"Risk-free rest and sleep:" Jornal do Médico (Portugal) and the thalidomide disaster, 1960-1962. / "Descansar e dormir sem riscos": o Jornal do Médico (Portugal) e o desastre da talidomida, 1960-1962.

This article analyzes the way the Porto-based journal Jornal do Médico reported on the thalidomide disaster. The pages of the publication are researched from the beginning of 1960 to the end of 1962 with the aim of identifying and discussing two interconnected questions: the delay in publishing news on the harmful effects of the drug, which was sold in the country under the brand name Softenon®, and the discursive construction of a lack of accountability on the part of physicians for the phenomenon of medication iatrogenesis.

O artigo analisa como o periódico Jornal do Médico, editado na cidade do Porto, em Portugal, divulgou o desastre da talidomida. A pesquisa percorreu as páginas da fonte desde o início de 1960 até o final de 1962. Aqui, objetivam-se apontar e discutir duas questões interligadas: a morosidade em publicar matérias sobre os efeitos deletérios do medicamento, vendido no país sob a denominação Softenon®, e a construção discursiva da isenção da responsabilidade do médico no fenômeno da iatrogenia medicamentosa.

"Descansar e dormir sem riscos": o Jornal do Médico (Portugal) e o desastre da talidomida, 1960-1962 / "Risk-free rest and sleep: " Jornal do Médico (Portugal) and the thalidomide disaster, 1960-1962

Resumo O artigo analisa como o periódico Jornal do Médico, editado na cidade do Porto, em Portugal, divulgou o desastre da talidomida. A pesquisa percorreu as páginas da fonte desde o início de 1960 até o final de 1962. Aqui, objetivam-se apontar e discutir duas questões interligadas: a morosidade em publicar matérias sobre os efeitos deletérios do medicamento, vendido no país sob a denominação Softenon®, e a construção discursiva da isenção da responsabilidade do médico no fenômeno da iatrogenia medicamentosa.

Abstract This article analyzes the way the Porto-based journal Jornal do Médico reported on the thalidomide disaster. The pages of the publication are researched from the beginning of 1960 to the end of 1962 with the aim of identifying and discussing two interconnected questions: the delay in publishing news on the harmful effects of the drug, which was sold in the country under the brand name Softenon®, and the discursive construction of a lack of accountability on the part of physicians for the phenomenon of medication iatrogenesis.

A History of United States Cannabis Law.

Perhaps the best way to understand early-Twenty-First Century state and federal cannabis law in the United States is to examine the relevant history. Justice Oliver Wendell Holmes, Jr.'s statement is apropos: "[A] page of history is worth a volume of logic." This article begins by discussing the early history of cannabis and its uses. Next, the article examines the first state and federal marijuana laws. After a brief comparison of alcohol prohibition to cannabis prohibition, this article addresses cannabis laws from the 1920s to the early 1950s. Then, the article takes up the reorganization of the federal drug regulatory bureaucracy since its inception. Addressing the current era of cannabis laws and regulations, this article recounts how marijuana became a Schedule I drug. The discussion then turns to changing social attitudes towards cannabis as reflected in presidential politics and popular culture. Starting with the late-1990s, this article describes the development of state and federal cannabis laws and policies up to the present day.

Drug policy and Collective Health: necessary dialogues. / Política de drogas e Saúde Coletiva: diálogos necessários.

The current status of policies on illicit drugs has implications for Collective Health that need to be discussed in depth. This essay aims to explore, in light of the best evidence, the public health impact of drug policies focused on the criminalization of growing, selling, and consuming psychoactive substances. Brazil provides the context for the main analysis. The principal points addressed in this work include drugs as a social issue and the definition of the prohibitionist paradigm, evidence of the unhealthy relationship between this paradigm and the population's health, the issue of a model of care for users of psychoactive substances focused on therapeutic communities, and future paths to be explored to overcome the prohibition of illicit drugs as the principal approach to the issue. Among the main problematic elements in the repressive approach in the Brazilian context, the study highlights violence and homicides, the health impacts of incarceration and blocked access to the health system, and potential new therapies derived from currently banned psychoactive substances. As proposals for future policy changes, the study highlights decriminalization of the use, possession, and small-scale sale of drugs; the reduction of the violence and discrimination associated with policing; focus on harm reduction policies; approach to gender-related specificities; and inclusion of social variables as metrics for successful treatment of problematic drug use. In conclusion, it is relevant that the social issue and drug policy have become the object of more studies in the field of Collective Health.

