Medical waste offers insights into South Africa’s use of pharmaceuticals

Editor’s Note: Today is the last piece in our six-part series of articles discussing drug use in Africa. These articles originally appeared on The Conversation, but we’re republishing them here as well. Today’s article comes from Rebecca Hodes, Director, AIDS and Society Research Unit, University of Cape Town. 

Much of what we know about human history comes from studying things that have been discarded. The archaeology of dumpsites and middens has long informed us about societies and their pasts. This has included how people survived and sustained themselves, what they gathered, made, amassed and discarded.

Histories of rubbish have also shown that beliefs about sanitation, and what makes for a clean environment, change. These changes are, in turn, influenced by developments in technology, forms of governance, and consumer norms.

I conducted a study on an archive of medical materials, collected over three years from public waste sites around South Africa’s Eastern Cape. What I refer to as ‘pharmatrash’ serves as a proxy for which medicines were provided or purchased, consumed, and then discarded. Pharmatrash in post-Apartheid South Africa shows the vast proliferation of medical waste, the result of increased access to healthcare products in both the public and private sectors – and on the formal and informal markets.

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The story of the pharma giant and the African yam

Editor’s Note: Over the next few weeks, we’re going to feature a series of articles discussing drug use in Africa. These articles originally appeared on The Conversation, but we’re republishing them here as well. Today’s article comes from William Beinart, professor at the University of Oxford. 

It was a drug produced in Nottingham in the United Kingdom that led us on a journey to South Africa to visit muthi markets, archives, herbariums and nature reserves.

We spoke with traders, healers, scholars and conservationists to learn more about Dioscorea sylvatica.

Dioscorea is a wild yam. Its name in different languages connects to its appearance – its rough skin resembles a tortoise shell. It’s known as ‘Elephant’s Foot’ in English, in isiZulu ‘ingwevu’, meaning grey/old or ‘ifudu’, meaning tortoise; in Sepedi the name is ‘Kgato’ – ‘to stamp’.

In the 1950s, the yam was heavily exploited by the British pharmaceutical firm Boots for the production of cortisone. But provincial conservation officials in South Africa fought back against the plundering of a wild plant that they recognised was in danger of being exploited to extinction.

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A history of how sedatives took hold in white South Africa

Editor’s Note: Over the next few weeks, we’re going to feature a series of articles discussing drug use in Africa. These articles originally appeared on The Conversation, but we’re republishing them here as well. Today’s article comes from Julie Parle, Honorary Professor in History, University of KwaZulu-Natal.

In the early 1960s, pharmacists and government authorities were of the view that South Africa had experienced key aspects of a ‘pharmaceutical revolution’ over the course of the previous 40 years.

These were fulcrum decades in South African medicines’ history in which newly invented medicines became critically important. Most of the new therapeutic substances in high demand were antibiotics. But the class of drugs comprising synthetic hypnotics, sedatives and tranquillisers were also important.

As early as the 1930s these substances – especially barbiturates – posed challenges to those who sought their control. Enmeshed in multiple issues of chemical, commercial, professional, and regulatory definition, timid controls were proposed in 1937. But even these failed to gain support, facilitating a permissive market for those who could afford the new drugs. These were, by and large, white South Africans.

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“Beyond the Medicines/Drugs Dichotomy: Historical Perspectives on Good and Evil in Pharmacy in Johannesburg, South Africa (5-7 December 2019) – Conference Report

Editor’s Note: Today’s post comes from contributing editor Dr. David A. Guba, Jr., of Bard Early College in Baltimore and Jamie Banks of the University of Leicester.

Twenty-one delegates from ten countries gathered in Johannesburg, South Africa from 5 to 7 December for the “Beyond the Medicines/Drug Dichotomy: Historical Perspectives on Good and Evil in Pharmacy” conference. Masterfully organized by Thembisa Waetjen (University of Johannesburg) and co-sponsored by the Alcohol and Drugs History Society (ADHS), the Wellcome Trust, the University of Johannesburg, and the University of Strathclyde’s Centre for the Social History of Health and Healthcare (CSHHH), the conference was held at the stunning facilities of the South Gauteng Branch of the Pharmaceutical Society of South Africa. The event also marked the latest step forward for the “Changing Minds: Psychoactive Substances in African and Asian History” project under the direction of Jim Mills (University of Strathclyde), which works to connect scholars of drugs and alcohol history in China, Africa, the UK, and beyond.

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CFP: Beyond the Medicines/Drugs Dichotomy: Historical Perspectives on Good and Evil in Pharmacy

Editor’s Note: You know you’ve always wanted to visit South Africa. Here’s your chance! Check out this CFP for an exciting conference at the University of Johannesburg this December.

