Podcast
Drug Story
Hosted by Thomas Goetz · EN
Every episode of Drug Story uses one prescription drug to tell surprising, true tales about the business of disease and health. Hosted by award-winning science journalist Thomas Goetz, MPH, this podcast asks the big question: What happens when we use drugs to fix our big problems?
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Bonus Episode: Thomas talks with STAT
Apr 2900:30:23Summary readyA bonus episode! Here is a conversation that I had recently with STAT, the excellent publication about health and medicine.If you are in the business of health and medicine, you surely know about STAT - For a decade they have been doing fantastic reporting from the frontiers of biotech, public health, and policy.STAT really has been a key resource for Drug Story, so I was honored to talk with STAT’s Torie Bosch for their First Opinion podcast. If you’re curious what inspired the idea for this show, or about the bigger ideas behind the show, or why I think everyone should get a degree in public health, well you’ll get some of the backstory here. Get full access to Drug Story at www.drugstory.co/subscribe
Summary
On fluoride and tooth decay
Mar 3100:50:27Summary readyYou may not think of fluoride as a drug, but it fits the bill: The FDA classifies fluoride as a drug, an essential nutrient to human health, and regulates its use. So yeah. It’s a drug.Fluoride used to be boring. 75% of US water is fluoridated, and it has greatly reduced the rate of tooth decay in this country and worldwide. Fluoridation has been among the biggest success stories in medical history.But like a lot of medicine these days, fluoride is suddenly controversial. Again. Here and there, governments - the whole state of Utah, towns all over Florida - have removed fluoride from water. And predictably, the rate of tooth decay in children soars afterwards.Still fluoride is also a riddle. Because while the US has had a lot of success with fluoride, most countries do NOT add it to their water - and many non-fluoridated countries have much the same rate of tooth decay as the US. Is fluoride toothpaste enough?What is going on with fluoride?!4 out of 5 dentists recommend you listen to this episode!Sources for this episode [1] Dentition of a Mesolithic Population (1967) American Journal of Physical Anthropology: Pre-industrial populations experienced significantly lower rates of dental caries, demonstrating the impact of modern diet and environment on oral disease.[2] Toothache (1994) Poetry Foundation: William Greenway: William Greenway’s visceral portrayal of dental pain.[3] A Colorado Story (2015) Colorado Dental Association: Naturally fluoridated water was definitively linked to reduced tooth decay, establishing the scientific basis for fluoridation policy.[4] The Story of Fluoridation (2024) National Institute of Dental and Craniofacial Research: Fluoridation emerged from observed natural fluoride exposure and was adopted as a nationwide preventive health strategy.[5] Pipe Dreams: America’s Fluoride Controversy (2011) Science History Institute Museum & Library: Water fluoridation sparked decades of political and scientific conflict, becoming one of the most contested public health interventions in U.S. history.[6] Big Hopes for Little Teeth (2024) National Institute of Dental and Craniofacial Research: Fluoridation significantly reduced childhood tooth decay and became a foundational population-level prevention strategy.[7] Community Water Fluoridation in Focus: A Comprehensive Look at Fluoridation Levels across America (2023) International Journal of Environmental Research and Public Health: Access to fluoridated water varies widely across the U.S., reinforcing geographic and socioeconomic disparities in preventive oral health.[8] Water fluoridation less effective now than in past (2024) Cochrane: Fluoridation still reduces cavities, but the magnitude of benefit is smaller than in the mid-20th century.[9] Water fluoridation for the prevention of dental caries (2024) Cochrane Library: Fluoridation consistently lowers rates of tooth decay across populations, though evidence quality and modern applicability vary.[10] Research review contends fluoride in water is less effective than in 1970s (2024) American Dental Association: The marginal benefit of water fluoridation has decreased due to widespread fluoride exposure from toothpaste and other sources.[11] Out of Pocket: A Snapshot of Adults’ Dental and Medical Care Coverage (n.d.) CareQuest Institute: Lack of dental coverage forces many adults to delay or forgo care, increasing reliance on low-cost public health interventions like fluoridation.[12] Health Disparities in Oral Health (2024) CDC: Oral health outcomes are consistently worse for low-income and minority populations due to structural barriers and uneven access to prevention.[13] Two Cities Fluoride Removal Evidence (2025) Science News: Discontinuing fluoridation results in measurable declines in dental health outcomes.[14] What happened when Juneau took fluoride out of the drinking water? (2019) University of Alaska Anchorage: Removing fluoridation leads to increased tooth decay and higher rates of dental procedures, especially in children.[15] The Fluoride Wars Rage On (2021) nature: Fluoridation remains politically and culturally polarizing despite decades of scientific support. Get full access to Drug Story at www.drugstory.co/subscribe
Summary
On ivermectin and parasites (and other things)
