Nicolas Rasmussen

America’s First Amphetamine Epidemic 1929–1971: A Quantitative and Qualitative Retrospective With Implications for the Present

Using historical research that draws on new primary sources, I review the causes and course of the first, mainly iatrogenic amphetamine epidemic in the United States from the 1940s through the 1960s. Retrospective epidemiology indicates that the absolute prevalence of both nonmedical stimulant use and stimulant dependence or abuse have reached nearly the same levels today as at the epidemics peak around 1969. Further parallels between epidemics past and present, including evidence that consumption of prescribed amphetamines has also reached the same absolute levels today as at the original epidemics peak, suggest that stricter limits on pharmaceutical stimulants must be considered in any efforts to reduce amphetamine abuse today.

Association of trial registration with the results and conclusions of published trials of new oncology drugs

BackgroundRegistration of clinical trials has been introduced largely to reduce bias toward statistically significant results in the trial literature. Doubts remain about whether advance registration alone is an adequate measure to reduce selective publication, selective outcome reporting, and biased design. One of the first areas of medicine in which registration was widely adopted was oncology, although the bulk of registered oncology trials remain unpublished. The net influence of registration on the literature remains untested. This study compares the prevalence of favorable results and conclusions among published reports of registered and unregistered randomized controlled trials of new oncology drugs.MethodsWe conducted a cross-sectional study of published original research articles reporting clinical trials evaluating the efficacy of drugs newly approved for antimalignancy indications by the United States Food and Drug Administration (FDA) from 2000 through 2005. Drugs receiving first-time approval for indications in oncology were identified using the FDA web site and Thomson Centerwatch. Relevant trial reports were identified using PubMed and the Cochrane Library. Evidence of advance trial registration was obtained by a search of clinicaltrials.gov, WHO, ISRCTN, NCI-PDQ trial databases and corporate trial registries, as well as articles themselves. Data on blinding, results for primary outcomes, and author conclusions were extracted independently by two coders. Univariate and multivariate logistic regression identified associations between favorable results and conclusions and independent variables including advance registration, study design characteristics, and industry sponsorship.ResultsOf 137 original research reports from 115 distinct randomized trials assessing 25 newly approved drugs for treating cancer, the 54 publications describing data from trials registered prior to publication were as likely to report statistically significant efficacy results and reach conclusions favoring the test drug (for results, OR = 1.77; 95% CI = 0.87 to 3.61) as reports of trials not registered in advance. In multivariate analysis, reports of prior registered trials were again as likely to favor the test drug (OR = 1.29; 95% CI = 0.54 to 3.08); large sample sizes and surrogate outcome measures were statistically significant predictors of favorable efficacy results at p < 0.05. Subgroup analysis of the main reports from each trial (n = 115) similarly indicated that registered trials were as likely to report results favoring the test drug as trials not registered in advance (OR = 1.11; 95% CI = 0.44 to 2.80), and also that large trials and trials with nonstringent blinding were significantly more likely to report results favoring the test drug.ConclusionsTrial registration alone, without a requirement for full reporting of research results, does not appear to reduce a bias toward results and conclusions favoring new drugs in the clinical trials literature. Our findings support the inclusion of full results reporting in trial registers, as well as protocols to allow assessment of whether results have been completely reported.

The Moral Economy of the Drug Company–Medical Scientist Collaboration in Interwar America

This paper explores the exchange relationships underlying collaborations between pharmaceutical companies and preclinical (laboratory-based) researchers, in universities and similar contexts, during the interwar period. It also examines the arguments advanced to justify such collaborations in particular contexts as a way of investigating the perceived costs and benefits, especially among the academic parties in these collaborations, and the way these collaborations were regarded in the US biomedical research community.

Medical Science and the Military: The Allies' Use of Amphetamine during World War II

Although amphetamine was thoroughly tested by leading scientists for its effects in boosting or maintaining physical and mental performance in fatigued subjects, the results never provided solid grounds for approving the drugs use, and, in any case, came too late to be decisive. The grounds on which amphetamine was actually adopted by both British and American militaries had less to do with the science of fatigue than with the drugs mood-altering effects, as judged by military men. It increased confidence and aggression, and elevated “morale.”

Steroids in arms: Science, government, industry, and the hormones of the adrenal cortex in the United States, 1930-1950

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Weight stigma, addiction, science, and the medication of fatness in mid-twentieth century America.

Obesity and overweight are today recognised as subject to harmful stigma. Through an analysis of discussions of obesity in major American newspapers, the medical literature, and pharmaceutical advertising in the 1930s, 1940s and 1950s, I document a significant shift in medical thinking about overweight and obesity based in psychiatry, and explore the relationship of that shift to changes in popular understandings of fatness after the Second World War. I argue that the psychiatrically-oriented postwar medical thinking about obesity was more stigmatising as compared with the endocrinologically-oriented thinking of the interwar period, in that the newer biomedical theory linked fatness to the already stigmatised condition of addiction and authorised attribution of moral blame to the fat. I further argue that the pharmaceutical industry cannot be assigned the lead role in medicalisation in this period that some authors attributed to it. These events cast doubt on the received view of fatness as subject to decreasing stigma and increasing medicalisation over the course of the twentieth century, and call for exploration of the social factors influencing specific forms of medicalisation.

