Gin, Beer, and Chicken: Hogarth’s Art and More

A new piece of art commissioned by the Royal Society for Public Health (RSPH) re-imagines William Hogarth’s classic 1751 cartoon Gin Lane. It depicts a society preoccupied by junk food rather than gin.

This is pretty amazing timing, considering this is the focus of my Disease and Society lecture this week!

_91991260_meginlane300dpia3
Reimagined Version by Thomas Moore

According to the BBC, the original showed the damaging effects of a gin craze sweeping London as well as a population suffering from deadly infections common at the time. Cholera. Syphilis. You name it. In contrast, Thomas Moore‘s new picture shows how obesity and mental health issues are today’s big health threats.

The updated version shows a mother salivating over yummy junk food, which she is also feeding her child. In contrast, Hogarth’s 18th century version focuses on a mum more interested in gin and snuff, who is suffering from syphilis sores.

Another stark difference is the prominent payday lender shop, replacing the pawnbrokers of 1751. (Just need a betting shop in there!) Moore’s modern version highlights the popularity of high street chicken shops today, while Hogarth’s work shows people almost skeletal with starvation.

gin-land
Gin Lane by William Hogarth

And…Beer Lane

hogarth

****

FULL BREAKDOWN OF CHANGES

gin-lane-2016-annotated-jpg

The overall scene is the same street as presented in the original, but has been developed and modernized so that it is representative of a typical street scene in London, or indeed anywhere in the UK today.

  1. The central character has been reinvented. Where the original depicts a mother who is drunk and too pre-occupied with taking snuff to care for her baby, Gin Lane 2016 instead shows the mother preoccupied with eating junk food, which she has also fed to her child.
  2. A pawnbroker is one of the significant and thriving businesses in the original piece. In the modern version, this has been replaced by one of the payday lenders which have become a feature of many high streets, and are perhaps a 21st century equivalent. The desperation of one of the customers leaving the payday lender represents the mental ill health associated with debt.
  3. The chicken shop is a representative feature of the obesogenic environment which is at the heart of Gin Lane 2016 – busy, vibrant, and packed full of glum looking customers.
  4. The man contemplating throwing himself off the top of a building is a nod to the original in which a barber is seen hanging, having committed suicide because his customers could no longer afford to have their hair cut. Suicide is now the single biggest killer of men under 45 in the UK.
  5. The original arch has been converted into Gin Lane tube station, with commuters glued to their smart phones – a depiction of the busy, potentially lonely existence of many Londoners today.
  6. Junk food adverts provide another reflection of the ubiquitous power of marketing in our obesogenic environment.
  7. The distillery from the original piece has become a busy pub, replete with rowdy drunk customers.
  8. A news vendor hands out a paper with another headline about the threat posed by obesity.

Courtesy of https://www.rsph.org.uk/about-us/news/gin-lane-2016-iconic-artwork-reimagined-for-the-21st-century.html

****

My lecture this Friday will definitely be connecting the past with the present…

GIN AND JUICE

 

Advertisements

EpiPen Price Gouging is Old News

On Thursday, Mylan announced a series of steps that will make its EpiPen more affordable for some patients. Over the past few years, Mylan had raised a standard two-pack of EpiPens to roughly $600. It had cost $100 in 2009. Then, following a recent uproar, including a public tongue-lashing from Hillary Clinton and a US Senator whose daughter uses the product, Mylan NV (MYL) said Wednesday it would help reduce the cost of the emergency allergy drug for people who are struggling to afford it. Clinton, for her part, became  excoriated Mylan’s “price gouging,” kicking off another selling spree on Wall Street, where Mylan’s stock has plummeted roughly 11% and the Nasdaq Biotech index saw a 3.4% decline, which was the worst of the summer.

Epipen

In a press release, Mylan said it would provide instant savings cards worth $300 to patients who have to pay full price for the drug out of pocket. That amounts to about a 50% price cut for people without insurance or for patients with high deductible plans.