Mar 2400:48:14Summary readyThis episode is all about ivermectin - which truly is a wonder drug! A veritable miracle cure.For, ahem, river blindness. And for some other parasitic diseases, like hookworm. Mostly in animals.But in the US, you have likely heard of ivermectin not as a treatment for parasites but for different purposes altogether. There are thousands of videos on YouTube and Instagram extolling ivermectin for viral diseases like Covid, various cancers, and for something called a “parasitic detox,” or a “parasitic cleanse.”Really? This one drug does all that?No. It does not.In this episode of Drug Story, we tell the tale of ivermectin, and what gets all those people on TikTok raving about this drug - what they hope it could be, what they believe it works on.And then, with an open mind, we go to the science – to tease apart the true miracles from the mere fantasies.Source for this episode:[1] Dirt Eaters (2006) NCpedia: Hookworm spreads through skin contact with contaminated soil, with infection linked to poor sanitation and barefoot exposure.[2] What Would It Take to Describe the Global Diversity of Parasites? (2020) Proceedings B (Royal Society): Discussion of parasite diversity and implications for global health.[3] Charles Wardell Stiles (n.d.) The Online Collection and Catalog of Rockefeller Archive Center: Stiles identified hookworm as a widespread cause of disease in the American South and helped initiate national eradication efforts.[4] The Great Hookworm Crusade (1978) Facing South: Exploration of early 20th-century public health campaigns targeting hookworm.[5] The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South (2007): Analysis of the Rockefeller Sanitary Commission’s hookworm eradication campaign and its role in shaping public health systems.[6] How a Worm Gave the South a Bad Name (2016) NOVA (PBS): Hookworm caused anemia, fatigue, and cognitive impairment, contributing to stereotypes of laziness in the American South[7] Lessons Learned (2016) Vanderbilt University: Hookworm campaigns demonstrated the importance of sanitation, education, and coordinated public health infrastructure.[8] Public Health: How the Fight Against Hookworm Helped Build a System (2020) REsource: Early hookworm eradication efforts contributed to the formation of organized public health systems in the U.S.[8] Dr. Abbott Assails “Freedom” League (1910) The New York Times: Physicians publicly criticized groups opposing national health initiatives during early 20th-century reforms.[10] America’s Deadly Flirtation with Antiscience and the Medical Freedom Movement (2021) Journal of Clinical Investigation: Historical medical freedom movements mirror modern resistance to public health guidance.[11] The Hookworm Blues: We Still Got ’Em (2017) American Journal of Tropical Medicine and Hygiene: Hookworm infection remains present in parts of the U.S., particularly in areas with inadequate sanitation and persistent poverty.[12] The American Murderer (2023) Bunk History: Hookworm campaigns in the U.S. South prioritized poor white populations to address labor productivity and regional stigma, while excluding Black communities from interventions.[13] The Debate Is On: To Deworm Or Not To Deworm? (2015) NPR Goats and Soda: Mass deworming programs reduce worm infections and may improve school attendance, though evidence on long-term health and economic benefits remains debated.[14] Hookworm Persists in U.S. Despite Belief That It Was Wiped Out (2017) NPR: Ongoing hookworm cases in Alabama are linked to failing wastewater systems and persistent poverty.[15] Nobel laureate William Campbell describes developing a new drug to Cornell audience (2016) Cornell University College of Veterinary Medicine: Overview of the discovery of ivermectin and its development as a breakthrough antiparasitic drug.[16] Progress and Impact of 13 Years of the Global Programme to Eliminate Lymphatic Filariasis (2014) PLOS Neglected Tropical Diseases: Mass drug administration programs using ivermectin significantly reduced transmission of filarial diseases worldwide.[17] The Discovery of Ivermectin: A Crapshoot or Not (2007) Cambridge University Press: Ivermectin originated from screening soil microbes, with discovery driven by trial-and-error experimentation.[18] The Life and Times of Ivermectin — A Success Story (2004) Nature Reviews Microbiology: Ivermectin disrupts parasite nerve and muscle function, supporting mass drug administration campaigns that significantly reduced global parasitic disease burden.[19] Two Elite Medical Journals Retract Coronavirus Papers (2020) Science: Retractions of major COVID-19 studies exposed weaknesses in peer review and data verification.[20] Medical Liberty and Drugless Healers Confront Allopathic Doctors (1910–1931) (2008) Journal of Medical Humanities: Early 20th-century conflicts between alternative practitioners and mainstream medicine centered on regulation and authority.[21] Ivermectin and COVID-19: How a Flawed Database Shaped Pandemic Response (2020) ISGlobal: Policy decisions in several countries relied on unreliable ivermectin data.[22] A Mysterious Company’s Coronavirus Papers May Be Unraveling (2020) Science: Surgisphere data was used in major studies before being discredited, leading to retractions.[23] How the Ivermectin Culture Wars Took Off (2021) NPR: Ivermectin became a symbol in broader political and cultural conflicts during the pandemic.[24] Unreliable Data: How Doubt Snowballed Over COVID-19 Drug Research (2020) The Guardian: Flawed studies and poor data quality amplified false claims about ivermectin’s effectiveness.[25] Ivermectin and the Integrity of Healthcare Evidence During COVID-19 (2022) Frontiers: Weak evidence standards and politicization affected interpretation of ivermectin research.[26] Merck Statement on Ivermectin Use During the COVID-19 Pandemic (2021) Merck: Manufacturer stated there was no scientific basis for ivermectin use in COVID-19.[27] Poll: Trust in Public ...
