthesis of the literature, the findings of her studies as well as her excellent and insightful analysis. Learn more about your ad choices. Visit megaphone.fm/adchoicesSupport our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery

Is there any such thing as a generic drug? Jeremy A, Greene‘s new book Generic: The Unbranding of Modern Medicine (Johns Hopkins University Press, 2014) treats its subject matter with a learned skepticism that lets the reader see through the eyes of the historical actors who helped define the modern drug industry. By inverting preconceived notions about what we take to be mundane, mass-produced chemical identities, the book offers a broad yet pointed glance at an industry and its attendant regulatory structures that developed alongside modern consumer culture. Claims about the equivalence and lower price of generic medicines, uncoupled from the patents held by major firms, were always hotly contested, and Jeremy’s book shows how debates about branding–or lack thereof–were at the heart of the rationalization of medical practice. Generic opens with evocative stories about the legal and scientific crises and personal tragedies wrought by tense relations between medical science and industry. We then learn about early debates over international standardization of chemical names and the emergence of firms that marketed generics as a specific kind of product that were a part of the very same consumer-driven value system their proponents wanted to replace. These anonymous drugs prompted research that could establish sufficient similarity between them, while at the same time provoking disputes of authority between physicians and pharmacists that produced a new regulatory regime and standards which were embodied and shaped by emerging large, bureaucratic health care providers. In the end, the story of generics as champions of access and affordability in an age of elusive therapeutics and ‘me-too’ drugs designed to cash in on innovation is complicated by the global changes in production and trade they have wrought. Are ‘global’ drugs perceived as ‘universal’? Jeremy’s book will promote discussion and thought about the medical mundanities we so often take for granted. Generic takes the philosophically-inflected themes of the history of science into a realm of pressing urgency, and reveals fascinating parallels that actually make it more enjoyable for a broad audience. This interview is the first half of a pair of new books on the pharmaceutical industry; be on the lookout for my next interview with Joseph M. Gabriel about his new book: Medical Monopoly: Intellectual Property Rights and the Origins of the Modern Pharmaceutical Industry (University of Chicago Press, 2014). Learn more about your ad choices. Visit megaphone.fm/adchoicesSupport our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery

I am old enough to realise that we have entered a science fiction world in which the old systems of the market place are being sidestepped by new technology. We who follow the tried and true methods are missing out of the brave new world. The changes are particularly true for the middle men whose services are no longer needed as the web allows customers to deal directly with producers. This also applies to the participants in organised crime. James Martin‘s terrific new book Drugs on the Dark Net: How Cryptomarkets are Transforming the Global Trade in Illicit Drugs (Palgrave, 2014)spells out how this is occurring in the drug trade as the Tor Network allows drug users to purchase their products from anywhere in the world. No longer are they tied to a street dealer or a friend for supply. No longer do they lack choice in quality or variety. Now they can peruse a range of products from the safety of their home. They have choice that would never be available without the internet. More importantly, as Martin points out, they are now valued customers with contracts, refund policies and providers of feedback on service quality. These websites provide all types of illicit goods but, surprisingly, many have ethical frameworks that limit their product ranges to restrict the sale of unacceptable goods and services such as child pornography or, in comes cases, firearms. This book is a mind expanding (pun intended) exploration of a high tech illicit market place that is essential reading for police, academics and the public at large. Learn more about your ad choices. Visit megaphone.fm/adchoicesSupport our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery

It may seem silly to ask why we seek ecstasy. We seek it, of course, because it’s ECSTASY. We are evolved to want it. It’s our brain’s way of saying “Do this again and as often as possible.” But there’s more to it than that. For one thing, there are many ways to get to ecstasy, and some of them are very harmful: cutting, starving, and, of course, drug-taking. These things may render an ecstatic state, but they will also kill you. Moreover, many of the ecstasy-inducing activities and substances are powerfully addictive. It’s fine, for example, for most people to use alcohol to feel more relaxed or even to achieve an ecstatic state. But something on the order of 10% to 15% of people cannot safely use alcohol at all without become seriously addicted. And once they do, they usually descend into a profoundly un-ecstatic nightmare that often ends in death. According to Sharon K. Farber‘s Hungry for Ecstasy: Trauma, the Brain, and the Influence of the Sixties (Aronson, 2013), our desire for ecstasy is first and foremost a psychic defense that protects us against on-going or anticipated trauma. When reality (as we perceive it, which, of course, is not always or even often accurately) becomes “too much” for us, we seek refuge in altered states of consciousness. The most attractive of these, of course, is ecstasy. It makes everything frightening just “go away.” Sometimes, the ecstatic state appears spontaneously. More often, however, especially in our culture, it is consciously induced by self-harming and drug-taking. For most of us, this sort of self-medication “works.” For a large minority, however, it ends in addiction and death. Listen in. Learn more about your ad choices. Visit megaphone.fm/adchoicesSupport our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery

