Are you a professional pillow fighter or a 9-to-5 low-cost time travel agent? Or maybe real estate sales on Mars is your profession? It doesn't matter. Whatever it is you do, however complex or intricate, monday.com can help you organize, work a straight, and make it more efficient. monday.com is the one centralized platform for everything work related. And with monday.com, work is just easier. monday.com for whatever you run. Go to monday.com to learn more. The Sephora Savings Event is here. Oh, it's true. Find everything you want on sale at the Sephora Savings Event. It only happens twice a year and it's on now through November 11th. Find brands like Rare Beauty, Glow Recipe, Valentino, K18, and more, all for less. Shop at Sephora and Sephora at Coles today. Limitations apply, must be a beauty insider. See terms at Sephora.com for complete details. Is it time to reimagine your future? The right business skills may make a difference in your career. At Capella University, we offer a relevant education that's designed to focus on what you need to know in the business world. We'll teach professional skills to help you pursue your goals, like business management, strategic planning, and effective communication. And you can apply these skills right away. A different future is closer than you think, with Capella University. Learn more at Capella.edu. Hi, I'm Dr. Robert Pearl, former CEO of the Permanente Medical Group, Kaiser Permanente, a Stanford Medical and Business School Professor, a Forbes contributor and bestselling author of the book Mistreated, while we think we're getting good healthcare and why we're usually wrong. And I am Jeremy Kor, host of the New Books and Medicine podcast. American healthcare is broken. Across the United States, there are over 200,000 patient deaths from medical error every year, growing physician burnout, outdated technology, and inconvenient and delayed care for patients. And on top of all of this, skyrocketing drug prices and increasingly unaffordable out-of-pocket patient expenses. For decades, our nation's political and medical leaders have talked about fixing the American healthcare system, and yet the problems are now greater than in the past. Every other industry that is inefficient and ineffective has experienced disruption. Healthcare will be no different. The question is whether the solutions will come from inside the healthcare system or be imposed on it. We'd like to invite you to listen to our new podcast, Fixing Healthcare with Dr. Robert Pearl and Jeremy Kor. Each episode will feature one of the top leaders and innovative thinkers in healthcare today. The show's format is simple. The guests will present their roadmap for fixing American healthcare's biggest problems. And from there, Jeremy and I will scrutinize the plan and help listeners separate, fixes that have the potential to succeed from simply the hype. Our goal is that everyone from healthcare consumers to political and medical leaders will find value in the discussions on our show. You may not agree with the different solutions offered, but you will never again conclude that nothing can be done. We hope you will join us. Please subscribe via iTunes or your favorite podcast software. For more information, visit our website at www.fixinghealthcarepodcast.com. Hey everyone, this is Mikey McGovern, and you're listening to new books in medicine. In my previous interview, I spoke with Jeremy Green about the history of generic drugs and their unique role in shaping the modern pharmaceutical industry. In this podcast, we're going to dial back a bit to the 19th century in order to chart the origins of the American pharmaceutical industry through Joseph and Gabriel's new book, Medical Monopoly. As it heads up, if you search for it, your first hit will be an allopathic version of the monopoly board game. But back to the book. Published by the University of Chicago Press last October, medical monopoly shows how commercial interests were integral to what many refer to as the rationalization of medical practice in the 19th century. Now, you know, it's easy to draw a clean moral line between physicians' norms of beneficence and industry's pursuit of profit. In fact, such unprofessional stance distinguished trained physicians from quacks, healers who relied on proprietary medicines for nearly a hundred years in the US and elsewhere. However, after the Civil War, Gabriel argues, commercialization and intellectual property law became treated as concerns internal and integral to medicine, rather than problems external to it. His central argument self-evowedly echoes the work of historian Martin Schlar, who argues that the corporatization of American capitalism was a thing people did rather than some mute force imposed on them. While I don't know much about economic and labor history, I can say that the thesis stands up thanks to Gabriel's thorough and groundbreaking research on the reformers who shaped modern medical law and industry. Often, social historians show how movements and events have shaped practice and policy substantially. But this book gets at something much bigger by focusing on how foundational legal and commercial structures, namely patenting, came into medicine as in other markets. It was a real pleasure to chat with Joe, though it's been a few weeks now since I recorded the interview. It was so refreshing to see how someone invested in the problems of subjectivity in modern medicine that have dominated so many other fields and discussions can own a completely different angle of such fundamental importance that it's often overlooked. As always, buy and read the book "All You Medical Buffs in American Historians", but I think in particular, anyone working in the law and policy of medicine, should pick this one up. Thanks so much, and I hope you enjoy. Hello everyone, welcome to New Books in Medicine. I'm Mikey McGovern, and on this podcast, I'm going to be speaking to Joseph M. Gabriel, author of the book Medical Monopoly, intellectual property rights, and the origins of the modern pharmaceutical industry. And Joe is an assistant professor in the Department of Behavioral Sciences and Social Medicine at Florida State. So welcome to New Books in Medicine, Joe. And thank you very much. So the way we like to start on these broadcasts is just to have our authors talk a bit more about their background and how they got interested in the current topic. So could you tell us sort of