University of Strathclyde

I just started a new job as a Lecturer at the University of Strathclyde, based in Glasgow. I’m absolutely thrilled to be a part of the School of Humanities and Social Sciences. It was a big, big move – from Saskatchewan to Strathclyde – and, to be honest, I’m still making the adjustment.

( Chips v. Fries ** Football v. Soccer ** Jumper v. Sweater ** Pants v. Underwear ** and so on, and so on…)

Luckily, the transition has been eased by amazing new colleagues, who are quite simply awesome. All the worst horror stories you hear about in academia, including internecine squabbling or raging egomaniacal personalities colliding with each other over hum-drum topics, aren’t an issue here. There’s way too much collegiality and friendliness. Everyone’s chipping in. It’s weird. And I like it.

I will be helping with two modules: (1) Disease and Society & (2) Madness and Society. It’s gonna be a blast!

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…

 

 

Sports and Sports Medicine in CBMH/BCHM

Do you have an Olympic hangover? Missing the thrills and excitement? You’re not alone. People are clearly pining for more of Bolt and Biles, Phelps and the Fijians. But fear not. You can get your fix in CBMH/BCHM.

Back in 2011, the journal held a special issue on sports and medicine. The editors, Eileen O’Connor and Patricia Vertinksy, argued that “elite sport” and “sports medicine are increasingly at the forefront of public consciousness, especially when the Olympic Games come to town…”

But they’re aim was to push beyond the Olympics. It would be an error, they suggested, to “confine the historical study of sport medicine to the world of high level athletics,” considering the linkages “between exercise, sport and medicine for all age groups and in different regions of the world goes back millennia.”

Nevertheless, the Olympics get some attention! Thankfully. In James Rupert’s Genitals to Genes: The History and Biology of Gender Verification in the Olympics and Parissa Safai’s A Healthy Anniversary? Exploring Narratives of Health in Media Coverage of the 1968 and 2008 Olympic Games, readers are exposed to scientific and mass media analyses of the games. Both are excellent and topical articles!

*****

The former is very interesting, especially since the 800 metre women’s final was the most controversial race of the Olympics. Some in the race openly questioned whether Caster Semenya of South Africa should have been allowed to compete due to a condition called hyperandrogenism, where an athlete’s testosterone level is elevated. It’s also been suggested that Francine Niyonsaba and Margaret Wambui might also have a similar condition. According to the National Post, Poland’s Joanna Jozwik, who was fifth in Saturday’s final, and Great Britain’s Lynsey Sharp, who was sixth, both openly questioned the fairness of female athletes competing with high levels of testosterone.

rio-olympics-postmedia-melissa-bishop-of-team-canada-finis
Canadian Melissa Bishop placed 4th

*****

If you’re interested in sports in specific geographical regions, then you can also get your fix. Bouchier and Cruikshank, in Abandoning Nature: Swimming Pools and Clean, Healthy Recreation in Hamilton, Ontario, c. 1930s-1950s, address Canada. Gertrud Pfister tackles “Sports” Medicine in Germany and Its Struggle for Professional Status, whereas the prolific public historian Vanessa Heggie showcases Sport (and Exercise) Medicine in Britain: Healthy Citizens and Abnormal Athletes. It’s a remarkable set of essays.

And below was a remarkable race!

For more on what I’m doing with the CBMH/BCMH, please see the announcement here.

 

The History of Medical Books in CBMH-BCHM

Bookworms & Medical History

Historians know all about books. Publishers. Proposals. Fonts. And proper theoretical frameworks. You name it. Historians have got it cased. Sure, to avoid becoming archaic – extinct – dinosaurs, historians are shifting with the times and engaging in a wider ‘digital turn’. But books still matter.

(Yes, I have a flair for the obvious.)

In Volume 12.2 of Canadian Bulletin of Medical History/Bulletin canadien d’histoire de la médecine , the University of Toronto’s Jennifer Connor offers up a series of articles on  A NEW HISTORY OF THE MEDICAL BOOK. She situates her edited volume in the larger ‘history of the book’ movement of the 1990s. It was a movement, she writes, that witnessed “the establishment of centres for book study at national libraries and universities,” “bibliographies and plans for national histories of the book,” and “new societies, conferences, journals, book series,” as well as “graduate-level courses and degree programs…” (204)

As she prepares CBMH-BCHM readers for the issue, Connor offers a thematic taxonomy of the fourteen essays. It’s a breakdown that includes: (1) the physical form of medical publications; (2) the range of genres for medical writing; (3) the collecting of print material in private and institutional libraries; (4) the links between medical publications and their social or intellectual milieu; (5) and the nature of the publishing enterprise itself.

