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“Beyond the Medicines/Drugs Dichotomy: Historical Perspectives on Good and Evil in Pharmacy"

Updated: Aug 29, 2023

Editor’s Note: Today’s post comes from contributing editor Dr. David A. Guba, Jr., of Bard Early College in Baltimore and Jamie Banks of the University of Leicester.

Twenty-one delegates from ten countries gathered in Johannesburg, South Africa from 5 to 7 December for the “Beyond the Medicines/Drug Dichotomy: Historical Perspectives on Good and Evil in Pharmacy” conference. Masterfully organized by Thembisa Waetjen (University of Johannesburg) and co-sponsored by the Alcohol and Drugs History Society (ADHS), the Wellcome Trust, the University of Johannesburg, and the University of Strathclyde’s Centre for the Social History of Health and Healthcare (CSHHH), the conference was held at the stunning facilities of the South Gauteng Branch of the Pharmaceutical Society of South Africa. The event also marked the latest step forward for the “Changing Minds: Psychoactive Substances in African and Asian History” project under the direction of Jim Mills (University of Strathclyde), which works to connect scholars of drugs and alcohol history in China, Africa, the UK, and beyond.

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The central aim of the conference was to bring together papers that interrogated the cultural, historical, and scientific distinctions drawn between “medicines” and “drugs.” In particular, the conference provided a forum for delegates to explore the kinds of knowledge which were generated to justify these distinctions. Supplementary to this central theme was also an effort to consider how the histories of particular substances, such as cannabis, morphine, GHB, and synthetic opioids have, at various times, been used to justify or dispute these dichotomies. Finally, the conference also invited papers which explored how chronologies of commodification, regulation, and/or prohibition of particular substances have followed similar routes in different geographical and historical contexts. 

The first day of the conference (5 December) was left free by the organizers as a chance to settle in and explore Johannesburg. The following two days (6 and 7 December) consisted of four and three single-session panels respectively. The organization of the conference into single panels, in a fashion akin to a workshop, was much appreciated and led to a strong sense of community and exchange between delegates. The sessions, each featuring three papers, were carefully curated to address related themes and issues. On the first day these themes included the place of pharmaco-politics in different national contexts, tensions between consumer agency and subjection, the colonial histories of various substances, and the role of experts and expertise in narcotics gatekeeping. The second day then explored themes such as the dichotomies evident in medical practice, the stigmatization of particular substances, and the question of whether the ‘global south’ is experiencing an opioid crisis of its own.

While all the papers from the first day deserve praise, the details of only a few can be mentioned here. Maziyar Ghiabi (University of Oxford), author of the recently published Drugs Politics: Managing Disorder in the Islamic Republic of Iran (Cambridge University press, 2019), gave a fascinating paper on the state-run opium maintenance program in Iran during the decade before the 1979 Revolution. As Ghiabi detailed, from 1969 to 1979 the Iranian government under the Shah (Reza Pahlavi) provided over 200,000 people, mostly men from the working class, daily quantities of raw opium via a state monopoly and regulation structure involving licensed doctors and pharmacists. But after the Revolution, the Islamic Republic canceled the program and within months recast the use of raw opium as an “evil pharmakon” and key component of the West’s imperial plot against the new regime. Ghiabi convincingly demonstrated how the ontological divide between accepted medicines and illicit drugs are often drawn in moments of heightened ideological conflict and with little regard for (if not outright rejection of) historical precedent and accepted tradition.

Alex Dymock (University of London) presented an intriguing paper on how the drugs/medicines dichotomy is not only politicized but often gendered and sexed as well. Dymock, co-director of the “Pharmacosexuality: the past, present and future of sex and drugs” research project funded by the Wellcome Trust, discussed GHB (gamma hydroxybutyrate) use in the UK and how recent public service adverts haphazardly link the drug to gay sex among men and both to notions of deviance. Though research shows more women than men use GHB in the UK, and that recreational GHB users often self-implement harm reduction strategies, public service adverts construct a “set” and “setting” for the drug replete with sensational stories of date rape, murder, and socio-sexual deviancy, together framed as a clear cause for strict prohibition. Dymock argues that this “wholly irrational and irresponsible” messaging simultaneously ignores the drug’s primary users (women) and promotes a punitive and bigoted criminal justice response to a public health problem. 

