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Book Review: Drugs For Life: How Pharmaceutical Companies Define Our Health by Joseph Dumit

Book Review: Drugs For Life: How Pharmaceutical Companies Define Our Health by Joseph Dumit Summary:
Written by a professor of Anthropology, this book explores the interaction of the cultures of medicine, pharmaceuticals, and public health and how they have impacted the modern Western perception of what constitutes health and what makes a person count as healthy.

Review:
Since I work in an academic medical library, I was immediately drawn in by this anthropological exploration of what has impacted the modern perception of health and requested it on NetGalley.  Although the book can sometimes feel a bit long and repetitive, the information it contains is an even-handed look at the reasons behind so many people in the West being put on preventive prescription medication.

Since this is written by an Anthropologist, not a journalist or a doctor or pharmaceutical representative, it has neither an expose feeling to it nor a particular slant.  It’s clear that the author originally was just looking at the culture surrounding healthcare, and the evidence led him down this path.  Anyone who is familiar with Anthropology knows that Anthropologists are trained to attempt to avoid biases and just report what they see.  Of course, everyone is human, and I definitely think that by the time Dumit finished his research he has formed an opinion that the reader can observe, however he does quite a good job of just presenting the facts.

The book is divided into six chapters, plus an introduction and conclusion.  The six chapters are: responding to facts, pharmaceutical witnessing and direct-to-consumer advertising, having to grow medicine, mass health: illness is a line you cross, moving the lines: deciding on thresholds, and knowing your numbers: pharmaceutical lifestyles.  The book thus moves from the culture of facts and how we respond to them, to the business of pharmaceuticals, to how public health has impacted how we treat individual health, to how the individual health care consumer responds to the information they hear from all sides.  Again, all of this is presented from an anthropological perspective.  If a reader has not read an anthropology-research based book before, the way in which Dumit looks at the information may be a bit confusing or surprising at first, since it is more about culture, which may not be expected at first, given the title.  However, the second chapter helps this perspective make sense, so even a reader new to this perspective will most likely be able to get into it.

What inspired Dumit to conduct this cultural investigation is the sheer number of drugs the average American is prescribed.

The average American is prescribed and purchases somewhere between nine and thirteen prescription-only drugs per year, totaling over 4 billion prescriptions in 2011 and growing. The range is wide, however, and many people are prescribed few or no drugs each year. (loc 100)

What Dumit’s investigations revealed was a cultural shift from treating an illness after it negatively impacts a person’s life to attempting to prevent illness.  Whereas individual doctors may prefer prescribing lifestyle changes (work out more, eat differently, stress reduction), some doctors prefer being able to simply prescribe a drug and some groups of patients may prefer to keep their lifestyle and take a preventative drug.  Similarly, the pharmaceutical industry sees preventative drugs that are taken by large groups of people with risk factors as a more monetarily sound investment than generating drugs for an illness that would be taken one-time or simply for the duration of the illness or just from the time of diagnosis to the end of the person’s life.  Preventative drugs are prescribed to people who have risk factors for developing an illness, and they then must be taken every day.  At the same time as these situations have developed, public health, since the 1970s, has started looking at groups of people at risk for developing a disease that would have a negative public health impact and advising that people with these risk factors be treated to prevent the disease from ever occurring.  All of these factors have created the environment in which we now live in the United States where people who are not yet sick are still taking multiple prescription drugs to prevent their getting sick, often in spite of dealing with side effects.

I will now discuss the elements of this overarching concept that I found most interesting.  The book contains many more facts and information than this, and if you find any of this at all intriguing, I highly recommend you pick up and read the whole book.

First, there’s the fact that clinical trials are extremely expensive to produce.  Pharmaceutical companies thus are most invested in clinical trials whose results would indicate treating the largest number of people for the longest amount of time and, perhaps most importantly, only for those people who are able and willing to pay for these drugs.  (loc 145)  What this means is that illnesses that only a small percentage of people have are not getting clinical trials for drugs.  Similarly, illnesses that a lot of people have but most of those people cannot afford to pay for the drugs, such as tropical diseases prevalent in African countries, also are not getting clinical trials for drugs to treat them.  The pharmaceutical companies are businesses that are interested in making money, not in improving the quality of life for everyone on the planet.

