Today’s post features an interview with Toine Pieters, professor of the History of Pharmacy and Allied Sciences, acting head of the Freudenthal Institute, chairman of the board of the Graduate School of Natural Sciences and senior fellow of the Descartes Institute of the History and Philosophy of the Sciences and the Humanities at Utrecht University. His broader interests include drug and addiction research, neuropharmacology, leprosy research and the digital reuse of heritage resources.
Toine recently authored ‘THE BATTLE BETWEEN DAVID AND GOLIATH: Drug Making and the Dutch Pharmacist versus the International Pharmaceutical Industry, 1865–2020‘ within the first issue of History of Pharmacy and Pharmaceuticals. Find out more about Toine’s background, article and future research plans in this interview.
- Please tell readers a little bit about yourself.
I’m a historian of science and STS scholar at Utrecht University. My research exemplifies that knowledge and materials – as historic markers of scientific progress and objects of mediation and imagination – provide an appropriate starting point for analyzing long-term patterns of economic and cultural change. I maintain a special focus on how drugs as commodities historically adapt and respond to societal and scientific events.
2. What got you interested in the history of pharmacy, drugs, or pharmaceuticals?
I was trained in the 1980s in the Pharmaceutical Sciences Department. At the end of my masters, I had to do a thesis and I got interested in the social construction of pharmaceuticals and especially of the new generation of recombinant-DNA produced biologicals like the interferons. It was interesting to learn more about the anthropology and sociology of “laboratory life” (inspired by Bruno Latour and Steve Woolgar) and the social lives of pharmaceuticals. I started raising questions about why people use medicines in certain ways, how doctors prescribe in the consulting room, and what is and was the role of pharmacists. I learned that therapeutic drugs have agency and that there is an ongoing co-construction between a drug, a disease, and its handlers. Thus, I became interested in long-term mechanisms and patterns of drug development, production, and consumption.
3. Explain your article in a way that your bartender won’t find boring.
I argue that the historically embedded tradition of magistral medicines in the Netherlands provides new compounding opportunities for twenty-first-century Dutch pharmacists in times of drug shortages and big pharma’s high-priced specialty drugs. The international pharmaceutical industry (“Goliath”) did and does not appreciate the craftsmanship of the Dutch pharmacist (“David”), who could and still can legally disregard drug patents as long as they produce medicines on a one-to-one, magistral prescription basis. The recent re-emergence of compounding pharmacies in western countries suggests that pharmacists are willing and able to improve the accessibility and affordability of medicines.
4. Is this part of a larger project? What else are you working on?
I have addressed the challenge of the accessibility and affordability of prescription drugs in other publications together with the concept of drug life cycles. Since the emergence of the pharmaceutical industry in the late nineteenth century we see a structural cyclical dynamics of the careers of therapeutic drugs. Drug life cycles generally encompass four phases: first, the testing and approval trajectory; second, after introduction product market expansion, accompanied by growing expectations; then, rising criticism and disappointment; and finally contracting use and limited application. In most cases this is a gradual process that involves the accumulation of less favourable experiences and reports around the drug´s effectiveness and adverse reactions in every day practice. Thus, a drugs’ benefit-risk assessment and the resulting safety-profile of a drug is under constant revision. Over time, newer and presumably better alternatives gain attention. This is part of an evolutionary process of selection and adaptation that I will continue to study the coming years.
5. Based on your research and experience, what do you see as the future of the field?
The conception, making, marketing, regulation, and consumption of therapeutic drugs illustrate that they are far more than just medical commodities. Pill making and pill taking have been important subjects of public and private mediation and imagination. The challenge of the coming years is to deepen our understanding of the interconnectedness of the scientific, economic, and cultural dimensions of the history of pharmacy and its allied sciences by digging into “big data” with innovative text-mining and other computational humanities tools.
6. Which scholar, living or dead, would you most like to have dinner with?
If we would be able to time travel I would opt for a dinner with the German-Jewish medical researcher Paul Ehrlich (1854-1915), who laid the foundation for what I call the ‘torpedo’ fallacy in medicine. Could he have imagined that his magic bullet concept started a victorious march of therapeutic accomplishment that would unfortunately blindfold researchers for exploring more holistic trajectories in medical research?