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Jeremy A Greene, Prescribing by numbers: drugs and the definition of disease, Baltimore, Johns Hopkins University Press, 2007, pp. xv, 318, £33.50, $49.95 (hardback 0-8018-8477-2).
In the second half of the twentieth century we have witnessed the emergence of a new model of disease based on numerical deviations rather than symptoms and treated on a preventive basis before any overt signs of illness develop. This concept of treating healthy patients is not a recent product of genetic medicine but arose gradually in concert with the development and use of a set of safe, effective and highly marketable prescription drugs. Jeremy Greene uses the careers of an antihypertensive, an antidiabetic and a cholesterol reducing agent to show how this rather "insidious" paradigm shift in American health care has come about.
Greene's historical journey starts with the development and introduction of the first palatable pill for hypertension, chlorothiazide or Diuril® in 1958. Diuril, however, did not develop out of any targeted search for an antihypertensive therapy. The drug did not even have any connection with hypertension until it had left the company's research laboratories. Rather, Diuril was meant to start its career as a novel diuretic agent; as a product of Merck Sharp & Dohme's Renal Program. Diuretics were known to capture a substantial market with many therapeutic indications-though...