Marketers want to maximize the number of prescriptions in order to maximize profits. They see clinical trials as investments whose purpose is to increase sales of medicines. (loc 1415)

I also found the question of what constitutes health and how that has changed over the years fascinating.  Originally, people generally only came to the doctor if they felt sick or as if something was off.  We are now encouraged to engage in preventative care.  How this impacts how we perceive of health is summed up well here:

We have a new mass health model in which you often have no experience of being ill and no symptoms your doctor can detect, but you or your doctor often discover that you are at risk via a screening test based on clinical trials that show some efficacy of a treatment in reducing that risk; you may therefore be prescribed a drug for life that will have no discernible effect on you, and by taking it you neither return to health nor are officially ill, only at risk. (loc 195)

Tied into this idea of risk factors being treated as illnesses and thus healthy people being treated as not healthy is the idea that outliers, variations, and things that are simply socially undesirable can often be reclassified as illness, particularly if doing so means that the pharmaceutical companies will make more money. (loc 1079)

Third, I was intrigued by the discussion on the public health model.  Public health seeks to reduce illness in the population as a whole by treating those with risk factors, but also by treating however many it takes to reduce the occurrence of illness.  An example of a community-wide public health intervention is adding fluoride to the public drinking water.  This is done to everyone in the hopes that it will help prevent cavities, regardless of the actual individual risk factor for developing cavities.  A public health intervention that is done only to those with a risk factor is taking statins to lower cholesterol.  This is recommended for individuals whose cholesterol falls in a certain range, but there is no exact science in creating that range.  In fact, the cholesterol range is frequently lowered, putting more and more people on statins, even if only a small percent (less than 10%) of people are actually helped by being on these statins.  The question Dumit raises in this discussion is:

At what point are public health officials justified in intervening on a community-wide basis to protect a group of people who are not all equally at risk and who might not want to be protected? The push and pull of paternalism versus autonomy is a constant refrain in the field. (loc 1667)

Of course, the pharmaceutical companies want more and more people included in the risk factor, they even would probably be fine with everyone being on statins as a community-wide public health intervention, since this increases their sales.

Finally, I was also interested in how the book examines how the average patient population responds to all of this information about risk factors and preventative drugs and medicine and constant flow of health information.  Dumit divides the response to this into three general groups: “expert patienthood, fearful subject of duties, and better living through chemistry.” (loc 2842)  The expert patient is like the teacher’s pet.  They know all their health numbers and risk factors, listen to their doctors, take anything prescribed, and advise others to do the same.  These guys are the health seekers.  The second category, fearful subject of duties, is motivated by avoiding illness, not by seeking health.  The final category of patient is the one I alluded to earlier.  These folks won’t change their lifestyle in response to risk factors, but will instead request a pill so that they can continue living how they prefer.  Which category do you think you fall into?

I think the book in general could be a bit better organized.  My notes, although taken linearly, read as a bit disjointed, with some jumping around among different ideas.  The overarching concepts are not laid out as clearly and succinctly in the book as they are in my review.  Similarly, some concepts can be repeated a bit too often, leaving the reader feeling like they’ve read this before.  Also, sometimes the book delves a bit too deeply into anthropological concepts and methods, given the fact that it is presented as a book for a layman.  Finally, I feel the title of the book is a bit too click-baity.  It reads as if it was written to sound much more controversial and attacking of the pharmaceutical industry than the book itself actually is.  The title reads like the book will be a heavy-hitting expose, when really it is an even-handed piece of anthropology work.

Overall, this book will appeal to anyone interested in how the United States health care culture has evolved to the point it is currently at in regards to prescribing so many drugs.  The reader does not have to be a scientist or involved in medicine to understand the book, although portions of it may feel a bit repetitive or overly technical at times.  Although the book could be a bit better organized, overall it presents a clear look into the culture of drug prescription in the United States, and I recommend it to anyone interested in that topic.

4 out of 5 stars

Source: NetGalley

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Faculty Panel on Research Methods (Social Sciences Librarian Boot Camp 2012)

“Anthropological Methods” Dr. Sarah Pinto, Tufts University

  • anthropology–study of human behavior in its cultural context
  • What do you want to learn?
  • How do you want to learn it?
  • People are complicated.  Worlds are complex.
  • Zora Neale Hurston was not just a writer, she was also an anthropologist.
  • Franz Boaz was the father of anthropology.
  • Anthropology can be done at home.
  • It requires constant reflection on oneself.
  • Work with people. Don’t enact on them.
  • It is not objective in search of fact but interpretive in search of meaning.
  • There are four principles of anthropological fieldwork.
  • #1 participant observation–to learn about what’s going on in people’s lives, you have to spend a lot of time with them.
  • #2 interviewing/conversation
  • #3 fieldnotes–there is tons of interesting writing on anthropological notetaking
  • #4 reflexivity–perspective, co-authorship, politics of the encounter
  • Recommends Tristes Tropiques by Claude Levi-Strauss (memoir, originally in French, translated into English)
  • Recommends In the Realm of the Diamond Queen: Marginality in Out-of-the Way Place by Anna Tsing
  • Data is inherently messy but when you put it together it gives us the richness we were looking for.