“We responded this morning, first and foremost, ensuring that everybody that needs an EpiPen has an EpiPen,” Mylan CEO Heather Bresch said in an interview with CNBC. “As a mother I can assure you that the last thing we could ever want is no one to have their EpiPen due to price.” When asked why the price of EpiPen increased so much over the years, Bresch, who is the daughter of Senator Joe Manchin of Virginia, blamed “the system” which needs to be “fixed.” She said that with the savings card, “We went around the system. The savings card is equivalent to cash.”

In the course of Canadian coverage, it was assumed that Americans would be travelling north to grab cheaper EpiPens. And this is far from new.

*****

In 2013, I wrote about Americans purchasing pharmaceuticals from Canadian stores in Canadian Review of American Studies. The paper was called The Maple Peril and it explored the practice of cross-border drug reimportation, and considered the Bush and Clinton administration’s policies regarding the necessary balance between drug access, affordability, and safety.

front_cover

In the 1990s, lower drug prices in Canada forged a strong relationship between American consumers and the Canadian industry, leading to the expansion of illegal cross-border reimportation. This occurred in person or through Internet pharmacies. In Canada, the Patented Medicines Price Review Board (PMPRB) imposes federal price regulations, but a number of other reasons also drive down Canadian drug prices. For instance, lower prices on Canadian brand-name drugs are likely the normal result of market economics; that is, prices are matched to different supply and demand dynamics in the Canadian and American markets.

In 2001, as President Bush took office, thanks to Canadian regulations— as well as a weak Canadian dollar—Americans were saving 50 per cent to 70 per cent filling their prescriptions in Canada. In 2004, Canada’s review board reported that Americans paid an average 67 per cent more than Canadians for patented drugs; in 2003, while a three-month prescription for Merck’s cholesterol reducer Zocor cost $172 in Canada, American patients paid $328 for the same pills. The antiretroviral drug ritonavir (Norvir) cost as little as a $700 per year in Canada as opposed to $7,800 per year in the United States.

From the consumer’s standpoint, it was thus eminently rational – or, smart – to seek alternatives to American drugs. And it should come as no shock that drug prices became a major political and economic question mark within the Bush administration.

***** BEGIN PRICES BACKGROUND *****

The troubling matter of drug costs was first contested in the 1950s. Historian David Herzberg argues that ‘‘increasing competition and ever more intense advertising transformed the character of the once staid prescription drug business’’. The new, transformed pharmaceutical industry was challenged in the political arena when, in December 1959, Senator Estes Kefauver (D-TN) took up the general issue of administered prices. Through the Senate Subcommittee on Antitrust and Monopoly he investigated a host of industries, including ‘‘bread, milk, auto, steel, and electrical manufacturing’’ industries. He also focused on the American pharmaceutical industry’s monopoly and revealed a ‘‘series of price-fixing and collusion scandals’’.

During the ten-month hearings, 150 witnesses testified about cortical steroids, tranquilizers, antibiotics, and oral antidiabetics. Kefauver, who ‘‘favored an economy in which competition among small producers set prices,’’ asserted that the drug industry practised ‘‘price leadership’’ and suffered little foreign or domestic competition. His two principal experts, Dr. John Blair and Paul Rand Dixon, were media savvy and compared a drug’s production costs to its wholesale and retail prices; thereafter they brusquely questioned representatives of the pharmaceutical industry and neatly underlined the fact that consumers in the United States were paying a hefty sum for their medications. In one extraordinary example, the markup was 7000 per cent.

Kefauver’s subcommittee hearings, aided by the Thalidomide scare in 1962, eventually led to the passage of the 1962 Kefauver-Harris Act. Compulsory licensing and greater patent regulation, significant
pricing reforms, were excluded from the final product. Still, Kefauver’s legislation had a lasting impact. It increased the power of the FDA—the ultimate authority on whether a drug goes to market—and mandated a drug be both safe and effective; the new law also established standardized manufacturing procedures.
According to physician Jerry Avorn, the new law represented a ‘‘watershed moment in the nation’s approach to medications.’’ The legislation ‘‘completely changed the way doctors and patients thought about drugs’’. Just as important, Kefauver (and his pricing hearings) was the forerunner for a cascading set of consumer oriented hearings which focused on the growing power of the pharmaceutical industry’s advertising as well as the addictive nature of stimulants and sedatives.

