What Exactly is the Difference?
Drugs feel like they’ve have become a near-constant news item recently. With opioid epidemics raging in many states, conversations about drug overdoses and prescription pills have become a regular feature of nightly newscasts. At the same time, conversations about the drug and medical industry itself have entered the mainstream. Between pharma executive loudmouth (and alleged crook) Martin Shkreli, the high-profile implosion of Theranos, and controversy over the pricing of EpiPen, Americans seem to be talking about drugs more than ever.
But what are we talking about when we talk about drugs? Are opioids good or bad, or both? When people talk about prescription drug pricing, are they entering uncharted territory for public discourse?
Danya Glabau is a New York-based medical anthropologist who is teaching a class in those very topics. Called Drugs and Society, the class will be at the Brooklyn Institute for Social Research starting October 19 and will attempt to get at some fundamental questions about drugs, including defining what a “drug” is and how we conceive of “good drugs” versus “bad drugs.”
In this class, in particular,she is trying to look at both the pharmaceutical side, what we think of as “good drugs” in our society, as well as the illicit side. In the tradition of Western medicine, there is this play on how we think of the pharmacon—that’s a Greek word that describes substances that can both heal and harm you. That’s deeply embedded in Western thinking—that medicine and drugs are both healing and harming. You can see this with, again, drugs like prescription opioids, where they can be really essential to helping people with injuries and they also have this dark side of addiction. You can see that in other classes of drugs, too. For example, chemotherapy drugs: They’re very powerful drugs. Some of them have done a lot in extending the lives of people with cancer, but they really come with very serious side effects. What we view as helpful, versus harmful.
Often, when we talk about drugs, especially outside of scholarly conversations, there is this split between, are we talking about prescription drugs, prescription medications, and the political economy of healthcare in our country, or in our society? Are we talking about bad, dirty drug users, who belong in jail? There is often a much harder split.
But there’s a real shift in how we are thinking about drugs and disease. It feels like we are making progress, having conversations about what we need to do to care for people with mental illness, or with food allergies, or whatever. There is more conversation to be had. With food allergies, the example recently is the conversation about the pricing of Epinephrine auto-injector, where the community was really united around helping companies expand access to them. Many activists got involved in lobbying their local, or state, governments to loosen restrictions on who could use them, in order to provide Epinephrine in places like schools.
One of the really interesting things is the way the drug development is financed in 2016. A lot of the Silicon Valley and investment banking models for what makes good investments are being used to make decisions about what makes a good medicine.Techniques developed for banking are now deciding what kinds of treatments are worth developing. Martin Shkreli, in particular, is such a fascinating figure because he is very well-versed in those financial techniques, and very enthusiastic to use those to defend his business practices.
Does that mean people now feel like they have more of a right to drugs—that they can demand lower prices, or that drug prices are going out of control, or both?
There are two ways to go about people’s “rights’ to drugs. Before, there were very strict rules about how you go about getting pre-approval, or approval after the fact. It felt like medicine was being controlled by some outside factor. Healthcare delivery drifted away from that, but with healthcare and insurance costs rising so much over the years, plus the controversy over the Affordable Care Act and drug pricing, it’s all really prompting people to now think deeper about the supply chain of their healthcare delivery and say, OK, maybe, it is not just the price I pay. Maybe, it is also the price my insurer pays to the drug company.
Maybe, it is also the outside commitments that a drug company has for dividends, to institutional investors who hold a lot of their stock, or dividends to private investors who hold a large chunk of equity, before the company goes public.
Anthropologist Joseph Dumit calls drugs like that “Drugs for Life,” in the way these are drugs that are meant to extend, or improve, our lives, in our current cultural and political context. Also, drugs that , once we start taking them, we need to keep taking for the rest of our lives, to sustain and extend the kind of lifestyle that we live. It is a drug that allows us to continue with our lifestyle, which our bodies are telling us maybe isn’t working. If we want to sleep at work, and we need some kind of stimulant to stay awake, then maybe there is something else going on that we can be thinking about.
Analysts worry about this trend but workers of the American society also state that they should understand the pressure that people are under.
That brings us to this divide between “good” and “bad” drugs—productivity-increasing drugs versus illicit drugs. There is this long line of thinking, and social theory, that disease is defined as the counterpoint to health. Without having diseases that we can define, and point at as something wrong, then it would be very difficult, if not impossible, to define health. Thinking about what it means to be healthy, as a student in a classroom, it is hard to imagine a “bad student” without being able to compare them to the “good student.”
We think of pharmaceuticals as these great technical accomplishments. They are really only technical accomplishments in the context of other systems of meaning, or other systems of social organization, that they are interacting with—they’re only “good drugs” because of context.