Miriam Kingsberg‘s fascinating new book offers both a political and social history of modern Japan and a global history of narcotics in the modern world. Moral Nation: Modern Japan and Narcotics in Global History (University of California Press, 2013) locates the emergence of a series of three “moral crusades” against narcotics that each accompanied a perceived crisis in collective values and political legitimacy in nineteenth and twentieth century Japan. In the first moral crisis after the Sino-Japanese War of 1894-5, opium became a symbol of difference between Japan and an “Other” epitomized by Qing China, as Japan sought to “leave Asia” and “enter” the West. Here, Kingsberg traces a series of attempts to regulate drug use in Taiwan in the wake of Japan’s transformation into a formal empire. Between the end of WWI and Japan’s defeat in WWII, Japan saw its second moral crisis as it navigated the most protracted and intense moral crusade against narcotics in its history. The central chapters of Kingsberg’s book trace this second crisis, paying special attention to Japanese colonial rule in Korea and in the Kwantung Leased Territory (KLT) in southern Manchuria as Korea became the “global capital of morphine” and the KLT port handled “the second-highest volume of banned drugs in the world.” The third moral crisis brings us to the end of Moral Nation and the thick of the “hiropon age” of the 1950s, when methamphetamine production and usage skyrocketed in postwar Japan and the nation saw its first full-fledged domestic drug plight. Kingsberg locates a changing cast of “moral entrepreneurs” who motivated these three crises, shedding light on the formative roles of merchants and mass society in this chapter of global narcotic history. It is a wonderful, meticulously researched book that contributes significantly to the histories of Japan, of drugs, and of global politics. Enjoy! Learn more about your ad choices. Visit megaphone.fm/adchoicesSupport our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery

Reading Peter Maguire and Mike Ritter‘s book Thai Stick: Surfers, Scammers and the Untold Story of the Marijuana Trade (Columbia Press, 2013) is the most fun I have had doing this podcast. Maguire makes a point during the interview that police officers preferred to arrest marijuana smugglers because they were so laid back and safe to handle. You get the same feeling reading his account of the members of the roaming hippy/surfer community who fund their lifestyle through ‘scams’, that is, smuggling marijuana into Australia, New Zealand, the USA and Canada. Maguire is a former pro-surfer and he communicates the culture of the surfer and their dedication to their past-time. Drug smuggling has a very utilitarian role. While the surfers smoke drugs and have the connections to buy them; a good smuggling run can fund many years on the international surfing trail. Thus they are not drug smugglers who surf but surfers who take advantage of the profit margin of smuggling. Reading the book made me think that they were almost outside the scope of the podcast; this is not organised crime but the occasional foray into crime. It is also the story of invincible young men taking on the impossible in an often amateurish manner and succeeding. However, as Maguire explains, the lure of money can change people and some of the people in the story reverse this equation. This is a story of a time that has passed. There was an innocence in the story during the 1960s and 70s that has been overtaken by the hard edge of the international drug trade. This is an important and overlooked story in the history of crime. The book provides an insight into how people can turn to crime in a manner that contradicts the strongly held theories of the life-course criminologists. I hope the book inspires others to study these marginal areas of crime. As you will hear in the interview, I have volunteered to do so myself. Learn more about your ad choices. Visit megaphone.fm/adchoicesSupport our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery

In this episode, I talk with Carlo C. DiClemente, a Presidential Research Professor in the Department of Psychology at the University of Maryland- Baltimore County, about his co-authored book, Substance Abuse Treatment and the Stages of Change: Selecting and Planning Interventions (Guilford Press, 2013). We examine the stages-of-change model (also known as the transtheoretical model) in behavioral change, particularly in substance abuse and drug addiction treatment. We discuss the complexity involved in substance abuse, and the need to consider stage status in effective treatment. We talk about relapse and its implications for individuals’ recovery trajectories. The importance of the individual client as the central mechanism of change is emphasized throughout our discussion. Learn more about your ad choices. Visit megaphone.fm/adchoicesSupport our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery

In this episode, I sit down with Karen G. Weiss, associate professor in the Department of Sociology and Anthropology at West Virginia University, to talk about her book, Party School: Crime, Campus, and Community (Northeastern University Press, 2013). We discuss the subculture of the “party university,” and how such an environment normalizes and encourages extreme binge drinking and reckless partying. We talk about how extreme partying harms students as well as the larger community, and why students willingly put themselves (and others) at risk for victimization. We discuss why the party subculture appears so resistant to change, and why efforts from university personnel and law enforcement often appear futile. We also explore possible ways to transform the party subculture and address the problems it causes. Learn more about your ad choices. Visit megaphone.fm/adchoicesSupport our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery