Fiction Points: Eileen Cronin

CRONINEileen Cronin is a writer and clinical psychologist. Her book Mermaid: A Memoir of Resilience (2014) centers on her search for the truth about her body and the role that the drug thalidomide played in its shape, her childhood in a large Catholic family, her mother’s mental illness, her marriage, and her own struggles with alcohol. In addition to nonfiction, Cronin writes poetry and fiction. Her work has appeared in The Washington Post, Bellevue Literary Review, Los Angeles Times, Third Coast,  and Best American Essays, among other venues. She also writes for The Huffington Post. Mermaid appeared on O, The Oprah Magazine‘s Best Memoirs of 2014 list and Pop Sugar‘s “Must Reads of 2014.” In 2008, Cronin won the Washington Writing Prize for Short Fiction. Her nonfiction has earned her a Pushcart Prize nomination, and her two novels were finalists for the Pirate’s Alley Faulkner Award for Novels-in-Progress. Cronin serves as an assistant editor for Narrative Magazine and lives in Los Angeles. 

Two nuns and a penguin approach you at a bar, and you tell them you’re a writer. When they ask you what you write about, how do you answer?

I can’t help but to notice the resemblance between these folks at the bar. But I don’t ask about that, nor do I tell them that I have written about a nun who looked like a penguin when she ran. Instead I tell them what I have in common with them. I write about Catholics, sort of like Alice McDermott but with a bit more of an edge.Read More »

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Will I Be A Dope Doctor When I Grow Up?

EDITOR’S NOTE: Points is delighted to welcome Kim Sue, a previous contributor (check out her earlier posts here and here), medical anthropologist, and dual degree MD/PhD candidate at Harvard University. On the heels of Points’ recent posts about the difficulties of reconciling clinical and scholarly perspectives on addiction treatment and the media frenzy about the recent prescription opioid epidemic, Sue offers a historical and ethical reflection on having the power to dispense prescriptions.

I first met Anita in the Boston jail where she was doing time for passing bad checks related to a prescription opioid addiction. She had first been introduced to opioids after giving birth to her first child several years earlier. “I was prescribed percs [percocets] for pain related to the delivery,” Anita explained. “I just remember taking them and being high and cleaning … I took four or five at a time.” Anita’s drug use spiraled out of control, as her physiological tolerance to the opioids increased and she needed to buy more and more pills to get the same effect. One day, Anita’s dealer offered her heroin, and off she went.

Ethnographers and historians of drug use are all too familiar with stories that resemble Anita’s. As an anthropologist who studies prisons and addiction treatment, I find it relatively easy to point the finger at doctors for their professional complicity in “epidemics” of opioid addiction.

But as a medical student in my final year, destined to start residency in July in an internal medicine-primary care program, I also worry I won’t be able to refuse prescriptions for opioids for patients presenting to me in distress and pain.

Historians of medicine and drug use have detailed how physicians—whether they wanted to or not—became central to the distribution and administration of opioids in the United States. In the wake of the Harrison Narcotics Act, addicts had to obtain prescriptions for their drugs, and so-called “dope doctors” would provide them for cash. The alternative to the dope doctor was the street druggist, the so-called “pusher.”

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Laudanum (image via Science & Society Picture Library/Getty Images)

 

Doctors and opiates have a long, complex history. In the era of magical formulations, Dr. Thomas Syndenham compounded laudanum by mixing “two ounces of opium and one ounce of saffron dissolved in a pint of Canary or sherry wine” with a “drachm of cinnamon powder and of cloves powder,” as historian Richard Davenport-Hines noted in his history of the subject. At the time, opiates (plus or minus alcohol) were among the few medicines that were actually effective pain relievers (working at the μ pain receptors in the brain). They were instrumental in bolstering the medical profession’s emerging reputation for dispensing effective interventions rather than simply bearing witness to suffering. Indeed, enterprising pharmacists and doctors alike created their own patented formulations of various narcotics marketed as cure-alls– a mix of magic, profiteering, and chemistry.

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Old Ideas for a New Era: On Reading Sam Quinones

Sam Quinones and I share an affinity for this startling fact: more Americans now die of drug overdoes than car crashes. I often say this when I am trying to convince someone that it’s important to study the drug wars; Quinones last week used the tidbit in the first paragraph of his New York Times opinion piece titled “Serving All Your Heroin Needs.”