A hegemonia atual das políticas de drogas ilícitas tem implicações à Saúde Coletiva que necessitam ser discutidas de forma aprofundada. Este ensaio procura explorar, à luz das melhores evidências, o impacto das políticas sobre drogas focadas na criminalização do plantio, comércio e consumo de substâncias psicoativas sobre a saúde das populações. O contexto de análise principal será o brasileiro. Os pontos principais abordados por este trabalho incluem a questão social das drogas e a definição do paradigma proibicionista, as evidências da relação insalubre entre tal paradigma e a saúde das populações, a problemática de um modelo de assistência aos usuários de substâncias psicoativas focado nas comunidades terapêuticas, e futuros caminhos a serem explorados na superação da proibição de drogas ilícitas como a principal forma de abordar a questão. Entre os principais elementos problemáticos da abordagem repressiva no contexto brasileiro podem ser destacados a violência e a mortalidade por homicídios, os impactos sanitários do encarceramento e o bloqueio de acesso ao sistema de saúde e a novas terapias derivadas de substâncias psicoativas atualmente proscritas. Como propostas de mudanças políticas futuras, ressalta-se a descriminalização do uso, posse e pequenas vendas de drogas; a redução da violência e da discriminação associadas ao policiamento; o foco em políticas de redução de danos; a abordagem das especificidades relacionadas ao gênero; incluir variáveis sociais como métrica do sucesso no tratamento do uso problemático de drogas. Concluindo, é relevante que a questão social e política das drogas se torne objeto de mais estudos no campo da Saúde Coletiva.

La hegemonía actual de las políticas de drogas ilícitas tiene implicaciones para la Salud Colectiva que necesitan discutirse profundamente. Este trabajo estudia, a la luz de las mejores evidencias, el impacto de las políticas sobre las drogas, enfocadas en la criminalización del cultivo, tráfico y consumo de sustancias psicoactivas, para la salud de la población. El contexto de análisis principal será el brasileño. Los puntos principales abordados por este trabajo incluyen: cuestión social de las drogas y la definición del paradigma prohibicionista; evidencias de la relación insana entre este paradigma y la salud de las poblaciones; así como la problemática de un modelo de asistencia a los consumidores de sustancias psicoactivas centrado en comunidades terapéuticas, y los futuros caminos que se exploran para que se supere la prohibición de las drogas ilícitas como la vía principal de abordaje de esta cuestión. Entre los elementos primordiales y problemáticos del enfoque represivo en el contexto brasileño se pueden destacar: violencia y mortalidad por homicidios; impactos sanitarios con conlleva el encarcelamiento y el bloqueo del acceso al sistema de salud; así como las nuevas terapias, derivadas de sustancias psicoactivas, actualmente proscritas. A modo de propuestas para posibles cambios políticos futuros, se resalta la descriminalización del consumo, posesión y venta de pequeñas cantidades de droga; la reducción de la violencia y discriminación, asociadas a la vigilancia policial; situar el centro de la cuestión en políticas de reducción de perjuicios para la salud; plantear las especificidades relacionadas con el género; así como incluir variables sociales como medir el éxito de los tratamientos relacionados con el consumo problemático de drogas. A modo de conclusión, es relevante que la cuestión social y política de las drogas se convierta en objeto de más estudios en el campo de la Salud Colectiva.

