Drug Idolatry

The Cult of Pharmacology
This is a new book recently reviewed in JAMA.
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Among the countless forces that shape attitudes toward drugs, science is arguably the least influential. Although irrationality pervades people's use of all substances, from herbal preparations to antibiotics, a singular foolishness imbues the views of mind-altering ones.
The most troublesome upshot of society's unreasonable approach to drugs is the war on drugs. As Richard DeGrandpre points out in The Cult of Pharmacology, the war on drugs is fueled by misconceptions about the nature of addiction, the danger of prohibited drugs, and the best ways to limit the damage that these drugs do inflict. Most worrisome of all, this war has already been lost several times.

The book's basic message is that certain drugs are demonized and others embraced not on the basis of a drug's pharmacological actions or what it actually does mentally or physically but because of the meanings attached to it. What the author calls "angel drugs"—those, like antidepressants, that are considered legitimate and beneficial—are a lot worse than people think, and demon drugs, like cocaine and heroin, he contends, are not actually so bad.

The book's other major point—and the one giving rise to its title—is that the "cult of pharmacology" or "pharmacologicalism" is at the root of misconceptions about drugs and society's wrongheaded drug policies. DeGrandpre never clearly defines these terms, but they seem to refer to the beliefs that drugs are uniquely powerful and that their effects come from their pharmacological activity alone. The Cult of Pharmacology states again and again that insufficient attention is paid to context, expectation, and meaning. For example, he asserts that nicotine is not the culprit behind addiction to cigarettes, but rather other attributes of smoking are—the anticipation, the smoking context, and what smokers expect to happen when they quit. As "evidence," the author points to the fact that not everyone on nicotine replacement stops smoking.

Science may not be influential but scientist are influential and often push the foolishness. This isn’t particularly original but such books usually don’t get a lot of press. Despite the media’s love of controversy, the press avoids certain subjects. Surprisingly, last month, the book was also reviewed by the Prozac Man, Dr. Peter Kramer in the Washington Post

Why isn't Nicorette gum a street drug? The Food and Drug Administration considers nicotine highly addictive. Tobacco companies seem to share this view when they manipulate the level of nicotine in cigarettes. But the gum, which packs a goodly dose of nicotine, appeals to almost no one. While we're at it, if nicotine dependence is what stands in the way of quitting, why do patched smokers -- their brains well-supplied with the substance -- still crave the next drag?

The anti-tobacco folks have reduced all the pleasures of tobacco to nicotine. However, tase has always been an important factor in smoking as well as the sensual experience of smoking. I’ve ordered nicotine gum for many folks. Either they quit or don’t quit smoking. They never switch to just taking the gum even though they may get the gum for free[GG].

If these questions have an answer, it is that addiction is not a simple matter of chemical and receptor. Habit, ritual, social context and the means of delivery all affect how the brain processes a drug and how we experience it. As a result, drug research is replete with paradox.

Of course, the addiction folks constantly preach this. It’s not so much that drug research is replete with paradox. The research seems paradoxical only if you approach drug abuse with a strictly materialist perspective.

Kramer who is a cheer leader for pharmacology is critical of the author’s arguments[GG]:

We need to develop a humane approach to street-drug use. We need more independent testing of prescription drugs. But to hold these views does not require the belief that America has been hijacked by a cabal of doctors, politicians and entrepreneurs. DeGrandpre's attack comes from a libertarian posture, anti-business but even more anti-government. There's an element of the personal hobby-horse here as well: Pharmacologicalism conveys state power more effectively than communism or national socialism? Isn't it likelier that -- the undeniable flaws of capitalism and democracy notwithstanding -- we're muddling along, trying to make what sense we can of medications, licit and banned, that are ever better attuned to the workings of those admittedly complex organs, our brains? ·