In this article—and probably elaborated in his new book Dreamland: The True Tale of America’s Opiate Epidemic—the L.A.-based journalist writes about a new breed of Mexican heroin dealers who deliver drugs “like pizza” in cities across the Midwest. He uses a nickname for the dealers coined by a cop he knows: Xalisco Boys, for the poppy-growing region from whence they come to the United States looking for a fast buck.

Sam Quinones, Dreamland (Bloomsbury Press, 2015)
Sam Quinones, Dreamland (Bloomsbury Press, 2015)

I have no doubt the system of low-violence, customer-service-oriented drug dealing that Quinones has studied for several years is real. But the old chestnuts he hauls out in talking about the public health problems caused by the increased availability of heroin in smaller cities deserve comment. Read More »

Pharma Gamesmanship in the Booming Business of Addiction Therapeutics: the Case of Suboxone

Editor’s Note: Points welcomes another new guest blogger to the ranks today. Kimberly Sue is an M.D.-Ph.D. candidate in medical anthropology at Harvard, doing ethnographic fieldwork with opiate-addicted women. Below, Kim details some very recent developments in the ways pharma companies invoke societal values around drugs in order to manage their market share, and discusses how the outcomes are likely to affect people in treatment.

Pharmaceutical companies and opiates have a complicated, intertwined history. Analgesia was and continues to be a big business as well as an ongoing medical conundrum. Opiates, as we know, are wildly popular analgesics. Yet when did opiates specifically indicated for treating addiction become such a big business, a lucrative niche market inciting pharmaceutical companies to aggressive industry maneuvers? As Penn professors John Kimberly and Thomas McLellan wrote in a 2006 article on the substance abuse treatment industry, “Pharmaceutical companies that, not long ago, refused to allow the use of even their discarded medications for clinical research in addiction now invest hundreds of millions of dollars in the marketing and sales of approved addiction medications.”

Mum, mustard, and maintenance. ( Reckitt Benckiser annual report, 2011).
Mum, mustard, and maintenance. (Reckitt Benckiser annual report, 2011)

Does this say something about the changing cultural attitudes towards addiction—that pharmaceutical companies are no longer afraid of being branded as making drugs for drug addicts—or does it simply speak to the enormous profits to be had?

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Weekend Reads: Lance Armstrong Edition

Viewed from the outside, many proponents of the War on Drugs seem intransigent in their views simply because they find it difficult to allow any new argumentation or evidence to affect what they’ve deemed a moral issue. Much as temperance was in the 1920s, those who support the American government’s battle to retain strict drug laws with severe punishments are undoubtedly engaged in a symbolic crusade (to borrow a term from Joseph Gusfield). Essentially, their support exists in the name of continuing counterproductive and often irrational public policies because, to many, such laws and strictures symbolize something more, something deeper. Many Americans don’t see the loosening of drug laws as a utilitarian means of harm reduction, but as a retreat from the “traditional” values from a morally cohesive age that never really existed.

To be fair, moral crusades regarding drug use are far too complex to be simply be reduced to the simplistic regressive, anti-modernist picture I just provided without heavy qualification. While it is true that the struggle over the meaning of drug laws remains largely politically partisan in American society, one need only look to the news to see how the issue of drugs, government oversight, and moralism can be reframed in a much more complex way. With the recent investigations of Lance Armstrong’s doping and illegal prescription drug muling coming to a close this week, one finds no clear political delineation among the cyclist’s supporters and opponents. Positions on drugs within the Livestrong Industrial Complex vary, as liberals, libertarians, conservatives, and independents struggle to disentangle the implications of L’affair Armstrong.

For those not yet aware, the Plano, Texas-born Armstrong is perhaps the most celebrated road cyclist in history, having famously won the Tour De France seven times, six times after having contracted cancer in his testicles, lungs, abdomen, and brain. Armstrong parlayed his seemingly superhuman ability to perform astounding athletic feats whilst struggling with a life-threatening illness into the multi-billion dollar Livestrong charity, which works as an awareness-raising (though not really a money-raising) foundation on behalf of cancer research. As one might expect, Lance’s combination of non-partisan do-goodery and athletic acumen – not to mention his celebrity romancing – made him an enormously popular and powerful fellow in the worlds of cycling and politics.