Política de drogas e Saúde Coletiva: diálogos necessários / Política de drogas y Salud Colectiva: diálogos necesarios / Drug policy and Collective Health: necessary dialogues

A hegemonia atual das políticas de drogas ilícitas tem implicações à Saúde Coletiva que necessitam ser discutidas de forma aprofundada. Este ensaio procura explorar, à luz das melhores evidências, o impacto das políticas sobre drogas focadas na criminalização do plantio, comércio e consumo de substâncias psicoativas sobre a saúde das populações. O contexto de análise principal será o brasileiro. Os pontos principais abordados por este trabalho incluem a questão social das drogas e a definição do paradigma proibicionista, as evidências da relação insalubre entre tal paradigma e a saúde das populações, a problemática de um modelo de assistência aos usuários de substâncias psicoativas focado nas comunidades terapêuticas, e futuros caminhos a serem explorados na superação da proibição de drogas ilícitas como a principal forma de abordar a questão. Entre os principais elementos problemáticos da abordagem repressiva no contexto brasileiro podem ser destacados a violência e a mortalidade por homicídios, os impactos sanitários do encarceramento e o bloqueio de acesso ao sistema de saúde e a novas terapias derivadas de substâncias psicoativas atualmente proscritas. Como propostas de mudanças políticas futuras, ressalta-se a descriminalização do uso, posse e pequenas vendas de drogas; a redução da violência e da discriminação associadas ao policiamento; o foco em políticas de redução de danos; a abordagem das especificidades relacionadas ao gênero; incluir variáveis sociais como métrica do sucesso no tratamento do uso problemático de drogas. Concluindo, é relevante que a questão social e política das drogas se torne objeto de mais estudos no campo da Saúde Coletiva.

La hegemonía actual de las políticas de drogas ilícitas tiene implicaciones para la Salud Colectiva que necesitan discutirse profundamente. Este trabajo estudia, a la luz de las mejores evidencias, el impacto de las políticas sobre las drogas, enfocadas en la criminalización del cultivo, tráfico y consumo de sustancias psicoactivas, para la salud de la población. El contexto de análisis principal será el brasileño. Los puntos principales abordados por este trabajo incluyen: cuestión social de las drogas y la definición del paradigma prohibicionista; evidencias de la relación insana entre este paradigma y la salud de las poblaciones; así como la problemática de un modelo de asistencia a los consumidores de sustancias psicoactivas centrado en comunidades terapéuticas, y los futuros caminos que se exploran para que se supere la prohibición de las drogas ilícitas como la vía principal de abordaje de esta cuestión. Entre los elementos primordiales y problemáticos del enfoque represivo en el contexto brasileño se pueden destacar: violencia y mortalidad por homicidios; impactos sanitarios con conlleva el encarcelamiento y el bloqueo del acceso al sistema de salud; así como las nuevas terapias, derivadas de sustancias psicoactivas, actualmente proscritas. A modo de propuestas para posibles cambios políticos futuros, se resalta la descriminalización del consumo, posesión y venta de pequeñas cantidades de droga; la reducción de la violencia y discriminación, asociadas a la vigilancia policial; situar el centro de la cuestión en políticas de reducción de perjuicios para la salud; plantear las especificidades relacionadas con el género; así como incluir variables sociales como medir el éxito de los tratamientos relacionados con el consumo problemático de drogas. A modo de conclusión, es relevante que la cuestión social y política de las drogas se convierta en objeto de más estudios en el campo de la Salud Colectiva.

The current status of policies on illicit drugs has implications for Collective Health that need to be discussed in depth. This essay aims to explore, in light of the best evidence, the public health impact of drug policies focused on the criminalization of growing, selling, and consuming psychoactive substances. Brazil provides the context for the main analysis. The principal points addressed in this work include drugs as a social issue and the definition of the prohibitionist paradigm, evidence of the unhealthy relationship between this paradigm and the population's health, the issue of a model of care for users of psychoactive substances focused on therapeutic communities, and future paths to be explored to overcome the prohibition of illicit drugs as the principal approach to the issue. Among the main problematic elements in the repressive approach in the Brazilian context, the study highlights violence and homicides, the health impacts of incarceration and blocked access to the health system, and potential new therapies derived from currently banned psychoactive substances. As proposals for future policy changes, the study highlights decriminalization of the use, possession, and small-scale sale of drugs; the reduction of the violence and discrimination associated with policing; focus on harm reduction policies; approach to gender-related specificities; and inclusion of social variables as metrics for successful treatment of problematic drug use. In conclusion, it is relevant that the social issue and drug policy have become the object of more studies in the field of Collective Health.

Pharmaceuticals and modern statecraft in South Africa: the cases of opium, thalidomide and contraception.