chart your development for us in the field? Yeah, sure. So I did my dissertation, my PhD in 2006, and my PhD was on drug addiction in the 19th century. And while I was researching that topic, you know, I kind of came across these set of papers from this guy named Francis Stewart, who is a pharmacist and a physician in the 1870s and 1980s. And he wrote a lot about intellectual property, and so I got interested kind of in the topic through his writings. He worked really closely with a company called Park Davis and Company, which became one of the largest manufacturers of pharmaceuticals. In the 19th century, he was just a fascinating character, so that's how he got into it. And what led you to, I guess, from that project on addiction to the sort of framing of the present book, and just for our listeners, what the book does really, really nicely is sort of frames the kind of modernization of medicine alongside the modernization of commercial capitalism. So obviously things that were very, very closely intertwined, but I had never really perceived them as such before, you know, getting into this book. So it really helps sort of, I guess, lay bare the assumptions that we tend to be complacent in about obviously medicine and commercialization work this way, because there was a time when those things were not actually so, so it just what actually led you into the framing of looking sort of at the corporate history of drugs themselves rather than looking at addiction. Yeah, well, my interest in addiction actually grows out of very similar interests about commodification and kind of ethics and kind of, you know, a lot of this book is about the ethical sensibilities of physicians, right, how physicians and pharmacists and drug manufacturers think about themselves, right, and what they're doing. And so kind of more, in a very general sense, I'm interested in the relationship between commodification and subject formation, you know, and that's kind of how I got interested in drug addiction, and there's kind of a natural progression to this topic. I think there's actually a lot of overlaps between, you know, the two projects. Yes, it's interesting and I think that what I found refreshing about this was that while a lot of accounts that are interested in, you know, subjectification will tend to sort of focus in on those kind of micro instances of the clinic, while leaving some of these larger issues that you chart, I kind of largely unexplored. Yeah, yeah, I mean, that's, you know, that's part of the overall, my overall interest is kind of thinking about how to bring, you know, it's in some ways kind of an old-fashioned, almost structuralist approach, in some sense, you know, it's like there's these big forces that are kind of going on doing things, right, and how to link that to kind of individual practice and individual behaviors, right, and kind of the accumulation of a whole you know, a huge number of individual people's behaviors that add up to kind of these big structural issues. And that's where my interest in Martin Schlar comes in. I don't know if he's familiar with his work. No, I actually wasn't familiar with his work, so that was seemingly, I mean, I remember flagging that in the opening as kind of one of the very big framings of his work. So if you want to elaborate on that for listeners, that'd be awesome. Yeah, I mean Schlar, so Schlar is a tremendously influential historian, kind of in kind of a new left historiography, you know, and one of his main points, you know, was that people, you know, when capitalism got reconstructed as the corporate former, right, that wasn't something that structures did to people, that was something that people built for themselves, right, and you know, that's kind of an, that's not always the natural way that people think about the relationship between individual people and markets, right. We tend to think of markets as doing things to us, right, rather than us building markets. You know, and so that, you know, that's kind of my argument about drug addiction too, right, is that drug addiction is this kind of subjective experience that we built, right. So it has a history, you know, commodities have a history, you know, and so all this stuff about, and so kind of that framework means that ethics, right, and ethical sensibilities, the worlds that people live in on a daily basis, are central to kind of these big kind of overarching themes that historians often explore. Okay, excellent. I think that that sort of leads us kind of to where we start in the book at your introduction with the framing that you take up and kind of lends us right into the first, the first chapter, where you kind of talk about, I guess, the origins of, you know, patent medicines and just generally the medical marketplace in America, the beginning of the 19th century. And I'll add for the, for our listeners out there that, whereas my previous interview with Jeremy Green, whereas Jeremy kind of looks at the, mostly the mid, early to mid 20th century onwards, in the marketplace for generic drugs, Joe Gabriel's book basically takes us all the way through the 19, through the 19th century, and then up into World War I. So we're kind of shifting the focus back a little bit in time to sort of look at the formation of the possibilities of the kinds of economic issues Jeremy Green talks about. Right, right. You know, a lot of my project is about the category of generic, right, how it is the names, this thing called generic names, that everybody's just kind of assumes all is existed, you know, itself has a history, right. So one of the things I do in the project is to show that, you know, in nearly 19th century, there were really no such thing as generic names in the way that we understand today. There were trade names, like commercial names, right, and there were scientific names, but there wasn't really a distinction between commercial names and commonly in the way that we assume that there was today. So I do think that, you know, my book and Jeremy's book make a nice kind of pairing together in that sense. Yeah, absolutely. And so where we begin kind of at the beginning of the 19th century, the, I guess, kind of the climate of American medicine is still, you know, very, it's not really very rigidly institutionalized. It's lots of kind of, I mean, individual physicians taking up intellectual projects and trying to sort of pursue these to their own ends, like you start with the