***** END OF PRICES BACKGROUND *****

While President Bush adopted an amorphous position on reimportation, his appointments at the HHS and FDA did not.

In 2002, Tommy Thompson, who had already scuttled the legalization of reimportation, combined US national security imperatives and a policy opposing counterfeit drugs. In his estimation, drugs reimported to the United States from Canada constituted a clear and present danger to American consumers and, building his case, drew parallels with the new War on Terror launched after 11 September 2001. Thompson warned that ‘‘opening our borders to reimported drugs potentially could increase the flow of counterfeit drugs, cheap foreign copies of FDA-approved drugs [what the rest of us call generics], expired and contaminated drugs, and drugs stored under inappropriate and unsafe conditions.’’ Thompson’s argument concluded with a reference to the recent terrorist threats in Washington DC and around the country: ‘‘In light of the anthrax attacks of last fall, that’s a risk we simply cannot take’’.

In 2002, FDA officials underscored the necessity for vigilance against the dangers of drug importation. After chronicling the FDA’s recent legal struggles with counterfeit criminal enterprises in Alabama, Los Angeles, and Texas, one FDA leader recounted the seriousness of drug importation’s risks to public health. ‘‘Throwing open the door to drugs purchased by individuals directly from Canadian sellers,’’ Hubbard said of potential legalized importation, ‘‘will encourage unscrupulous individuals to devise schemes using Canada as a transshipment point for dangerous products from all around the globe’’.

Another tactic was to direct advertisements at consumers. One particular ad, sponsored by the drug industry, depicted two identical looking pills over the caption Quick. Pick the Capsule that Hasn’t Been Tampered With. The advertisement cited the support not just of the FDA and HHS, but the US Customs Service and Border Patrol and the DEA, arms of government usually concerned with protecting
Americans from very different kinds of drugs. The ad warned, furthermore, that allowing Americans to fill prescriptions in Canada ‘‘could open America’s medicine cabinets to an influx of dangerous drugs,’’ and it closed with an appeal to ‘‘Keep Black Market Drugs Out of America’’.

Ominous government advertisements also influenced Americans not to purchase drugs from Canada. A poster sponsored by the FDA and CBP also cast doubts on the safety and quality of foreign drugs. In an ad titled ‘‘Buying Medicine from Outside the U.S. Is Risky Business,’’ a vicious green snake, with fangs bared and piercing golden eyes, is shown squeezing a bottle of pills. To the right of the viper, the ad asked Americans: ‘‘Think it’s safe buying medicine from outside the United States? Think again.’’

 

Clipboard01

 

*****

Essentially, the recent story of the EpiPen is far from new. Thanks for reading!

Here’s Bernie on prices after the Martin Shkreli story…

 

 

The Business of Body Parts and Body Products

Ewww. The business of body parts and body products? What? Sounds gruesome. Kinda grisly and macabre. But, as we discuss assisted suicide, selling plasma, or Canadian transplant tourists, in the media the way that we conceptualize the buying and selling our bodies will be vital.

Just like the poster for Daybreakers says, our bodies are a crucial “natural resource.” Hopefully not for a Vampire elite.

Picture2

In the newest edition of the Canadian Bulletin for Medical History, I review Banking on the Body , which opens with an account of Connie Culp, the first American woman to undergo a face transplant after having been severely disfigured by a shotgun blast to the head. Yeah, a shotgun!

The groundbreaking surgery in 2008 included a new mouth, nose, and cheeks and, afterwards, Culp was once again able to talk, smile, and smell.  It was a transformation of Culp’s appearance, her quality of life, and so much more.

Picture1

For Kara W. Swanson, an Associate Professor of Law at Northeastern University, this procedure transformed all human faces and signified that it was “now a body product” to be “harvested from one body for use by another” (1).  Culp’s story is one of medical ingenuity and ultimately positive, but it also fits within a larger history where “…the human body has become a source of property and value, as well as a source of hope to the dying and the disfigured” (2).