First she meditates on the history of the book in medicine. She then turns to what the new history of the medical book may look like in the years ahead. Thereafter, she concludes with some general thoughts that still possess force:

“Publishers’ promotion aside, the transformative power of electronic media on the book cannot be denied. Certainly the economic advantages to publishers, researchers, health-care practitioners, and patients alike in having information widely available, continually updated, and easily accessed hold tremendous implications for the health sciences in future.” (211)

Indeed.

*****

One of the stand-out articles (for me) has to be Heather Burton’s ‘ “Still in Process”: Collaborative Authorship in a Twentieth- Century Biomedical Textbook,’ an account of Molecular Biology of the Cell. More particularly, it’s an account of the “unique and close collaboration between six outstanding scientists” who wrote one of the best-selling textbooks of all time. Even more particularly, it’s about Burton chronicling the writing of the book with one of her own. Essentially, Burton’s awesome article is about a book about a book. Seriously trippy.

Molecular Biology of the Cell, according to Burton was conceived by James Watson as far back as the late 1960s and early 1970s. He saw “that molecular biology was at the forefront of science and that the curriculum was on the verge of changing.” However, the field had no textbook to guide and define it. And he sought to move beyond another boring, traditional text. “His idea was for a bold, fresh approach, yet at the same time one that was comprehensive and cohesive.” (374)

My favourite moment in the article is the authors’ back-and-forth about the writing of their now seminal textbook. It wasn’t always an enjoyable, seamless process. It wasn’t always easy – as any historian or author knows all too well. Yet, the collaborators still managed to have some fun, including posing for a photograph in which they recreated the Beatles’ Abbey Road cover. See page 377 for the image that mirrors the one below.

abbey road

And so the article goes…

*****

Yet, Connor’s edited issue was not the only place in which CBMH-BCHM drilled deeper into the history of the book.

In 1993, Ian Carr explored the life of William Boyd,  one of the best known figures in the history of Canadian pathology. A professor of pathology in three Canadian universities, Boyd “is remembered chiefly because of the number and success of his textbooks.” (77) The article is called “William Boyd-The Commonplace and the Books.”

In what could have been a straightforward (and Whiggish) history of Boyd, Carr instead gets very interesting. In an effort to understand his historical actor more closely, Carr places a spotlight on Boyd’s ‘commonplace’ book.

According to Carr: “Commonplace books, in which people recorded what they had read, were written in increasing numbers in the late fifteenth and sixteenth centuries; they were used during the Renaissance as places of reference, in formal arguments) but the keeping of a commonplace book gradually became the hallmark of a writer or literary individual. It was, before the Xerox or card index, an artificial memory. Robert Burns, Thomas Hardy, and W. H. Auden, among others, have left interesting commonplace books. William Boyd is therefore in good company. To my knowledge, no other major medical writer of this century has left such a book.” (78)

While some of the material in Boyd’s book may seem frivolous, Carr believed that (and so do I) “the choice of quotations gives a picture of the inside of William Boyd’s mind…” (79)

Kipling and Shakespeare, Milton and Wordsworth – for Carr, the inclusion of these greats offers historians of medicine a more comprehensive view of one Canada’s luminaries in pathology.

*****

And there’s more…

In David Shephard’s 2000 article on “The Casebook, the Daybook, and the Diary as Sources in Medical Historiography,” readers are exposed to the writings of John Mackieson, Jonathan Woolverton, and James Langstaff – three Canadian physicians.

While diaries and journals have long been used in order to describe personal experiences, explains Shephard, doctors also relate their medical experiences through casebooks and daybooks. And when placed alongside “account books” and “clinical-notes,” the “casebooks” and “daybook” constitute “a common literary genre among physicians in the nineteenth century.” (245) They were, as Shephard argues, “used to report the details of interesting clinical cases, to provide records for future reference, to serve as aides-memoires in the preparation of journal articles, books and lectures, and sometimes to fulfill requirements in a student’s training.” (246)

And so Shephard delves into Mackieson’s, Woolverton’s, and Langstaff’s casebooks/daybooks, thereby moving CBMH-BCHM readers beyond the standard textbook (Molecular Biology of the Cell) and the commonplace book (re Boyd)…

In Shephard’s estimation, these types of historical sources provide a snapshot of medical training and, more importantly, lend insight into rural vs. urban medical practice.

*****

Accept it. Historians of medicine truly are bookworms. Thanks for reading!

banner_literatum6

This short article is part of broader series of posts. And I’m incredibly excited to be working with CBMH/BCHM and University of Toronto Press over the summer months. It will be my pleasure to help out with journal’s migration to the UofT’s publishing platform. As part of this transition, we are moving all of the back issues onto UofT’s server, and in some cases enhancing them, with abstracts and keywords. The journal is about to publish its 66th issue, so there are lots to consider!