image of one physician who's sort of going on botanical excursions to find potentially valuable medicines in New England. So, I mean, just as a general over for our listeners who aren't really familiar with the kind of periodization of medicine, what was, you know, what was medicine like in America at the dawn of the 19th century? Yeah, so, you know, unlike many of my colleagues, I think I take a very broad view of what medicine is, right? And so, you know, in the early 19th century, medicine was incredibly diverse, right? There were many, many, many traditions. People practiced medicine in many ways. There were lots of, there were many, many remedies, right? Because remedies were mostly plant-based, they're mostly botanicals, but there were also many manufacturer products. There were elixir, there was some tinctures and, you know, all kinds of things, right? So, it was a very diverse market, a very diverse therapeutic market. It was also, it was also a market that was changing very rapidly, which I think is something that people don't often think of when they think about the early 19th century market points, right? Physicians, you know, in the early 19th century were actually very concerned about how many new remedies there were on the market, right? And they were concerned about kind of the diversity of the market because they were concerned about questions about standard halfway paths at reforming the market and rationalizing the market to kind of reduce the problem of of, you know, difference in the marketplace. And the issue that you kind of hit on in the first chapter is that while, you know, different, I guess what we then begin to see as ethical firms will sort of name, name substances differently, you know, like parks, you know, tonic versus Jones's tonic. And then, but also at the same time, around these sort of issues of commodifying their unique substances, the problem emerges of the idea of patenting nature itself, which is sort of where the kind of property debates that you take up in the book begin. So basically what happens is that there's lots of, you know, obviously lots of cases of people being taken into court over attempts to patent, you know, these individual substances that as the ones bringing them, the court will say are, you know, bound in nature and therefore can't be patented. But then the idea of patenting processes sort of comes into play. And of course, the problem with processes that processes in medicine can fundamentally alter what the thing itself is. So how are these debates resolved? Well, I mean, I don't know if they were resolved, right, to be honest. I mean, it's that, so the question about whether products in nature can be patented, right, that question has a long history, you know, it goes up to the present day, right, disagreeing the court ruled on that issue not that long ago. Right, the time of Chakrabarti on genes, right? Yeah, right. You know, and so it really goes back. So, you know, from the earliest patent law in this country of 1790 law, right, it was assumed, it was generally assumed that you couldn't patent naturally occurring substances or products in nature, right? So you couldn't patent rainbows or lightning or electricity or anything like that, right? But starting in 1795, the British case about the steam engine. And that case basically said, well, you can't patent products of nature, but you can't patent naturally occurring effects, but you can patent the processes that we use to harness those things, right? So this distinction between processes and the things themselves got established. And that kind of distinction both for its time got linked to the question of utility, right? So something could be patentable if it was a method that harnessed the principle of nature, but it had to make something useful, right? It had to make something more useful. And so utility became, you know, one of the criteria of patentability, okay? So basically what that meant was that in this developed all kind of course of the 19th century, but what that meant was that you couldn't patent a naturally occurring substance, but you could patent a naturally occurring substance that you had made into something useful, right, or something commercially useful, right? So, you know, something like, you know, something like a yeast, right? You couldn't necessarily patent yeast itself, but if you could make the yeast useful in a commercial way, then you could patent, okay? And so that's what, that doctrine is what eventually led to the patenting of adrenaline in 19, and the decision is about the patenting of adrenaline in 1911, which, you know, adrenaline is a hormone, right? So it seems kind of strange that you can patent a hormone that naturally curves over body, right? But of course adrenaline doesn't naturally occur in a therapeutically useful form, right? Because you can't actually use it when it's in an animal's body. You have to take it out of the body, right? It's been, you know, isolated out of the body and make it into a useful product, right? And that's kind of that, that question about utility is what allowed naturally occurring substances to be attacked. Essentially, the other, the other issue that you kind of frame in the first chapter is that around kind of essentially physicians trying to maintain the integrity of their own practice by rejecting quackery, which has a very, very long tradition in which the, you know, the pharmacist or the alleged, you know, heterodox healer sort of peddling their own cures is sort of seen as the classic case of, you know, medical quackery. And a lot of physicians sort of, you know, set themselves against commercialization because of this very same reason that it seemed to sort of be counter to the ethos or the emerging sort of ethos of professional medicine, especially in America, right? Or that's what we tell ourselves, right? I mean, that's the story we tell ourselves about the history of medicine. I don't think that story is true, right? I think that physicians have always been part of the marketplace, right? And they've always, you know, they've always availed themselves to the market, right? The question was, for them, you know, in the early 19th century, the question was the relationship between the market and science, okay? So they never wanted to reject the market at all. But what they wanted to do was they wanted to have the market be subordinate to science, right? And they saw science as