Summary
On patent medicines (with Tim Harford)
Mar 1700:38:45Summary readyToday we’re sharing an episode of Cautionary Tales, by Tim Harford.This show concerns Lydia Pinkham’s Vegetable Compound - one of the most popular patent medicines of the late 19th century. Mrs. Pinkham’s compound was sold as a “women’s tonic,” ideal for menopause or menstrual pain. The package promised big: "It cures bloating, headaches, nervous prostration, general debility, sleeplessness, depression, and indigestion.”But did it, really? No, it did not. Lydia Pinkham’s compound was the epitome of a cure-all that cured nothing, a secret concoction of herbs and roots and other ambiguous ingredients that promised tremendous benefits without any evidence whatsoever. Eventually, it was outrage over patent medicines like Mrs. Pinkham’s that turned into the creation of the FDA, and the evidence-based medicine we have today. Back next week with a new episode of DRUG STORY! Get full access to Drug Story at www.drugstory.co/subscribe
Summary
On medicine, with Dr. Eric Topol
Mar 1000:30:18Summary ready20 years ago, pharmacogenomics was all the buzz: matching specific drugs to our personal DNA was supposed to transform medicine and human health.But here we are 20 years later, and much of that excitement has fizzled. Very few doctors are actually tailoring their treatments to individual patient DNA in the clinic.In this special episode, I talk with Dr. Eric Topol, author of the new book Super Agers, about the promise of pharmacogenomics and the new frontiers of medicine. We talk about how he has always put science first - he shares the story of Vioxx, a pain reliever that he was early to see carried massive risks. Eric put his career on the line to let the world know about the problems. Get full access to Drug Story at www.drugstory.co/subscribe
Summary
On Ambien and insomnia
Mar 300:48:16Summary readyEver heard of neurasthenia, aka Americanitis? It was the first epidemic of the 20th century - and it's number one symptom was insomnia.It may have just been the electricity.In this episode of Drug Story, we step into that sweet oblivion called sleep, and that infernal torment called insomnia. We visit hustle culture, where sleep is just an obstacle to crushing it.And we learn about Ambien: the most popular sleeping pill ever invented. Until women started showing up in emergency rooms with amnesia...Sources for this episode[1] NEURASTHENIA, DEGENERACY, AND MOBILE ORGANS (1906) The British Medical Journal: Neurasthenia is defined by a state of "nervous exhaustion" and can include physical symptoms like head or spinal pain, insomnia, and constipation, along with mental depression.[2] Neurasthenia and a Modernizing America (2003) JAMA: Introduces neurasthenia after the Civil War as a nervous-energy disorder; the term declined in use after the 1930s.[3] ‘Americanitis’: The Disease of Living Too Fast (2016) The Atlantic: Frames neurasthenia as a disease of living too fast in industrializing America.[4] Insomnia and the late nineteenth-century insomniac: the case of Albert Kimball (2020) Interface Focus:The identity of the “insomniac” emerged alongside industrial-era stress and the concept of neurasthenia.[5] A short history of insomnia and how we became obsessed with sleep (2023) The Conversation: Industrialization increased insomnia rates through artificial lighting, work shifts, and societal change.[6] The Pathophysiology of Insomnia (2015) Contemporary Reviews In Sleep Medicine: Insomnia can be influenced by genetics, cellular and physiological mechanisms, and sleep behaviors.[7] Insomnia: a cultural history (2018) The Lancet: Contrasts pre-industrial ritualized sleep with modern increases in chronic insomnia.[8] Phenome-wide Analysis of Diseases in Relation to Objectively Measured Sleep Traits and Comparison with Subjective Sleep Traits in 88,461 Adults (2025) Health Data Science: In a research study, poor sleep quality was associated with increased risk for 172 different diseases including Parkinson's disease and type 2 diabetes.[9] A Short History of Sleeping Pills (2018) Sleep Review: The history of treatments for insomnia covering alcohol, opiates, barbiturates, benzodiazepines, and “Z drugs” like Ambien.[10] The Evolution and Development of Insomnia Pharmacotherapies (2007) Journal of Clinical Sleep Medicine: History of pharmacological treatment for insomnia: from older, less safe options like barbiturates to the current generation of medications with improved safety profile.