The following is a full transcript tor the History of UK drug use: The 1950s and 1960s series, Episode 1: The rise of psychopharmacology and medical and philosophical reactions to it.
A full list of references for this episode can be found here.
In post-war Western Europe and North America, a revolution broke out. Created by an intellectual class and pushed along the mechanisms of capitalism, it was enthusiastically received by the populace. Before being fully understood it was adopted into 1950s everyday life. This is the story of amphetamines, barbiturates, tranquillisers and the pharmacological revolution.
It is hard to understate the drug-taking boom that took place in mid-20th-century Britain. By 1960 Newcastle's populace of 270,000 people was taking 200,000 amphetamine tablets per month. Even more startling, the hypnotic and tranquilliser Barbiturate made up between 5 and 10 per cent of all prescriptions throughout the 1950s. To put that into perspective that's more than all antibiotic prescriptions. Of course, there had been other periods of mass drug-taking in the UK; the huge consumption of opium and cheap spirits in the 19th century for example. However, with the creation of the Nationalised Health Service and subsidisation of prescription medicine, a unique position had come into being where through their employees, the medical personal, this drug-taking was being done with the governments blessing - they were even footing much of the bill.
In order to explain the origins of mass amphetamine use, we will need to go back a few years. In fact, we will need to go back a few years and change location to Nazi Germany on the outbreak of the Second World War. You see Germany had a few disadvantages over its western enemies, principally in resources. This deficit was significantly felt in the cases of oil, rubber and stimulants. Where Britain and France had large empires from which they could import naturally occurring stimulants like tea and coffee, Germany did not have this luxury. So, in the interwar period, Germany made up for their lack of stimulants the same way they attempted to make up for their lack of oil and rubber. They started producing synthetic stimulants. By the outbreak of the Second World War the stimulant the German military decided to adopt was sold under the brand name Pervitin. The active ingredient of Pervitin is now commonly known as crystal meth, and it was a hit.
Methamphetamine had bonuses beyond increasing alertness and banishing fatigue, it provided euphoria and managed depression. This helped the soldier get on with the mission instead of wondering why he was in a foreign country committing homicide. A report from a panzer division in Poland said of the drug; “Often there is euphoria, an increase in attention span, clear intensification of performance, work is achieved without difficulty, a pronounced alertness effect and a feeling of freshness. Worked through the day, lifting of depression, returned to normal mood”. The nature of war also dispelled reservations over taking meth, as one pilot stated, “One wouldn’t abstain from Pervitin because of a little health scare. Who cares when you’re doomed to come down at any moment!” Methamphetamine would assist the German armed forces to carry out the business of killing 100,000 Polish soldiers, and by the year's end 60,000 civilians; according to a prescribing staff Sargent, “without any sign of tiredness until the end of the mission”. With this… success under its belt, in 1940 the German army and air-force placed an order for 35 million tablets of Pervitin and production was ramped up to the point that 833,000 tablets could be pressed a day.
In September 1940, with the German Air Force bombing the British Isles, a Milan daily reported that the Germans were using a ‘pillola di coraggio’ or courage pill, allowing its soldiers uninterrupted operational capabilities. This article would apparently push the British to give pharmaceutical strength stimulants to its forces. The British had been toying with the idea of this for a while, but when they were eventually motivated to, the British opted for the less powerful and less toxic amphetamine - in the form of Benzedrine - over methamphetamine. The British would also note the psychological benefit amphetamines had on the overstressed soldiers and would equip its forces every bit as zealously as the Germans did. In all its estimated the British armed forces purchased 72 million amphetamine tablets. The list of nations issuing amphetamine continued to lengthen and at the height of the war, across Europe and the Pacific, soldiers both sides of the line were equipped with amphetamines. A global psychoactive arms race had been created.
However, with the war's end, production didn’t ramp down. Drug companies and their supply chains had swelled through the age-old practice of war profiteering. But the war had also increased the market for amphetamines. Due to their experiences during the war, a whole generation of military personnel was now returning to civilian life with knowledge of how to use amphetamine not only to manage lethargy but more importantly depression.