being outside the marketplace, okay? And outside of kind of selfish, what they consider to be selfish intro, selfish efforts to monopolize information or knowledge or the use of remedies, right? So, so for them, quackery and monopoly were fundamentally intertwined categories because they believe that science operated within a community of respectable peers and it was based on the sharing of information, right? And if you monopolize something, right, through a patent or trademark or through secrecy, then you're preventing other physicians from using that to advance science, right? So, monopoly itself was considered quackish, right? It was anti-scientific to patent something. That didn't mean they were outside of the market, right? I just meant they were concerned about monopolization in the market, you know? And then kind of over time, as I argued in my book, over time, the relationship between the market and science got transformed around the question of monopoly, right? So that monopoly eventually became a chain being an indicator of quackery to being kind of the central part of the science of the Toronto office. And it's interesting, I think, because in the book, you sort of, you find a lot of physicians describing their views about what you just said, sort of, that science is a republic of physicians that's kind of maintained in its own, right? That's not necessarily outside of the market, but it sort of functions in its own way with its own set of rules. But then within that, you know, republic or democracy as sort of some of the later actors will say, there's always potential for a kind of slippage, right? Where in, you know, it's about the possibility of a form of governing practice. And once it becomes permissible for that practice to be governed by, you know, or to govern directly, I guess, more importantly, the market, then these practices kind of become normalized. Right. Yeah. I mean, I talk a lot in the book about efforts to rationalize the market, right? To reform the market. What historians of medicine are scientists called therapeutic reform, right? You know, if therapeutic reform, the effort to rationalize the market, you know, a lot of the historians assume that that is an anti-market position, right? Like reformers who are trying to rationalize the market are somehow hostile to the pursuit of profit, right, or the pursuit of market forces. That's not the case at all, right? It wasn't the case at all, right? They wanted a market that would help, that would serve people, would help everybody, including themselves, right? So they wanted to reform the market, but they never, they weren't, you know, they weren't opposed to the market, right? And understanding of their attitudes towards the market explains a lot of why, you know, I think helps explain a lot of our kind of misconceptions about the attitudes of physicians towards the pharmaceutical industry, right? Physicians have never been hostile to the pharmaceutical industry itself, right? They've been hostile to aspects of the industry or certain behaviors in the industry, right? But, you know, going back to the early 19th century, physicians have always wanted the drug market to work and work well and work rationally, both to advance our interests and to help patients. Thus, we sort of get the emergence of what you describe as these ethical firms, whose desire is to produce drugs in accordance with the kind of standards of the medical community. So can you talk a bit about those? Because I know those also play a big role kind of going into the 20th century when then you begin to get the emergence of huge global for-profit pharmaceuticals and then also generic firms. Right. So these have always been for-profit companies, right? Right. So the ethical firms, you know, started in the 1840s, maybe a little earlier, 1830s, 1840s, and these were drug manufacturers that self-consciously conform to the norms of the orthodox medical community. Okay. So they only manufactured well-known goods, right? Goods that had already been scientifically investigated by physicians. They only manufactured- they all manufactured basically the same products, right? They were very kind of circumspected in their advertising. They didn't advertise to the public. And they didn't do anything that would violate the ethical norms of physicians, right? So they didn't patent or trademark their goods because monopoly was considered in form of quaggery. Things like using secret ingredients, patenting their goods, because if for the orthodox physicians, science was supposed to control the market. So ethical firms in the 1840s and 1850s, actually, they couldn't really innovate new things, right? Because doing that would have violated kind of the norms of the orthodox medical community. You know, going into falling a civil war, going to the 1870s and 1880s, that made a huge problem for the industry. And the industry tried to figure out how it could, you know, ethically introduce new goods in order to make a profit, right? And that's kind of where this guy Francis Stewart comes in, that I mentioned earlier. Because when he was working for Park Davis, one of the things he did was he innovated a new way to introduce new products, you know, for profit in a way that wouldn't violate the norms of the ethical, of the orthodox medical community. That's kind of his key, one of his key innovations. You know, I mean, and he did that, basically, by getting new new, new, new, new remedies or new products and sending them out to physicians to test and then publishing the results, right? So in bringing up the, in bringing up this idea of, you know, making pharmaceutical scientific, I find it really, really interesting that, you know, you begin to see these, you begin to see these firms conforming to the norms of the scientific community, but also it's worth pointing out at the time, you know, large scale laboratories, you know, on the scale of some of these organizations are kind of just a phenomenon that's kind of that's coming into Vogue. I mean, with the rise of metrology and standardization in Germany, you begin to see all these engineering and manufacturing firms employing stricter, stricter standards. So that move is both about, you know, the scientific community and about kind of the new practical possibilities that I found really, really interesting. Yeah, yeah, absolutely. And, you know, it's also based, you know, it's also about both laboratory