This article provides a history of three pharmaceuticals in the making of modern South Africa. Borrowing and adapting Arthur Daemmrich's term 'pharmacopolitics', we examine how forms of pharmaceutical governance became integral to the creation and institutional practices of this state. Through case studies of three medicaments: opium (late 19th to early 20th century), thalidomide (late 1950s to early 1960s) and contraception (1970s to 2010s), we explore the intertwining of pharmaceutical regulation, provision and consumption. Our focus is on the modernist imperative towards the rationalisation of pharmaceutical oversight, as an extension of the state's bureaucratic and ideological objectives, and, importantly, as its obligation. We also explore adaptive and illicit uses of medicines, both by purveyors of pharmaceuticals, and among consumers. The historical sweep of our study allows for an analysis of continuities and changes in pharmaceutical governance. The focus on South Africa highlights how the concept of pharmacopolitics can usefully be extended to transnational-as well as local-medical histories. Through the diversity of our sources, and the breadth of their chronology, we aim to historicise modern pharmaceutical practices in South Africa, from the late colonial era to the Post-Apartheid present.

Rethinking 'flexibilities' in the international drug control system-Potential, precedents and models for reforms.

BACKGROUND: Much international drug policy debate centres on, what policies are permissible under the international drug treaties, whether member states are openly 'breaching' these treaties by changing national regulatory frameworks and shifting priorities away from a 'war on drugs' approach, and what 'flexibility' exists for policy reform and experimentation at national and local levels. Orthodox interpretations hold that the current system is a US-led 'prohibition regime' that was constructed in an extremely repressive and restrictive manner with almost no flexibility for significant national deviations. This paper challenges these orthodox interpretive frameworks and suggests no absolute and clear dichotomy between strict adherence and 'breaches' of the international treaties. METHODS: This paper uses historical analysis to highlight the flaws in orthodox policy analyses, which assume a uniform interpretation, implementation and set of policy trajectories towards a 'prohibition regime' in the 20th century. It challenges some existing legal interpretations of the treaties through recourse to historical precedents of flexible interpretation and policy prioritisation. It then examines the legal justifications currently being formulated by member states to explain a shift towards policies which, until recently, have been viewed as outside the permissible scope of the conventions. It then examines a functionalist framework for understanding the likely contours of drug diplomacy in the post-UN General Assembly Special Session (UNGASS) 2016 era. RESULTS: The paper highlights that, contrary to current policy discourses, the international control system has always been implemented in a 'flexible' manner. It demonstrates that drug control goals were repeatedly subsumed to security, development, political stability and population welfare imperatives, or what we might now refer to under the umbrella of 'development issues.' The paper further demonstrates that policy prioritisation, inherent treaty ambiguities and complexities as well as the recognition of broader issues of security and development were just some of the ways in which member states have flexibly implemented the treaties over the last century. This has frequently occurred in spite of apparent contradictions between national policies and reigning interpretations of international drug control obligations. CONCLUSION: UNGASS 2016 inaugurated a new era based on an evolving understanding of the UN drug control system. In this 'post-'war on drugs' era', national and local policy choices will increasingly hold greater relevance than international ones. Further, based on numerous historical precedents, international legal interpretations will likely continue to evolve and serve a reactive functional role in providing the formal scope to justify national and local deviations from past global norms. These shifting interpretations are, and will continue to be, reflected in an interim reliance on treaty 'flexibilities' to explain sustained international cooperation, even as that cooperation shifts to an entirely new implementation framework.

Entitled to Addiction?: Pharmaceuticals, Race, and America's First Drug War.

This article rethinks the formative decades of American drug wars through a social history of addiction to pharmaceutical narcotics, sedatives, and stimulants in the first half of the twentieth century. It argues, first, that addiction to pharmaceutical drugs is no recent aberration; it has historically been more extensive than "street" or illicit drug use. Second, it argues that access to psychoactive pharmaceuticals was a problematic social entitlement constructed as distinctively medical amid the racialized reforms of the Progressive Era. The resulting drug control regime provided inadequate consumer protection for some (through the FDA), and overly punitive policing for others (through the FBN). Instead of seeing these as two separate stories-one a liberal triumph and the other a repressive scourge-both should be understood as part of the broader establishment of a consumer market for drugs segregated by class and race like other consumer markets developed in the era of Progressivism and Jim Crow.

