Disparities & Inequalities in Ending the HIV Epidemic: Treatment of HIV

Editor’s NoteMaeleigh Tidd delivers another thought-provoking post in our Pharmaceutical Inequalities series. She reaches back to the 1980s to consider how ACT UP protests led to greater affordability of HIV drugs, and argues that the persisting structural inequalities must be addressed by EHEI.


In 1987, six-years into the rampant spread of the human immunodeficiency virus (HIV) and progression of acquired immunodeficiency syndrome (AIDS) leading to 40,000 deaths in the U.S., the FDA approved the first known antiviral drug for the treatment of AIDS. The approval of AZT (zidovudine) was the first scientific breakthrough in treating, and potentially ending, this “death sentence” of a disease. Yet, as the only treatment option available to the growing number of vulnerable and dying individuals with HIV/AIDS, it was outrageously unaffordable with a price tag of over $10,000 per year. 

This drug profiting and the overall poor response to the epidemic at hand, led to the formation of the non-partisan group Aids Coalition to Unleash Power (ACT UP), a group of LGBTQ+ activists ‘united in anger and committed to direct action to end the AIDS crisis’.

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Pharmacy in History Interview—Kathi Badertscher, “Insulin at 100: Indianapolis, Toronto, Woods Hole, and the ‘Insulin Road'”

Editor’s Note: This is the first installment of the Points series of interviews with authors from the latest issue of AIHP’s journal Pharmacy in History (vol. 62, no. 3-4). Today we feature Kathi Badertscher, Director of Graduate Programs and a lecturer at the Indiana University Lilly Family School of Philanthropy. You can see her article here. Contact AIHP to subscribe to Pharmacy in History.

Article Abstract

“Insulin at 100” joins a body of new scholarship being produced globally to commemorate the discovery of insulin. This paper brings to light a new perspective on the collaboration between two North American institutions: the University of Toronto in Canada and Eli Lilly & Company in the United States. It focuses on the collaboration’s complexities, actors who have not been examined previously, and implications for both parties and the general public. The article contributes to existing scholarship by expanding the collaboration story to include central actors at both Eli Lilly and the University of Toronto in a continuous and collaborative cycle of discovery and innovation.

Tell readers a little bit about yourself

I am the Director of Graduate Programs and a lecturer at the Indiana University Lilly Family School of Philanthropy. I worked in the corporate sector for 26 years before coming to IU as a master’s student. In 2006, I thought I would take a few classes on philanthropy to become a more intentional and informed volunteer, board member, and donor. I never imagined I would stay for the doctoral program and have the privilege of joining the faculty.

Kathi Badertscher PH Interview Title Card

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A Bloody Business: American Vaccine Production at the Turn of the Twentieth Century

Editor’s Note: Patrick M. Walsh is a doctoral candidate in the Department of History at the University of Wisconsin–Madison. He studies the the cross-talk between bacteriology, immunology and endocrinology in the late-nineteenth and early-twentieth centuries.

Vaccines and Blood
“Preparation of an Antitoxin” at Parke-Davis Laboratories during the 1920s. Left: “Bleeding and siphoning—Collection of blood from the immunized animal in a large bottle containing oxalate.” Right: “Removal of antitoxic plasma by siphoning after the formed elements of the blood have been allowed to settle out.” Source: Parke-Davis and Company Biological Products catalog, c. 1930, Courtesy of AIHP Kremers Reference Files.

Blood is everywhere I look in the Kremers Reference Files (KRF) at the American Institute of the History of Pharmacy (AIHP). It’s in trade manuals published from the 1890s to the 1930s by Parke-Davis, Eli Lilly, and H. K. Mulford. It’s in advertisements from meatpacking-turned-drug companies, including Bovinine and the Cudahy Packing Company. It’s in dusty, century-old newspaper clippings that describe how tons of animal flesh were transported from slaughterhouse to factory line, ripe for experimentation and drug production.

I came to the KRF to start my dissertation work about the American vaccine industry at the turn of the twentieth century, but, instead, all I found was blood. Image after image of blood being suctioned out of stable-bound horses. Blood coursing through plastic tubes that look like fiberoptic cables. Blood being rapidly deposited into oversized receptacles, red foam climbing up the sides of the glass. Some of the images look almost staged—deliberately and self-consciously reenacting a scene from Mary Shelley’s Frankenstein, then just 80 years old.

Maybe I shouldn’t have been surprised. I knew before going into the KRF that the vaccine industry was fully launched in the 1890s with the diphtheria antitoxin vaccine, that this was a “serotherapy,” and that all serotherapies involve a process of blood harvesting. It is a vampiric practice by definition. Hundreds of horses stand at attention, and scientists buzz around them like angry mosquitoes, directing their syringes with precision into pulsing jugulars, delighting at the extraction of potent antitoxins that hurtle invisibly through equine vascular systems. Antitoxin-rich blood was as good as gold at the turn of the century, and it brought companies like Parke-Davis and H. K. Mulford material, social, and political capital.