The first day’s presenters also included Mat Savelli (McMaster University), who spoke about his ongoing project “Psychoactivity for sale: The global advertising of psychoactive substances, 1886-2001” examining the ways in which pharmaceutical, coffee, and tobacco advertising in some 13 countries promoted a “culture of capitalism” to sell intoxicants across the globe during the long 20th century. Takesure Taringana (University of Zimbabwe) finished the day with a presentation on the Medicines Control Authority of Zimbabwe (MCAZ) and its struggle to provide the nation’s citizens sufficient access to medications on a limited budget, often compelling the MCAZ to purchase expired, dangerous, and even counterfeit medications from India and China. 

Phil Withington (University of Sheffield), lead investigator of the Intoxicating Spaces digital humanities project and of the Intoxicants and Early Modernity research project both at Sheffield, started off the second day’s papers with an interesting discussion of evolving concepts of addiction in early modern medicine. Toine Pieters (Universiteit Utrecht), who also is involved with the Intoxicating Spaces project, in his paper argued that doctors and pharmacists practicing in the modern era also struggle to comprehend and appreciate addiction to pharmaceuticals, preferring instead to develop new medications to combat addictions to old ones or to ignore issues of dependency to licit substances altogether. The papers together highlight the importance of continued collaboration between scholars of the medical humanities and practicing doctors and pharmacists who function as society’s “gatekeepers” to licit narcotics.

Catherine Burns (University of the Witwatersrand) challenged traditional perceptions of pharmaceutical gatekeepers in her captivating paper on Louisa Mvemve, a healer, chemist, and businesswoman who practiced in the East Cape (South Africa) in the early decades of the 1900s. As a woman of color in a profession dominated by white men, Mvemve faced steady pressure from professional pharmacists and the authorities of the Union of South Africa, particularly after she turned a healthy profit from her “bread powder” remedies (finely ground widow bark, yeast, and dried fermented sorghum) and expanded her operations. Burns’s paper detailed malpractice cases brought against Mvemve in 1916 and 1932 after two patients died (of natural causes) under her care and argued that the power to determine between medicine and malpractice was historically contested even as it was drawn from racial and gender privilege. 

The conference proceedings also included a tour of the on-site Pharmaceutical Society of South Africa Museum at the South Gauteng Branch of the Pharmaceutical Society of South Africa. This tour was led by Ray Pogir, the former president of the Pharmaceutical Society of South Africa and the museum’s current curator. Ray expertly guided delegates through the museum’s numerous exhibits, which included nineteenth-century pill makers and compounding books, a mid-twentieth-century ample maker, antique talc and leech jars, and an on-site reproduction of a late-nineteenth-century pharmacy shop counter. The tour was also supplemented with an additional talk by a Traditional South African Healer, who guided delegates through some of the museum’s collection of over 700 traditional medicines and herbs. 

In the conference’s plenary session, which was led by Jim Mills, it was aptly noted that the papers had illustrated that the dichotomy between medicines and drugs was, itself, sustained by a number of related dichotomies. In particular, Jim suggested that this central dichotomy was also sustained by the tensions between pleasure and pain, poisons and medicines, capitalism and regulation, and between consumers and producers. These, he hoped, would continue to be explored in subsequent works. Both Jim Mills and Thembisa Waetjen, the co-convenors, have stated that they do not intend to lead the organisation of a publication directly stemming from the conference. However, they have strongly encouraged the participants to organize the production of an edited collection or journal special issue. They also encouraged participants to submit applications to the ‘New History of Pharmacy and Pharmaceuticals’ symposium. This symposium is organizing a ground-breaking special issue across the Pharmacy in History, The Social History of Alcohol and Drugs, and the Canadian Bulletin of Medical History journals. 


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