The book is really quite excellent. By examining human milk, blood, and semen, it clarifies how bodies and body products have been organized and exchanged in the United States over the past century. In doing so, Swanson highlights the significance of two interrelated concepts –  the banking metaphor and the gift/commodity dichotomy – and provides lessons for Canadian policymakers.

In 1937, Dr Bernard Fantus of Cook County Hospital in Chicago borrowed the term bank from the world of money and markets to describe the process of stored blood in his hospital. Blood banks were a fresh way to think about maintaining the American blood supply and, not surprisingly, came under fire for the implied association between body products and money.

Picture4

Yet, Fantus’s aim was not to promote commercial enterprises. Amid the toil and deprivation of the Great Depression, Fantus sought to “subvert the market allocation of blood solely to those who could afford to pay.” Cannily, “…by treating blood as money, he was trying to circumvent the need to pay money for blood” (7-8). The term bank proved resilient and the banking metaphor has grown as the dominant way of understanding the tradable value of “disembodied fluid,” as well as other body parts (7).

While the two hundredth anniversary of Mary Shelley’s Frankenstein inches closer and we continue to make advancements in the transplantation of human body parts, as in the case of Connie Culp, this sophisticated book has the potential to guide policy and frame future debates on bodies as both personal and civic property.

My review of Banking on the Body: The Market in Blood, Milk, and Sperm in Modern America can be read here.

Are you an Anti-Vaxxer?

Why do we question vaccines? And who are the thought leaders involved? Are they respectable, or are they hacks? And, more importantly, what can we glean from past debates about vaccines? In Elena Conis’s new book, we get a sense of this – and so much more.

conis book image

In the newest edition of Social History of Medicine, I review Elena Conis’s new book, Vaccine Nation: America’s Changing Relationship with Immunization.

In tracing over 50 years of vaccine controversy, we get to know the key institutions, opinion leaders, and major ideas that have driven debates. We are exposed to federal law, feminism, and, oh yeah, Jenny McCarthy and the mass media.

She began her career in 1993 as a nude model for Playboy magazine and was later named their Playmate of the Year. McCarthy then parlayed this fame into a television and film acting career. She is a former co-host of the ABC talk show The View.

McCarthy has also written books about parenting and has become an activist promoting research into environmental causes and alternative medical treatments for autism. In particular, she has promoted the idea that vaccines cause autism and that chelation therapy helped cure her son of autism.

Both claims are unsupported by medical consensus, and her son’s autism diagnosis has been questioned. McCarthy has been described as “the nation’s most prominent purveyor of anti-vaxxer ideology”, but she has denied the charge, stating: “I am not anti-vaccine…”

jenny_mccarthy

In Conis’s book, we get a better understanding of how someone like McCarthy can drive the policy process and shape our View on vaccines.

Here is a brief excerpt from the review:

“Vaccines are significant medical interventions that naturally induce powerful economic, social, and political reactions. Vaccines have helped shaped narratives about American scientific and technological ingenuity, as well as therapeutic progress, yet they have also been ‘cast in the image of their own time’ (p. 10), The pathway to effective, accepted vaccines has been neither simple nor straightforward.

In Elena Conis’s penetrating new book, Vaccine Nation, this fluid negotiation over vaccines for polio, pertussis and Human papillomavirus (HPV), among others, is on full display. We are exposed to a ‘wildly diverse set of influences, including Cold War anxiety, the growing value of children, the emergence of HIV/AIDS, changing fashion trends, and immigration’, that have shaped vaccine acceptance—as well as resistance (pp. 2–3). Conis, a former journalist, offers punchy and accessible prose as she skilfully traces the ebb-and-flow of vaccine history from the 1960s to the present.”

*

If you’re interested, PBS has done a great job covering anti-vaccination in the U.S.

Tories, Turmoil, and Marijuana Legalization

THE CBC reported yesterday that there is tremendous turmoil within the Conservative Party over the legalization of marijuana. Without Stephen Harper, the issue has created controversy. The story below is by Stephen Dyer.

stephen-harper-on-marijuana-oct-2015

*

As candidates for the Conservative Party’s leadership race continue to line up, an issue has emerged that many thought the Tories had put to bed a long time ago — the legalization of marijuana.

