Prescribing by Numbers: Drugs and the Definition of Disease

The second half of the twentieth century witnessed the emergence of a new model of chronic disease-diagnosed on the basis of numerical deviations rather than symptoms and treated on a preventive basis before any overt signs of illness develop-that arose in concert with a set of safe, effective, and highly marketable prescription drugs. In Prescribing by Numbers, physician-historian Jeremy A. Greene examines the mechanisms by which drugs and chronic disease categories define one another within medical research, clinical practice, and pharmaceutical marketing, and he explores how this interaction has profoundly altered the experience, politics, ethics, and economy of health in late-twentieth-century America. Prescribing by Numbers highlights the complex historical role of pharmaceuticals in the transformation of disease categories. Greene narrates the expanding definition of the three principal cardiovascular risk factors-hypertension, diabetes, and high cholesterol-each intersecting with the career of a particular pharmaceutical agent. Drawing on documents from corporate archives and contemporary pharmaceutical marketing literature in concert with the clinical literature and the records of researchers, clinicians, and public health advocates, Greene produces a fascinating account of the expansion of the pharmaceutical treatment of chronic disease over the past fifty years. While acknowledging the influence of pharmaceutical marketing on physicians, Greene avoids demonizing drug companies. Rather, his provocative and comprehensive analysis sheds light on the increasing presence of the subjectively healthy but highly medicated individual in the American medical landscape, suggesting how historical analysis can help to address the problems inherent in the program of pharmaceutical prevention.

Table of Contents:
Preface Acknowledgments Introduction: The Pharmacopoeia of Risk Reduction Part One: Diuril and Hypertension, 1957-1977 1. Releasing the Flood Waters: The Development and Promotion of Diuril 2. Shrinking the Symptom, Growing the Disease: Hypertension after Diuril Part Two: Orinase and Diabetes, 1960-1980 3. Finding the Hidden Diabetic: Orinase Creates a New Market 4. Risk and the Symptom: The Trials of Orinase Part Three: Mevacor and Cholesterol, 1970-2000 5. The Fall and Rise of a Risk Factor: Cholesterol and Its Remedies 6. Know Your Number: Cholesterol and the Threshold of Pathology Conclusion: The Therapeutic Transition Notes Index

About the Author :
Jeremy A. Greene is an assistant professor in the Department of the History of Science at Harvard University and an instructor in the Division of Pharmacoepidemiology and Pharmacoeconomics at the Department of Medicine of Brigham and Women's Hospital, Harvard Medical School.

Review :
Greene provides suggestions on how to address some of the problems inherent in medical prevention. Choice 2007 Shows how the process of defining disease 'illustrates the porous relationship between the science and the marketing of health care.' -- Nina C. Ayub Chronicle of Higher Education 2007 A gripping story... Greene warns us in his superb book that things are not always as they are claimed. -- Howard Spiro Yale Journal for Humanities in Medicine 2007 This is, I believe, one of the best, and most significant, books published recently on the development of medical practice and the pharmaceutical industry in the USA in the second half of the twentieth century. -- Judy Slinn Social History of Medicine 2007 Greene focuses on the question of how public health priorities became closely aligned with the pharmaceutical industry's marketing practices... Offers a nuanced description of the development of 'therapeutics of risk reduction' with multiple lines of influence, subtle power shifts, and gains and losses for patients and physicians. -- Arthur Daemmrich Chemical Heritage 2008 Greene describes the relationship between advances in treatment, the incentives of manufacturers, and the effect on the public of increased attention to prevention... The risk-benefit trade-offs of the quantitative approach are complex, and Greene's historical revelations are timely. -- Kevin A. Schulman, M.D. New England Journal of Medicine 2007 The interaction between medical science and industry has been fruitfully explored by several excellent historians... but Greene's intricate narratives extend their work. -- Marcia Meldrum Isis 2008 I heartily recommend this book. -- Toine Pieters Medical History 2008 By the end of Prescribing by Numbers, one realizes it is an excellent book to think with. Greene uses his case studies to juxtapose the therapeutics of risk with more contemporary health dilemmas. -- Gregory J. Higby Pharmacy in History 2009 Greene's nuanced and lucid research yields new insight into the mechanisms that linked specific medications to the management of particular chronic diseases in the postwar era. -- Cynthia A. Connolly, PhD, RN Nursing History Review 2011