[11] The Big Sleep (2013) The New Yorker: In 1973, Jean-Pierre Kaplan began work on a new class of sleeping pills at Synthélabo, leading to zolpidem’s development.[12] Critics say drug ads should be a wake-up call (2006) Star News: Critics link increased use of Ambien and Lunesta to aggressive advertising campaigns.[13] Evaluation of the long term efficacy and safety of zolpidem-MR 12.5 mg compared to placebo, when both are administered over a long term period “as needed”, in patients with chronic primary insomnia (2008) Sanofi-Aventis: Summary of Phase III clinical trial investigating the long-term efficacy and safety of the extended-release sleep medication, zolpidem.[14] Emergency Department Visits for Adverse Reactions Involving the Insomnia Medication Zolpidem (2013) SAMHSA: There was a 220% increase in emergency department visits related to adverse reactions from the sleep medication zolpidem between 2005 and 2010[15] FDA Drug Safety Communication: FDA approves new label changes and dosing for zolpidem products and a recommendation to avoid driving the day after using Ambien CR (2013) The U.S. Food and Drug Administration: FDA recommended lower doses and advised avoiding driving the day after using Ambien CR.[16] FDA adds Boxed Warning for risk of serious injuries caused by sleepwalking with certain prescription insomnia medicines (2019) The U.S. Food and Drug Administration: The official safety communication from the FDA announcing a Boxed Warning for specific prescription insomnia medications, including eszopiclone, zaleplon, and zolpidem, due to reports of dangerous side effects.[17] Zolpidem-Induced Sleepwalking, Sleep Related Eating Disorder, and Sleep-Driving: Fluorine-18-Flourodeoxyglucose Positron Emission Tomography Analysis, and a Literature Review of Other Unexpected Clinical Effects of Zolpidem (2009) Journal of Clinical Sleep Medicine: PET scans and literature review on zolpidem’s association with abnormal sleep behaviors.[18] Zolpidem and Driving Impairment — Identifying Persons at Risk (2013) New England Journal of Medicine: Examines risks of zolpidem, including sleepwalking, sleep-related eating disorder, and sleep-driving. Get full access to Drug Story at www.drugstory.co/subscribe
Summary
On chronic pain
Feb 2400:50:41Summary readyPain is probably the oldest problem in medicine. It’s the way our bodies tell us that something is wrong here.But pain has long been considered a symptom. So when medicine can’t find what’s wrong, or when medicine can’t fix the pain, well, that’s usually the end of the story. And that’s left a lot of people with chronic pain suffering in silence.In this episode, we learn why pain is one of the great mysteries of medicine - one of the most challenging conditions to diagnose, to measure, and to treat successfully.We explore why the worthy effort to bring pain into the light inadvertently created what may be the most devastating social crisis (ahem, opioid epidemic) of the last century.And we look at a new pain medicine - Journavx - which is not approved for chronic pain (yet) but has a lot of people hoping for a path to peace without addiction.Sources for this episode[1] "Wrestling With Pain:" John J. Bonica, MD. Autobiography (1987) The International Symposium on Pain Analgesia: Dr. John J. Bonica recounts his life as a "wrestling match" against medical indifference to establish the multidisciplinary approach to pain therapy. [2] Oral History Interview with John J. Bonica (1993) John C. Liebeskind History of Pain Collection: John Bonica is widely regarded as the founding father of pain management.[3] International Symposium on Pain (1974) Raven Press: Proceedings from the first major international meeting on pain research and management.[4] Individual Differences in Pain: Understanding the Mosaic that Makes Pain Personal (2017) PAIN: Explains how biological, psychological, and social factors shape personal pain experiences.[5] Chronic Pain: What Does It Mean? A Review on the Use of the Term Chronic Pain in Clinical Practice (2021) Journal of Pain Research: "Chronic pain" is a semantically inaccurate and potentially misleading clinical label because it overemphasizes duration while failing to account for biopsychosocial factors.