“Exploring Social Psychology” Dr. Keith Maddox, Tufts University

  • social psychology–scientific study of how individuals think, feel, and behave in a social context
  • We tend to want to conform to the norms others have set.
  • We’re different people when we’re with other people than when we’re by ourselves.
  • What makes social psychology scientific is all in the method.
  • Three guiding principles of social psychology
  • #1 reality is a social construction–we perceive our ideas of others more than how they are in fact
  • #2 determinants of behavior–person(ality) x situation = behavior
  • #3 the power of the situation–personality is often overemphasized.  We fail to take into account the situation the person is in.
  • Tools of the trade include: questionnaires, rating scales, statements, movements, body language, self or observer reported
  • Tricks of the trade (overcoming challenges).  When people know they’re being studied, they might alter their behavior.  How to combat this?  Use deception, for instance, mislead people in the instructions to think we’re studying one thing when really we are studying another.  Use of confederates.  Field experiments.
  • Social Psychologists must balance a number of concerns.  Scientific rigor, setting that is psychologically valid, and ethics.

Book Review: Abject Relations: Everyday Worlds of Anorexia by Megan Warin

Woman standing in waterSummary:
Warin, an anthropologist, takes an entirely new approach to anorexia, looking it from a purely cultural and anthropological perspective.  She spends a couple of years interviewing women with anorexia at various points in the life of the illness from early treatment to recovery to relapse.  In this way she analyzes not just the culture of women and men suffering from anorexia but also how anorexia is a response to the culture these people find themselves in.

Review:
This was my first read from the holdings of my new workplace.  The instant I saw the title and book cover, I knew I needed to read it.  The anthropology of anorexia? How fascinating!

It’s interesting that I feel I actually learned a bit more about anthropology than anorexia from this book, but perhaps that is because I am more familiar with the latter than the former.  From my work in psychiatry and as a mental illness advocate, I was already aware that people suffering from anorexia have their own culture.  I still highly valued seeing this presented in an academic fashion with a respect for the people involved.  I commend Warin for her ability to interact with these women and glean a sense of how they came to be who they are now with a respect for them as people that is all too rare to see in this type of work.

So what of the anthropology then?  What are abject relations?  Over the course of the book I learned that abject relations are ambiguous relations.

What is abject is in between, ambiguous, and composite. Abjection is thus contrary to dualist concepts because it undermines and threatens that which is separate. As such, abjection is fundamentally concerned with the complexities and contradictions of relatedness. (page 184)

Whereas most books about eating disorders attempt to say THIS definitively caused it, this book’s premise is that the etiology is entirely ambiguous.  What caused it, what makes it persist, what it is to suffer from anorexia.  Nothing about it is clear-cut.  That is the powerful statement of the book.  There are no easy answers to anorexia, but we can do much more to understand it both as its own culture and as an aspect of our own.

This focus on anorexia as a response to the mainstream culture and a formation of a new culture leads Warin to question a lot of the inpatient treatment techniques.   Warin sees anorexia as frequently about women attempting to assert a right to control over their own bodies that goes horribly awry, ripping the control out of society’s or tormentor’s hands, into their own, into ana’s hands, then into the hands of an authority figure again at treatment.  Warin sees value in helping people suffering from anorexia recover in the context of society.  Instead of feeding them alone in a single room have them cook and eat together in a group.  This reenforces the cultural and connecting aspect of eating that they have been denying for so long.

It is an interesting idea to look at anorexia as an abject cultural response, but I don’t think it’s one that is quite as unique or revolutionary as Warin seems to think.  Whereas there have always been those who think anorexia is the ultimate kowtowing to what society deems feminine, there have also been those who view it as women protecting themselves from being perceived as feminine, from having unwanted interactions with those who would objectify them.  Perhaps it is really both, which is what makes it so hard to treat.  I believe this is what Warin is trying to say, although she is often not as clear as she could be.  She gets caught up in academic jargon.  She is at her strongest when simply organizing her interactions with the women into themes and presenting them to the reader to do with what they will.

Overall, for an academic look at anorexia this is unique in that it is an anthropological study instead of a psychiatric one.  Looking at a group of people who are a group simply because they share the same illness and studying their anthropology is a truly fascinating concept.  The book is scientific, but it is social science and is thus easy enough for the mainstream reader to follow.  It provides the human aspect of anorexia without sensationalizing.  Anyone with an interest in eating disorders or anthropology will enjoy this book.

4 out of 5 stars

Source: Work Library

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