In Drugs for Life: How Pharmaceutical Companies Define Our Health, Joseph Dumit discusses and analyzes the notion that to be normal is to have symptoms. Rather than taking medication, or visiting a doctor or physician when a person feels or falls ill, the now common notion is that the human body is sick, inherently disordered, and in need of constant medication to control or prevent such illness.
Dumit therefore describes not only how the rhetoric of health and illness has changed, but also how people's perception of being healthy or sick is now different. One of the examples that Dumit uses to strengthen his argument is that of cholesterol, specifically HDL (good cholesterol) and LDL (bad cholesterol. Over the last few decades, these numbers have changed several times. In order to be healthy, a person's HDL needs to be higher than before whereas the LDL needs to be lower. The redefining of health and changing the cholesterol numbers have lead to millions of people being considered unhealthy, or at risk, over night. Dumit points out that "The effect was to redefine normal health in a highly categorical manner" (p. 123).
What Dumit does so well throughout the book is to help make sense of how pharmaceutical companies define health, how they seek to increase their market share and certain products, their strategies, how they categorize health, and the rhetoric they use. Dumit examines everything from medication advertisements to websites, conferences, and conducts interviews. Dumit finds that not only has the notion of illness changed, but so have the ways in which we think about and diagnoses, health, and illness. Pharmaceutical brands have created websites and online universities where self-help in terms of online health seeking and short quizzes help patients consider if they are indeed normal, at risk or ill.
Dumit also states that other factors of the redefinition of health has contributed to the belief that the body is inherently sick, such as the mass marketing of medicine, focusing on profit more than health, that health has become a statistic due to the use of clinical trials, and that these trials are viewed as an investment for the companies in the sense that they need to "make their money back". As clinical trials have become an investment, pharmaceutical companies focus on having patients take as many medications as possible while staying on them for a long period of time. At the same time, patents only last for 10 years, creating a race for pharmaceutical companies to invest more time and money in creating alternative or similar medications targeting or improving health factors that will subsequently increase profit.
Dumit concludes that the health market will continue to grow and expand, but also states that it is the redefinition of health that is more worrisome. "This book makes clear that the usual critique, namely, that profit motives work against our health, is both right and beside the point. The point is that corporate marketing logics are redefining health and our relationship with it in such a way that they are actually completely compatible and therefore very hard to criticize" (p. 216). Such notions make it difficult to predict any form of change in the way that we view health, especially since health is a major financial player and our economy is based on growth and competition. At the same time, Dumit does note that there are ways in which we can improve the way health is viewed and handled, including changing patents and regulating clinical trials. "Extended patent life might actually enable the best drugs to be fairly tested and discovered, and it might cut down on the number of me-too drugs" (p. 212). Another option is to remove patents altogether as Dumit points to the fact that neither health nor life should be patentable. Dumit focuses much on the issue of clinical trials and he believes that clinical trials should be better regulated, even though such trials are also needed. What Dumit tries to convey is not so much that the pharmaceutical companies are simply evil and money hungry, but that the system in place focuses more on expanding profit than improving health. "…if companies are allowed to design clinical trials, they end up shaping the very meaning of health, a health known only through those trials" (p. 208). "Worth is literally turned on its head once clinical trials are seen as investments because if the potential patients cannot pay for the treatments, then the treatments are not valuable" (p. 209).
Dumit manages to weave together complicated issues surrounding health, profit, public attitudes and the rhetoric of health in a way that creates and understanding of medication and pharmaceutical companies in Drugs for Life. At times, some of Dumit's arguments can be difficult to follow, but the question and answer section at the end of the book makes the arguments come full circle and helps create an understanding of his main points. As such, the target audience is mostly those interested in the topic of health but also pharmaceutical companies, even though anyone with an interest in public health can certainly enjoy the book as well.
© 2013 Hennie Weiss
Hennie Weiss has a Master's degree in Sociology from California State University, Sacramento. Her academic interests include women's studies, gender, sexuality and feminism.