Beyond the Medicines/Drugs Dichotomy: Historical Perspectives on Good and Evil in Pharmacy 

University of Johannesburg
5-7 December 2019

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The dichotomy between pharmacologically-active substances considered legitimate (and therefore worthy of regulation as medicines, and also provided as public goods) and those considered problematic (and therefore deserving of moral and legal opprobrium, prohibition and sanction) has informed global regulatory regimes for decades.  (Andy Gray, 2017)

Drug policies and ways of thinking and talking about substances and treatment approaches are changing fast, both at national and international levels. These changes reflect a growing acknowledgement of core contradictions within the legislative regimes Gray described above, crafted respectively for ‘drugs’ and ‘medicines’ from the nineteenth-century onwards. Subversions of this dichotomy have lately become more apparent in the public eye – for example, in widespread addiction to opioid painkillers; in the repurposing of pharmaceuticals for pleasure, sedation or sociability; in the scientific legitimation of previously restricted drug alkaloids for medical application. Increasing criticism of ‘war-on-drugs’ style governance, the liberalisation of cannabis laws, and the advocacy of harm reduction approaches to drug treatment are among the indications of shifting views even within governments themselves.

The organizers of this event argue that precise historical understandings of how this dichotomy has worked in practice, in multiple and very different contexts, are necessary in order to map possible alternatives and futures. To clearly identify who established and maintained classificatory boundaries, what interests lay behind their actions, how they have been challenged, and why it is only now that faith in them seems to be waning are important tasks for historians of health, medicines and modernities, and those working in related fields and disciplines.

This event at the University of Johannesburg aims to draw together those addressing the questions below in their research. We invite submissions from postgraduates, together with emerging and established scholars, and are keen to include studies from around the world, as well as those that look at international or transnational contexts.

Guiding questions:

  • What knowledge was generated to justify distinctions between medicines/drugs? By whom? How were decisions made about what evidence could be considered authoritative?
  • Which groups and/or disciplines were involved in establishing or challenging the emergence of this dichotomy and what determined their success or failure?
  • How have histories of various substances been created and deployed in justifying or disputing this dichotomy?
  • What values have driven pharmaceutical technologies and their regulation? How have ideas about ‘good’ and ‘evil’ framed scientific and political discussions?
  • How long has a shift towards a neuro-chemical society been happening and with what effects? Has it necessarily been a dehumanising process?
  • Have chronologies of commodification, lawmaking and enforcement followed similar routes in different countries or contexts?
  • How do historians recover neuro-chemical biographies, and what do these reveal about individual or collective experiences of the medicines/drugs dichotomy in practice?

The event is funded by the Wellcome Trust and is jointly organised by the Department of History at the University of Johannesburg and The Centre for the Social History of Health and Healthcare (CSHHH) Glasgow through the ‘Changing Minds: Psychoactive Substances in African and Asian History’ project.

The event will take place from 5 to 7 December 2019 at the University of Johannesburg.

Call for Papers
Please submit a title, an abstract of no more than 200 words which addresses some of the above questions, along with a narrative biography of 200 words, to Caroline Marley (caroline.marley@strath.ac.uk) and Thembisa Waetjen (twaetjen@uj.ac.za) by 20 September 2019.

Applicants will be informed of the committee’s decision by 4 October 2019.

Funding
This event is made possible by the generous support of the Wellcome Trust. Some funding for travel and accommodation is available, and will be prioritised for graduate students, post-doctoral fellows and early career researchers, particularly where they are located at institutions in the Global South.

Video: Thembisa Waetjen at Cannabis: Global Histories

Editor’s Note: We hope you enjoyed Thembisa Waetjen’s article that we published on Tuesday on how cannabis, or dagga in local parlance, became a “drug” in South Africa. Today you can see Prof. Waetjen discuss her work at the Cannabis: Global Histories conference. Enjoy!

 

How cannabis became a “drug” in South Africa

Editor’s Note: Today’s post comes from Thembisa Waetjen, professor of history at the University of Johannesburg, and is derived from her presentation at the Cannabis: Global Histories conference, which was held from April 19-20, 2018, at the University of Strathclyde, Glasgow. In it, she argues that international cannabis criminalization was, in part, the result of an appeal made by the South African government in 1923. But what lay behind that appeal? And what were its consequences, locally?

On 31 March last year, the Western Cape High Court of South Africa, in the case of Garreth Prince, ruled as constitutional the personal use of cannabis by an adult in a private dwelling, along with the possession, purchase or cultivation associated with such use. Reflecting liberalizing trends in other parts of the world, this outcome signaled a shift in South Africa’s punitive drugs policy.

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Thembisa Waetjen presents at the Cannabis: Global Histories conference. Photo by Morgan Scott, Breathe Images

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Jan Christiaan Smuts, 1919. Courtesy Wikimedia Commons.

Many people don’t know that African countries, specifically Egypt and South Africa, played a crucial role in international cannabis criminalization in the early 20th century. In 1923, the office of Prime Minister Jan Christiaan Smuts requested that the League of Nations include Cannabis Sativa and Cannabis Indica on the list of ‘dangerous drugs’, to be regulated by global narcotics law. He explained:

“… from the point of view of the Union of South Africa, the most important of all the habit-forming drugs is Indian Hemp or ‘Dagga’.” [1]

What was the local story behind this appeal?

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