Barbiturates became popular much earlier on. Throughout the 19th century, the vogue drug for coping with the hardships of the industrial revolution had been alcohol and opium. However, after the turn of the century opium was being heavily legislated against around the world and was getting a bad rep for it. Barbiturates with their drowsy anti-depressive properties handily filled the gap. It would become the family doctor’s standard recourse in dealing with common symptoms from insomnia to anxiety and the vapours. By the 1920s the brand names had become household names. However, in the 1930s more experience and closer examination of the drug showed it to be problematic. The media started publishing statistics that showed an alarming amount of barbiturate deaths rippling through the middle class; causing it to come under stricter control and damaging its reputation amongst its gentile users. This really should have been the nail in the coffin of this problematic drug, but as we know in the 1950s it was just as popular as ever. So what happened?
Well to explain, it might be easier if you know what the Seige Cycle is. The Seige Cycle is used by the kind of people who write academic journals to describe the career of a mood-altering drug. First, you get those positive reports from clinical trials and small scale use exciting medical professionals and causing sensational media coverage. This leads to the drug's adoption as the new fashionable way to deal with negative emotions. However, of course, the drug does not live up to expectations and with its widespread use, more and more negative aspects are discovered causing its gradual decline in popularity until it disappears from medical use to be replaced by a drug at the beginning of this cycle. And so it goes on and on.
An important aspect of this is the demand for a drugs always exists. So when barbiturate found itself on the downward trajectory of this cycle the populace and medical industry demanded another drug to take its place, not for example regular exercise or other methods of helping insomnia or anxiety. As there were not many other successful hypnotics and sedatives around, drug companies simply tweaked their formulas and produced a new generation of more potent, shorter-acting barbiturates, with favourable reports and new brand names stamped on them and viola barbiturates were back on the upstroke of the Seige Cycle. Barbiturate resurrected itself from the junk pile of disreputable drugs just in time for the Second World War where it was not only used as a hypnotic and sedative but also an anaesthetic. As a result, the already considerable barbiturate production also increased.
In the meantime, psychiatry itself was expanding. In the 1930s and 1940s British psychiatrist Aubrey Lewis pushed the field forward into a more scientific footing by adding a heavy reliance on statistics for diagnoses and treatment. This would have an important effect in bringing mild depression into the field's sphere of influence. In the post-war era, psychology was expanding into everyday life. Issues such as the boredom and depression amongst housewives started becoming heavily represented in mainstream media and psychology. In 1947 American sociologist Ferdinand Lundberg and psychoanalyst Marynia Farnham wrote in their bestselling book Modern Woman, “the social development which created the physical slum also created throughout society what may be termed the emotional slum”. This emotional slum resulted from progression into the ‘modern world’, the“emotional slum” was not linked to class, race, geography or poverty, but presented a lack of psychiatric care for the private (home) life.
And drugs would be increasingly turned to to treat whatever conditions psychiatry found in the private life. This along with a burgeoning illicit market allowed pharmaceutical manufacturers to continue expanding production. By 1950 British, US and Canadian production was far beyond even the most generous estimations of therapeutic needs. In the US for example, 25 barbiturate and 10 amphetamine pills were being pressed annually for every American citizen. The two ballooning fields would combine to a greater degree than ever before into psychopharmacology.
In this episode we will examine psychopharmacology’s rise and the reactions of the medical profession during a period where their societal and professional role increasingly revolved around supplying drugs to the British public. We will also discuss the philosophical ideas surrounding drug use in this epoch by academics like Aldous Huxley as his fictional predictions surrounding drug use started to beat fruit.
When comparing drugs to the physical treatments for depression that preceded and coincided the rise in pharmacology, it is not difficult to see why these drugs were so enthusiastically embraced by the medical profession. The three main physical treatments for depression were insulin-induced comas, electroshock therapy (ECT) and leucotomy or lobotomy.
However, these were obviously problematic. Insulin coma therapy was the practice of subjecting patients to insulin-induced comas. A course of this treatment could involve up to 60 commas which were dangerous for the patient and costly in the medical personnel needed. Plus it doesn't seem to have worked anyway.
Leucotomy involved the cutting of the white matter in the frontal lobe. Unsurprisingly cutting up the brain carried heavy side effects: patients became emotionally blunted, some underwent personality changes or became epileptic or became intellectually impaired. In all 20,000 people became victims of lobotomies before it was fazed out.
