A recent piece in The Independent (May 27, 2007) tells us that the US is losing its war on cocaine, and why: “America has spent billions battling the drug industry in Bolivia, Colombia and Peru. And the result? Production as high as ever, street prices at a low, and the governments of the region in open revolt.”

The report, filed by Hugh O’Shaughnessy from La Paz, Bolivia, offers new and interesting information on America’s longstanding drug war in South America.  The bad news is that it ends with the same old, dusty conclusion, that America is losing the war on drugs, and that therapy is better than prison bars.

Some of the info:

• “The immensely costly “war on drugs” in Latin America is slowly collapsing like a Zeppelin with a puncture. The long-forecast failure for strategies which involve police and military in forcibly suppressing narcotics - first decreed by President Richard Nixon decades ago - is now pitifully evident in Bolivia, one of the poorest countries of the Western hemisphere.”

• “The estimated $25bn (£13bn) that Washington has spent trying to control narcotics over the past 15 years in Latin America seems to have been wasted.”

• “In 2005, according to UN guesses - and, amid merciless political spinning of what few facts there are - Colombia, Peru and Bolivia, the main producers of cocaine, had the capacity to produce 910 metric tons a year. As more productive strains of coca bushes appear, production has been increasing. Unsurprisingly, the price of cocaine on US streets has tumbled, according to the White House drug tzar John Walters, to $135 (£70) a gram, a fraction of the $600 a gram it was fetching in 1981. The purity of cocaine has gone from 60 per cent in mid-2003 to more than 70 per cent last October. Like the conflict in Iraq, the US’s other great war is now being visibly lost.”

The conclusion: “In Britain, as in Latin America, drugs clearly can’t be controlled by armies and police forces.”

This is interesting stuff, to be sure, and there’s lots more of it in the article. But what to do with it? My view is that we need to take it in hand and move on. We need to start asking some new questions. Here are a few:

Q1: Why is losing the war on drugs a status quo that America can live with?

Answer: Because winning’s got nothing to do with it. As with the war on terror, this is a war without end, severing many functions, some ideological and some financial, and some both. As noted in a recent review of my book, “This is a conflict that, as Chomsky and others have pointed out, many people have an interest in fighting, but very few have an interest in winning.”

Q2: What drugs, what users?

Answer: cocaine and heroin and other despised drugs (e.g., marijuana) are derivatives of natural substances (plants!), that are non-toxic. This is very much unlike other drugs, like Prozac, Xanax, and the barbiturates, made by the drug industry. The latter “medicines” tend to carve big channels in one’s brain-biochemical streams, holding the habitual user in a stranglehold of withdrawal.

In other words, we need to break down the barriers that reinforce the myths of differential prohibition, that there are the good drugs (called medicines) from the pharmacy, and bad drugs, called drugs – sold on the street. As I discussed in an op-ed piece a few months back in the International Herald Tribune, British researchers have argued that many of the most dangerous drugs in society are legal, and more toxic than many illegal drugs, including marijuana and Ecstasy. So when we talk about drugs, let us consider who the end user is and ask another question:

Q3: Are some people bad because they use certain drugs, or have some drugs become bad because of who now uses them?

Answer: the history of drugs tells us that the reputations of mind-altering substances is strongly driven by the users. As users change, so do the myths regarding the drugs they use. And this raises another question:

Q4: Have the myths that permeate the use of illegal substances in America, exported around the world, now have more effect on the harmful outcomes of this use than the pharmacology of the drugs themselves?

Answer: this sounds like a crazy idea, but it’s certainly true in some cases. It’s a long story, and certainly recommend my book as one available account to read.

So… enough questions for now. Here’s a story on cocaine from my book you might enjoy:

From The Cult of Pharmacology

On February 29, 1996, retired Army general Barry McCaffrey was sworn in as President Clinton’s new director of the Office of National Drug Control Policy. He would stay at the post longer than any of his predecessors, stepping down in January 2001 after five years of service.  McCaffrey, a 29-year Army veteran when appointed as director, had received two Distinguished Service Crosses, a Bronze Star, and three Purple Hearts during his earlier military career. He had served as a combat soldier in Vietnam, as well as the commander of the 24th Mechanized Infantry Division during Desert Storm.  McCaffrey was an obvious choice to be the nation’s fourth drug czar, having also served as the Commander-in-Chief of the US Southern Command (SOUTHCOM) from February 1994 to February 1996. This made him responsible for overseeing counter-drug operations in Central and South American countries, familiarizing him with the drug trade in Central and South America.

As drug czar, McCaffrey made some of his own appointments, including the choice of Colonel James Hiett as head of the US Army’s expanding anti-drug control operations in Columbia. Like McCaffrey, Hiett had served a tour of duty in SOUTHCOM. It was in the summer of 1998, after Hiett’s SOUTHCOM assignment and while stationed at Ft. Bragg, North Carolina, that the Colonel was awarded the coveted anti-drug position. The appointment sent him southward again, this time to the US Embassy in Bogotá. Hiett’s promotion to the embassy made him the top military official in charge of “counternarcotics” operations in Columbia. Commanding a unit of 200 Army troops, the Colonel’s top responsibility was to train and assist the Colombian Army in mobilizing operations against the indigenous cocaine trade, as well as the growing heroin trade. Between eighty and ninety percent of the cocaine consumed in the US at the time was either produced and/or distributed in Columbia, as well as some 60 percent of the heroin.

Colonel Hiett remained at his post in Bogotá for only one year however before being returned stateside, this time to sit idle at a desk at Ft. Monroe, Virginia. Why the sudden career-halting reassignment? The reason was neither his performance as a military officer – Hiett’s twenty-four year record was spotless – nor his behavior off duty. The reason was his wife. As Mike Wallace would later remark in an episode of 60 Minutes, “In Colombia, the wife of America’s top military drug-fighter was herself a drug smuggler.”

It was a few years before the Colonel’s assignment to Columbia, when the Hietts were still at Ft. Bragg, that both he and the US Army first became aware of Laurie Anne Hiett’s drug problem. The problem involved the same white powdery substance that had for more than twenty years financed, via the demand of American illegal drug market, a brutal civil war in Columbia, and the same substance that had brought Colonel Hiett to Columbia: cocaine.

James Hiett met the 12-year younger Laurie when serving in the Canal Zone in Panama. Living with her mother, a Panamanian, and her father, an American engineer, Laurie was employed at SOUTHCOM as a secretary. During the time when Jim and Laurie met – and then married a year or so later, in 1989 – Laurie says she had recreated with cocaine but not to excess. It was the cloistered life of an Army wife that brought her drug habits to the fore, she later admitted, blurring out most everything else. Not unlike the domestic housewives of the ‘60s and ‘70s, who took the edge off their staid lives with daily doses of barbiturates (Seconal) or benzodiazepines (Valium), Laurie Hiett developed her own domestic drug habit, albeit a more perilous one for her husband, the Army, and America’s drug war.