research, right? Which, you know, I think that much of the historiography has focused on laboratory research, right? But it's also about clinical research. So what happened was that in the 1870s, Park Davis, which was a new drug firm at the time, started people out to kind of distant parts of the country, different parts of the world, and looking for new plants, new botanicals, that have medicinal properties. And the company would then go back and introduce these products to market, right? Now, at the time, that was a gross violation of the ethical norms in the community. But so what Stuart did, what Francis Stuart did, was he innovated a way of validating the legitimacy of those remedies by sending them to physicians and having physicians test them in their clinical practices, right? Test them on patients, and then report back with the results, right? And then Park Davis, the company, would publish the results, right? And that basically said, you know, this is a scientific process that we're doing. So even though we're a commercial firm, we're still able to pursue science and advance scientific knowledge, right? And that was a tremendously important innovation, right? Because that basically opened up the floodgates to allow, you know, to allow commercial firms to engage in scientific practices in a way that they hadn't been able to before, because of the ethical barrier on doing so. And what I was, what I maybe missed in the book was, did they initially publish and sort of establish periodicals, or did they kind of begin by circulating results independently, which then later became formalized? Yeah, no, they didn't, they didn't, I mean, they did publish some in, you know, I mean, reputable journals, it's hard to know what that means and what that meant at the time, because journals came and go, and many journals were being, you know, it's kind of a moving target, right? But Park Davis just printed its own material and just published its own material, right? So George Davis was actually one of the large, what's actually a major force in medical publishing at the time. He published, you know, multiple medical journals, you know, and that's kind of a whole other side to the story, right? Because there's a way in which Davis and Stewart, like they saw themselves as advancing science, right? And they believed very strongly that they were advancing science and benefiting the public, right? At the same time, you know, they were publishing their own scientific literature, the scientific things that they were publishing that were clearly biased towards their own products, right? And, you know, and so at that moment, you can kind of see what we would consider the corruption of the scientific process, kind of built into the scientific process of drug discovery right at the beginning. Right? And it's all the people who are sort of very actively involved in making this kind of infrastructure, because it really, you know, as you sort of say, all these periodicals and journals came and went and it really wasn't quite there to be made. So it almost makes sense that alongside the rise and standardization of the market and all of these kind of companies that could essentially, I mean, through economic, through economic power, could sort of, you know, produce something that was standard and distributed, kind of makes sense that that's where a lot of these, you know, kinds of journals and forms of, you know, standardization we associate with medical practice today would originate. Yeah, yeah. And, you know, what I'm interested in about that process is the way that trust in science, right, and the legitimization of science and skepticism of science, right, and suspicion of science, kind of, you know, basically have the same origin point, at least when it comes to pharmaceuticals, right? You know, and so distrust of science is, in my view, is built into the very mechanisms that we use to produce science. That's an interesting claim. Yeah, it is. I'll depress you more on that. Yeah. I also want to get back to my first question. Sorry, was that? Well, I might get myself into trouble. We'll see if we can turn to that later, because it's, you know, this duplicity at the heart of, you know, the making of modern science is something that's really interesting. But a lot of people, I think, do pick up on, but I really like that phrasing of it, actually. I mean, it does make sense. The distrust of science being, I mean, you know, the rise of standardization in science is kind of, you know, a way to ensure, or as almost like, you know, a systemic distrust in the integrity of any individual. And this idea that we relinquish our notion of, you know, trust at all to, you know, have some kind of security that's, you know, not really quite trust, but something else. Right. Yeah. And you know, it's, it's about power too, right? Yeah. Because, I mean, it's about power too, because part of what the reform, the reformers are doing, right, is that they're, they're rationalizing the market. But they're doing that through legal mechanisms, right? They're passing laws that are, you know, basically enforcing their own vision of what a rationally operating market is, right? They're also doing it rhetorically, right? So, they're dividing people up into groups, right? You know, ethical, legitimate manufacturers and quacks, right? And, you know, for the people who are on the right side of the equation, it works pretty well, right? You know, Park Davis makes a lot of money, right? The AMA becomes a very powerful organization, right? So, it works fairly well for them. But for all the other people, it doesn't work that well, right? And, you know, all the other people are kind of on the opposite side of this process. And, you know, for them, the process is not a happy one necessarily, right? You know, and that's kind of a source of this distrust too, right? Because science, you know, it's not, it's like, it might be like it's a moving target, right? But it's also an embodied practice that people do, right? And, as people will do it, and they, you know, they kind of make their own vision of what it is happening, right? Other people don't necessarily agree with that, right? Or they don't necessarily go along with that. And so, it's kind of always this, you know, it's always this process. It's embedded in politics and better than in controversy, in power relations, and so on. You know, and I try to talk about that in the book