Review: “How to Fix a Drug Scandal”

Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University. He reviews the Netflix series How to Fix a Drug Scandal, a mini-series released earlier this year. We also wanted to point out an article from The Conversation, a site that, like Points, offers academic insights on contemporary and historical events. Did you know that the Mother’s Day flowers you might have bought last Sunday are potentially tied to the US war on drugs? You can read more about that here

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How to Fix a Drug Scandal is a four-part docuseries directed by Erin Lee Carr streaming on Netflix. The scandal centers on two chemists: Annie Dookhan and Sonja Farak who were employed by the state of Massachusetts to perform chemical analysis on drugs in criminal cases, verifying their authenticity. The two pursued their crimes quite differently. Dookhan was good at falsifying reports. She did it through so-called “dry labbing” or visual testing: say police sent an evidence bag filled with a white powder to her office. Maybe the substance was table salt or maybe it was cocaine. If it was table salt rather than cocaine and you were the defendant in the case, you definitely didn’t want the evidence to be analyzed by Dookhan because the drug certificate submitted was going to say cocaine. Was there a specific reason Dookhan did this? Not really. We know she didn’t care about accuracy or the real-world effect of her actions, which had devastating effects on the lives of individuals and their families. 

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Public Relations Language Disguises How Drug Discourse Today Is More Successful – and More Sinister – Than Anything Harry Anslinger Could Concoct In His Wildest Dreams

Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University. 

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If you’ve followed the opioid issue, you might suspect, based on media reports and statements from policymakers, that we have turned over a new leaf in our attitudes toward drugs and are finally moving in the right direction: today we are “expanding treatment” and abandoning the former “punitive” morality play model. Elite discourse reinforces the perception that we have become more sophisticated, science-based and compassionate to users and those with substance use disorders. 

That’s only partially true, but not because powerful institutional actors experienced a change of heart; they had to be dragged kicking and screaming into embracing, if only rhetorically, this new model. If anything, grassroots activists, harm reductionists, health workers and criminal justice advocates on the front lines have waged tireless, and at times seemingly thankless, campaigns to reform our draconian laws, and they have succeeded. (Prime examples of these successes include legalizing cannabis, decriminalizing psilocybin in Denver, and expunging criminal records for marijuana arrests in some states.) Activists also shifted the conversation away from the dehumanizing language used to describe people who use drugs among press and policymakers (“junkie,” “addict,” etc), a language that enabled us to conceive of other people as less than human, making it easy on our collective conscience to confine them to cages. Even now, further incremental baby steps are met with the same hostilities and recitations of the parade of horribles that would be unleashed as they used before. 

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Self-Help Isn’t The Solution; It’s The Problem

Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University. 

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The sober curious movement (or “new sobriety”—the branding comes in a variety of flavors) is less a coherent philosophy or sound medical advice and more of a marketing campaign, hawking self-help merchandise and thousand-dollar yoga retreats, along with run-of-the-mill solipsism. It is an online phenomenon, fluent in the language of Instagram, elevated by media-types who share similar well-to-do backgrounds and sensibilities. It is hash-taggable psychobabble meant to solve cosmopolitan ennui and stay-at-home malaise. Its fans are not only upper class but also ultra-fit, photogenic 30-and-40-somethings ready-made for television. 

Scratching the surface, you discover that the day-to-day problems of sobriety-curious enthusiasts aren’t what most of us would classify as problems. And as for solutions, it features primarily simple adjustments like not carrying into adulthood the same level of alcohol consumption you did as an undergraduate. I can’t imagine the people quoted in these stories as real; they are much closer to Arrested Development or Schitt’s Creek characters. Even that comparison might be generous. 

A reporter comparing “mindful drinking” (lots of terms for the same thing) to AA’s anonymity found, “No longer is the topic of sobriety confined to discreet meetings in church halls over Styrofoam cups of lukewarm Maxwell House. For these New Abstainers, sobriety is a thing to be, yes, toasted over $15 artisanal mocktails at alcohol-free nights at chic bars around the country, or at “sober-curious” yoga retreats, or early-morning dance parties for those with no need to sleep off the previous night’s bender.”