As the journey commences this summer, I’ll be posting and tweeting about the process – all of the amazing stops and bumps in the road, as well excellent articles and contemporary health and medicine issues dating back to the mid-1980s. I’d guess holidays would come first, but I encourage you to share and participate in the voyage as much as you can!

@DrLucasRichert

 

Medical History and the Arts!

Walt Whitman,  John Keats, and Franz Schubert. Literature, poetry, and classical music.

In the early stages of cataloging the Canadian Bulletin of Medical History/Bulletin canadien d’histoire de la médecine for the University of Toronto it has become abundantly clear that the journal showcased the intersection medicine, health, and the arts. (Here’s the announcement about what I’m actually doing.)

In 2014, the New York Academy of Medicine held its second annual Festival of Medical History and the Arts, which celebrated the 500th birthday of anatomist and humanist Andreas Vesalius. Vesalius’ groundbreaking De humani corporis fabrica (The Fabric of the Human Body) of 1543 remains one of the key Renaissance texts. It profoundly altered medical training, anatomical knowledge, and artistic representations of the body.

Page 174 of Andreas Vesalius’ De corporis humani fabrica libri septem, available at National Library of Medicine

 

While few figures have been so influential to the arts, learning, and medicine – and while Vesalius’ influence has persisted over the centuries in anatomical training, representations of the body and the visual arts – other important figures in the Arts deserve attention, too.

The CBMH/BCHM was addressing this as early as 1984, when S.E.D. Shortt probed Walt Whitman’s and Richard Bucke’s fiery friendship. In “The Myth of a Canadian Boswell: Dr. R.M. Bucke and Walt Whitman,” Shortt seeks to correct the view of Bucke, one of the most notable figures in Canadian mental health history. And he recasts the Bucke/Whitman relationship as one of “symbiosis rather than of master poet and sycophantic admirer.” (55) It’s a fascinating read and timely, especially since the New York Academy of Medicine just this month held a public forum on Walt Whitman, ‘Manly Health,’ and the Democratization of Medicine.

http://whitmanarchive.org/multimedia/image007.html?sort=year&order=ascending&page=1
Available at the Walt Whitman Archive

 

Thereafter, in 1986 (Vol 1) CBMH/BCHM placed a spotlight on the early medical career of John Keats and Franz Schubert’s terminal illness.

For G. Hetenyi, in the early 1980s “considerable uncertainty” still existed about Schubert’s terminal illness and the cause of his death in 1828. Thus, his article, “The terminal illness of Franz Schubert and the treatment of syphilis in Vienna in the eighteen hundred and twenties,” is part biography, part nosography. (51-52)

It ably locates Schubert within a particular medical culture (Vienna) and provides a unique window into his musical career. Along the way, Hetenyi raises some tantalizing questions: Was Schubert being poisoned? Was he suffering from Typhus?

 

Finally, “Keats as a Student at Guy’s Hospital” offers a wonderful snapshot of medical training within an elite institution, as well as the “varied profession.”  According to Donald Goellnicht, “Keats is famous first as a poet, second as a letter-writer, and hardly at all as a man of medicine.” (65-66)

John Keats – available on Biography.com

The goal, then, is to furnish a fuller portrait of Keats’s background. And the reader is exposed to the volatile nature of the medical field in the early 19th century, the gritty and grotesque world of anatomical and surgical education, and absorbing accounts of leading physicians, including Ashley Cooper who was widely regarded as one of the best medical lecturers in Europe.

*

In essence, the earliest issues of CBMH/BCHM sought to highlight the crossroads of medicine, health, and the arts, which is, of course, very fashionable now.

The University of Toronto has recently started a Health, Arts, & Humanities Program, while the University of Saskatchewan just launched a Health Studies Program. And this is simply the tip of the iceberg. Many more universities and many lecturers/physicians/educators are evaluating the relationship between Medicine and the Arts.

It’s affirming that Canadian Association for the History of Medicine/  Société canadienne d’histoire de la médecine was doing this from the journal’s inception.

By Lucas Richert @DrLucasRichert

 

 

Medical History on the Move

I have a new blog post on the University of Toronto’s site.

 

I’m incredibly excited to be working with CBMH/BCHM and University of Toronto Press over the summer months. It will be my pleasure to help out with journal’s migration to the UofT’s publishing platform. As part of this transition, we are moving all of the back issues onto UofT’s server, and in some cases enhancing them, with abstracts and keywords. The journal is about to publish its 66th issue, so there are lots to consider!

As the journey commences this summer, I’ll be posting and tweeting about the process – all of the amazing stops and bumps in the road, as well excellent articles and contemporary health and medicine issues dating back to the mid-1980s. I’d guess holidays would come first, but I encourage you to share and participate in the voyage as much as you can!

For updates see, @DrLucasRichert and LucasRichert.com

Lucas Richert, PhD

banner_literatum6