Teaching Points: History as a Resource for Understanding Drugs Today

Editor’s Note: This post is brought to you by Marco Ramos and Tess Lanzarotta. Ramos is an MD/Ph.D. candidate in the History of Science and Medicine program at Yale University focusing on the production and circulation of scientific knowledge during the Cold War in the global south. Lanzarotta is a Ph.D. candidate in the same department focusing on the ways that contemporary interactions between biomedical researchers and indigenous populations are shaped by their historical antecedents. Together, Ramos and Lanzarotta are teaching a course on the history of drugs in the twentieth century and we’ve invited them to contribute to our “Teaching Points” series. Enjoy! 

ClassroomThe idea for our course on the history of drugs developed out of a conversation a few years ago concerning the medical management of opiate addiction in our community of New Haven, CT. We are both graduate students in the Program in the History of Science and Medicine at Yale University, and Marco is also a medical student at Yale School of Medicine. Having recently completed a clinical rotation at the hospital, Marco reflected on the patient-blaming and suspicion that often accompanies discussions of opiate prescription among physicians. During his rotation, he heard physicians and residents bemoan their patients who requested, and often demanded, opiate prescriptions. He watched as physicians speculated about whether patients were “feigning” their pain to acquire drugs and realized that physicians made judgments about who should receive opiate prescriptions based on imperfect, biased assumptions about what “addicts” looked like racially and economically. Given the large body of medical evidence that demonstrates addiction is not a matter of voluntary choice or individual responsibility, Marco wondered why physicians continued to blame and shame patients for their struggles with addiction.

Tess pointed to the utility of history in understanding opiate addiction in the United States today. She discussed the pharmaceutical companies’ role in this story, as the industry downplayed the addictiveness of opiates and encouraged their widespread use for profit in the medical community throughout the 1980s and 90s. A long history of inadequate consumer protections from the Food and Drug Administration did not safeguard patients from the rapid circulation of this dangerous class of drugs during this period. Though the pharmaceutical industry and a weak federal regulatory body were largely to blame for the growing incidence of opiate addiction across the country, drug enforcement held individual patients responsible for their addictions.

As the conversation progressed, we began to reflect on the importance of history for understanding dilemmas — like opiate addiction — presented by drugs today. We imagined a course that would focus on the history of drugs as a way of generating “useful pasts” that could inform how our students thought about drugs and drug policy in the present. As our thinking evolved, we drafted an application to co-teach a course that centered on the categorization of drugs across the twentieth century. Rather than using drugs as a lens to understand social, cultural, legal, or political history in the Unites States, we hoped to use history to reflect on drug categories themselves. We were interested in how lines dividing chemically active substances into categories and classes, such as illicit and licit or medical and recreational, have shifted across the twentieth century. Historically shifting boundaries between drugs have hinged upon changing cultural norms surrounding the characterization of “use” versus “abuse,” the prescribed treatments or punishments for drug users, and the labelling of drug use as an individual or social problem. Such beliefs continue to be wrapped up in socially-mediated understandings of identity — along ethnic, racial, gender, class, and religious lines — and in opposing ideologies of health and governance.

In tracing the shifting boundaries between drug categories, we wanted students to reflect critically on why drugs are classified they way they are today. Who does the current categorization of drugs both benefit and harm? How do these categories affect consumers and patients? And perhaps most important, can we imagine more just classification schemes that protect the interests of traditionally marginalized populations?

From the start, we felt that co-teaching the course was crucial, as this framework allowed us to articulate exactly what we would each bring to the table. As a medical student, Marco planned to bring his clinical experience to bear on the historical discussion of drugs and how the past lives of pharmaceuticals affect patients and their providers in the present. At the time of designing the course, Marco was in Buenos Aires conducting fieldwork for his dissertation on the history of psychiatry amid the political volatility and violence of Cold War Argentina. He was particularly interested in the rise of psychopharmaceuticals at mid-century in both Latin America and the United States. In this course, Marco wanted to use his clinical experience as a physician-in-training, as well as his historical research on psychopharmaceuticals in diverse contexts, to help students connect their historical understanding of drugs with current, pressing debates on domestic and global drug policy.

Tess has completed an MA with a focus on the history of alcohol and alcoholism in the United States. Her Master’s research explored the role of gender in shaping the disease paradigm of alcoholism and the subsequent development of therapeutic approaches to treat alcoholics. Tess planned to use her research background to help students explore the culture-bound nature of understandings of substance abuse and the ways that therapeutic approaches are shaped by the racialized and gendered identities imposed upon users.

We believed that this interdisciplinary approach to co-teaching would allow us to reach a wide range of students, including but not limited to pre-health and pre-law students, undergraduates interested in health policy and advocacy, as well as those pursuing a major in History or History of Medicine.

Our course was approved earlier this year, and we’ll be teaching it over the course of five weeks this summer. The course will follow a loose chronology beginning in the early twentieth century and ending in the present day. Instead of focusing on the biography of a single drug, or group of drugs, the course incorporates a range of substances and geopolitical arenas, ranging from the history of  alcoholism and cigarettes in the United States to American involvement in the violent War on Drugs in Latin America. We hope this broad framework will give our students a sense of how drug definitions have been constructed over time, through an extensive set of contingent historical processes.

Because the course begins in early July, we are still debating the nature of course assignments. We would like to try to use course assignments to help students bring historical knowledge and tools to bear on contemporary issues surrounding drugs. For example, we have explored the possibility of creating a class blog and assigning students to write blog posts that identify and reflect on present issues through a historical lens. To incorporate the methods and skills of historical research, we have also discussed assignments that teach students how to analyze and use primary source material (in addition to, or instead of, the blog posts). In such a short course, there is not enough time for a final paper, so we have also debated what kind of final assignment allows students to demonstrate what they’ve learned. The most obvious final exam would be an in-class short answer test, but we’ve also played with the idea of having students write a historically-informed policy recommendation around a current drug issue today.

As you can see, our thinking about the course is still very much in progress, and we would love to hear any suggestions or questions about any aspect of the course, from recommendations concerning co-teaching to reflections on different types of assignments. Stay tuned for a follow-up post on this course in August, when we’ll reflect on what we’ve learned from teaching the history of drugs.

Note: If you have any comments, suggestions or ideas for Tess and Marco’s class, feel free to leave them in the comments section below. Thanks!

2 thoughts on “Teaching Points: History as a Resource for Understanding Drugs Today

  1. What an interesting course! I’ll be looking forward to learning more about how it went. One question: I wonder if the prescribers mentioned in the first paragraph, who are concerned about the legitimacy of patients’ requests for opioids, will be asked to contribute to the conversation. To me is seems unlikely that they are dividing patients only into the two categories of “in pain” and “addicted.” More likely, they are acutely aware that a patient might see an opioid prescription as a source of cash, might see “gaming the system” as perfectly legitimate, and might cause them to develop a reputation as easy to fool. Are all such concerns evidence of social or racial prejudice?

  2. If you’re interested, I can send you the syllabus and/or a rough draft of a conference paper about a drugs-themed course a colleague and I co-taught for an International Studies capstone course. Email me at: gkpierce@ship.edu.

Comments are closed.