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Points Bookshelf: “Dignity,” by Chris Arnade

Editor’s Note:  Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University. As part of our Points Bookshelf series, he reviews Dignity: Seeking Respect in Back Row America (Sentinel, 2019). 

Screenshot 2019-11-14 at 8.36.59 AMChris Arnade was an unlikely candidate to write Dignity, an intimate portrait of the ignored communities dotting America’s landscape. His professional adulthood has leapfrogged from elite institution to elite institution: first, getting a Ph.D. in physics from John Hopkins University, then planting himself in Wall Street, at the nexus of wealth and power, working as an early “quant” (a trader)—popularized on-screen in films like The Big Short—for the next several decades.

Tired of staring at screens, reducing complexity down to data points, he expanded his routine walks around safe New York neighborhoods into those considered dangerous, beginning with Hunts Point in the Bronx. Arnade assumed he would find, as numerous colleagues suggested, violence, crime, and prostitution. What he did not expect was to be welcomed. A curiosity at first, Arnade, a white guy carrying a camera, lessened concerns when asked what he was doing there by saying that he was hanging out and taking photos. People wanted him to snap their picture, while others wanted a chance to tell their life stories. Surprised, he discovered self-sustaining tight-knit communities which produced vibrant street art, as well as places filled with fascinating people, like the man he met who worked with pigeons. 

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Points Bookshelf: “Bottle of Lies” by Katherine Eban

Editor’s Note:  Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University. As part of our Points Bookshelf series, he reviews Bottle of Lies: The Inside Story of the Generic Drug Boom (Ecco, 2019). 

Screenshot 2019-08-07 at 4.49.07 PMKatherine Eban previews Bottle of Lies: The Inside Story of the Generic Drug Boom with shocking statistics on the state of pharmaceuticals: “Roughly 40 percent of our generic drugs are manufactured in India. A full 80 percent of the active ingredients in all our drugs, whether brand-name or generic, are made in India and China.” China is the sole source for many of America’s essential medicines, including those used in anesthesia and the treatment of cancer and HIV/AIDS. It is the world’s only source for antibiotics. One drug importer explained to her that “without products from overseas, not a single drug could be made.” 

Bottle of Lies’s popularity and positive press stems from Eban asking what appears, at first blush, to be a naïve set of questions: What are generic drugs? How are they made? Where are they made? And what are the consequences? If you surveyed the American people’s knowledge of what a generic drug is, they would probably say something to the effect of “generic drugs are the cheaper version of the name-brand.” “Patients” Eban writes, “tend to assume that their generic drugs are identical to brand-name drugs in part because they imagine a simple and amicable process: as a patent expires, the brand-name company turns over its recipe, and a generic company makes the same drug, but at a fraction of the cost.”

It doesn’t happen this way. Instead companies, “erect a fortress of patents around their drugs, sometimes patenting each manufacturing step—even the time-release mechanism, if there is one. At any point, they can tweak a drug “declare it new, to add years to their patents, a move known as ‘evergreening.’” Whatever generics hit the market, they arrived there “not with help from brand-name drug companies, but in spite of their efforts to stop them.”

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Points Bookshelf: “The Age of Addiction” by David Courtwright

Editor’s Note: It’s David Courtwright week on Points! Today we feature a review by contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University, of Courtwright’s most recent book, The Age of Addiction (Harvard University Press, 2019). We’ll follow Hudson’s review with an interview with Courtwright on Thursday. Enjoy!

Screenshot 2019-07-16 08.40.48In Age of Addiction, the acclaimed historian David Courtwright dips his toes into familiar waters, analyzing the history of the brain reward mechanism through its component parts: pleasure, vice, and addiction. The book expands on earlier attempts, such as John Burnham’s Bad Habits, which investigated America’s evolving attitudes on everything from alcohol and drugs to gambling, swearing, and sex. Building off and updating Burnham, Courtwright injects fresh blood into the discussion, mapping the newest additions to our pleasure palettes. Courtwright catalogs sugary sweets formulated by Nestlé and Kraft, delineates digital subcultures such as the frenzied World of Warcraft, and documents young men’s sexual fetishes—with Pornhub substituting as both sex education and a how-to manual—while still leaving room for gambling, an ever-changing issue as states embrace sports betting following last year’s Murphy v. NCAA decision. Courtwright draws our attentions to the vast “pleasure meccas” erected of late, updating parts of his previous book Dark Paradise (Harvard University Press, 1982) as opioids have returned to the headlines too.   