Former prime minister Stephen Harper called marijuana “infinitely worse” than tobacco. “If we sell marijuana in stores like alcohol and tobacco, that will protect our kids? No one believes that,” he said.

But last week Maxime Bernier injected a slightly unexpected element into the race when he suggested he was leaning toward supporting a Liberal motion to legalize possession of marijuana for recreational use, as has already happened in four U.S. states and the District of Columbia.

“I think it must be time to have a discussion with that,” he told Rosemary Barton, host of CBC News Network’s Power & Politics. “I am happy that this government will bring a bill.”

“I am more for it” than against it, he said. “It depends how the government will do it. At the end I will decide whether I will vote for it or against it. But I am more toward — for — that.”

That position sets Bernier at odds with his party’s long-held opposition to loosening the laws against recreational use of marijuana.

Law unpopular with Tory voters

According to Vote Compass, CBC’s voter-engagement survey, about 37 per cent of Conservative voters in the last election said they supported the full legalization of marijuana.

Another 38 per cent of Conservatives supported the NDP’s position of decriminalization of marijuana — a step short of legalization that would treat pot possession similar to a traffic offence.

Only a quarter of Conservative voters agreed with Harper’s position that marijuana possession should remain a criminal offence —  a number that drops to 14 per cent across all voters.

These numbers suggest there is an audience within the Conservative Party for a more libertarian viewpoint — like the one Bernier is pitching.

On the other side of the debate is Bernier’s only other declared rival, former minister of labour Dr. Kellie Leitch. She is one of the few Conservatives who have continued to thunder against the impending legalization of marijuana since the party’s electoral defeat in October 2015.

cartoon

“Health Canada spends hundreds of millions of dollars every year to encourage Canadians to stop smoking. Now the government wants Canadian kids to have access to a drug to smoke, marijuana,” she told the House of Commons in February. “Parents are scared and concerned for their children. The government is sending out mixed signals.”

Indeed, the Liberals have been criticized by advocates of marijuana reform for maintaining the current criminal penalties while they take their time drafting a legalization plan, rather than moving immediately to decriminalize as an interim measure.

Not clear where leader stands

Also sending out mixed signals is interim Conservative Leader Rona Ambrose.

As Harper’s health minister, Ambrose often found herself fronting the party’s anti-legalization approach, including the “reefer madness” strategy of linking marijuana use to mental illness.

So an interview she gave in January to Vancouver radio station CKNW caused considerable confusion about her position.

“The bottom line is there’s a huge faction of people in this country that want — that are mostly adults, to be frank — that want access to pot and they want it legalized and it’s for recreational purposes.”

Ambrose then said she hoped the Liberals would push ahead faster to regulate storefront pot dispensaries that have sprung up around Vancouver.

“I hope the faster they move on this the better, because the proliferation of pot dispensaries is quite large, so it has moved now not just in Vancouver but across the country, and they’re unregulated. So the sooner they can move on that, the better to protect kids.”

Conservatives later explained that Ambrose was merely recognizing the inevitability of legalization, and encouraging the Liberals to get on with it. But government supporters jumped on what they saw as another Conservative post-election reversal.

“Health minister who spent millions of your $ on misleading ads against pot wants us to legalize faster,” tweeted Trudeau’s principal secretary Gerald Butts.

Will the vote be whipped?

It remains to be seen whether marijuana will become an issue in the Tory leadership race, or if members who dissent from the official party line will be able to express those views in Parliament.

Asked whether the party intends to allow a free vote when marijuana reform finally comes before the House, Ambrose’s director of communications Mike Storeshaw told CBC News no decision has been taken.

“Decisions on caucus positions for legislation aren’t made until there’s actually legislation to consider, and we don’t appear to be anywhere near that point yet.”

In the Weeds: Understanding Government Action and Canada’s Marijuana Industry

What is happening with Canadian marijuana policy? We seem to be stuck in the weeds. And there’s a fog of confusion. According to Jim Bronskill, there are the 9 major factors that have driven the Canadian government’s “federal marijuana moves” over the past few months. The key source for him was a November 2015 ministerial briefing presentation, which was called “Legalizing & Regulating Marijuana.”