too, right? That's kind of one of the themes that comes through that. And so, to get back to also, so, as before we began on that, I said I had kind of two questions, and the first one that we reversed was actually kind of, so in the third chapter, which is called "In the Shadow of War," you talk about sort of, you know, these post-Civil War reforms, but I just was wondering, because it wasn't as clear to me from the book and might be of interest to some listeners who have sort of more of a general inclination toward these histories. What actually was the influence of the Civil War on some of these, on some of these practices? Was it that, I mean, obviously the destabilization of most American industry was the immediate result, and the antebellum and reconstruction sort of led to a lot of standardization, but really what happened sort of in those interim, what happened during the Civil War II, a lot of this drug development and, you know, rational medicine in this way? Yeah, I mean, you know, I think your question is a very fair one, and, you know, I kind of came up with the title for the chapter because I thought it sounded nifty, you know, and it didn't necessarily reflect the chapter itself that well, right? You know, so I don't, you know, to be honest, I don't talk a lot about the influence of the Civil War on later developments, right? I mean, probably the main way it comes out is kind of through, you know, just basically federal spending, right? Because this government spending on the war, right, was a massive stimulus for, you know, many of the, you know, what were once very small companies? He came very big companies very rapidly because of war spending, you know, but there's a lot of other kind of other areas that it could get out, you know, like the massive amounts of pain and suffering, right, that resulted from the war and that developed kind of over time, for example, you know, made a huge market for help units, right? Yeah. You know, but so there's a lot of kind of other issues. I guess moving further along into that chapter, we begin to get into kind of the issues that preoccupy the fourth chapter, and talking about sort of the reinterpretation of monopolies, right? And what's interesting here is that sort of, you know, what you're describing about, you know, the Civil War being, you know, kind of, you know, the most fundamental human level of problem of pain and suffering, you sort of talk about the reinterpretation of monopoly as a way, at least it seems to kind of prevent accidental suffering against, you know, accidental suffering resulting from misprescriptions or misunderstandings, and sort of the monopolization as kind of a way of further enforcing kind of legal standards and otherwise. So I think it's an interesting connection there. Yeah, absolutely. You know, so, I mean, what, what, so what the reform, what therapeutic reformers wanted to do was, you know, they wanted to rationalize what they saw as a predatorial, chaotic, dangerous market, right? And this market did all kinds of bad things to people, right? Well, the distorted market did all kinds of bad things to people, right? A rationally operating market, on the other hand, would do all kinds of good things for people, right? It would, it would produce, you know, a bounty of medicines, like a heel, right? It was only when the market became distorted by monopoly or other kinds of forces, right? That things went bad and people got hurt, right? And so, so their vision was to rationalize the market and then you have this awesome, wonderful situation, the result, right? And, you know, and so all this kind of pain and suffering, right? Accidents, you know, mistakes, adulterated products, like quackery, all these things were seen as distortions of an ideally rashing operating market that had to be eliminated, right? And monopoly, so what happened was that in the antebellum period, monopoly was an indicator of quackery. It was an indicator of the distorted market, right? But following the Civil War through the 1880s and 1990s, monopoly became a way to rationalize the market, right? And then, because, and that happened in a lot of different ways, but one of the main ways that happened was that it became a way that ethical manufacturers could invest, you know, invest resources into developing new products, right? And those new products could be sold on a rationally operating market and help people, right? So, monopoly became kind of the condition of producing new therapeutic goods through the rational, through the process of losing through science. And, you know, and that was really kind of steward, Francis Stewart's, that was one of his central insights, right? Was that, you know, he wrote a lot about patents and trademarks and argued that if used appropriately, patents could advance therapeutic reform. It could be a vehicle for improving the market, rather than where it works. So, one of the problems that you, one of the problems that you discuss is this idea of, you know, these, I guess, our later called generic names, right? And then the brand names and sort of where that can lead to obvious sort of confusion in the medical marketplace, and also where these brand names are seen as sort of the last safeguard that a lot of these companies have when the patents on drugs expire. So, this, this link between, you know, patent name and substance that's really, really important. And I don't know, it really starts to come to the fore, I think, later in the story. So, if you could expand on that, that would be awesome. So, one of the questions is that one of the questions that the therapeutic reformers struggled with was how to standardize monopolized products. Okay? In the antebellum period, this was an issue because monopolized products were, by definition, quackish. And therefore, we're not part of the pharmacopoeia, right? They didn't think you should be using quackish products at all, right? Beginning in the 1870s and 1880s, there were a number of products that introduced that were both patented and trademarked, the names were trademarked. And, but they were also highly effective products, right? And what that did was, that was one of the ways that the equation between monopoly and quackering got ruptured, okay? So, you mentioned Vaseline, right? So, Vaseline was introduced in these, and it was a tremendously important therapeutic advance, right? It was a very, very, very important innovation in healing