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." Glabau spoke with VICE about her course.
VICE: How'd the idea of this class came about?
Danya Glabau: My dissertation looked at allergy activism in the US, trying to understand the the culture of food allergies. A big part of looking at any medical condition, or community united by medical condition, is thinking about the different kinds of pharmaceutical interventions that they use. I've been studying the different interactions among communities and drugs for six years, since I started graduate school. This class comes out of that work, in large part.
Can we define what we talk about when we talk about drugs? What even are drugs?
That's a really good question. In this class, in particular, I am 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.
I think 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, I think, in public conversation about drugs.
Do you think that Americans have a hard time talking about drugs, or conceptualizing a framework for how to even talk about drugs? It seems to me that there are so many people on various drugs—whether it is antidepressants, or anti-anxiety pills, smoking weed, or whatever it might be—but it's still a not polite conversation to have, though.
I think because pharmaceutical drugs, in particular, are used to treat bodily dysfunction, bodily ills, illness, disease, whatever you want to call it, there is a big taboo about talking about that, in American society in particular. In my research, I was struck after reading about how in Europe there is much less of a taboo around talking about illness. I think the taboo around that in the US is is a big part of it. I mean, I also think it is difficult to think about drugs as a monolithic class.
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. Then, all of a sudden, there is this pricing debate, which dovetails with some concerns of people who are already working on the activist side, about the rising cost of the drug. Now, there is skepticism about, Well, was it really, actually, a good idea to work so hard to expand access to this, potentially life-saving drug? I think most the activists say yes, but we should think more carefully about who our allies are, moving forward.
There was that controversy, and then the controversy about Martin Shkreli. Why do drugs seem so controversial this year?
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. I think this ties really closely to Martin Shkreli, for example, or the Theranos controversy, or valiant stock pricing strategies. I find it curious that 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 think about it. In the 1990s, the big bad boogeyman of health care was managed care, and Health Maintenance Organizations (HMOs). These were plans that were highly managed by the private corporations that ran them, like Aetna, or Blue Cross Blue Shield, where insurance companies had a very set protocol for determining what treatments, or what interventions, would be covered. 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. I think it has been a slow creep, and it just hit a tipping point, where people are really feeling very squeezed, and very interested.
You mentioned Silicon Valley, and how it in a way is intertwined with the drug industry. I was wondering what you thought of all these new smart drugs. Is that is a new frontier of drug use?
This 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. As an analyst, that worries me. Then, as a worker, as a laborer in American society, I also understand the pressure that people are under, because I am under it myself.
That brings us to this divide between "good" and "bad" drugs—productivity-increasing drugs versus illicit drugs. I am just curious what you see, or what you see people conceptualizing, as drugs that are good versus drugs that are bad, and if that is a false divide?
Yes, I do think it is a false divide. I think it is also tied to how we define diseases. 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." I think drugs intervene on those levels—on a social ordering of the world. 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.
Did you have any personal experiences with drug use that made you interested in this subject matter?
I have always been fascinated by medical oddities, and gross medical things. My favorite app on my iPhone, is Figure 1, which is Instagram for doctors. You scroll through and it's brain scans, dismemberment, and oozing wounds. There has just always been something fascinating to me about thinking about how the human body works, how it is bounded, defined, how it becomes relevant to different kinds of social contexts. Then, just observing—in general terms in my own life, but even more so in the lives of certain friends and family members—how fast and direct an impact drugs like antidepressants, or drugs like Epinephrine, can have on someone's well being, or someone's participation in everyday life, really made me think there was something more here.
Drugs and Society starts on October 19. Visit the Brooklyn Institute for Social Research's website for more information, as well as to sign up.
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