Prescribing by Numbers: Drugs and the Definition of Disease

Johns Hopkins University Press, 2007 - 318 .

The second half of the twentieth century witnessed the emergence of a new model of chronic diseasediagnosed on the basis of numerical deviations rather than symptoms and treated on a preventive basis before any overt signs of illness developthat arose in concert with a set of safe, effective, and highly marketable prescription drugs. Physician-historian Jeremy A. Greene examines the mechanisms by which drugs and chronic disease categories define one another within medical research, clinical practice, and pharmaceutical marketing, and he explores how this interaction has profoundly altered the experience, politics, ethics, and economy of health in late-twentieth-century America. His provocative analysis sheds light on the increasing presence of the subjectively healthy but highly medicated individual in the American medical landscape, suggesting how historical perspective can help to address the problems inherent in the program of pharmaceutical prevention.

"Greene describes the relationship between advances in treatment, the incentives of manufacturers, and the effect on the public of increased attention to prevention... The risk-benefit trade-offs of the quantitative approach are complex, and Greene's historical revelations are timely." New England Journal of Medicine

"One of the best, and most significant, books published recently on the development of medical practice and the pharmaceutical industry in the U.S. in the second half of the twentieth century." Social History of Medicine

"Greene focuses on the question of how public health priorities became closely aligned with the pharmaceutical industry's marketing practices... [and] offers a nuanced description of the development of 'therapeutics of risk reduction' with multiple lines of influence, subtle power shifts, and gains and losses for patients and physicians." Chemical Heritage

"A gripping story... Greene warns us in his superb book that things are not always as they are claimed." Yale Journal for Humanities in Medicine

Jeremy A. Greene is a fellow in the Department of Social Medicine at Harvard Medical School and a resident in the Department of Medicine at Brigham and Womens Hospital.

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