ECT does pretty much does what it says on the tin - you strap some electrodes to the temples send around 100 volts into the brain to induce seizures. Unlike the previous two treatments, ECT does seem to work and is still used today; although, we still have no idea how it works. Carrie Fischer of Star wars fame was an advocate of it. Medicine has come a long way since the 30s, 40s, 50s; modern ECT doesn't seem too terrifying, it looks like something akin to going to the dentist. However, ECT in this period was a more brutal affair. If you want to know what it looked like think of that famous scene in One Flew Over the Cuckoo's Nest where Jack Nicholson's character is punished by getting electroshock therapy. He goes into the room, they strap him down, attach some electrodes to his head, and shock him for a split second. And this was true, ECT and the threat of it was used in psychiatric hospitals to control unruly patients.
This sort of cruelty displayed by the psychiatric profession at the time can also be seen in how it was discovered. I like the way E Dickinson describes it in her article From Madness to Mental Health, it's very dry but the dryness perfectly captures that cruelty:
Ugo Cerletti, an Italian professor in psychiatry, got his inspiration following a visit to a slaughterhouse. The hogs were thus stunned before they were slaughtered. He experimented on a patient who had been diagnosed as schizophrenic by administering 80 volts for 0.2 seconds. The patient stiffened but there was no loss of consciousness. The team were discussing whether to give him another treatment the following day when the patient, on hearing this, stated, 'Not another one. It's deadly.' They administered a stronger shock straight away.
Suffice to say this was a terrible time to be schizophrenic (though when isn’t?). Regardless of its effectiveness, this treatment was too unpleasant and too costly to use on the general public.
Of course, you also had psychotherapy; however, at the time people were sceptical of its use partly due to the length of time it took to take effect but also because of the medical model which dominated psychology and psychiatry at the time, which favoured medical diagnosis and medical treatment.
Understandably these physical treatments were only used in cases of severe depression. However, as I stated in the introduction, throughout the thirties and beyond psychiatry was expanding its scope of those thought to need medical help to people suffering more minor depressive symptoms and anxious states. It would take another 10 or 20 years but the pharmacological revolution would handily fill this gap and work toward supplanting the controversial physical treatments.
A psychiatrist, Richard Hunter, saw this historical context as important to understanding the profession's reliance on drugs. Stating “the tendency throughout psychiatric history has been to practise psychiatry without psychology, which in treatment means attempting to reduce the mind by whatever means medical and physical science offer.” In a speech given before the Society for the study of Addiction in 56 he explained:
When in the 1920s the focal sepsis theory of ill-understood illness held sway, many psychiatric patients lost their teeth, their wombs, and their colons. When insulin was discovered and found to increase appetite, it was soon tried on mental patients whose illness was accompanied by inanition. When further experience, albeit accidental, showed that coma resulting from insulin over-dosage was sometimes recoverable, psychiatrists hastened to subject their patients to a regular programme of insulin over-dosage. When by the 1930s brain surgery became safe, psychiatrists settled on a supposedly silent area of the brain, ablation of which would not leave gross neurological deficit to severing thalamo-frontal connections...
With these examples before him, what is the practitioner to do with the large group variously estimated at 50-75 per cent of his patients, whose symptoms he is forced to recognize-if only because of their refractoriness to treatment and the patient’s persistence as having their origin in the mind or emotional life but with which he is not equipped to deal psychologically? The answer, of course, is drugs: sedatives, hypnotics, and stimulants. For this group of patients, not seriously ill mentally or physically, barbiturates have come to be used almost as a placebo, often to assuage the doctor’s own anxiety.
Following this thinking, these drugs were playing the same role as the prior physical treatments; however, were far less obtrusive. With psychiatry expanding the amount of people who need treatment, which the GP is not trained to deal with through time-consuming talk therapy, what else is going to happen but the prescription of tons and tons of drugs?
Another thing which must be realised is that the drugs themselves represented a massive jump in technology. The ratio between positive and negative effects was far greater than anything that had come before. Here is Aldous Huxley in 1958 talking about real drugs becoming closer to his fictional one:
In this book that you mentioned, this book of mine Brave New World, I postulated a substance called soma, which was a very versatile drug; it would make people feel happy in small doses, it would make them see visions in medium doses, and it would send them to sleep in large doses. Well I don't think such a drug exists now nor do I think it will ever exist, but we do have drugs that will do some of these things. And I think it is quite on the cards that we may have drugs which will profoundly change our mental state without doing us any harm. This is the pharmacological revolution which is taking place, that we have now powerful mind-changing drugs that physiologically speaking are almost costless. I mean they are not like opium or like coca, cocaine, which do change the state of mind but leave terrible results physiologically and morally.
