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.

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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.

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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.

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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?

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Friday Reads, Vol. 3

Editor’s Introduction: Because we here at Points believe that an understanding of the past is best supplemented with an eye toward the present (and the future), we offer up this weekly selection of long-form pieces on drug- and alcohol-related issues. This past week, the British Isles have been abuzz with discussion about how best to deal with the …

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Down to Earth: Rick Doblin on MAPS’ Day-to-Day Operations and Basic Philosophies

During the first installment of our three-part interview with Multidisciplinary Association for Psychedelic Studies (MAPS) Founder and Executive Director Rick Doblin, the visionary nonprofit head explained that his organization’s “mission is to conduct scientific research into psychedelics and marijuana and their therapeutic potential, to develop them into legal prescription medicines.” Points wanted to hear from Doblin more about MAPS’ unique purpose and how Doblin and staff set about fulfilling it on a daily basis. Doblin can’t help launching into explanations of the historical context that informs that work, so we managed to get another dose of psychedelic oral history out of him, as well. We spoke further about the kinds of drugs into which MAPS is looking, their promising potential uses, and what exactly “prescription psychedelics” look like. The second installment of Points’ engaging interview with Doblin appears below.

Points: We touched briefly on MAPS works to fulfill its mission earlier, but I know there’s a lot more to be said. If the bulk of your work is researching clinical and therapeutic uses for psychedelic drugs, can you talk about some of those uses?

MDMA shows promising results in PTSD treatment.

Doblin: Well, our top priority project is MDMA-assisted psychotherapy for post-traumatic stress disorder. MDMA reduces fear: it reduces activation in the amygdala, the fear processing centers of the brain. It increases activation in the prefrontal cortex, where people put things in context, so people can tell then from now, and can overcome the fear that has blocked them from integrating the traumatic experience. We have an international series of Phase II pilot studies: In the United States we’ve completed one; in Switzerland, we’ve got one on-going; [we have one in] Israel; [and] another study in the US underway with veterans with posttraumatic stress disorder. We’re trying to start a new study in the US to evaluate our female/male co-therapist team, that would include a graduate student intern as one of the two therapists. We’ve got a study in Canada, and we’re working to start a study in Jordan. We’ve got other projects in Australia and England in the early stages of development.

There have also been projects with MDMA for cancer patients with anxiety. There’s been a study at Harvard to help people deal with fearful emotions around dying. We have a study with LSD with people who are dying that we have just completed in Switzerland, the world’s first therapeutic study of LSD in about 40 years. We’ve got projects that are about to start with MDMA where we are going to put out a request for proposals for protocols for MDMA for Aspberger’s and autism. There are a lot of reports on the internet of people with Asperger’s who have done MDMA recreationally and found it to be helpful for them.

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Far Out: Psychedelic History with Rick Doblin, Founder of the Multidisciplinary Association for Psychedelic Studies (MAPS)

The Multidisciplinary Association for Psychedelic Studies (MAPS) is not your typical drug policy reform organization. Since 1986, MAPS has worked as a nonprofit pharmaceutical company to turn psychedelic drugs into prescription medicines to treat afflictions — including postraumatic stress disorder, pain, depression, and even addiction — for which conventional therapies offer little relief. The term “prescription psychedelics” may sound like something out of a 70s science fiction story — politically impossible and culturally strange — until you hear it explained in context by Rick Doblin, MAPS’ founder and executive director.

Points is pleased to have had the opportunity to speak with Doblin about his organization’s relationship to past psychedelic research efforts, its major goals and day-to-day operations (Part II), and the philosophy of addiction and recovery that informs its work (Part III). We proudly present below the first installment of a three-part interview we will showcase over the next week in celebration of MAPS’ 25th anniversary this year. Today, we’ll hear about Doblin’s thoughts on the organization’s first 25 years and MAPS’ place within the larger context of psychedelic movements past and present.  

Points: Hi, Rick. We’re really glad to have you here. First, could you explain a little bit about MAPS’ work and its mission? In other words, what does MAPS do on a daily basis and what do you want that work to accomplish in a larger sense?

MAPS Founder Rick Doblin

Rick Doblin: MAPS’ mission is to conduct scientific research into psychedelics and marijuana and their therapeutic potential, to develop them into legal prescription medicines. A lot of our work is trying to design studies, get permission for studies, raise money for studies, and then conduct them. And then our broader mission is to educate the public honestly about the risks and benefits of these drugs and to establish a network of psychedelic clinics whereby these substances would actually be administered to patients. What we’re finding is that unfortunately, because the drugs are controversial and because the drugs are illegal, there’s a lot of difficulty, particularly with marijuana, in getting permission to do the research. And though we can get permission with psychedelics, there are challenges with funding. But the most important thing to say about this is that the FDA has decided to put science before politics unlike the DEA, NIDA, or the drug czar’s office. So we have the opening, and our mission is really to try to take the fact that all drugs have risks and benefits and develop contexts whereby the benefits of psychedelics and marijuana can be taken advantage of to help people in a wide range of uses.

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Forgotten Drugs of Abuse I: T’s and Blues

Stop me if you’ve heard this one before.  It’s about a new drug, a killer, raging through a major American city filling ERs and morgues and leaving a trail of wrecked lives.  Just a year ago heroin was the big problem, but now this new scourge accounts for three-fourths of drug busts and a third of all addicts seeking treatment.  Experts are saying there’s no way the drug will stay in one city: “similar to an infectious process,” it will inevitably spread across the nation.  It’s already surfaced in a handful of cities, and who knows where it will strike next.

Scourge of Our Cities

The year is 1978, and the Talwin panic is in full swing.

Wait, you don’t remember the great Talwin terror of 1978?  Maybe haven’t even heard of Talwin?  Don’t feel bad.  Despite the promising start, the Talwin scare never really got off the ground.  There were a few headlines here and there, a TV documentary, and a day of testimony in Congress, but in the annals of anti-drug crusades it was small potatoes.

Why?  1978 was a great year for drug crusades, and this one seemed to have plenty going for it:  Talwin really was causing major public health problems in Chicago; it had a hip, media-friendly street name (“T’s and Blues”); and most of its abusers were nonwhite, urban poor—classic drug-war boogeymen.  More:  one of the largest sources of Talwin in Chicago was a Medicaid clinic, where, Congress was told, the drug was “handed out literally like M&Ms.”  The headlines could have written themselves.  “Hard Working Taxpayers’ Dollars Going to Give Dope to Junkies!”  And if that wasn’t enough, how about this sound bite from the Congressional hearings:

Thank you indeed!  “Grandmothers are buying Talwin on the street”:  does it get any better than that for an anti-drug crusader? It wasn’t supposed to end up like that for Talwin. 

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