technologies. But it was also patented and trademarked, right? So, the question was, how do you include that in the pharmacopoeia and how do you standardize that? And it wasn't at all clear to people. What they eventually came up with was, you introduced it under a new name that wasn't trademarked, right? There were all kinds of problems with that. And one of the problems, I think, as you pointed to, was that the name Vaseline kind of became over-determined and took the place of all of Vaseline, all of their controlling jelly products, right? So, you know, including it under what came to be called the generic name, for Vaseline didn't really work that well. But the central idea of rationalizing the market by creating new names for substances and then linking these new generic names to this process of standardization, you know, one of the basic ways that we standardize drugs, I mean, that is how we standardize drugs now. You know, so generic names, you know, I trace the origin of generic names in the 1870s, and, you know, argue that it was a way of kind of dealing with the question of monopoly. And strangely enough, you know, the introduction of generic names actually made monopolization of products possible, right? Because it meant that you could include monopolized products in the pharmacopic, instead of just defining in this quackish. Right, that's interesting. And then the other, I guess, one of the other major issues that comes up, that comes along is, you know, I guess the increased visibility of, I guess, of patent medicine and, you know, sort of, I guess, of commercialization within medical advances. So, there's a really interesting case you discuss toward the end of the, I guess, in the middle of the fifth chapter on the development of the diphtheria antitoxin, for which the, I guess, the alleged inventor of the process, a German scientist in the name of Bering won the Nobel Prize. And it's interesting, and I just want to sort of read a couple of the quotes from it, just to, you know, sort of give people the framing. But the way he defends the, the way he defends this discovery of essentially what is a naturally produced antitoxin is, he says, "No one before the invention of my process has ever gone beyond establishing general scientific principles." So, this idea of, you know, taking something and standardizing it, bringing it past science, although, you know, still pretty, pretty vague saying that, okay, I've not taken this past science and made it industrial standard. And then what's interesting is that when he, when he wins the Nobel Prize in 1901, there is an editorial in the Journal of the American Medical Association that says, quote, "There are many who think the professor Bering's position in securing a patent on his invention in order to reap the benefit of it for himself should preclude him from an award for humanitarian advances made." And so, you, so you begin to see here kind of what you talked about, this idea of setting up the, you know, the idea of an unjust monopoly in medicine, as opposed to the just monopoly, and that those two kind of emerge really strongly together. Right, right, and somebody like Bering, you know, he was, so he was easy to criticize, right, for the, for the, for the, for Jam, for the General of the American Medical Association, you know, in 1901 or 1902, he was easy to criticize because he was German, right, and that was a big, that was a big part of the problem, right, if he had been, you know, because it basically this same time, right, Park Davis introduces a journal, right, and Park Davis patents the journal, and I think in 1903, right, 1904, right, and nobody raises an eyebrow about the fact that they patented what was one of the most important therapeutic advances of, you know, the early 20th century, right, so, you know, so, so this question about, so, so at the one hand you have this whole kind of process whereby patenting and trademarks become scientifically an ethically legitimate, right, but at the same time as that happened, certain kinds of patenting and certain kinds of trademarks remain illegitimate, remain disreputable, right, and the Germans get, you know, get the brunt in many ways, so German patenting remains kind of a big, big problem and lots of people critique it, you know, in a variety of different ways, and so I think that's what, you know, so bearing, you know, they saw him as kind of this, like, predatory German vampire, right, who's going to come in and patent this antitoxin that would save, you know, all the lives of all these children, right, but I think the problem was, was that he was German, right, right? Yeah, it's, it's really interesting, you know, this linkage of, you know, this linkage of distrust with geopolitics is obviously, you know, it becomes very, very important, getting into the war time years. Yeah, I mean, I couldn't, I didn't really develop that well as I would have liked to, but this kind of parallel story about aspirin and before the lesson, which were two very important drugs in the late 19th century. So, finacidin was introduced in 1887 in aspirin in 1900, and you know, they're both patented by Bayer, right, and Bayer's patent on those two drugs allowed them to charge twice in the United States, then they could charge for the same drug in other countries, right? So, you know, I think, I think the price in the United States compared to Canada, I think aspirin was almost twice as much in the United States as it was in Canada, right, and, or something like that. And that just made everybody incredibly angry, right? And so, the patent on aspirin, even though patenting in general was becoming scientifically and ethically legitimate, there was a tremendous amount of criticism of the patent on aspirin because of this price differential, right? You know, and, and drugists were, like, smuggling aspirin, there were all these police raids on drugists who were selling illegal aspirin, right? And again, you know, that's, again, this kind of geopolitical linkage between monopoly, there's a linkage between monopoly and kind of geopolitics, and how it plays out, it's sort of everyday ways of ethical sensibilities. Yeah, absolutely. And so, just sort of getting, getting to where, I guess, the book is beginning to wrap up in your conclusion, you know, this, I mean, this idea of, you know, sort of medicine as a potentially, you know, transcultural and international and kind of, you know, universal, undisputed