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Points Interview: “The Drug War Dialectic in Early Twentieth-Century Chicago” with Richard Del Rio

Editor’s Note: Points continues its series of interviews with authors from the latest issue of ADHS’s journal Social History of Alcohol and Drugs (vol. 34, no. 2; Fall 2020), published by the University of Chicago Press. Today we feature Dr. Richard Del Rio, a Provost’s Postdoctoral Fellow within the Department of Behavioral Science and Social Medicine at the Florida State University College of Medicine. You can see his article here. Contact the University of Chicago Press to subscribe to the journal or request access to this article, or any other article from SHAD’s history. 

Dr. Richard Del Rio
Richard Del Rio

Tell readers a little bit about yourself

Yikes! In my view you’re starting with the hardest part of this interview. In the professional sense, I am a historian trained in the social history of the United States and the histories of Latinx and African American peoples. My academic specialty and research focus is to contribute to these fields of history through the stories of pharmaceuticals and drugs. In case you’re asking for something a little more personal, I’ll just mention that I’m a lover of Caribbean culture, admirer of martial arts, enjoy building community/fellowship, and always try to learn from others. And just in case there are any gamers checking this interview, when I have the time for it (and I rarely do), I really enjoy a competitive bout of Super Smash Bros.!

What got you interested in drugs (and their history)?

Scholars across academic disciplines have recognized the pervasive influence of the United States’ policy regime known as the “War on Drugs” in the late twentieth century. Along wIth the more recent “War on Terror,” the War on Drugs has served as an important pretext for American foreign interventions and international ambitions. Domestically, I think the broad public calls for reforms to our drug laws and the complete legalization of cannabis highlight the recognition that the War on Drug’s impact on the public’s health and wealth was mostly damaging. Its emphasis on punishment and supply side controls contributed to the militarization of police, the alienation of the citizens they serve, and the controversial growth of publicly traded corrections companies. There is a growing recognition that we need some new ideas about how to approach or shape the public’s consumption of strong, potentially addictive, psychoactive drugs. I am part of a generation of historians in my field who have been working to understand “how did things get so bad in the first place?”

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Whitewashing History: Osaka’s Tanabe Mitsubishi Pharma Museum

Editor’s Note: Today’s post comes from Dr. Miriam Kingsberg Kadia, Associate Professor of History at University of Colorado Boulder and author of the books Moral Nation: Modern Japan and Narcotics in Global History and Into the Field: Human Scientists of Transwar JapanHere she continues her fascinating museum reviews with an examination of a museum in Osaka from her recent trip to Japan.

The Tanabe Mitsubishi Pharma Historical Museum (Kusuri no Doshōmachi Shiryōkan) is located in Osaka, a half-hour ramble from the main train station. It lies in the heart of the city’s traditional merchant quarter (still dotted with preserved architecture dating to the late nineteenth century). The museum occupies the second floor of the Tanabe Mitsubishi Pharma Company headquarters. It is open from 10:00 a.m. to 5 p.m. on all weekdays excluding holidays. Advance online reservations are required for entry. Admission is free, the staff is welcoming and helpful, and all films, exhibits, and interactive materials are bilingual. At the time of my visit (around 2 p.m. on a Wednesday in early January), I was the only guest.  

As the museum narrates, Tanabe Mitsubishi Pharma is both a new and an old entity. The company acquired its current form in 2007 as the result of a merger. However, its origins date back to 1604, when Osaka-based merchant Tanabe Gohei received a permit from the Tokugawa shogun (then ruler of Japan) to peddle medicines. In 1678, his grandson opened the family’s first shop (Tanabeya) and began selling medicinal products imported from the Philippines. At the time, Japan was under a strict policy of seclusion, and Tanabe’s foray into international commerce must have required considerable negotiations. (Unfortunately, the process by which he obtained his permit is not elucidated.) Tanabeya truly thrived during the Meiji period (1868-1912), when, in advance of most competitors, it began providing Western medicines in addition to traditional Sinic treatments. Within a short while, the former dominated sales. Another major period of growth took place during World War I, when Germany, then the global leader in developing and manufacturing pharmaceuticals, became unable to export its products. Local concerns including Tanabeya stepped into the breach and greatly expanded their market share.