Let me invite the skeptical reader to ask the obvious question: hasn’t this always been the case? Courtwright would agree, but with a caveat. To conclude “more of the same” ignores three critical distinctions. First, the rate “hedonic change” has accelerated, Courtwright likening it to the rapid pace of technological change, following its own “Moore’s Law of brain reward” (164). (Moore’s law, first delineated in 1965, predicted that the speed and capability of computers would double every two years due to advancements in the number of components per integrated circuit; in the past half-century, this has proven to be untrue: computer speed now doubles much more rapidly.)

Second, pleasure and vice are more diverse and ubiquitous, appealing to specific subsets of the population. Third, and most significantly, pleasure and vices are meticulously engineered by companies with billion-dollar marketing and advertising budgets. In effect, this means that Big Pharma, Silicon Valley and the food industry have grown much more efficient at weaponizing our weaknesses against us, and reaping the profitable rewards. This asymmetry means companies are able cater and concoct an ever-widening array of products and pleasures, while conveniently sidestepping externalities and effects on global health. Whereas earlier eras met vice with reluctance, if not with outright resistance, today the tendency is on an opposite trajectory: vice is both normalized and accepted. 

 

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David Courtwright

The Age of Addiction hones in on the brain reward system’s “big bang” moment, tracing it back to the agricultural revolution. What characterized pleasure, vice and addiction then was limited. People dabbled with local food-drugs but had little else at their disposal. Pleasure was in its infancy. Gambling, for instance, consisted of improvised devices: “sticks, shells, fruit pits,” and the occasional animal bone. Questions of accessibility or affordability were not yet part of the vocabulary. From the agricultural revolution on, the story follows a familiar trajectory: the invention of new technology, innovative forms of transportation, and specialized knowledge that built up networks for global trade, transforming rickety ship with a few luxury goods into colossal container ships packed with the inexpensive goodies we all enjoy today. 

The second half of the book deals with changes over the last hundred years or so. In the late nineteenth and early twentieth centuries pleasure, vice and addiction seeped into urban areas, leaving few places or people untouched by their influence. In response, anti-vice reformers rallied and challenged vice’s legitimacy and sought to ban or suppress commodities like narcotics and alcohol and activities like prostitution and gambling. Reformers, as Courtwright sees it, have been unfairly maligned and should be given a second hearing, or at least some credit for enacting regulatory measures that curbed use and resulted in improvements to public health. He argues that we should not separate some reform measures and label them “progressive” (among them, sewage and water infrastructure and vaccination efforts) from their other attempts to eliminate vice. In practice the desires that propelled one propelled the other activities as well, all with the aim of improving public health and safety. Yet the gains made by anti-vice reformers were partial. They failed, as Courtwright documents, for multiple reasons: from internal divisions, corporate resistance and government ambivalence on the one hand, and from their desire to raise revenue on the other. 

Neoliberalism was in its ascendancy by the late twentieth century. It brought with it a new figure, the “vice entrepreneur” who pushed and profited from packaged delights. Courtwright coins the term “limbic capitalism,” described as “a technologically advanced but socially regressive business system in which global industries, often with the help of complicit governments and criminal organizations, encourage excessive consumption and addiction.” Limbic capitalism refined the art of exploiting brain reward and weaponizing it against consumers, perhaps best captured by the Pringles slogan: “Once you pop, the fun don’t stop.” This corporate slogan distills the limbic capitalisms formula: hook customers, encourage them to indulge, rinse and repeat—or, in short, reap the rewards and ignore responsibility for subsequent externalities. Limbic capitalism continues as a force to be reckoned with. It has aided overeating, led to distracted driving, compulsive porn consumption, and other ills. And all of it was intentionally constructed to be this way, causing some of the biggest public health problems globally, according to Courtwright. 

