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Theses Doctoral

Late 20th-Century Consumer Advocacy, Pharmaceuticals, and Public Health: Public Citizen's Health Research Group in Historical Perspective

Alkon, Ava Elyse

This dissertation examines precursors, origins, and select efforts of Public Citizen's Health Research Group (HRG), one of the first and most influential consumer advocacy organizations to focus on prescription drug issues before the 1980s. Over the course of seven chapters, I situate HRG's critical appraisals of pharmaceuticals with respect to those made by interwar consumerists, several critics in the 50s, radical health activists in the 60s, contemporary health activists in the 70s and 80s, and activists mobilized by the HIV/AIDS epidemic in the 90s and 00s. By doing this, and by connecting each of these phases of pharmaceutically-centered critique to the history of social medicine with which it tracked closely, I suggest that late 20th-century pharmaceutical activism was, at least in part, a politically-engaged critique of modern epidemiology's application to health policy and practice. HRG, like reformers both before and after them, were attempting to challenge an American orientation in health policy that emphasized the development and implementation of private clinical medical interventions over population-level public health measures and that failed to contemplate structural alterations to economic and political institutions. I do not mean to argue that the consumer movement was unaffected by ideological transformations in the postwar period that altered the way many people thought about government, or deny that consumerists largely shrunk from the challenge of building a mass-based political coalition across bounds of race and class, depending instead on the engagement of small subsets of mostly middle-class consumers. By recovering the connections between HRG's work and that of other sociomedical reformers who were also concerned about pharmaceuticals, however, I am trying to alter the perception (possessed by critics on both right and left) of late 20th-century consumerism as a middle-class movement untroubled by its alienation from working- class consumers. I also challenge the perception (possessed by only critics on the left) of consumerists as ideologically aligned with "free-market" proponents of "economic" deregulation. By relying upon a spurious distinction between "economic" and "social" (or "health and safety") regulation, such analysts artificially harden the boundary between consumerists and the radical left, make many consumerist actions that were pragmatic appear ideological, and flatten the meaning of consumerist commitment to "health and safety." I argue that HRG represented, at turns, both a perpetuation of the class- conscious radicalism of the late 30s and late 60s and its postponement - a grappling with social determinants of illness that the civil rights and antiwar movements had helped lay bare and a turning to more tractable, class-stratified determinants in lieu of structural change. HRG's story also makes palpable the connections between present-day activism around pharmaceuticals and public health and the long lineage of such advocacy linked to earlier political and social movements. A new generation of activists that emerged alongside the AIDS epidemic in the late 80s and 90s tended to view this reformist heritage at some remove, in part, I argue, because of their alienation from consumer advocates of the late 60s and early 70s. This dissertation thus aims to facilitate strategically-minded reflection by present-day health reformers about the consumer advocacy of the previous generation and the longer history that shaped it.

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Academic Units
Sociomedical Sciences
Thesis Advisors
Rosner, David
Degree
Ph.D., Columbia University
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