Regulação, circulação e distribuição da penicilina em Portugal (1944-1954) / Regulation, circulation and distribution of penicillin in Portugal (1944-1954)

Portugal foi um dos primeiros países do mundo, não participantes na II Guerra Mundial, a obter penicilina para uso civil. Em 1944 o medicamento começou a ser importado dos Estados Unidos da América pela Cruz Vermelha Portuguesa, mas como as quantidades eram escassas a sua distribuição foi confiada a uma comissão controladora constituída pela instituição. Em 1945, com o aumento da produção mundial, a penicilina foi integrada no circuito comercial de venda de medicamentos. A Comissão Reguladora dos Produtos Químicos e Farmacêuticos, fundada em 1940, enquadrada na política normalizadora do Estado Novo, com a finalidade de tutelar a atividade farmacêutica e o comércio dos medicamentos, exerceu um importante papel na regulação da venda do antibiótico. Entre 1945 e 1947 a penicilina foi importada como medicamento. A partir de 1947 a penicilina começou a ser importada como matéria-prima e em 1948 foram lançadas no mercado as primeiras especialidades farmacêuticas com penicilina preparadas em Portugal. Para garantir a qualidade dos medicamentos e minimizar a existência de produtos sem eficácia terapêutica comprovada a Comissão Reguladora dos Produtos Químicos e Farmacêuticos estabeleceu, em 1942, um laboratório para proceder à verificação analítica de medicamentos e produtos medicinais. Somente a partir de 1948, após o início da produção nacional de medicamentos com penicilina, é que o antibiótico começou a ser verificado analiticamente. A produção industrial de penicilina em Portugal surgiu em 1966. No presente artigo pretendemos demonstrar o papel da Comissão Reguladora dos Produtos Químicos e Farmacêuticos na regulamentação e no controlo da penicilina em Portugal no contexto dos outros medicamentos, bem como dar a conhecer o modo de regulação, circulação e distribuição da penicilina em Portugal nos anos 40 e 50 do século XX (AU)

Portugal did not participate in World War II but was one of the first countries in the world to receive penicillin for civilian use. The Portuguese Red Cross began to import the antibiotic from the United States of America in 1944 and appointed a controlling committee to oversee its distribution, due to the small amount available. In 1945, as world production increased, penicillin began to be distributed through the normal channels. An important role in its regulation was played by the official department responsible for controlling pharmaceutical and chemical products in Portugal, the Comissão Reguladora dos Produtos Químicos e Farmacêuticos (Regulatory Committee for Chemical and Pharmaceutical Products). Penicillin was imported as a raw material from 1947 and the first medicaments containing penicillin, prepared in Portugal, were released into the commercial circuit in 1948. A laboratory had been established in 1942 by the Comissão Reguladora for the analytical verification of medicaments and medicinal products with the aim of certifying their quality and minimizing the number of products with no attested therapeutic efficacy. The number of medicaments analysed by this laboratory increased substantially from 72 in the year of its foundation (1942) to 2478 in 1954, including, after 1948, medicaments containing penicillin. The aim of the present paper was to elucidate the role of the Comissão Reguladora dos Produtos Químicos e Farmacêuticos in regulating and controlling the distribution of penicillin in Portugal during the 1940s and 1950s

History and the future: Looking back to look forward?

History is often dismissed as of little utility in the analysis of policy. This paper provides a justification for its use as evidence. It surveys the rise of the use of history, including public history and history and policy. It looks at two issues which draw on the author's own work: the relationship between regulation and culture for smoking and alcohol; and the response to electronic cigarettes in the light of smoking and public health history. It analyses what history can contribute. Responses are time dependent and change is an essential parameter in understanding policy. Historical research can challenge stereotypes, for example that prohibition was abandoned because it 'failed'. It also forms the bedrock of historical interpretation, which is mutable and often misunderstood outside the profession. History provides policy analysis rather than policy prescription and is a challenging approach, not just a convenient support for established positions. The paper concludes that history is far from moribund as a policy science.