“Limbic capitalism” differs from capitalism through its route of administration: brain reward and its repetition. But is limbic capitalism more predatory or detrimental to public health than the routine behavior of say, Big Pharma or the climate catastrophe wrought by the fossil fuel industry? And does that matter? These are some questions that lingered. One feature that works in limbic capitalism’s favor it is that it is easy to understand, meaning there is less asymmetry of information—risk, for instance—when buying cigarettes or alcohol than in other transactions, like purchasing health insurance, signing financial contracts, or whatever it is we are agreeing to when we hit the “agree” button after every iPhone update. The book’s last line recommends that “we should be against excess,” which, in general, is sensible. But as a concrete matter, policy implications and what limiting excesses means in practice—preference for punitive or health-oriented approaches—also matters but gets less attention. Courtwright offers solutions: government regulation, restrictions on advertising, targeted taxation, and education campaigns. All of these could be good, depending on a lot of other things. 

Like any book, Age of Addiction has shortcomings, many of which might be exposed by the authors and thinkers he cites. Critics of the brain disease model will be disappointed there is not a full airing of arguments made against it, such as Marc Lewis’s The Biology of Desire. Stanton Peele, mentioned twice, will likely continue to have his reservations about this book over exposure and accessibility. This same could be said for Bruce Alexander, whose book The Globalization of Addiction disagrees with Courtwright when Courtwright argues that exposure is a driving force for addiction — Alexander’s other writings suggest that exposure is a secondary or tertiary concern.

Courtwright also perhaps missed an opportunity in his exploration of vice, a very elastic category, limiting it only to individuals and excluding corporate persons. Vice is defined as “bad for the individual, bad for other people, bad for the social order, or some combination of the three” (emphasis mine). Vice looked at through the lens of greed would have been an edifying avenue for him to pursue: patients rationing insulin, some dying; the “public health” consequence of things like the EpiPen, a drug that sells for several hundred of dollars while its active ingredients cost pennies. This could have played to Courtwright’s advantage, given that he uses the idea of “nudges.” Everyone can get behind Courtwright’s goal, which ultimately is about improving public health, but if public health continues to be mostly privatized, preventing people from accessing essential services—mental health services, medication, and the rest—many of the issues discussed will unfortunately remain unresolved. 

 

Points Bookshelf: “Ten Drugs” by Thomas Hager

Editor’s Note:  Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University. As part of our Points Bookshelf series, he reviews Ten Drugs: How Plants, Powders, and Pills Have Shaped the History of Medicine (Abrams Press, 2019), and breaks his findings down into a few major takeaways.

 

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Drug policy historians, academics and the press more generally often present drug use as though it were a marginal activity. We can fault a lot of this confusion on the arbitrary distinctions that are commonly made, starting with categories like legal and illegal use, which are then further subdivided and sliced into even more granular classifications.

Thomas Hager’s Ten Drugs whose focus is on prescription “medications,” opens the book by highlighting drugs’ ubiquity in American life: “More than half of all Americans take at least one prescription drug on a regular basis, and most of those who fall into that group take more than one (somewhere between four and twelve prescriptions per person per year, depending on which study you look at). One expert estimates that Americans takes an average of ten pills per person per day. Add in nonprescription drugs—over-the-counter vitamins, cold and flu remedies, aspirin, and other supplements—and run the numbers: Let’s say a low-ball estimate of two pills per day per American over an average of seventy-eight plus years of life. The total outcome comes to somewhere more than 50,000 pills, on average, in the average American’s lifetime. And there’s a good chance it’s a lot more. Americans constitute less than 5 percent of the world’s population but spend more than 50 percent of the money that flows into the world’s drug companies. And that’s not even counting illegal drugs.”

Once you throw in recreational and illegal drugs, this leaves no segment of society untouched. These figures could be interpreted as troubling, as our society grows ever reliant on psychological crutches to get through the day. Of course, while that’s partially true, there are also serious issues that have been left unresolved, to say nothing of the precarious state millions wake up to. Setting that aside, the larger point is our discourse is divorced from this underlying reality.  

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