Interesting, this story made it onto both CTV and Global News, although CBC did not run with it immediately.

9 MAIN SOCIAL, POLITICAL, AND ECONOMIC DRIVERS:

Canadian marijuana usage rates 11 per cent of the population age 15 and older used marijuana in the past year, according to a 2013 survey. Use was highest among 20-24 year-olds at 26 per cent. The presentation characterizes this as “relatively low overall rates of usage” and points to evidence that use declines with age.

Evidence of health benefits and risks There is some evidence of limited therapeutic benefit to marijuana use for managing symptoms of chemotherapy, neuropathic pain and treatment-resistant epilepsy in children. But the health-community consensus is that regular recreational usage carries risks, including long-term cognitive ones for those under 25.

International legal framework — Canada is party to a global legal framework on psychotropic drugs, including the 1961 Single Convention on Narcotic Drugs. It does not allow for legalization but allows leeway on the kinds of sanctions imposed. The International Narcotics Control Board expressed regret over Uruguay’s decision to legalize marijuana, but it is not clear what practical impact this has had, Health Canada notes. A UN special session on the World Drug Problem is slated for next month.

Canadian regime for medical marijuana — The 2013 Marijuana for Medical Purposes Regulations attempted to shift the medical marijuana industry to licensed producers, away from home growers. But thousands of Canadians were allowed to possess or grow marijuana pending a court ruling that came down last month.

Domestic legal context — The court ruling handed down in February affirmed the right of people to grow their own medical marijuana. The presentation, drafted before the ruling, says the decision and others from the courts could affect government choices on the new legal regime.

Role of provincial and territorial governments — The federal and provincial / territorial governments would be able to regulate in many of the same areas concerning access to legal marijuana. The federal government could set minimum standards, but provinces and territories might enact more stringent requirements on where pot is consumed, retail sale locations or minimum age for purchase. Achieving a national approach will require close co-operation.

Experience of other jurisdictions — While Uruguay adopted tight government control, Colorado and Washington states chose models that spurred involvement of commercial interests, increasing risks to health and safety. Early lessons from the U.S. reinforce the need to take time to implement a legalized model, figuring out the complexities of how best to protect public health.

Law enforcement issues — Organized crime groups are heavily involved in the marijuana trade. Illicit grow operations exist in all parts of Canada. Police-reported drug-impaired driving incidents are a small fraction of actual drug-impaired driving incidents, as it is difficult to recognize the signs. Given all this, a national approach will require police agencies to work together.

Youth justice — The Youth Criminal Justice Act requires police to consider use of measures such as warnings and referrals to community programs for those ages 12 through 17. Careful consideration will need to be given to how the new regime will be enforced when it comes to young people.

For more, check this out.

Mixed reviews for the Allard marijuana decision

Cannabis. Pot. Marijuana. Ganga. Weed. Grass. These are interesting times for sure.

I was interviewed for the Saskatoon local news on the recent Allard decision. Honestly, I wasn’t terribly happy with this interview, but it can be viewed here.

http://globalnews.ca/video/2541487/mixed-reviews-for-federal-court-marijuana-decision

Finally:

I would like to be upfront about something. The Global story used the word “Professor” to describe me, which is something I most certainly DID NOT call myself. I referred to myself as an instructor in history and a sessional lecturer in history.

Many people casually use the word PROFESSOR to describe all those individuals who offer classes within a university setting. There is, however, a scale and hierarchy of individuals who work in an academic department. A full PROFESSOR is highest level that can be reached.

uk_v_us_academicranks1

And that is not at all me. It is regrettable that I was designated in this way. Just wanted to clarify.

Plasma Clinics Deserve Debate

There has been much media coverage about the opening of Canadian Plasma Resources’ first clinic in Saskatoon. I’ve been a part of that debate, having written for the Star Phoenix just yesterday.

Canadian Blood Services has a number of videos that explains the plasma business in Canada and beyond. Thanks to John Dexter for finding these videos on Youtube.

tumblr_ni0hd9RsT91rx06nvo1_500