Guest Contributor: David Shane Lowry, Assistant Professor, Chicago Medical School and College of Health Professions
I worked as a technician for five years (between 2007 and 2012) in the Department of Pharmacy in a hospital in western North Carolina. The local interstate brought a fairly steady number of car accident victims. Some of them were drunk drivers who, after being rushed into the intensive care unit of the hospital, were provided Jack Daniels whisky mixed by pharmacy employees into intravenous (IV) bags. This type of treatment didn’t happen all the time, but when it did I felt as if we were returning to a Civil War era where drug treatments were much more organic and rustic.
The hospital’s pharmacy maintained a fairly large stock of alcohol. Pharmacy technicians went on “beer runs” to our local alcoholic beverage control (ABC) store to pick up cases of liquor, beer, and wine. Physicians ordered “cocktails” for patients who demanded that the hospital provide them with spirits before bedtime. They prescribed alcohol in exact doses according to conversations they had with their patients and other physicians, and they used the alcohol to help make patients’ transitions into healthcare smoother. Physicians and nurses would ask patients for beer preferences. Some patients wanted alcohol-free O’Doul’s. These particular patients weren’t seeking the inebriation of alcohol. They simply wanted the taste.
Around 2010, the rules changed for the clinical use of alcohol in this hospital. For example, the hospital’s administration encouraged physicians to use standard “detox” protocol for drunken patients, which included use of pharmaceutical drugs instead of alcohol. The administration also decided to make the hospital’s Department of Nutrition responsible for keeping and distributing any alcohol that was used in clinical care.
The shift of alcohol between the Department of Pharmacy and the Department of Nutrition – between a place of “drugs” and a place of “food” – wasn’t a hospital-specific conversation. It had a deep American history. Alcohol actually began a transformation from “food” to “drug” during the Prohibition period of the 1920s. Prohibition was the period when alcohol was made illegal for use in American homes and businesses. In a matter of hours (literally!) alcohol went from a beverage served with dinner to a substance regulated by the Federal Government. During Prohibition, alcohol was only legal when it was obtained via prescriptions written by physicians. Drug stores like Walgreens made their names (and large profits) by serving their customers “doses” of alcohol.
After Prohibition was over in 1933, alcohol came from under the watchful eyes of pharmacists, and retail pharmacy executives had to find new ways to create profit. They obtained help from Uncle Sam. Between 1935 and 1955, the Food and Drug Administration (FDA) became the federal overseer of drugs, cigarettes, food, and cosmetics. They worked with drug retailers – who were profiting from sales of drugs, cigarettes, cheap snacks, and cosmetics – to create and maintain pipelines for all kinds of consumable materials at the intersection of “food” and “drug”.
In the last few decades, pharmacies and hospitals have become increasingly dependent on these materials. Corporations like Abbott Laboratories produce “shakes”, “formula”, and “nutritional bars” for humans across the age spectrum. Brands like Gatorade advertise in ways that give their products the duality of “food” and “drug”. In the 1990s, you wanted to drink Gatorade to “be like” super-athlete Michael Jordan.
Whosoever has the power to sell has the power to feed and drug. What I am concerned with is the notion that when “food” becomes “drug” – beer used to treat a patient, for example – it is of little value. But when “drug” becomes “food” – e.g. when a pharmaceutical corporation has large stakes in feeding the most vulnerable humans among us – it is of great value. Such an inversion may seem non-critical within the current global food crisis, but it is quite critical if we are concerned with the fact that what heals us includes our taste buds, our hunger, and the communities we eat within.