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travisclau's review against another edition
5.0
Incredible, accessible, and incisive critique of Big Pharma -- demonstrates the logics and processes of how medicine has become an industry. The marketable culture of risk and health is made clear in a way that I think needs to be taught and shared more widely.
mosshaunt's review against another edition
challenging
slow-paced
1.5
i understand the need for generalization in persuasive texts, but a lot of the points made here are very hard to relate to, as a physically disabled person who went undiagnosed for years.
mburnamfink's review against another edition
4.0
Joseph Dumit’s new book, Drugs for Life, is subtitled “How pharmaceutical companies define our health.” He has a clear perspective, and one that makes his ‘apoplectic’ (his own words, page 177); that pharmaceutical companies in the latter half of the 20th century have misused science to manufacture a population perennially at risk, so as to satisfy the capitalist demand for ever expanding markets and increasing profits, at the expense of both truth and health. But in some cases, if you’re not mad, you’re not paying attention, and Dumit has performed a valuable service in tracing and revealing the constructed nature of the facts that underpin the modern healthcare system.
Dumit frames his book around a double insecurity: that we as modern biocitizens can never be sure that our bodies are not concealing some future illness, and that knowing this, we can never be sure how best to react to this risk. He argues that the randomized clinical trial model developed in the 1950s established illness as invisible and unknowable, except in statistical terms. This would not be a problem, except that by and large the only organizations with the resources necessary to conduct clinical trials are pharmaceutical companies, and they’re motivated to expand the size of their market above all else.
This conflict of interest means that the number of sick people, and the attendant personal and social cost of illness, has consistently risen over the past 70 years. More aggressive screenings for cancer, heart disease, and mental illness, and broader diagnostic standards, mean that larger number of people become patients and potential customers. The logic of NNT (number-needed-to-treat), becomes perversely twisted. A NNT of 1 (everybody treated improves) is the worst from a financial standpoint, while higher NNT means a less effective drug, and great financial returns. Similarly, direct comparative study between similar drugs, research on tropical diseases, and acute cures over chronic disease maintenance, are all discouraged.
Dumit’s sources for these “revelations” are the textbooks and journals produced by pharmaceutical executives themselves, analyzed using Actor Network Theory(ish) approaches to epistemology, and how facts circulate through society, and a theory of power and political economy strongly influenced by Marx. The theoretical framework is workable, but not brilliant. Marks-The Progress of Experiment, is a better book on randomized clinical trials in a historical context.
Where this book shines is in the ethnography of patient types, about how people respond to living in a culture of “surplus health”. The Expert Patient, critically engaged with the latest scientific literature, is the neoliberal ideal of the engaged and critical consumer. In practice, most of us are the Fearful Subject, perennial under threat from all directions, only able to achieve a paranoid vigil against illness that will inevitably fail. And at some point, a person reaches a balance with Better Living Through Chemistry, believing that they can trade off risks and pleasures through a studied management of ignorance.
Having read a few of these books (Epstein-Black Coat, White Hat and Conrad-The Medicalization of Society), Dumit is equally outraged but a little bit more balanced. He sees the corruption as systemic rather than personal, as something that patients and doctors are forced to buy into as part of becoming informed users of the latest medical data. The (unstated) problem for is not so much that health has become commoditized, but that we are unwilling to face up to our own mortality.
Dumit frames his book around a double insecurity: that we as modern biocitizens can never be sure that our bodies are not concealing some future illness, and that knowing this, we can never be sure how best to react to this risk. He argues that the randomized clinical trial model developed in the 1950s established illness as invisible and unknowable, except in statistical terms. This would not be a problem, except that by and large the only organizations with the resources necessary to conduct clinical trials are pharmaceutical companies, and they’re motivated to expand the size of their market above all else.
This conflict of interest means that the number of sick people, and the attendant personal and social cost of illness, has consistently risen over the past 70 years. More aggressive screenings for cancer, heart disease, and mental illness, and broader diagnostic standards, mean that larger number of people become patients and potential customers. The logic of NNT (number-needed-to-treat), becomes perversely twisted. A NNT of 1 (everybody treated improves) is the worst from a financial standpoint, while higher NNT means a less effective drug, and great financial returns. Similarly, direct comparative study between similar drugs, research on tropical diseases, and acute cures over chronic disease maintenance, are all discouraged.
Dumit’s sources for these “revelations” are the textbooks and journals produced by pharmaceutical executives themselves, analyzed using Actor Network Theory(ish) approaches to epistemology, and how facts circulate through society, and a theory of power and political economy strongly influenced by Marx. The theoretical framework is workable, but not brilliant. Marks-The Progress of Experiment, is a better book on randomized clinical trials in a historical context.
Where this book shines is in the ethnography of patient types, about how people respond to living in a culture of “surplus health”. The Expert Patient, critically engaged with the latest scientific literature, is the neoliberal ideal of the engaged and critical consumer. In practice, most of us are the Fearful Subject, perennial under threat from all directions, only able to achieve a paranoid vigil against illness that will inevitably fail. And at some point, a person reaches a balance with Better Living Through Chemistry, believing that they can trade off risks and pleasures through a studied management of ignorance.
Having read a few of these books (Epstein-Black Coat, White Hat and Conrad-The Medicalization of Society), Dumit is equally outraged but a little bit more balanced. He sees the corruption as systemic rather than personal, as something that patients and doctors are forced to buy into as part of becoming informed users of the latest medical data. The (unstated) problem for is not so much that health has become commoditized, but that we are unwilling to face up to our own mortality.
hybridpubscout's review
4.0
Depressing but enlightening, and easily understandable by anyone who has worked in marketing, been marketed to, or been to a doctor in the United States. It's presented as a resigned indictment of medical capitalism, almost with a shrug emoji and a "welp, it's what's happening and I don't see a way out" attitude. I think the idea that pharmaceutical companies realize that their approach is problematic but blame consumers for the way the market works is very telling.
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