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Healthy Skepticism International News

February 2009

Introduction to On speed : the many lives of amphetamine

by Nicolas Rasmussen
New York: New York University Press, 2008

Ours is an age accustomed to miracle drugs. We expect new triumphs of science that will in our lifetimes eliminate mankind’s most ancient enemies: all the remaining illnesses that bring pain, sorrow, feeble old age, and untimely death. And we expect these triumphs to come in pharmaceutical form. The most famous miracle drug remains penicillin, and rightly so. In the 1940s this microbe-derived antibiotic (and its successors) made a huge difference to human well-being and life expectancy. Thanks to penicillin, death by bacterial infection changed from a commonplace tragedy into a rarity, almost overnight. Before penicillin’s introduction, there were also a few medicines one could fairly call miracle drugs like the anti-syphilis medicine Salvarsan in the 1910s, insulin for diabetes in the 1920s, and the first ‘sulfa’ anti-bacterial agents in the 1930s.

Many more drugs have been hailed as miracles since the Second World War, now medicines for the soul as well as the body. In the 1950s, alongside the cortical steroids that helped the crippled walk again, there were the first anti-psychotic drugs like chlorpromazine (Thorazine), restoring composure to the raving mad. In the 1960s, alongside the birth control pill and beta-blocker heart drugs, there were the benzodiazepine ‘minor tranquilizers’ (like Librium and Valium) that saved us suffering unduly from anxieties born of inner conflict. And so on. None of our latter-day miracles for mind and body has made a contribution to health matching penicillin’s, nor presented so few adverse consequences to weigh against the benefits. The hearty acclaim of new pharmaceuticals as miracle drugs continues nonetheless. Creating or at least amplifying such acclaim is now a routine function of pharmaceutical company marketing.

Just as the the first flush of enthusiasm inevitably leads to a marvellous new drug’s prescription to millions, so inevitably does consumption of a new drug by millions reveal its limits and its darker side. Now cortical steroids are known to cause their own set of crippling side-effects, antipsychotics like chlorpromazine cause brain damage, the benzodiazepine tranquilizers are fiercely addictive, and the original contraceptive formulas can cause deadly blood clots and probably cancer too. To be sure, certain people did derive an overall benefit from these drugs. Some are still part of medical practice, but are now used much more cautiously than when they were first welcomed as panaceas. Other drugs have fallen completely into disuse when harms turned out to outweigh benefits. None were the miracles they first appeared to be.

Yet despite the predictability of disenchantment, we remain prepared to welcome new new miracle drugs with undiminished optimism. In the 1990s Cox-2 inhibitors, such as Bextra and Celebrex, were the miraculous breakthroughs. These drugs promised to make arthritis suffering obsolete. Joining them were the selective serotonin reuptake inhibitor (SSRI) antidepressants like Prozac and Zoloft, which transformed oversensitivity and pessimism into easily treatable illnesses. The Cox-2 inhibitors are now in dramatic decline following revelations about the way they may damage the heart. The SSRIs too have lost a little lustre, but have not progressed as far through the full cycle from tremendous promise to bitter disappointment. If past experience is any guide, they too will soon be seen in retrospect as overprescribed to millions of unsuitable patients who could never have benefitted, and who thus only bore risk. The pharmaceutical industry has long understood this pattern of over-zealousness, disillusionment, and rational re-assessment of a drug’s place in medicine-and has learned to make the most of the first phase of enthusiasm. Physicians seem at least partly aware, as suggested by their old joke that one should ‘always the prescribe the latest drug, while it still works.’ The rest of us seem to prefer boundless hope to cynicism, trusting in the latest miracle drugs despite the repetitive lessons of the past.

Ultimately, this book is about the way we continue to expect magic in pill form. It is about the place drugs have come to occupy in our culture, and the role they play in medicine. It approaches these general questions through the remarkable and unique history of amphetamine, or ‘speed’ as it has long been known colloquially. This choice of drug may at first seem a peculiar basis for generalizations about pharmaceuticals. But even though we now think of recreational street drugs when we hear the name of this powerful stimulant, amphetamine was originally another miracle drug. By about 1940 its fame was so great that it could have been included in the list of medical breakthroughs above, alongside insulin and penicillin. According to both experts and advertisements, amphetamine was not only the first anti-depressant, but the first ever specific medicine for a mood disorder. It was also among the first generation of medicines developed through scientific research managed by drug companies. As a new chemical invention, it was protected by the limited-term patents that create such an incentive for manufacturers to maximize the wave of early zeal around novel drugs.