Laurie Hiett first received treatment for a cocaine problem in the mid-1990s at the Army hospital in Ft. Bragg, followed by a brief stay in a private drug rehab center. Of all this her husband was fully aware, as was the Army and drug czar McCaffrey when Colonel Hiett was appointed to the Bogotá position. What the Colonel also knew was that his wife had strayed back into her drug lifestyle well before their departure to Columbia. Drug treatment had kept her clean for only a few months. She was teaching Spanish in a local high school, where fellow teachers later reported knowing of her drug habits. According to one drug-using friend, these habits sometimes included lunches that began with marijuana and rum-and-Cokes and ended with amphetamines or cocaine.  When Laurie told a friend about her husband’s promotion, and that she would be moving to Bogotá, the friend’s first thought was, “Oh wow, that’s where cocaine comes from. This ain’t gonna be good.”

By age 36, Laurie was a compulsive drug user. In one instance, which took place only four months before the Colonel’s Columbia promotion, she snorted a line of cocaine in front of him. His response was to walk out of the room in silence. The Colonel was in denial of his wife’s habit, enforcing a familiar military policy of do not ask, do not tell. So was the Army. It was not long after the Hietts were transplanted to Bogotá that drug czar McCaffrey reported to the Senate Committee on Foreign Relations that the members of a new Columbian antidrug battalion… “have been carefully selected, fully vetted, and are being trained and equipped with U.S. support.” What he failed to mention was that this was not exactly true for the chief US military officer advising the battalion, Colonel Hiett.

Not long after the Colonel’s arrival in Columbia did the actions of his wife appear to confirm the stereotype that drug availability leads inevitably to drug problems. In fact, Laurie’s lifestyle in Columbia was in fact anything but the norm. Attracted to the diplomatic life when viewed from afar, she was in reality a rather unsuitable candidate for the straight-and-narrow world inhabited by the spouses of diplomats. Others described the Colonel’s wife at the time as a young, giggly, out-of-control party girl. Like the teachers at the school where she taught in Fayetteville, embassy officials, diplomats, spouses of diplomats, and business associates had little trouble remembering her comportment at the time, and few were surprised by the international scandal that followed.

Trying to live a life in Bogotá, with her leopard skin blouses, miniskirts, and casual references to cocaine, Laurie quickly found herself excluded from the diplomatic soirees attended by her husband, and purged from the daily social functions of the wives’ club. Shunned from the diplomatic social scene, she turned to her friendly Columbian driver Jorge Ayala. Obliging her, he took her away from the high-security embassy compound, across its encircling moat, and into the Bogotá night.

Laurie Hiett’s forays into Bogotá’s nightclub scene included visits to the infamous La Zona Rosa, a district filled with casinos, clubs, and cocaine. It was there that she first asked her driver whether he could score some cocaine for her. When he returned with a one-pound brick of high-grade cocaine, Laurie was amazed. Expecting to pay her usual $100 for a single gram, she ended up paying only $1,000, for 500 grams – a mere $2 a gram. Reflecting on the cocaine binge that followed, which began only minutes later with her snorting a few lines in the embassy bathroom, she remembers thinking… “‘Oh my God, I’m so wired’... It was this beautiful thing, you know?”

Beyond La Zona Rosa, and with cocaine back in her life in a big way, the Colonel’s wife also began venturing into other high-risk environs. She is said to have even occasioned an underground nightclub district where a US DEA agent was shot a year earlier. While her husband was off waging America’s drug war in the Andean mountains, which was most of the time, Laurie also indulged in weekend drug binges at her favorite Andean resort – a drug haven that could only be accessed via a mountain road known for its frequency of guerrilla kidnappings. The Colonel’s wife had unwittingly stumbled into a world that placed essentially no financial limits on cocaine consumption, a situation that, in the case of the Hiett’s, would end badly for everyone.

Laurie Hiett’s coke habit was an embarrassment, but one that like the other nefarious ongoing said to occur regularly in the US embassy in Bogotá, might have been kept short of a public scandal. When Laurie the habitual drug user became Laurie the drug trafficker, however, the stage was set for a personal tragedy – the Hietts had two young boys – as well as what could have easily become a public relations disaster for America’s international drug war. As it turned out, most Americans would not hear the news until months after it was initially reported in the New York City weekly, the Village Voice , and well after the multi-billion dollar militarization of America’s drug war in Columbia, known as “Plan Columbia,” had been “debated” and approved on Capital Hill.

The three-month investigation into Laurie Hiett’s drug trafficking began on May 24, 1999, when a drug dog showed interest in a parcel sent to Miami from the American embassy via diplomatic post. Noticing the dog’s interest in the package, a US-Customs agent decided to go against customary procedure for embassy parcels and open it. What was first believed be a shipment of pure cocaine – and what was declared on the package to be coffee, candy, and a t-shirt – actually turned out to be almost three pounds of high-grade heroin. Conspiring with her driver and his friend in New York, Laurie had put her faith in the rule that Customs agents do not inspect diplomatic mail. What she and her colleagues failed to appreciate was that Custom’s drug dogs in Miami sometimes do.

As covered by Gabriella Gamini in the London Times, the discovery of the Colonel’s wife’s drug shipment came just days after Laurie’s husband, the Colonel, was nominated for a post that would involve him even deeper into the Andean drug war.  The assignment, had it not been revoked, would have placed him in charge of US troops stationed at two new anti-drug bases located in Columbia’s southern jungles. One was established in the area of Tres Esquinas, an air base for counter-drug operations in the center of the coca-growing region; the other was set up in the area of Tolemaida. The Colonel could not keep cocaine out of his own home, but apparently the Army still thought he could keep it out of America.

After the May discovery by Custom’s officers of what was later found out to be Laurie Hiett’s seventh shipment of drugs to New York, an undercover agent delivered the intercepted package to its Queens address, followed by an arrest of one of Laurie’s partners, and soon thereafter her friend and driver in Bogotá. The Army Criminal Investigation Division (CID) then showed up to question the Colonel’s wife (albeit only after the Colonel was given advanced warning that his property would be searched). This led two months later to her voluntary arrest in Brooklyn, where the case was eventually heard in US federal court.

As court records later showed, Laurie Hiett made two trips to New York during her brief tenure as a drug trafficker, bringing a sum of about $40,000 in cash back to Columbia. This money she admitted giving to her husband. And in a move more surprising than anything Laurie herself did, the Colonel accepted the drug money, no questions asked. He then set out to launder it, or “dissipated” it, to use his word, which he did by paying off Laurie’s exorbitant shopping bills, and by placing small amounts of cash in various bank accounts. At one point during the ongoing investigation he met her in Florida with $11,000 of the cash still in hand.