good, right? That's sort of people, I guess, try to assert in a way that it's immune from these similar kinds of forces. But, you know, I think that what you, what you kind of hint at toward the end is a, you know, a nice rhetorical strategy. And you claim that, you know, the world, you know, the world, the promise of pharmaceuticals and the way that the market ended up taking shape is not necessarily, it didn't necessarily have to occur that way, right? And so, I guess that you talk about, you know, the other issues you say is that we, you know, the problem is we fabricate this rational world, right, that we believe to be a potential horizon, right, something that we would like to achieve, but continually struggle with the kind of ways in which it doesn't meet up to our expectations. So, it's just, you know, in closing the book, what were your, you know, how would you describe some of your takeaways from the book and from this research? So, like, I teach in a medical school, right? I believe in the power of science, and I believe in the power of medicine to make the world a better place, right? You know, if I didn't, I wouldn't be able to say I come to work every day, right? And, you know, and to be honest, I think, I think most people do, right? I think most people, you know, we, we get, is dreamed of a rational way of science as a rational process, and we want to make that true, or at least people in the world that I move and want to make that true, because you read the newspapers and then you read all these drug companies doing all the kinds of things they shouldn't be doing, right? Or you read about all these other problems, you know, like, you know, but at the other time, it's incredibly optimistic, right, because we continue to believe in some kind of beautiful world that we can make possible, right? You know, and I guess, you know, part of what I was doing in this book is trying to chart, you know, how that dream became so linked up with markets, right? But markets are the same way, you know. I mean, we all believe in markets as making the world a better place in some way. You know, even the hardest, the hard left, believes, right? You know, so, so I, you know, I like to think that it is possible to make things better, and it's possible to reform the world we love it. So, now it's helpful, and on that note, I think you may have hinted at this a bit before, but we like to sort of wrap things up in new books by asking, what are you currently working on? Well, I'm still trying to finish my book on drug addiction, so I'm staying on that. Yeah, and then also, I'm also working on SQL, so I'm going to write a second call out for this project about the 20th century. How far along are you in that process? I think I'm about halfway done. I think, yeah, I mean, I have a pretty good, I have drafts of about half the chapters, and then kind of rough stuff with the other half of the chapters. You know, unfortunately, like, like the 20th century, it kind of sprawls out of control, you know, so I like these, I like these big sprawling stacks of emotes and stuff. You know, it's a kind of the process of therapeutic reform in general. Well, well, you know, thanks so much for talking with us, Joe, and I think that, you know, between, between this conversation and my talk with Jeremy, our listeners will have a lot to think with about the role that pharmaceuticals play in the, you know, formalization of medicine and, you know, the marketplace and modern consumerism. So, you know, thanks so much. We look forward to those, those next books and future stuff you do. And yeah, just thanks so much for giving us your time this evening. Yeah, well, you're welcome. Thank you very much. It's been a real pleasure. Great. Thanks. And so I thank you all who have been listening. This has been new books in medicine. I'm Mike McGovern, and I'll see you next time. Bye. [BLANK_AUDIO]
Commercial interests are often understood as impinging upon the ethical norms of medicine. In his new book, Medical Monopoly: Intellectual Property Rights and the Origins of the Modern Pharmaceutical Industry (University of Chicago Press, 2013), Joe Gabriel shows how the modernization of American medicine was bound up in the ownership, manufacture, and marketing of drugs. Gabriel unearths the early history of intellectual property concerns as they entered the domain of medical practice itself. Through his careful marshaling of evidence, he takes readers back to a time when the norms and legal structures of commercial capitalism in the U.S. were just as much at issue as those of the professionalization of medicine. This fascinating book serves as a pointed reminder that the sources of therapeutic rationale are just as much tied to the production and regulation of therapies as the collective decision-making on ethical practice. Along with my previous interview with Jeremy Greene, this discussion will hopefully make accessible a broad perspective on the development of medicine in the 20th century by focusing on its ties to industry.
Medical Monopoly charts the history of property rights over medicines at the dawn of the 19th century through World War I. The important broader transition here is that while before the Civil War–at least in medicine–patents were seen as tantamount to granting problematic monopoly, by the end of the 19th century they were understood as the best available regulatory mechanism for preventing more problematic imitation. Whereas patent medicines had previously been linked to quackery, the emergence and rapid expansion of the “ethical” pharmaceutical industry after the Civil War was due to its adherents advocating for more effective regulation of commerce within medicine. Rather than reverting to secrecy, firms began to circulate and publish information on new remedies and the results of studies to physicians. As the explosion of new medicines remained at pace with the boom of consumer goods in the late 19th century, patenting and corporate investment in monopolistic practices became understood as a mechanism to advance the public good. The expansion of laboratory science and norms of chemical manufacturing in the 20th century only bolstered this union further.Medical Monopoly is a fascinating and important read that people interested in medical policy should pay attention to.
Learn more about your ad choices. Visit megaphone.fm/adchoices
Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery
