Tranquillizer consumption in 1970s America

HPSC2665 short essay (week 8), S2 2006

Pellegrino's (1976) suggestion that over-prescription can be a function of the symbolic needs of doctors, but this alone cannot explain the massive consumption and prescription of minor tranquillizers in America during the 1970s, especially given the issue of non-compliance (Pellegrino, 1976; Speaker, 1997). The part prescription plays in helping doctors reinforce their power over disease and social authority, as well as providing tangible evidence of the fulfilment of the healing contract between doctor and patient was certainly as significant in the 1970s as it ever was in the history of medicine, but the doctors and patients of the 20th century were different people compared to their historical counterparts. In addition to this, Pellegrino's extremely narrow conception of the object of prescription (the chemical) limits the usefulness of this symbolic view of the prescription[1], but understanding how such a narrow view could come about in the context of Western medicine might also help us understand issues such as the high levels of minor tranquillizer consumption in the 1970s.

Speaker (1997) also mentions many valid theories on the origins of the 'medicated society' of the 1970s and suggests that while minor tranquillizer prescription and consumption was considerable, the perceived undesirability of a 'medicated society' could also have been due to political agendas and a backlash against society itself, rather than an inherent fault of the medical profession or pharmaceutical industry. Speaker, too, does not go into historical changes to the doctor-patient relationship and significance of the prescription to that relationship. However, a significant point that she does note is that implicit in the political critique of minor tranquillizer prescription and consumption was that, rather than less medical care, or alternatives to the mainstream system, everyone should have access to more and better health care (Speaker, 1997 p. 372-373). I believe it is largely this view that has lead up to such scandals as the minor tranquillizers and other issues of medical incompetence and social irresponsibility.

So how did the prescription become so widely perceived to be abused or perverted by profiteering pharmaceutical companies that the public viewed doctors as no better than pushers? I believe that it has to do with the complex activity of prescription itself. It is unlikely that the issue of patient non-compliance is a recent phenomenon or that doctors throughout history have not realised that by issuing prescriptions that are unlikely to be followed, they are putting their patient's health and their own reputations (and finances) at risk. The prescription has therefore never been purely scientific or medical, but has always to some extent taken into account the willingness and ability of the patient to follow a treatment regime.

Whereas once doctors were at liberty to prescribe things like exercise regimes, a change of diet or climate and other non-chemical therapies, the changing nature of their patients, combined with the success of the pharmaceutical industry in adding to the range of effective medications inevitably made drugs the preferred prescription. It is only in recent times that the ideal of affordable and equitable health care meant that nearly everyone in developed nations has access to a physician. Before then, those who could afford to engage the services of a physician were also the most likely to be able to undertake the regime they would prescribe, whether it be to relocate somewhere sunnier or reduce one's working hours, and so forth. The inevitable truth is that the fewer a patient's resources are, the less treatment options are open to them. Thus, throughout the 20th century, doctors were increasingly treating patients with less and less realistic therapeutic options. For the working poor and others of little affluence, their ability to change things that influenced their health, such as diet, working conditions or even the climate to which they were subject, was limited.

Moreover, once pharmaceuticals became recognised as effective treatments for certain diseases, the comparative ease with they could effect a cure compared to non-pharmaceutical prescriptions would have made them more desirable to patients regardless of their means. Doctors might have been more willing to prescribe drugs rather than other treatments because they felt that the drug regime was more likely to be followed. The question of what the patients themselves want is also an issue, medicine being a commercial as well as healing exercise. As Pellegrino (1976) points out, when visiting the doctor it is the patient's idea of illness and health that the doctor must deal with. Further barriers to non-pharmaceutical prescriptions include the new location of the consultation with the physician, from the home of the patient to the doctor's office, and the new nature of the consultation itself, removed from the context of disease, with emphasis on the communication of symptoms. Diagnosis made on this basis, rather than investigation of any reasons underlying the physical manifestation of disease, would lend itself to the treatment of symptoms rather than behavioural or occupational changes.

In conclusion: while the symbolic function of the prescription makes its overuse possible, in the case of the minor tranquillizers in the 1970s the changing nature of patients and their treatment options, as well as the location of the medical consultation and doctor's perception of what treatments were most likely to inspire compliance, were more significant factors in the massive consumption of prescription tranquillizers than any symbolic meanings of the drugs or prescriptions in socially recognising and legitimising illness.


References

Pellegrino, E (1976) 'Prescribing and drug ingestion symbols and substances', Drug Intelligence and Clinical Pharmacy. 10: 624-630.

Speaker, S (1997) 'From “happiness pills” to “national nightmare”: changing cultural assessment of minor tranquillizers in America 1955-1980', Journal of the History of Medicine and Allied Sciences. 52: 338-376.

[1] But this view makes more sense when we consider his article is written for a pharmaceutical audience.