Medical Involution

The social history of US, especially ‘science-based’ medicine is perfectly enthralling already, but I can’t help heap a bit more into the hopper, even if my points are less than that.

One of the great ‘exposes’ that helped catapult ‘scientific medicine’ (such as it was) into prominence was the interesting confluence of social movements (specifically the temperance movement) and phenomenal power of the ‘patent medicine’ trade groups (among other things).

Collier’s Magazine did a great expose on the whole patent medicine business in a series of articles (click to download)  that was a fine example of investigative journalism.  The fabulous connection to the temperance movement was that folks who were rabid temperance (redundant, I know) believers were free to consume ‘patent medicines,’ of which many were largely alcohol, with very liberal doses (several glass or even bottles a day).  There were plenty of other goodies, cocaine, heroin, codeine, etc., in the wide variety of ‘patent medicines.’  Obviously, the temperance folks held tightly to their patent medicines, the only thing that gave them the fortitude to combat evil. The manufacturers were free to make any claim they liked (see right) and also collected testimonials as the principal ‘support’ for their effectiveness.  So important were the testimonials, there was an active trade in them, with companies simply in the business of collecting testimonials around a patent cure and a specific complaint and then selling them is lots, like 1000 testimonials on catarrh (which, of course, we don’t today, but was quite popular in the late 1800s.  But don’t feel neglected, we found plenty of other disorders to fill in the slot) for $10.

Eventually this was all legislated away (or so folks thought) by the establishment of the Pure Food and Drug Act in 1906, then later the FDA in 1938.

Okay, fast forward.  So scientific medicine and the FDA are established to both produce ‘evidence-based medicine’ (‘evidence’ the key word, much like trying to understand what the meaning of ‘is’ is) and the FDA running herd on the whole deal. 

“Patent,” in patent medications meant that the ingredients were proprietary and the notion of proprietary medicine was foreign to clinical medicine at the time and suggested that someone was concealing something because of commercial interests.  So they were banned.  But wait, aren’t ‘patented’ medicines today the basis of the pharmaceutical industry?  Did we forget history?
Maybe.  Fast forward to today.  Hormone replacement therapy for post-menopausal women.  In the first incarnation, lots of ovarian cancer.  So a new version is put into widespread use, without that effect.  But it has others, from heart disease to increased breast cancer.  But a vast campaign to buffer the market came from the pharmaceutical giant who was making all the money, in the form of academic articles, with prominent clinicians as authors, but actually written by a company contracted to manage publications.  Until, of course, the whole apparatus was revealed.  This phenomenon has been quite common and widespread, called ghost writing, but interest never really took hold until the NYT and PLoS got there hands on the internal communications between the contract company, Wyeth and the clinicians.  It is pretty well laid out in “The Haunting of Medical Journals: How Ghostwriting Sold “HRT”  (Fugh-Berman, PloS 2010).

This is the sort of thing we find commonly in cultures, where the ‘paradigm’ has been established, like an aesthetic or artistic form that has to be maintained.  Since real creativity, meaning new methods, are not ‘sanctioned’ or ‘legitimate,’  the current forms just get iterated and iterated, more complex, but at the core, always the same.  That, BTW, is called ‘involution.’