The Forgotten Promise of Thiamin: Merck, Caltech Biologists, and Plant Hormones in a 1930s Biotechnology Project

The physiology of plant hormones was one of the most dynamic fields in experimental biology in the 1930s, and an important part of T. H. Morgans influential life science division at the California Institute of Technology. I describe one episode of plant physiology research at the institution in which faculty member James Bonner discovered that the B vitamin thiamin is a plant growth regulator, and then worked in close collaboration with the Merck pharmaceutical firm to develop it as a growth-boosting agrichemical. This episode allows one to draw continuities between certain fields of life science in the United States circa 1940 and the biotechnology industry today, and also foregrounds a number of similarities between plant physiology of the late 1930s and the molecular biology of the period.

Making Addicts of the Fat: Obesity, Psychiatry and the ‘Fatties Anonymous’ Model of Self-Help Weight Loss in the Post-War United States

Purpose – To reconsider the historical relationship between addiction and obesity, which current literature tends to treat as unrelated until the late twentieth century. Approach – We describe the forms of sociality and therapeutic discourses manifested in the emerging weight loss group movement from the 1940s until 1970 in cultural and intellectual context, drawing mainly on popular media and medical literature. The histories of these ‘Fatties Anonymous’ groups serve as valuable lens for studying the mutable cultural linkage between drug addiction and obesity that was first forged in the golden age of psychoanalysis. Findings – We show that medicine began interpreting obesity as addiction around 1940 and that this view achieved dominance in both medical and popular discourse by 1950. The theoretical framing of a psychoanalytical interpretation of obesity in the 1940s, combined with the simultaneous rise to prominence of obesity-related problems in public health and popular stigma around fatness, was translated in the Cold War United States into a popular mutual-aid weight loss movement modelled on Alcoholics Anonymous. Originality value – Our account challenges the present received view that the stigmatised health conditions of obesity and addiction only came to be related in the late twentieth century. There is notable similarity between the 1950s ‘Fatties Anonymous’ type group and present public health campaigns in fostering the individuals sense of self-control and encouraging self-enterprising improvement. Neither historical and contemporary similarities nor differences should be elided. Further research in this area would be of value to current and future developments in public health.

Stigma and the addiction paradigm for obesity: lessons from 1950s America

AIMS To discuss an historical episode in which obesity was conceptualized as an addictive disorder and declared to be a major epidemic in the early postwar United States. This history illuminates past consequences of framing obesity as an addiction in ways that may inform constructive policy responses today. METHODS Review of secondary and primary sources, including archival documents, relating to obesity in biomedical and popular thought of the 1940s and 1950s. RESULTS In the United States in the late 1940s and 1950s, new medical thinking about obesity reinterpreted overweight and obesity as chiefly the consequence of addiction (understood in the then dominant psychodynamic theory as a psychological defect, oral fixation). This new conception was rapidly taken up in popular discourse and clinical practice, with adverse effects through amplification of weight stigma. Further, in the conservative political context, the addiction concept contributed to an ineffective policy response to the alarming new epidemiological evidence about obesitys consequences. Despite a lack of evidence for efficacy of the intervention, public health efforts focused on correcting individual eating behaviour among obese people by encouraging self-help in lay groups modelled, in part, on Alcoholics Anonymous. Population-level intervention was neglected. CONCLUSIONS Current public health policy initiatives must be mindful of the risks of reframing obesity as an addiction. These include inadvertently reinforcing stigma, narrowing responses to those aiming to modify individual behaviour and biology and neglecting population policies aiming to reduce the consumption of energy-dense foods, as all occurred in the 1950s United States.

Evolution of Physician-Industry Relationships in Producing Knowledge of Drug Therapy - Comparison of the United States and Finland

This paper presents a historical perspective on the evolution of relationships between the pharmaceutical industry and physicians in two countries, the United States and Finland. Despite divergence early the twentieth century, and the absence of any large pharmaceutical firms based in Finland, by the 1950s a similar partnership between medical experts and drug companies had developed. In the US, commercial influence in medical research can be divided into five periods: pre-reform (late 19th century – 1905), first reform wave (1905-1930), growing collaboration (1930-1945), merger of interests (1945-1950s, and second reform wave (1960s and 1970s). The history in Finland until the War was different: a preindustrial pattern persisted into the ‘teens, followed by an interwar period in which the fostering of a domestic pharmaceutical industry was a national project and collaboration officially encouraged. After the Second World War the drug industry was no longer local, but the close physician-drug industry relationship largely continued as before. There are indications today that both countries have entered another reform period, this time international in origin. It is hoped that understanding of the origins and nature of relationships between biomedical experts and drug industry will help physicians offer better patient care.