During the Second World War, amphetamine and methamphetamine were adopted in the military services on all sides, in quasi-medical efforts to tune mind and body beyond normal human capabilities. Similarly, athletes welcomed the drugs as performance-enhancing panaceas in the postwar years. Around 1950, family doctors embraced amphetamines as psychiatric medications for their distressed patients, cementing the notion that depression was both commonplace and easily treatable. Moreover, amphetamines were hailed as a breakthrough in weight loss, and enjoyed enormous success as diet pills, helping transform obesity into the terrible though preventible epidemic medicine views it as today. When scientists and drug firms began looking for improved antidepressants and diet drugs in the later 1950s, they based that search on amphetamine and the benchmarks it set in both areas of medicine. In revolutionizing the understanding and treatment of disease and paving the way for progress, amphetamine behaved as a model miracle drug, a pathbreaking pharmaceutical.

As with most miracle drugs before and since, the imperfections of the amphetamines emerged with heavy prescription use. In the late 1950s researchers gradually learned that amphetamine and related drugs are addictive, and that with heavy enough use also cause a severe psychotic condition. Psychiatrists abandoned amphetamines for newer, better antidepressants by the beginning of the 1960s. Remarkably, though, the consumption of amphetamines did not decline, as one would expect of outmoded miracle drugs. In general practice amphetamines remained the drugs of choice for lifting mood, and for aiding weight loss too. In the late 1960s, at the peak of their popularity, one in twenty American adults were active users of amphetamines by prescription. At least half as many again were using ‘speed’ without prescription-altogether around 10 million people, equal to the entire combined populations of New York and Philadelphia at the time. Amphetamine abuse was for a short time recognised as the United States’ leading drug problem. Finally, in the early 1970s strong government actions overcame drug industry resistance and restricted the supply of pharmaceutical amphetamines. By the late 1970s, America’s speed epidemic seemed almost a concern of the past.

However, this onetime miracle drug still refused to retire gracefully. Speed remains with us today, despite relentless narcotics enforcement. Indeed, we are now suffering another epidemic of amphetamine abuse, driven by a recent surge in the popularity of crystalline methamphetamine or ‘ice,’ and also the amphetamine derivatives known as ‘ecstasy.’ Amphetamine and its close relatives have also become enormously popular pharmaceuticals again, for Attention Deficit. And the replacements for amphetamine offered up by the pharmaceutical industry as diet drugs have have remained closely related to amphetamines, from the 1970s to the mid-2000s. We might also consider the antidepressant drugs which, although not amphetamines, have recently acquired the psychiatric market once belonging to amphetamine. From the perspective of user demand, more than one in ten Americans is now using drugs that would in the 1960s have been amphetamines. It seems America’s need for speed has doubled since 1970. So, although it might at first seem odd to look at the business of pharmaceuticals through the lens of amphetamine, I believe the opposite is true. In a sense there has never been a more successful pharmaceutical.

Amphetamine’s triumphant career makes its history an excellent vehicle for understanding our society’s routine miracle, the pharmaceutical blockbuster. Its late deviations from a breakthrough medicine’s typical life cycle only help cast extra light on the place of drugs in our culture, and what drives demand and success in the drug business. Of course, researching the history of commercial drug development, especially the action behind the experimental reports and advertisments published in the medical journals, always presents challenges for the historian. Reliable documentary evidence on what occurs within corporations is rare. In the case of this particular drug, rumors and fables abound. Certainly, I have been fortunate in having some excellent work by other historians to rely upon, and also by social and medical theorists about drugs, all cited where the story makes their contributions especially valuable. Where I have been able to go further than previous authors in finding facts and sorting them from fiction, it has largely been by using evidence generated in the course of intellectual property lawsuits, where often secretive drug companies must publicly struggle to reconstruct and document the past. Amphetamine’s story encapsulates America’s love affair with pharmaceuticals, and that story now needs to be told.

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