And this is something that needs to be appreciated. Nowadays we are so used to these drugs that it can be easy to take for granted what a massive jump in technology these drugs were. Not only when compared to the prior physical treatments, but also the drugs that existed 30 years prior. This is particularly true of the new tranquillisers which would become the true workhorses of psychopharmacology.
Huxley lays these ideas out more clearly in an essay he wrote in 58 for the Saturday Evening Post:
In England, during the first years of the eighteenth century, cheap untaxed gin-"drunk for a penny, dead drunk for twopence."-threatened society with complete demoralization. A century later, opium, in the form of laudanum, was reconciling the victims of the Industrial Revolution to their lot - but at an appalling cost in terms of addiction, illness and early death...
Do we have to go on in this dismal way indefinitely? Up until a few years ago, the answer to such a question would have been a rueful "Yes, we do." Today, thanks to recent developments in biochemistry and pharmacology, we are offered a workable alternative. We see that it may soon be possible for us to do something better in the way of chemical self-transcendence than what we have been doing so ineptly for the last seventy or eighty centuries.
Is it possible for a powerful drug to be completely harmless? Perhaps not. But the physiological cost can certainly be reduced to the point where it becomes negligible. There are powerful mind changers which do their work without damaging the taker's psychophysical organism and without inciting him to behave like a criminal or a lunatic. Biochemistry and pharmacology are just getting into their stride.
Here we can see the excitement in this new technology compared to the drugs people were using before. Especially in the form of alcohol or laudanum, which had side effects that were far more egregious than these modern drugs. But also these modern drugs could be far more specific in what they target. If we take Richard Hunter’s psychiatric aim of reducing the mind, people have been taking drugs to do this for millennia. However, something like alcohol would produce an extremely broad range of effects, whereas modern drugs could focus in on their specific aim with much greater accuracy. Making them safer. And credit must be given to the pharmaceutical companies for this stark improvement in the quality of drugs. Especially since they are going to receive a lot of criticism in future episodes of this podcast for their shady practices.
This excitement shines through in the writings of some medical professionals. In 1961 The Head Psychologist at St Thomas’ Hospital London, William Sargent, would celebrate the pharmacological revolution writing:
When I first entered psychiatry in 1934 there were no effective treatments of depression, and, just as now, psychotherapy was showing itself to be a most uncertain and very limited form of treatment in this large group of illnesses. But in the past twenty-five years one has seen what has amounted to a total revolution in treatment.
The provision of better and more varied types of long- and short-acting barbiturates, all the amphetamine drugs, the new tranquillizers, the use of modified insulin, and, when everything else has failed, a consideration of the most successful new and more modified forms of leucotomy -all such advances make the actual position to-day one in which there are very few cases of depression indeed occurring in good previous personalities.
However, we should be careful not to over romanticise these drugs. While relatively speaking they were miles ahead of what came before, they still had major side effects, especially when taken habitually as barbiturates, amphetamines and tranquillisers were. Here is author Kurt Vonnegut talking about his mother, who killed herself in 1944:
The awful secret is that my mother was crazy toward the end and we kept this a secret. She was alright during the day time – she’s dead now and I finally figured out that dead people don't care what you say about them, and also I’m her son and she wouldn’t knock me – but anyway she was alright in the day time unless you tried to take her picture. Boy, you’d get a bizarre reaction at night; she would really get wild, squaring people away and crashing around the house. And that was barbiturates you see. They were supposed to tranquillise her and they turned her brain to cobwebs.
In a future episode we will get on to the side effects of the mass taking of these drugs, but they could be quite large, especially when taken as a total value. Barbiturates for example, despite being prescribed for depression, were found to cause suicide ideation.
During this period worries over the immediate side effects and safety issues surrounding these drugs, took more of a back seat to philosophical discussions on the long term effects mass drug-taking would have on people and society as a whole. Tabloids would run editorial pieces with titles like How Can We Cure Pill Mania and Drugs - are they a help or a menace. Huxley, unsurprisingly, also cast a worried thought toward what this would mean for society:
In view of what we already have in the way of powerful but nearly harmless drugs; in view, above all, of what unquestionably we are very soon going to have--we ought to start immediately to give some serious thought to the problem of the new mind changers. How ought they to be used? How can they be abused? Will human beings be better and happier for their discovery? Or worse and more miserable?