Because it seems counterintuitive that someone should not only recover from cancer to win a prestigious endurance race, but should do so without the use of performance enhancing drugs (PEDs) within a sport rife with said drug use, Armstrong has also spent much of his adult life under suspicion. He is undoubtedly the most famous and divisive longtime target of both national and international anti-doping agencies. Despite numerous allegations and investigations, however, Armstrong has never (publicly) tested positive for PEDs and has vigorously defended, in both the courts and the press, his personal reputation as a “clean” racer. Nonetheless, fans and journalists have continued to widely (and openly) suspect Armstrong’s use of non-detectable PEDs, including “The Clear.” Read More »

The Points Interview: Dominique Tobbell

Editor’s Note: We’re more than a quarter of the way to one hundred Points Interview features today!  We dry out from our recent spate of alcohol histories to pop a few pills with Dominique Tobbell, our twenty-sixth interview subject and author of Pills, Power, and Policy: The Struggle for Drug Reform in Cold War America and Its Consequences (California, 2012).

Describe your book in terms your mother (or the average mother-in-the-street) could understand.

My book explains the complex relationships between drug companies, physicians, and academic researchers. During the 1960s and 1970s the American drug industry confronted a reform movement that sought to reduce prescription drug prices by securing legislation that would increase the government’s control over drug development, distribution, and therapeutic practice. This reform movement brought together congressional Democrats committed to protecting the economic interests of consumers and organizations dedicated to increasing Americans’ access to affordable health care. It also included state welfare agencies and hospital groups struggling to balance their budgets amidst rising costs, and a growing number of physicians who accused drug firms of spending far more on misleading and excessive marketing than on research, needlessly driving up the costs of prescription drugs. My book describes this reform effort and the historical emergence of a politically powerful pharmaceutical industry in opposition to it. In the decades following World War II, the industry developed extensive networks with academic researchers, medical schools, and government officials. These relationships underpinned innovation and growth in the U.S. pharmaceutical sector and formed the basis of the industry’s political support after the war. I argue that the shared interests among academic researchers and the drug industry and the industry’s responsiveness to the needs of the biomedical community led the drug industry, organized medicine, and leading academic physicians to join forces against reformers in the 1960s and 1970s. My book demonstrates the economic and intellectual influence of drug industry interests on research universities and medical schools in the second half of the twentieth century.

What do you think a bunch of drug and alcohol historians might find particularly interesting about your book?

Because of its focus on pharmaceutical politics, my book explores the dynamic process by which drug companies, physicians, patients, and regulators debated, contested, and defined the regulatory framework for prescription drugs in the U.S. after World War II. As drug and alcohol historians have shown, this regulatory framework has necessarily had a determinative role in defining the legal status of specific of drugs, at the same time that these same groups—drug companies, physicians, patients, and regulators—have been the central actors in demarcating, maintaining, and contesting the boundaries between licit and illicit drug use. My book, I hope, will thus provide drug and alcohol historians with valuable context for understanding the political and politicized history of drugs in American society in the second half of the 20th century.

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The Myth of the Health-Maximizing Consumer

Editor’s Note: We’re pleased to kick off the month with the second in a series of posts by UCLA’s Brad Fidler, Director of the Kleinrock Internet History Center and a historian of anti-psychotic medication and its markets.

Gary Becker Wants You to Maximize Utility

Economists often expect us to be rational and self-maximizing when it comes to the financial choices we make as consumers: we are meant to wisely allocate our resources in order to secure the most utility for our dollar—and in the process to reward the most efficient companies.  However, it turns out that we don’t always behave this way, and our economies are correspondingly less stable and prone to growth than was once imagined.  Indeed, if we are truly self-interested, our interests are broad and contradictory, and each of us works from a laundry list of altruistic and other inexplicable motivations.  The ideal of the rationally self-maximizing model of human behavior is called “homo economicus,” often derisively, by academics who believe it flies in the face of reality and decry the way it has been used to justify mainstream economic models that have led to forty years of slowing growth and stagnation. 

Homo economicus is a useful concept for drug historians because, sometime during the heyday of the American post-war economic expansion, another rational consumer emerged: the health-maximizing consumer.  (The homo salinas, perhaps?)  It is worth rethinking the role that this ideal health maximizer plays in debates concerning the use and overuse of psychiatric medication.

The health maximizer is a model of the consumer whose motivation and behavior flow from concern for the risk-benefit ratios of the individual medications she takes.  It’s a reasonable model, and also the place where controversy begins.Read More »

Qnexa in America: Thinner, Happier, and Less Reactive

Welcome to the first installment of guest blogger Brad Fidler’s new four-part series. Brad is a postdoc researcher at UCLA, where he is developing a new program on Internet history.  He studies the crossovers between information technologies and psychiatry. Over the coming weeks, Brad will discuss the increasing use of psychiatric drugs in the treatment of, and the expanding definitions of, mental illness.

A Big Bottle O' Qnexa

When mood stabilizers and stimulants fail to interest the American public– often because their use has been stigmatized– drug companies often look to rebrand them as diet pills.  That’s what the pharmaceutical firm Vivus, Inc. plans to do with their new drug Qnexa. Vivus is planning to mix a mood stabilizer from the 1970s with a stimulant from the 1950s and sell the new cross-breed medication as a weight loss drug.

The two drugs that make up Qnexa have been criticized as a part of the bad form of medicating society, emblematizing the habit of profit-hungry pharmaceutical firms to “disease monger” and “sell sickness.”  This backlash critique of psychiatry and psychiatric drugs has risen  dramatically in the last few decades as pharmaceutical solutions to behavioral and mood problems have become more popular and more visible.  It has remained relatively easy to critique the over-prescription of psychiatric drugs because the relatively private nature of the doctor-patient relationship has not been subject to scrutiny like public drug policy activities like community policing and foreign policy associated with the War On Drugs.

But the critique of pharmeceutical “disease mongering” is not just opportunistic; there are important historical reasons that we are suspicious of psychiatric treatments. Read More »

African Perspectives on Pharmaceuticals and Drugs

Fann-Hock Pharmacy, Dakar

In a panel on “Drugs in Africa” at the African Studies Association annual meeting in Washington, DC in November, Donna Patterson, a historian in the Department of Africana Studies at Wellesley College, presented a paper on “Drug Trafficking in Africa:  Historical Cases from West Africa,” which in contrast to other papers on the panel looked at the commerce in legal pharmaceuticals.  The discussion that followed made clear the value of exploring the histories “legal” and “illegal” drugs in conjunction one with the other—something that has rarely been done for Africa, where the focus has been much more on understanding the linkages between “traditional” and Western medicine.  At the same time, the discussion led us to consider how those very linkages might inform our understanding of the trade and consumption of various kinds of drugs—however categorized—in African societies.

Patterson specializes on Francophone Africa, African-Atlantic exchange, health, and gender and is working on a larger project, “Expanding Professional Horizons:  Pharmacy, Gender, and Entrepreneurship in Twentieth Century Senegal,” that  examines the emergence and expansion of African medical professionalization between 1918 and 2000.  That work explores the growth of the African biomedical industry, African access to French systems, and the training of doctors, pharmacists, and midwives.Read More »

Michael Jackson’s Addiction Problem

Murder weapon?
Murder Weapon?

On 25 June, 2009, Michael Jackson died of a propofol (and possibly lorazepam and midazolam) overdose. Soon after, his personal doctor, Conrad Murray, was charged in the singer’s death. Although Murray claimed his job was to “keep surveillance” on the health of Jackson and his children and to make sure that everyone “washed [their] hands” and ate right, it was clear that his most important job was to enable the singer to sleep with the help of a pharmacopeia of drugs. On 7 November, 2011, Murray was found guilty of involuntary manslaughter.

Portrait of the Addict as a Young Man

Murray chose not to testify at his trial, but in the media circus that accompanied the proceedings, he more than made up for his silence on the stand. In particular, he participated in a BBC documentary (The Man who Killed Michael Jackson – a name I’m sure he did not choose), which was eventually sold to MSNBC and renamed Michael Jackson and the Doctor: A Fatal Friendship. The film covered the months leading up to the trial and a small portion of the trial itself. A few days before the verdict, Murray granted an interview to the Today show. His arguments in the court of public opinion hinge on what strikes me as an interesting red herring: was Michael Jackson an addict?Read More »