In the 1960s revolution was afoot. Antipsychiatry was born. The new revolutionaries targeted medicalization and claimed mental illnesses didn’t exist. Out of this cauldron, postmodernism was discovered. Postmodernism provided the basis for an ongoing guerilla war against capitalism and industrial society waged by social scientists, anthropologists and others trained in the humanities.
Science had led us to doubt the Bible, to doubt the stories of national identity and to doubt other stories that bound us together – and in so doing had led us into modernity. Now the message was that we should doubt science itself, which was after all just a bunch of stories – post-modernism. Just as science had once raised the question of whose interests our myths served, now post-modernism asked whose interests did the myths of science serve.
Finally in the 1990s science drew a line in the sand. The best account of this lies in the book Higher Superstitions. Perhaps to the surprise of most scientists – and why few people have heard of it – the Science Wars were over almost at the first engagement. When the bunkers in which the postmodernists had been hiding were examined, there was almost no-one there. The social scientists and others at whom these missiles were directed had apparently deserted the cause. One group were ironically seduced by a New Biology. In the 1990s, the Human Genome Project and developments in psychopharmacology catalyzed this New Biology. Academic social scientists, bioethicists and others rushed to be there at the birth of the New Man whose Star had arisen in the West. Another group vanished.
In the course of the Second World War, US Air Force planes flew into islands in the Pacific, disgorging all sorts of goods. Some of the islanders were so impressed by the appearance of these flying cornucopias that long after the military left they maintained the runways and control huts, beside which they continued to fly the American flag, in the apparent belief that the right appearances would lead to the right results. These were the Cargo Cults. For scientists reality is not a text that can be read one way today and another tomorrow. The ultimate defense of science has been that its planes fly. Science’s trump card against post-modernists is that having them in a laboratory would be the same as reproducing the airstrips and the US flag – we’d be left waiting forever for results.
But what we have now in healthcare increasingly resembles a Cargo Cult. Today’s drugs are less effective than yesterdays, treatment is now in some areas of medicine the leading cause of death, and life expectancy in the US – the country that consumes the most of the latest on-patent blockbuster drugs – is now lower than Cuba’s. Have the post-modernists slipped in unnoticed and taken over the laboratories of science?
We have all the appearances of science – controlled trials, a relentless quantification, and a stupefying recourse to statistics. And in the front row, we have anthropologists, bioethicists and others who are singularly ill-equipped to deal with statistics and issues of causality. There is no critique of what passes for ‘evidence’, and little exploration of the growing threat to all of us.
Meanwhile, the marketing departments of pharmaceutical companies have achieved what the post-modernists of the 1980s could barely have dreamt of. They rewrite the text that is the human body from year to year with afflictions such as osteopenia, erectile dysfunction and pediatric bipolar disorder that appear out of nowhere, creations of ghostwriters who practice to deceive.
Take Donna, for example. In marketing Zyprexa for bipolar disorder, in 2002, Lilly produced Donna, “a single mom, in her mid-30s appearing in your office in drab clothing and seeming somewhat ill at ease. Her chief complaint is ‘I feel so anxious and irritable lately’. Today she says she has been sleeping more than usual and has trouble concentrating at work and at home. However, several appointments earlier she was talkative, elated, and reported little need for sleep. You have treated her with various medications including antidepressants with little success….You will be able to assure Donna that Zyprexa is safe and that it will help relieve the symptoms she is struggling with”.
In the 1960s and 1970s Donna would have been seen as anxious, a poster case for treatment with Valium. In the 1990s, presenting with the same symptoms, she would have been seen as depressed, and in need of treatment with Prozac. Neither neuroscience nor any aspect of clinical science had moved forward by 2002 in a manner that might justify rediagnosing Donna as bipolar. But this doesn’t stop companies who are quite happy to read the vast majority of our problems one way today and quite another tomorrow.
When it comes to the hazards of Zyprexa Donna may suffer from, just as with the hazards of the Lipitor she may have to take because Zyprexa has raised her cholesterol levels, or the Celebrex she may now be on because of arthritis linked to Zyprexa-induced weight gain, or the Avandia she needs because Zyprexa has caused diabetes, Donna and her doctor will find themselves up against a radical skepticism. When it comes to the hazards of a pharmaceutical company’s drug, the rules of science do not apply and causality, it seems, can never be proven. A more succinct definition of the post-modernist credo cannot be found than the phrase “doubt is our product.”
In the midst of the Industrial Revolution, the factories around cities like Sheffield were belching out so much smoke that the sun was blocked out and children famously developed rickets. The factories of industrial post-modernism are also belching out vast amounts of smoke and people are developing diseases from pediatric bipolar disorder to osteopenia as a result that will only clear when the smoke clears. These factories also contain a production line that turns out “North Koreans”, whose job it is to defend the system (see We’re all North Koreans now). They have a department whose brief it is to work out new initiatives such as the colonization of May Fool’s Day (see May Fools’ Day).
In the face of this we need to recapture the ability to say that an increase in mortality is an increase in mortality. We need to be able to recognize that little that glistens with statistical significance is therapeutic gold, and refuse to allow companies, their experts and regulators to stand common sense on its head (see Psychotic Doubt). Speaking out would be a way for doctors and scientists to demonstrate the “right stuff” (see We need to talk about doctors).
We need our media studies and other university departments on the humanities side of the fence to deconstruct industry rhetoric. Where are they now when science needs them?
A small band of women clustered around Leonore Tiefer have responded – and derailed company efforts to industrialize female sexuality. Other women, mothers, wives and daughters have done more than any doctors to get recognition of drug-related hazards.
They are up against the vanished post-modernists, who for the most part now have jobs in the marketing departments of pharmaceutical companies.