Huxley would go on to call for a meeting of “biochemists and physicians, psychologists and social anthropologists, for legislators and law-enforcement officers” to decide “in the light of the best available evidence and the most imaginative kind of foresight, what should be done.”
Such ideas are echoed in the medical profession. Hesitant acceptance of the need for drug use and the profession’s role in prescribing them ring out of their writings. Physician and pharmacologist Pond and Laurence would conclude an article complaining about lax drug testing thusly:
It is to be hoped that the discovery of a "complete" or "absolute" tranquillizer is an impossibility, for it is essential to distinguish between biologically useful and useless symptoms. The removal of fear, guilt, and anxiety under all circumstances would render man less than human. However, tranquillizers have their place as what H. G. Wells called "Doors in the Wall" to provide temporary refuge from acute stress, as all who have taken alcohol know.
Aldous Huxley (1954) has defined the "perfect" tranquillizer as a drug- "which will relieve and console our suffering species without doing more harm in the long run than it does good in the short... It must be... less likely to produce undesirable social consequences than alcohol or the barbiturates, less inimical to heart and lungs than the tars and nicotine of cigarettes... It should produce changes in consciousness more interesting, more intrinsically valuable than mere sedation or dreaminess, delusions of omnipotence or release from inhibition." Huxley concludes that we shall not escape "the need for frequent chemical vacations from intolerable selfhood and repulsive surroundings," because "most men and women lead lives at worst so painful, at best so monotonous, poor and limited that the urge to escape... is, and has always been, one of the principal appetites of the soul." Although this may be true, it might be wiser for the community to start trying to alter the conditions of life to render the "perfect" tranquillizer unnecessary, for it will certainly be long in coming, and may very well be a chimaera and altogether unattainable.
Meanwhile doctors will do their best with the unsatisfactory drugs at their disposal to reduce the total of human misery.
And this really highlights a trope in medical writings of the time that drugs were being used to plaster over societal issues rather than being a societal issue in themselves. And this does raise an interesting philosophical question in if we use drugs to cure human misery too much might we lose the motivation to create solutions to human misery that don’t involve drugs?
We can also see some doctors had a hesitant acceptance of their role in prescribing these drugs. And I guess what more can you expect from a doctor, there job is to minimise harm in the immediate; not to take to account all of society’s needs but the needs of their patient. We can also see in that quote through their comparisons to alcohol, doctors hesitent acceptance of the need for what today we would today call recreational drug use.
This element of drug use being seen as at least in part a result of societal issues is prevalent among medical journals and speeches in this epoch. In a speech read before the Society for the Study of Addiction in 1956 discussing overprescription, Dr A MacDonald would ask his audience, “Are we really in need of something equivalent to the ‘soma’ that Aldous Huxley found necessary for life in his ‘Brave New World’?” Before continuing:
Is the blameworthiness of this limited to the doctor and the patient? Do the Government and the National Health Service, or the pharmacist and the manufacturer and the advertising campaigns share the blame? It is so easy to fold our hands and shake our heads over the stress and strain of life, the hurry and the worry. Are our maladjustments and frustrations, our dissatisfaction with life due to the decline in the influence of organised religion which is blamed for losing or failing to maintain its ancient hold and the comfort and security this can bring? Is life in the modern community with all its amenities of theatres and concerts, of W/T and T/V, of dance halls and cinemas, books and lectures such a fiasco that we all seek some further escape from reality-some in the public house, others from the pharmacist, a few in mental hospitals?
Here we see modern society itself being identified as a reason for drug use. And MacDonald certainly was not alone in this line of thinking; especially when it comes to the supposed decline of religion.
In a 53 Guardian article, a doctor wrote, “It has been suggested that the broken home, the gangster film, the present insecurity, and the lack of religious and spiritual comfort account for our increase in crime. They also account for our craving for medical panaceas for our spiritual discomforts.” My initial reaction to this was to put it down religious moralism, its a trope we still hear today. You know, people are turning to drugs and the world’s going down the toilet because we no longer have the moral fibre religion provides. But we should not be too dismissive of the link between religion and drug use.