A year after the initial discovery by Customs agents, Laurie Hiett pleaded guilty in US federal court to distributing cocaine. She received a five-year sentence, meaning she would be out in three. The sentence by federal judge Edward Korman was two years shy of what was actually required by federal sentencing guidelines, and while a punishing sentence in real terms, it is a much shorter sentence than typically received for a first-offense felony charge of this sort – the unsympathetic trafficker can receive 10 to 15 years imprisonment for such a first offense. In fact, the same federal judge handed down a longer sentence to the middleman in Laurie’s drug-dealing scheme, that is, her driver’s friend in New York.

The Colonel, meanwhile, had his hopes of light punishment – forced retirement from the Army, rather than felony charges of laundering drug money – dashed, if only somewhat. The Army CID initially cleared the Colonel of any wrongdoing. But pressure eventually mounted, and in the same courtroom in which his wife was sentenced to five years, the Colonel received a sentence of five months.

The Hiett affair was a bizarre scandal that threatened the American drug war, but it was not a surprising affair. Laurie Hiett was a party girl who liked shopping and taking drugs that she viewed as benign, someone who exploited an unlikely situation that was hardly of her own making. Her husband found himself in an absurd situation, meanwhile, but one that he could compartmentalize in much the same way as could the rest of America: when those involved in using and selling drugs are close to us, or have ties to the powers that be, they are treated in an understanding way; when they have no such status or access to power and privilege, like Laurie’s middleman in New York, they are made “examples of,” punished in the most draconian fashion. That the wife of America’s top military drug-fighter in Columbia could be a drug trafficker did not prove to America that its drug war was a hopeless debacle, or suggest that perhaps Columbia’s drug problems hail from America’s drug demand. Rather, these events, viewed through the prism of drugs as inherently good or evil, proved just the opposite: cocaine is so corrupting that it must be fought with even greater fury.

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Wine, Sex, and War
Meaning and the Making of the Modern World

Scroll down, or read first entry HERE.

Why swallow a lie, when the truth can make you well?

The placebo project
is a campaign to bring the placebo officially into psychiatric medicine, asking the provocative question,
Should the First Course of Treatment in Psychiatric Medicine be a Placebo?

Read more about the project, and comment, below.

Image: download the Adbusters Placebo Ad (PDF 4mb)

Download and read Park and Covi’s placebo study in the Archives of General Psychiatry – a classic in the placebo library (PDF)

• Even the New York Times has pondered the possibility of making the placebo a part of everyday medicine.

Read Talbot’s The Placebo Prescription in the New York Times Magazine

The Cult of Pharmacology & Intoxication in Mythology

Richard Barnett | from NthPosition.com

Johnson’s ‘War on Poverty’, Nixon’s ‘War on Drugs’ and ‘War on Cancer’, Bush Jr’s ‘War on Terror’: the self-appointed Leaders of the Free World are fond of declaring war on abstract nouns. Each has proved to be an effective (if temporary) way of distracting public attention from the chronic policy errors at the root of the problem they claim to address, and each has been pursued with all the deluded gusto of Xerxes’ satraps hurling their spears into the Hellespont. As Ziauddin Sardar and Merryl Wyn Davies argue in Why do people hate America? (2002), the just war is a deeply influential topos in American culture. It underpins a wealth of foundation myths, from the Revolution to the Wild West, and pervades the profoundly religious structure of political thought. To wage war in this manner is to invoke the Puritan rhetoric of the Pilgrim Fathers in their redemptive crusade against the world, the flesh and the Devil. It is to declare the conflict eternal, the enemy irredeemable, the conclusion divinely ordained. One hesitates to reach for a stock Orwellian parallel, but this is war in the sense that the residents of Nineteen Eighty-Four’s Oceania understood them - without aim, without mercy, without end.

Nowhere is the yawning gap between rhetoric and reality more apparent than in the ‘War on Drugs’. This is a conflict that, as Chomsky and others have pointed out, many people have an interest in fighting, but very few have an interest in winning. At home, it provides a rationale both for the centralisation of executive and fiscal power in the hands of a profoundly anti-democratic governmental-military complex, and for the extension of official surveillance and disciplinary apparatus such as the Drug Enforcement Agency (DEA). Abroad, it enables the US to extend its military, economic and diplomatic reach, frequently under the aegis of high-profile but low-impact military missions. In 1989, as part of Operation Just Cause, US marines took Manuel Noriega out of power in Panama and into (questionably legal) US custody, all under the celebratory gaze of the world’s media. Meanwhile, cocaine shipments - ostensibly the target of the operation - continued to pour through Panama and into the US.

The result is a growing sense that the rabid attitudes expressed by government bodies and the media towards illegal drugs bear no relationship to the day-to-day realities of their use. As a headline in The Onion some years ago had it, “Drugs Win War On Drugs”. Despite their strikingly different ways of framing the question, both Richard DeGrandpre and Ernest L Abel seem to suggest that much of this confusion arises from the enforcement of a rigid distinction - central to the rhetoric of the ‘War on Drugs’ - between ‘good’, legal therapeutic agents and ‘bad’, illegal drugs of addiction.

In The cult of pharmacology DeGrandpre brings together two genres, one a distinctive product of postmodern disenchantment, the other as old as written culture. The first is the highly successful series of texts critiquing the modern, monolithic pharmacological industry, kicked off by Elizabeth Wurtzel’s Prozac nation (1994) and featuring such highlights as Jackie Laws’ Big pharma (2005) and DeGrandpre’s own Ritalin nation (1999). The second can be broadly if clumsily categorised as studies of the psychoactive effects of particular drugs. This includes both personal narratives, from De Quincey’s Confessions of an English opium eater (1821) to Burroughs’ Junky (1953), and more sober (in every sense) academic texts such as Larry Sloman’s Reefer madness: The history of marijuana (1979) and Abel’s Psychoactive drugs and sex (2003). DeGrandpre is on familiar territory here: in addition to Ritalin nation he holds a PhD in psychopharmacology, and has been a fellow of the US National Institute on Drug Abuse.

DeGrandpre’s theses are firstly, that the distinction between clinical medicines and drugs of addiction - ‘pharmacologicalism’, in his slightly clunky coinage - is a social construct rather than a physiological fact, and secondly, that this construct, rather than the ‘objective’ effects of illegal drugs or a conspiracy of Big Pharma, Big Tobacco and Big Government, is responsible for the Ballardian car-crash of modern attitudes towards drugs. Pharmacologicalism is, in his definition, the claim that drugs can be “classified as having inherent good or evil properties, independent of time, person or place” (p173). The cult of pharmacology is based around a rigorous and highly convincing structural-anthropological critique of pharmacologicalism, founded not on a binary opposition between the raw and the cooked but between inherently ‘good’ and ‘evil’ drugs. His strategy, set out in three sections of three chapters each, is to historicise the status of various drugs, ‘good’ (Ritalin, Prozac) and ‘bad’ (cocaine, heroin, tobacco), showing in each case the shifting social and cultural factors responsible for labelling particular drugs as ‘angels’ or ‘demons’.

In the first section DeGrandpre examines the history and current status of three iconic modern drugs: cocaine, tobacco and the selective serotonin reuptake inhibitor (SSRI) anti-depressants such as Prozac. In the second he takes a long view of US drugs policy over the twentieth century, tracing the parallel emergence of a legally sanctioned ‘white market’ and an equally lucrative ‘black market’. In the final section he reviews the evidence from pharmacological and sociological studies in this field. In the hands of a lesser author this subject might have been rendered dry and vague, overburdened with detail and finger-wagging in tone. Fortunately, DeGrandpre is master both of his subject and his chosen style. The cult of pharmacology is journalism in the best sense - incisive, meticulous, compelling. The text is not without faults: he has a slight tendency to repeat himself, and attributes ‘soma’ to Nineteen Eighty-Four rather than Brave New World (p 163). The structure of the book is at times confusing, and might have gained in impact if presented in simple chronological order. But these are mere quibbles. His prose is a model of clarity and elegance, his examples well-chosen and finely limned, his arguments lucid and enlightening.

Take cocaine, for example. Cocaine - particularly in the form of crack - is widely portrayed as the very model of an inherently addictive, socially corrosive, physically debilitating drug. On this basis, the US government has put intense diplomatic and economic pressure on South American states, linking financial aid programmes to the eradication of coca plant cultivation and the native habit of coca leaf chewing. But as DeGrandpre points out, if cocaine is an inherently addictive and destructive drug, how is it that rural Andean communities have been chewing coca leaves for centuries with no signs of addiction or dependence, no breakdown in traditional social structures, and no apparent ill health? (Ironically, the arrival of cheap imported American spirits has brought illness and deprivation to many of these communities). How can regular cocaine users mistake caffeine and even sugar pills for the hard stuff in clinical trials? How did an entire generation of Americans survive the 1920s while consuming prodigious quantities of coca extract in tonics, unguents, pep pills and the most successful product of a world-famous but highly litigious soft drinks manufacturer? How did Ritalin - a drug whose psychoactive effects are generally indistinguishable from those of cocaine in clinical trials, and which is rapidly acquiring high status as a party drug - become one of the most feted and widely prescribed pharmaceuticals of the twenty-first century?

DeGrandpre’s answer is that the pharmacological action of a particular drug cannot be considered in isolation from the context in which it is taken. “Drugs are animated by the ecology of the human settings they enter - psychosocial, cultural and historical - and it is in these powerful and complex settings that drug discourse and so-called drug effects emerge” (p174). These discourses - the “placebo text”, as he calls them - give form to the apparently objective clinical aspects of drug use. He cites a wealth of experimental evidence to demonstrate that neither addiction nor dependence nor the ‘high’ can be identified as consistent physiological phenomena. All are, he argues, functions of “the ritual of drug use, used in combination with a certain attitude and a certain placebo text” (p124). Even opiate withdrawal - one of the most emotionally loaded tropes in drug literature from De Quincey via Burroughs to Irvine Welsh - seems to be largely a matter of expectation and acculturation. (One further quibble: after this thoroughgoing critique of withdrawal as an objective phenomenon, it is slightly disheartening to find DeGrandpre using the term unproblematically in subsequent chapters).

But hold on. If the effects of drugs are socially constructed, subjective, all in the mind of the user, where’s the beef? Why can’t addicts just pull themselves together? To take this line is to miss the powerful sense of social responsibility at the heart of DeGrandpre’s project. As Jacques Derrida never tired of pointing out, to show that something is socially constructed is not to make it any less real or powerful. Rather, it is to expose its foundations to the most radical and searching of critiques. DeGrandpre has the intelligence and compassion to take the placebo text seriously, to trace the sources and structures of its power, and to look for ways in which this power can be redacted. The cult of pharmacology will expand the consciousness of anyone who cares to read it. It is a surprising, questing, questioning book, but most of all it is full of hope and humanity. DeGrandpre offers us the chance not to replace myth with truth (and who could honestly offer such a thing?) but to restore agency to individuals and cultures in their mythmaking.

Which brings us to Ernest Abel’s Intoxication in mythology. Abel, a Distinguished Professor (though of what he does not say) at Wayne State University in North Carolina, dedicates the book to his “personal intoxicants” - his parents, wife and children. Fortunately, this touching display of familial affection is not sentimentalised by Flanders-esque animadversions on the intoxicating power of love, life or homemade lemonade. Like DeGrandpre, Abel is scrupulous, sharp, and very good company. Intoxication in mythology marks his 30th year of publishing, both as Ernest L Abel and E Lawrence Abel, on a truly bewildering range of subjects. These include the sociology and psychology of graffiti; cultural histories of marijuana and alcohol; the aforementioned study of psychoactive drugs and sex; a collection of Confederate sheet music; and, with an admirable sense of geopolitical correctness, laymen’s guides to both Arab and Jewish genetic disorders.

As its title suggests, Intoxication in mythology is laid out as a dictionary, though Abel might have been nearer the mark had he called it an encyclopaedia. Entries are between a sentence and several pages in length, and a typical entry provides a brief description of an intoxicant or mythological figure, an outline of the rites and stories associated with it, and an account of its action in terms of current Western botanical and pharmacological thought. From this (English) reviewer’s perspective, the entries encompass both the well known - opium, alcohol, Trickster, Anansi, the denizens of the Classical pantheon - and the completely unfamiliar. The Chinese Peaches of Immortality? Pass. Kezer-Tshingis-Kaira-Khan, the Siberian counterpart to Noah? Well I never. Welsh brewing lore? Erm…

Fortunately, the text is accompanied by two appendices, covering subject categories and the geography of mythologies, a detailed bibliography and a brief but illuminating introductory essay. Abel has based his selection on two criteria: “to be included, an intoxicant had to have been mentioned in a myth… [and] had to have a connection with the supernatural; either it is considered a gift from the gods, contains their spirits, or liberates the soul so that it can communicate with the supernatural” (p3). This is reflected in Abel’s broad and permeable distinction between ‘intoxicants’ and ‘entheogens’ (a term coined in 1979 to replace the increasingly pejorative ‘hallucinogen’. Both intoxicants and entheogens produce altered mental states, but entheogens are capable of producing “not only mystical states, but also prophetic seizures, erotic passion, and artistic inspiration” (p69). Abel follows DeGrandpre in arguing that psychoactive effects are context-dependent. Alcohol, for example, may be an intoxicant or an entheogen when used in different circumstances: consider the pub and the bacchanal.

Faced with so many parallels between the cultural practices associated with, say, tobacco or opium, it is difficult to resist a spot of Golden Bough-style armchair anthropology. Like DeGrandpre, Abel addresses this point in his introduction: “There is in fact no society in the world where some kind of consciousness altering substance hasn’t been used” (p2). Both cite Andrew T Weil and Mary Bernard as suggesting a role for intoxicants in the genesis (pun intended) of mythological and religious categories of thought. Intoxicants have, Abel argues, provided the “common human experience” (p2) from which widely employed concepts such as the soul and the spirit world emerged. “Who discovered you could get milk from a cow”, Billy Connolly used to ask, “and what did he think he was doing at the time?” Abel’s point about “common human experience” raises a similar question. Who discovered that if you scraped out the soft inner bark of the Amazonian Virola vine, roasted the scrapings, ground them, sifted them, and finally hoofed the result, you could achieve a brief but consistent entheogenic experience, albeit at the cost of a very runny nose? The answer seems to lie in an inversion of the question. The exhaustive (not to say exhausting) lengths to which cultures have gone to secure these experiences reflect the powerful sense of place and meaning they provide, and the strength of the social bonds they forge.

In terms of a potential readership, the only major drawback to Intoxication in mythology is its layout. One problem with setting out this sort of information in the form of a dictionary is that the “gods, rites, intoxicants and places” associated with a particular culture are necessarily split up and scattered throughout the text. So, to return to my earlier example, references to intoxication in Mayan mythology are spread across 15 or so entries, admittedly with a rigorous system of cross-referencing and the very useful appendices and bibliography. This is fine for those who already possess a good knowledge of the subject, and for these readers - Mike Jay springs to mind here - Intoxication in mythology will surely become a standard reference work. But if, like me, your acquaintance with the subject is limited to hazy adolescent memories of the Metamorphoses and the Bacchae, hacked into prep-sized chunks, you may find yourself flicking back and forth like a schoolboy chasing dirty words in a Latin primer.

Both the peril and the charm of a book like this is its tendency to rouse the reader’s latent, lurking EL Wisty. I found myself, in an ecstasy of sorts, having to hold back from pressing (ahem) “interesting facts” on unsuspecting friends, colleagues and strangers. Did you know that the Mayans measured intoxication on a scale of rabbits - the rabbit being the least sensible creature they could think of - so that ‘15 rabbits’ denoted pleasant social tipsiness and ‘400 rabbits’ signified a state of utter oblivion? Or that the decline of mead drinking in early modern England was a consequence of the fall in demand for beeswax church candles following the Reformation? Or that… you get the picture. As any fule kno, the highest praise a bibliophile can bestow on a book is to put it on the shelf in the lavatory, alongside a broken-backed copy of Molesworth and a collected edition of MR James. Intoxication in mythology is, amongst other things, a splendid lavatory book. Armed with this, and with a paperback copy of Westwood and Simpson’s masterful The lore of the land: a guide to England’s legends (2005), you may be in there for days.

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So, yes, we need to take more seriously issues of mental health. But what does this mean, exactly? Does it mean more testing for psychiatric disorders and more psychiatric drugs? I hope not.

I have mixed feelings here because I know that viewing mental health as primarily a medical and psychiatric issue is not working. In 1999, the U.S. Surgeon General David Satcher released a report on growing problems of mental health in America. This report encouraged us to view mental problems in terms of illness and disease. To this I responded in an opinion-editorial that this is the wrong approach, noting for instance that several of the individuals involved in school shootings had been prescribed the latest psychiatric drugs.

There is some suggestion that this appears to be the case this week as well. Whether or not this proves to be true, it should be clear that leaving mental-health issues to the professionals will not protect us from the “aberrant” and “violent behavior” of a troubled 23-year-old student. We now know that Cho Seung-Hui experienced some psychiatric treatment in December 2005. That he was soon thereafter sent off to drift alone in a sea of people and peers is a fact that now haunts the lives of hundreds, perhaps thousands, of people.

A growing body of research reminds us that mental health is very much a product of our social environment, from family to society. We know, for instance, that strong ties to family and a social community buffer individuals from mental disorders, whereas a breakdown of these ties is linked closely with problems ranging from domestic violence to drug abuse to depression to schizophrenia. Some of this research has examined the plight of immigrants, who often go adrift in their adopted country. None of these immigrant studies show, incidentally, that achieving greater economic wealth improves, by itself, people’s mental health. The relationship, more often than not, goes in the other direction.

As the nation and much of the world attempts to comprehend America’s most deadly shooting rampage, we seek to learn some lessons and find some small good that might come of such horror and tragedy. I only hope that more tragedy will not come from drawing the wrong conclusion, that in listening to Rev. Jesse Jackson’s plea, we will forget his other message, that we are, whether we like it or not, all brothers and sisters in this global village.

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The good, the bad and the addictive
IHT | Richard DeGrandpre | Thursday, March 29, 2007

A new report by British researchers in The Lancet argues that alcohol and tobacco are more dangerous than some illegal drugs, including marijuana or Ecstasy.

The study, based on evidence of actual risks and harms associated with drugs, suggests that alcohol and tobacco be legally reclassified as among the top 10 most dangerous drug substances. The report follows an independent commission by the Royal Society of Arts that described Britain’s drug laws as driven by “moral panic.”

This “rational scale” for assessing harm and misuse has been hailed as a breakthrough. But the idea of reclassifying drugs legally in terms of harm is not so easy.

After all, several of the drugs that top the revised list are prescription drugs, such as barbiturates, benzodiazepines and Ritalin. Are we really to believe that users of these substances should be deemed drug abusers?

What this research really demonstrates is that the tangled idea of classifying drugs as good or evil has put society in knots.

As “patent medicines,” including cocaine and Heroin (a brand sold by Bayer pharmaceuticals), fell from grace early in the 20th century, the American Medical Association merged with the pharmaceutical industry to create a notion of “ethical” drugs. This meant in turn that psychoactive drugs expelled from the medical pharmacopeia were deemed “unethical.”

As the white market of prescription, “mind-altering” drugs developed, from benzedrine to barbiturates to benzodiazepines, a black market also emerged. This put into place a social rubric for understanding drugs based not on pharmacology, but on a drug’s social history.

By the end of the 20th century, this differential prohibition had evolved into a shameful situation in which those with access to legal medicines could become legal drug abusers while those purchasing drugs on the street were deemed criminals and incarcerated.

This was especially true in the United States.  As the opiate abuser Rush Limbaugh, the popular conservative radio talk-show host, kicked up his feet in rehab after years of railing against addicts, thousands were lying in prison after committing more or less the same acts.

The million little pieces of America’s drug problem was not to be found in rehab centers across the nation, but in the state and federal prison system.

Also woven into knots in the 20th century was the concept of addiction. Alcohol is indeed comparable in its addictiveness to heroin and cocaine, as the British study suggests, but we do not realize this because of the different lenses we wear when looking at different drugs.

These lenses are so powerful today that we do not even refer to alcohol as a drug. Nevertheless, alcohol is similar in harm to these other drugs, and this is not just because it is used by so many people.

When cocaine and morphine were used by the masses a century ago, people knew about them what we know about alcohol today: Most users do not develop addictions, although some people are more likely to develop them than are others - for developmental, personal and biological reasons.

A rational systems of drug classification is a good idea, but it must not only reclassify drugs. It must go further by tearing down the myth that some drugs are inherently good, bad, powerful or addictive.

The cult of pharmacology must be replaced, in other words, by a cult of reason, and one that emphasizes that drugs are us. What good or bad drugs do is first and foremost a social issue, not a pharmacological one, or a medical one.

– Richard DeGrandpre, a past fellow of the National Institute on Drug Abuse, is the author of a history of drugs in America, “The Cult of Pharmacology.”

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"All of you boys look at this elder. What do you think he has done? Heard this teaching this moment and grown big! All of [these men] ate the penis… and grew big! All of them can copulate with you; all of you can eat penises. If you eat them, you will grow bigger rapidly.”

Anthropologist Gilbert Herdt witnessed and translated these words, spoken by an elder of the Sambia of Papua, New Guinea to a group of boys about to be initiated into a traditional insemination practice. The practice, observed by Herdt from 1972 to 1974, consists of the ingestion of semen via fellatio ("oral sex"), and is believed by the tribe to be essential for a boy’s full masculine development. The boys are “inseminated” from the age of eight until about fifteen, at which time they become inseminators themselves until married, when they cease all such same-sex sexual practices.

Just as the Sambian infant sucked white milk from his mother’s breast to grow bigger and stronger, he is told that he must now as an older boy also suck white semen from the penises of older, pubescent boys. This belief system, rooted in the myth that repeated semen insemination is required for pregnancy and, later, for the male child to ensure full masculine development, is held throughout the group, and is in fact common historically among many Papuan tribes. Dwelling on a boy’s developmental potential is no surprise, moreover, since these are warrior cultures where fitness and courage as well as hard physical labor have been vital to their survival for hundreds, even thousands, of years.

Here, again, meaning lies at the heart of the “sexual” behavior. Because semen is understood to be a limited, vital substance for preserving the strength of the tribe, the entire village is focused on ensuring that not a drop is wasted. This even applies to intercourse between men and women, where sex for anything but procreation is considered indulgent and reckless, since it needlessly drains the man of his masculine essence. Semen insemination is not practiced on females, moreover, since it is believed that their maturation occurs naturally as the body grows. The female’s sexual essence is her menstrual blood, which symbolizes the sexual and reproductive power of women.

The practice of semen insemination, Herdt found, takes place within a larger induction process that reflects the highly gendered nature of the society. Between the age of 7 to 10, the boys are taken away from their mothers to live in a kind of men’s clubhouse in the village. There they will live for the next several years, out of the reach of women. The elders spend the first three or so years teaching the ritual secrets of the village’s men, threatening them with death if they disclose them to any women. This includes the necessary instruction for establishing the association between the penis ("oral sex"), the sacred flutes played by the adult men to influence powerful spirits, and the role of the semen in transmitting these spiritual powers into the bodies of the boys. This also includes lessons on ritual nose bleeding, a technique used by the men to remove the “pollution” they inevitably take in as adults when mixing with women to procreate. These are quite violent nose-bleeds that function as a kind of blood-letting.

Once the indoctrination process has been completed, the practice of semen insemination begins. This is done in private at a mutually agreed upon time. Putting the penis of the male in their mouth, the prepubescent boy engages in regular fellatio with a pubescent teenager who is eligible because he is physically and sexually mature. Herdt calls the latter “bachelors,” or “junior warriors.” The younger brings the older to orgasm and then swallows the sexual fluid. The “bachelor” affirms his superior position by standing, while the other acknowledges his inferior status by kneeling. Typically, according to Herdt, the young boys are initially reluctant, and many have to be told to do what the older partner demands, or in the case that no one has sought them out, to find a partner to inseminate them. Later, however, the boys accept the practice and readily initiate the meetings. Semen insemination being the reason for these sexual encounters, fellatio must always be non-reciprocal: the older males must always be fellated, and never younger males, no matter what attraction might arise between pairs.

The influence of sexual desire in this institutionalized system of “oral sex” is complicated. Herdt’s study makes it clear that, however forced and aversive the indoctrination process is initially, the practice ultimately becomes a pleasurable one for many if not most boys. As the younger males developed, they showed sexual excitement by becoming themselves aroused with erections. As they matured further and took on the role of the bachelor, becoming the receiver of fallatio, they continued to experience pleasure, albeit a mixed one, knowing that their vital fluids were being drained from them. Herdt noted, for instance, that some bachelors commented and joked with others about which boys they found especially attractive.

Once the Sambian bachelors aged beyond their teens, they entered into their first sexual relationship with an adult female partner – a partner who is preselected at the time of their birth. Sexual behavior at this first stage of marriage excludes intercourse, and the young men continue being fellated by younger males, defining a short period of ongoing bisexuality. This is followed by a second stage of marriage in which the man now cohabitates with his wife and engages in sexual intercourse for the purpose of procreating his children. The exposure of the man’s penis to a woman’s vagina means that the penis is contaminated. He must therefore cease all same-sex encounters with the boys. Interestingly, Herdt did find that some young husbands continued seeking out illicit male fellatio for a year or two – a practice that would be considered pedophilia by Western standards. Ultimately, as elders of the village, the men often reflected back on their boyhood erotic pleasures, much as seniors in the Western world look back on their own innocence of youth.

The ritual of male semen insemination is rooted in a myth with little biological validity. Still, it is true that semen is necessary for procreation, and one can imagine how, upon this realization, other beliefs involving the power of semen arose. It is also clear that the ritual, although harsh, aversive and, from a contemporary Western point of view, abusive for the boys, does have positive, self-reinforcing social effects, not the least of which is the cultivation of strong and brave men who become successful warriors in protecting their village against neighboring enemies. Indeed, sexual acts that have been deemed immoral and damaging to modern society and institutions such as marriage – namely, homosexuality, oral sex, pederasty – are deemed here to be of absolute necessity. The survival of the ritual, not to mention the continued survival of the village, shows these sexual practices to be historically constructive. This is not a popular conclusion, of course, which accounts for why earlier investigators of Papuan groups, dating at least as far back as the 1930s, kept hush about them.

The nature of the same-sex practices of the Sambia differ from those in ancient Athens, since the two set of practices have quite different cultural origins and cultural functions. This notwithstanding, the example of the Sambia reinforces the same point as the Greeks regarding the geography of desire: sexual desire is less a product of individual inclination than it is of cultural norms. Certain same-sex relations were accepted and expected among the men (including teens) in both these cultures, with most men engaging in behavior that by contemporary definitions is bi-sexual. Thus, even if the path of any one individual’s sexual desire cannot be easily predicted, explained, or controlled by society, as highlighted by the example of pedophilia, the general pattern of people’s sexual desires are clearly open to societal pressures. For better or worse, by constructing meaning via soft or hard socialization practices, culture organizes sexual desire.

* * *

When Portuguese explorer Pedro de Magalhales de Gandavo traveled in northwest Brazil in 1576, he discovered a fierce group of warriors among the Tupinamba Indians. They would not have seemed terribly noteworthy except for one important characteristic: they were women. As he later wrote, “there are some Indian women who determine to remain chaste: these have no commerce with men in any manner, nor would they consent to it even if refusal meant death… They wear the hair cut in the same way as men, and go to war with bows and arrows and pursue game ... each has a women to server her, to whom she says she is married, and they treat each other and speak with each other as man and wife.” It is said that de Gandavo named the nearby river the “Amazon” because the female warriors reminded him of the Amazon women of Greek mythology.

A similar and older story concerns the Spanish conquistador and explorer Francisco de Orellana. In December 1541, at what is known today as the Napo River, Orellana’s ship was separated from the main body. In a most improbable voyage, Orellana sailed the length of the Amazon River, arriving at its mouth in August 1542. When he returned from his exploration, he reported an unusual encounter: a race of courageous women warriors. According to Orellana’s account, these women mated with males captured from neighboring tribes, killed and drank the blood of the male offspring, and reared the female offspring in their own image.

These accounts have been viewed historically as far-fetched. As noted in a report in Time magazine in 1971, however, evidence of the women warriors surfaced four centuries later, found by Jesco von Puttkamer. A German ethnologist and photographer, von Puttkamer was studying the Galeras Indians, a primitive people who live deep in the rain forests in Brazil’s Rondonia territory. Like Herdt in New Guinea, he befriended the tribesmen and learned their language. Subsequently they led him to three secret caves with mysterious markings on the walls. Struck by their potential significance, von Puttkamer sought help from anthropologist Altair Sales. Sales explored the caverns and probed what knowledge the Indians had, ultimately emerging from the jungle with a dramatic conclusion: the caves were inhabited long ago by warrior women similar or the same as those described by Francisco de Orellana.

Studying the cave illustrations, Sales identified the recurring theme of a triangle marked by a deep cut running from one apex into the center. Sales interpreted the triangle as a symbol for the female, noting that the same symbol had been observed on the jewelry of the Amazons by Father Caspar de Carvajal, a chronicler of Orellana’s expedition. Seeing that one of the cave triangles has a smaller triangle carved inside it, Sales speculated that it represented pregnancy, while another triangle with two stripes symbolized a tribal leader. Others triangles were positioned side by side, suggesting the “lesbian” relationships described by de Gandavo. Based in this and various other evidence, the Time report noted, Sales concluded that there may have once been many feminist tribes roaming through the Brazilian jungles.

In actual fact, despite the skepticism with which these stories of woman warriors have been treated, Sales’ conclusion is consistent with a vast amount of evidence concerning tribes in the Americas before and after Columbus. This evidence suggests that the “cross-gender” phenomenon demonstrated by the warrior women in the Amazon was even more common among men.

The Papago people of the American southwest, for example, believed that children experience dreams derived from the supernatural realm that then guide their gender development. Like many other North American tribes, the Papago viewed development as reflecting a spiritual path, and one that was not to be meddled with. The anthropologist Ruth Underhill studied the Papago as late as the 1930s, and described an interesting test that today would be viewed as a kind of psychiatric assessment. Sometimes a boy would be suspected by his mother as having a feminine spirit. When such a suspicion arose, the mother tested the child’s tendencies by placing a bow and arrows as well as a women’s basket in some bushes. After telling the child to go into the bushes, they would be set fire. If the child ran out with the basket, the suspicious was confirmed: his spirit had crossed over to the wrong side of meaning. Or had it? Unlike today’s psychiatric assessment, this confirmation did not lead to the pathologizing of the child. To the contrary, the boy was usually deemed a special person and subsequently accepted either as a female or as a member of a third gender.

When French explorers and missionaries discovered such individuals in the mid-eighteenth century they labeled them “berdache.” This is a french term for male homosexual, and it has since become the historical term to describe cross-gendered individuals in North American tribes. The understanding of the berdache among the tribes is, as in the semen-insemination example of the Sambia, governed by a larger, cosmological framework. The Navajo, for example, embrace a creation ("Adam and Eve") myth in which the first man and women are said to have lived a miserable life until they were taught the skills of farming, pottery, etc, by two twins, Turquoise Boy and White Shell Girl. According to myth, the twins are the first two berdaches, or what the Navajo called nadle, meaning “the one who is transformed.”

The berdache were usually men who dressed as women and took up female roles, sometimes becoming respected for their exception skills in crafts such as weaving and pottery. Sometimes they took on special roles, however, such as the group’s shaman (medicine man). Berdache were also sometimes women who dressed as men and engaged in what were otherwise exclusively masculine pursuits. The Mohave Indians, for instance, called berdache women “hwame.” As girls, the female berdache usually played boy’s games, and, like the Papago, were required to pass a ritual test. Once passed, they were assigned masculine name, male clothing, and were taught the warrior and hunting skills of the other boys. Like the women warriors encountered by de Gandavo in northwest Brazil in the sixteenth century, these females, when old enough, were expected to marry a woman. If the latter had a child from a deceased husband, the child would be adopted by the berdache as her own.

More often the berdache were men who took on a female identity, however, as Underhill reported concerning the Papago. Contrary to earlier accounts of women warriors, the Europeans who first came across male berdache were not impressed. The individuals were labeled “sodomites dedicated to nefarious practices” who had “abandoned themselves to the most infamous passions,” writes Francis Mark Mondimore in A Natural History of Homosexuality (p. 11). Even more disturbing to early missionaries and explorers was the fact that the tribes had allowed these sexual deviants to take up respected roles within their society.

Needless to say, the early European understanding of the berdache was distorted by a certain prejudice. The berdache were not in fact the equivalent of their persecuted “sodomites” back home. For instance, men who had sexual relations with a male berdache were not viewed within the tribe as having same-sex relations; the meaning of sexuality was as normal and accepted as were standard male-female relations. The spirit interpretation was felt deeply enough, in other words, that these cross-gendered individuals were simply not viewed as men. It is thus equally wrong to view these tribes as being sexually permissive. At least in some tribes, sexual relations between one berdache and another were viewed as perverse and incestuous. Still, there are always exceptions. In some tribes, male berdache engaged in bi-sexual relations, whereas others were sometimes celibate or sometimes strictly heterosexual.

The homosexual habits of the berdache might appear on the surface to be similar to the Sambia of Papua, New Guinea. In each example there is widespread acceptance of same-sex desire, although there were also rules that constrained sexual behavior. If homosexual desire is viewed as a perfectly normal expression of human sexual desire, neither account, nor the account of the ancient Greeks, should be viewed as radical or surprising.

Significant differences also exist, however. In the case of the berdache, gender and sexual preference are uncommon and arise in a unpredictable fashion. In the example of the Sambian boys, by contrast, such preferences could be predicted based on institutional norms. The berdache example thus reinforces the view that the pathways of sexual desires for a specific individual cannot be easily predicted or controlled. The Sambia example does not contradict this, but reinforces the other side of the equation, that the general pattern of a society’s sexual desires are shaped by the sexual norms of the larger culture.

Constructing, reinforcing, and institutionalizing meaning, culture organizes and institutionalized certain sexual desires, whether it is the same-sex desire of the berdache, of the Sambian boys, or the ancient Greeks.

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The latter findings involving Paxil (Seroxat in the UK) are hardly the first of their kind, but they are noteworthy for what they revealed – namely, a concerted and sophisticated effort on the part of Glaxo to pervert the regulatory process. Data from clinical trials showing unfavorable results were either buried or edited; “independent” ghostwriters were employed to conceal the company’s “spin” in journal articles; and only those researchers producing positive results were rewarded with generous, new contracts.

Nor are the charges involving the SSRIs specific to Glaxo. As reported in 2003 by Sarah Boseley of The Guardian, JAMA published data from two trials supporting the pediatric use of Pfizer’s SSRI antidepressant sertraline (Lustral, Zoloft). In actual fact, 17 children left the trial because of side effects (compared to five taking placebo) – a rate that is unacceptable given that only 10 percent more children improved on the drug than on placebo. The lead author of the study was, oddly enough, also among the authors of studies supporting the pediatric use of Glaxo’s Paxil. When British regulators reexamined these data, they concluded that a number of children had become suicidal on the drug.

The industry defends its billions of dollars in profits, meanwhile, stressing that it is the “engine of innovation.” Perhaps it is, but it is worrying to find that this innovation seems directed less at the creation of new and more effective therapies and more toward litigation, advertising, and data engineering. Some have suggested that civil lawsuits are viewed inside the industry as “the cost of doing business,” but you cannot disregard human life and expect to sustain public confidence for long. As a Harris Poll in 2004 showed, fewer than 1 in 7 Americans now believes the pharmaceutical industry to be “generally honest and trustworthy.”

If this is the same path the tobacco industry broke decades ago, as appears to be the case, then this is especially worrying. Even some industry executives have acknowledged that there are problems. An executive at drug maker Roche openly said in 2004 that the industry exaggerates the prevalence of psychiatric disorders to increase profits. A year earlier a vice president at Glaxo admitted, “our drugs do not work on most patients.”

It might appear to be a contradiction to suggest that medicines can be a direct cause of illness and death, yet not be effective in most patients. In fact, there is no contradiction. The creation of the Food and Drug Administration in 1906 and the passage of the Food, Drug, and Cosmetic Act of 1938 were motivated by this very scenario, where a patent medicine was found to have powerful effects on the body, but was not very powerful in doing what it was claimed to do. While a variety of the patent medicines had little hope of ever working as advertised, except as placebos, moreover, their active ingredients posed an immediate hazard to the public health.

Consider one physician’s experience, from 1937: “To realize that six human beings, all of them my patients, one of them my best friend, are dead because they took medicine that I prescribed for them innocently, and to realize that that medicine which I had used [was] recommended by a great and reputable pharmaceutical firm..., that realization has given me such days and nights of mental and spiritual agony as I did not believe a human being could undergo and survive.”

The medicine prescribed was Elixir Sulfanilamide. Sulfanilamide had been used safely and effectively in tablet and powder form to treat streptococcal infections. After a salesman suggested a demand existed for the drug in liquid form, the company – S. E. Massengill – formulated a mixture in diethylene glycol (antifreeze). After testing it for flavor, appearance, and fragrance, the company distributed its raspberry and caramel flavored-medicine throughout the country. Within a few months the drug, said to be “entirely suitable for children,” was responsible for the painful and protracted deaths of at least 34 of them, and twice as many adults.

Within a year new drug regulations were signed into law by President Roosevelt. Thirty-two years after the creation of the FDA, the Food, Drug, and Cosmetic Act finally established regulations requiring safety tests be conducted for new drug products. The FDA had become the regulatory watchdog America needed to safeguard the public health.

The social history of drug regulations is a useful reminder of where we are headed without effective government oversight. Indeed, there is already evidence of a significant backward trend: In 1998, Britain’s leading medical journal The Lancet published a report showing that adverse reactions to drugs “properly prescribed and administered” had become the fourth leading cause of death (accounting annually for 100,000 hospital deaths in the US). This finding was echoed four years later in a JAMA report by five physicians from Harvard Medical School.

It is true that drug companies are often under enormous pressure to secure their profits from one or two drugs that might generate billions of dollars in sales, and that this pressure encourages abuse. Because the FDA has not held steady in applying equal, opposing pressure, however, this abuse appears to have grown out of control.

The latest changes being proposed at the FDA, to ensure that marketed drugs are as safe as advertised, for example, and to assess new drugs 18 months after their introduction, are not enough. The Institute of Medicine’s damning report of the FDA, in 2006, suggested it give officials who assess existing drugs more authority to act. The FDA declined. As Senator Charles Grassley has noted, the agency is simply too “cozy” with drug makers to fix itself. If external pressures are not put on the FDA, we can expect more stories the likes of Vioxx, Prempro, and Paxil.

So what ever happened to the S. E. Massengill Company? Well, Samual Evans Massengill never apologized. Presenting the bold face that would later be worn by the executives of Big Pharma, the company hid behind the claim that thorough and complete clinical tests had been done. “My chemists and I deeply regret the fatal results, but there was no error in the manufacture of the product. We have been supplying a legitimate professional demand and not once could have foreseen the unlooked-for results. I do not feel there was any responsibility on our part.” A $26,000 fine was paid, for mislabeling their medicine an elixir when it contained no alcohol, and S. E. Massengill Company carried on diong business. In 1971 they were acquired by what is now GlaxoSmithKline.

Richard DeGrandpre is an independent scholar of psychiatric medicine. His new book is The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture

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