Lessons in ambivalence: The Shanghai Municipal Council's opium policies, 1906-1917.

BACKGROUND: Shanghai was considered to be a "capital of opium" in modern China, hence the history of opium in the city has received significant attention. In the Shanghai International Settlement, where Chinese and foreigners lived as neighbours, drugs were considered by the administration as both "trouble maker", and important financial resource. This paper explores how the Shanghai Municipal Council (SMC), the most senior governing body in the settlement, used its position to maximize political and economic profit from the trade and consumption of opium. METHODS: The paper is based on documentary analysis of records of the SMC board meetings and other related material stored at Shanghai Municipal Archives. Interpretive approaches were used to analyze the shifting SMC strategies on opium consumption, the competing power relations and the way they were negotiated between actors with a stake in the region, including semi-colonialism and world systems analysis. RESULTS: With the dual purpose of preventing damage and enhancing municipal management, the SMC introduced a licensing system permitting the consumption and trade of drugs. However, the anti-opium policies of the late Qing government and the Anglo-Chinese 10 Year Agreement meant SMC had to shut down opium "houses" (opium dens) and "shops" (for the sale of opium to be consumed off the premises). CONCLUSIONS: Over almost a decade, the SMC shifted emphasis from political regulation of a social, recreational practice to maximizing financial benefit. In the process, SMC made full use of the opportunities it gained from a period of ambivalent Chinese and British power relations and local community rule.

Evidence-based policy? The re-medicalization of cannabis and the role of expert committees in the UK, 1972-1982.

BACKGROUND: Cannabis was introduced to the UK as a medical product in the nineteenth century. However, with questions over its safety, efficacy, and possible harms its medical role diminished and by the 1950s it was viewed as a drug of misuse. Nonetheless, scientific and lay knowledge around cannabis expanded from the 1960s and cannabis re-appeared in different therapeutic forms. In re-medicalizing cannabis, science-policy transfer proved important and was enabled by the developing mechanism of expert committees, most notably the Advisory Council on the Misuse of Drugs (ACMD). METHODS: This article draws upon previously unknown archival material on the ACMD held at the National Archives and covers the period 1972-1982. It considers how expert groups were established, their membership, and the evolving discussion over therapeutic cannabis within the broader drug policy debate. RESULTS: Three distinct periods emerged: 1972-1976 with the creation of the Working Group on Cannabis; 1977-1979 when the Working Group focused on potential amendments to the Misuse of Drugs Act and recommended downgrading cannabis from Class B to Class C; 1980-1982 when the Expert Group on the Effects of Cannabis recommended downgrading cannabis and encouraged research into cannabis as a medicine. Sources reveal that driven by drug control imperatives the ACMD stimulated research on cannabis leading to increased research on medical applications. CONCLUSION: Expert advice was critical in the process of re-medicalization. Initially, discourse occurred in the closed expert committees of the ACMD. The drug problem had been framed under the criminal justice system but as the limitations of this were revealed, and there was continuing uncertainty over cannabis' impact, new approaches to cannabis were sought. It was this combination of more relaxed attitudes towards cannabis, research incentives, as well as a developing desire to draw medical needs away from discussion of drug control that was to allow re-medicalization to develop.

Shaping drug policy in Poland.

Poland, a post-socialist democracy with a high interest in successful integration with the European Union and a strong catholic tradition, currently has some of the most restrictive anti-drug laws in Europe. Structural violence towards drug users has intensified as a result of decades of shifting drug policies and, surprisingly, the more recent process of political and economic liberalization. This commentary considers the contextual and historical dynamics of drug policy-making in Poland. It traces transitions in Poland's drug control policy, throughout Poland's history as a soviet satellite state, under martial law, and in the democracy that it is today. This case study draws on an analysis of interviews with key actors and participant observations in combination with documents and archival records. This paper follows the changes in Poland's drug control policy, throughout Poland's history as a soviet satellite state, under martial law, and in the democracy that it is today. Factors contributing to the enactment of restrictive drug laws have occurred in a highly politicized context during a series of dramatic political transitions. Current drug policies are woefully inadequate for treating those in need of drug treatment and care as well as for preventing HIV and other harms linked to drug injecting.