Religion plays a large role in giving its practitioners life meaning. Nietzsche, for example, would use this to label Christianity as something people use to distract themselves from their problems and the problems of the world. He also accused alcohol of playing the same role. Summing the link up in the famous quote, “There have been two great narcotics in European civilisation: Christianity and alcohol.”
And of course, Karl Marx would similarly accuse religion of playing the same role as drugs, in distracting people from their problems when he declared religion to be the opiate of the masses. Links between religion providing people with meaning and drugs distracting us from meaningless is well-trodden philosophical ground. This is not to say we should attribute the decline of religion to the uptake of pharmaceuticals, but it can explain why some saw the psychiatrist, family doctor and the drugs they prescribed as replacing the societal role of the priest and religion.
Apart from the society they live in, at the beginning of this quote MacDonald offers others who should be blamed. He lists the Government and the pharmaceutical industry and marketing, which is something we will examine in another episode. But all this is almost to partly excuse the doctor and the patient. We have heard a lot about doctors theoretical opinions, why were doctors not doing more to stem what they perceived as over-prescription.
The thing that rings out from the sources is doctors exhaustion. I don't know what experience you dear listener has had with drug addicts, but they are not the easiest of people to deal with, middle class and gentile or otherwise. And it must be remembered to a certain extent they are entitled to these drugs through the NHS. In the same speech, MacDonald would display this exhaustion stating:
I recently asked two busy, conscientious medical practitioners - they were partners - “Do you have patients who come along and demand amphetamines or phenobarbitones or this and that?" And when they looked at each other and nodded, I continued "What line do you take?" The answer from the senior was "I look at the clock, at the length of the queue in the waiting-room, sigh and reach for an E.C.lO."
This level of exhaustion in dealing with the issue even comes out in their humour. At the end of a discussion on tranquillisers and drug addiction at the society for the study of addiction, a GP Dr Leon Shirlaw joked that with the advent of longer-acting anti-biotics;
I am eagerly awaiting the day when this activity will affect the tranquillizers and one tablet will remain active for one year. I shall then be able to issue a prescription for twelve tablets and hand it with these words to some of my favourite neurotic patients: ‘Take one tablet every year and come and see me in twelve years time and let me know how you are progressing.'
And that was a joke made at the Society for the study of addiction.
This feeling of helplessness to do anything more than prescribe drugs was exacerbated by G.P.’s not believing they could get their patients sufficient psychological treatment. In July 1962, a British Medical Journal article stated amphetamines were addictive. A month later Dr Wilson explained in the Mirror, “General practitioners cannot obtain adequate psychotherapy for their patients. The prescription of… [amphetamine barbiturate mixes] cannot be condemned even if patients become addicted to them”.
And these were the medical professionals who felt like all this drug-taking was a problem. Otherwise, it seems that this level of drug-taking slowly just became institutionalised, even encouraged. In 1963 Dr Donald Blair described a hospital stay he experienced a few years back to the Society for the Study of Addiction:
Following an operation, I was presented by the night nurse with tablets, which she told me I must take to make me sleep. I told her that I did not think I needed them, and felt I would sleep without them. However she persisted, and said that as they had been prescribed I must take them. For peace sake I put them in my mouth, swallowed the water, but kept the tablets between my gum and my lips, and recovered them after the nurse had gone to other patients to follow the same routine. Each night the same procedure took place, and when I left after being in hospital for about a fortnight, I presented the night nurse with all the tablets I had not taken. In fact I had only required to take them on two occasions out of the fourteen. She was quite astonished. It is understandable how easily the compulsory use of hypnotics in this manner, over weeks or even months, can produce habituation in patients.
Isn’t that just like something straight of One Flew Over the Cuckoos Nest?
I think we will have to take a break here. But I hope you have learnt something about the medical reactions to this drug-taking boom in the 1950s. Of course, the medical profession is a massive body of people many of whom likely had their own complicated opinions that would never make it into the medical journals, as a result, we should not treat the profession as a monolith. However, from examining the opinions that were written down, we can see the medical profession's excitement in how useful these drugs were to them. Especially when compared to physical treatment that came before them. Also, why the professionals might think these drugs were needed. At the beginning we discussed some of the origins of these drug’s popularity; in the next episode, however, I will discuss the true pushers of these substances, the pharmaceutical companies and their marketers.