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GlaxoSmithKline, Drug Marketing, and the Problem of Disease Inflation

Earlier this month, the Department of Justice announced that the pharmaceutical giant GlaxoSmithKline had agreed to settle criminal and civil complaints related to its illegal marketing of the popular antidepressants Paxil and Wellbutrin from the late 1990s through the mid-2000s. In addition to a number of other offenses, the settlement also covered allegations that the company had failed to report safety data to the Food and Drug Administration (FDA) for its diabetes drug Avandia. In order to settle the case, the company agreed to plead guilty to promoting Paxil and Wellbutrin for uses that had not been approved by the FDA. The company also agreed to pay $3 billion in criminal and civil fines, which might seem like a huge amount of money until you realize that Paxil, Wellbutrin, and Avandia earned the company at least $28 billion during the period covered by the settlement. As one industry analyst commented, “a $3 billion settlement for half a dozen drugs over 10 years can be rationalized as the cost of doing business.”

For those of us interested in the machinations of Big Pharma, neither GlaxoSmithKline’s behavior nor the terms of the agreement are particularly surprising. Over the past decade these types of settlements have become increasingly common. In 2007, for example, Purdue Pharma settled for the relatively modest sum of $634 million for illegally promoting OxyContin as less addictive than other painkillers. In 2009, Eli Lilly settled for $1.4 billion for illegally marketing Zyprexa for the treatment of dementia, among other problems, despite being approved only for the use of schizophrenia and bipolar disorder. In the same year, Pfizer settled for $2.3 billion for illegally promoted its painkiller Bextra, and in 2011 Merck agreed to pay $950 million to settle complaints that it had illegally marketed Vioxx. In May of this year, Abbott Laboratories settled for $1.6 billion for illegally marketing an anti-seizure drug. Any day now, the Justice Department is expected to announce that Johnson & Johnson has settled claims that it illegally promoted Risperdal, a drug currently approved for the treatment of schizophrenia. The expected settlement is about $2.2 billion. Earlier in the year, a judge in Arkansas had ordered the company to pay $1.2 billion in fines for hiding the dangers of the drug in its promotional efforts. I could go on, but I think you get the point.

There is a tremendous amount to be said about all this, most of which isn’t good, but for the moment I want to focus on the effort to promote drugs for so-called “off-label” use. Under the 1938 Food, Drug, and Cosmetic Act (and subsequent amendments and laws), it is illegal for pharmaceutical companies to promote drugs for uses that are not approved by the FDA, or for the treatment of patients that are outside of the approved age range, or to promote the use of drugs at higher doses than for which they are approved. However, it is perfectly legal for physicians to prescribe drugs for any condition, to any patient population, and in any amount that they see fit. The result is that there is a tremendous incentive for companies to promote their products illegally:

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The Points Interview: David Herzberg

Editors’ Note: We’re delighted to bring Points readers another installment (number sixteen) in the “Points Interview” series.  Today, we’re getting happy with David Herzberg, author of Happy Pills in America: From Miltown to Prozac (The Johns Hopkins University Press, 2009).  David Herzberg has been a Contributing Editor here at Points, and is also an Associate Professor in the Department of History at SUNY-Buffalo (where he also hosted the recent conference of the Alcohol and Drugs History Society).

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

Happy Pills is a cultural history of Miltown, Valium, and Prozac—three of the best known, Cover of Happy Pills in Americamost widely used, and controversial medicines in the postwar era.  It tells their medical and commercial stories, but also asks why they became so faddish and contentious, and how their fame (and infamy) influenced medical and popular ideas about consciousness and identity.
The book begins in the 1950s, when Miltown became the first “blockbuster” tranquilizer and an early icon of biological psychiatry.  The drug’s celebrity was the product of several developments:  intensified popular marketing of prescription drugs; increased medical and public attention to anxiety as an illness, led in part by Freudian psychiatry; and a burgeoning consumer culture primed to deliver technological wonders in the name of comfort and convenience for the middle classes.
But Miltown’s popularity didn’t sit well with everyone; in fact the prospect of eradicating anxiety made some people quite nervous.  The tranquilizer and its successors quickly became embroiled in postwar gender battles and the explosive politics of the “war against drugs,” and Happy Pills traces these stories to their combined conclusion in a feminist campaign against Valium addiction in the 1970s.  This was a most unusual anti-drug campaign, targeting sexism in drug companies and the medical system rather than stoking fear of addicts.  It capped off a decade of challenges to the pharmaceutical industry, and was part of a broader effort by reformers to rethink the boundaries between “drugs” and “medicines.”

Happy Pills ends with a look at the emergence of Prozac and other antidepressants in the late 1980s and 1990s, and the accompanying revival of popular belief in wonder drugs.  Why was this resurgence so successful when the drugs themselves turned out to be far from revolutionary?  Prozac’s boosters, I argue, took new findings in brain science and used them to create a story that was as much political as it was scientific:  miraculous new consumer goods now made it possible to pick and choose personalities—identities—in a utopian free market of accessorizable selfhood.  However exaggerated such promises may have been, they proved a powerful cultural vehicle for pushback against feminist-era drug critics, and a fitting vision of identity and personal change for an increasingly conservative era.

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