[6] Prevalence of Depression and Anxiety in Chronic Pain (2025) JAMA: Systematic review and meta-analysis showing high rates of depression and anxiety among adults with chronic pain.[7] Improving Outcomes of Analgesic Treatment: Is Education Enough? (1990) Annals of Internal Medicine: The persistent undertreatment of pain is rooted in a historical medical focus on physical lesions over subjective symptoms. [8] Pain as the 5th Vital Sign Toolkit (2000) The Veterans Health Administration: A comprehensive guide developed by the Veterans Health Administration (VHA) to institutionalize a standardized, system-wide approach to managing patient discomfort.[9] A Capsule History of Pain Management (2003) JAMA: Historical overview of approaches to managing pain, from ancient remedies to modern treatments.[10] Bridging Old and New in Pain Medicine: An Historical Review (2023) Cureus: Historical review linking traditional pain remedies with modern medical practices.[11] The Opioid Epidemic: It’s Time to Place Blame Where It Belongs (2017) The Journal of the Missouri State Medical Association: Dr. Ronald Hirsch argues that the opioid crisis was driven by a network of "co-conspirators" including pharmaceutical companies, medical oversight organizations, and government agencies.[12] The 5th Vital Sign and America’s Painkiller Epidemic (2016) The University of Arizona Health Sciences: The institutionalization of pain management led to a surge in prescription drug abuse and overdose deaths. [13] The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy (2008) The American Journal of Public Health: Oxycotin’s commercial success was driven by predatory marketing tactics, such as targeting high-volume prescribers and systematically understating the risk of addiction.[14] The fifth vital sign: A complex story of politics and patient care (2016) Cleveland Clinic Journal of Medicine: Aggressive marketing and institutional mandates minimized the perceived risks of addiction, leading to the current opioid epidemic.[15] The Pain and Opioid Epidemics: Policy and Vital Signs (2016) JAMA Health Forum: The historical movement to treat pain as a fifth vital sign inadvertently fueled a massive increase in narcotic prescriptions.[16] Addiction Rare in Patients Treated with Narcotics (1980) The New England Journal of Medicine: a 1980 letter to the editor of the New England Journal of Medicine covers the low incidence of narcotic addiction in medical settings. [17] Remove Pain as 5th Vital Sign, AMA Urged (2016) Medpage Today: Medical professionals at an American Medical Association met to advocate for the removal of pain as a "fifth vital sign".[18] FDA Approves Novel Non-Opioid Treatment for Moderate to Severe Acute Pain (2025) US Food & Drug Administration: FDA announcement of approval for a new, non-opioid treatment for moderate to severe acute pain.[19] F.D.A. Approves Drug to Treat Pain Without Opioid Effects (2025) The New York Times: The FDA approved a non-opioid painkiller developed by Vertex.[20] What Is Journavx, the New Opioid-Free Painkiller from Vertex? (2025) Scientific American: Journavx functions by blocking sodium ion channels to stop pain signals before they reach the central nervous system, offering a mechanism entirely different from traditional treatments.[21] Painkillers without the addiction? The new wave of non-opioid pain relief (2025) Guaridian: The pharmaceutical industry is shifting toward developing non-opioid pain relief to address the devastating global addiction crisis.[22] An SCN9A channelopathy causes congenital inability to experience pain (2006) Nature: Discovery that mutations in the SCN9A gene cause congenital inability to experience pain.[23] Chronic Pain Is a Hidden Epidemic. It’s Time for a Revolution. (2025) The New York Times Magazine: Opinion piece calling for a revolution in how chronic pain is addressed in society. Get full access to Drug Story at www.drugstory.co/subscribe
Summary
On tuberculosis (with John Green)
Feb 1700:45:29Summary readyThe idea of drug patents makes a lot of sense: The company that put the effort and resources into developing the medicine is the first to reap the benefits. That company gets a limited monopoly for 20 years, when it is the only company allowed to manufacture and sell that drug.The deal is that after that patent expires, other companies can manufacture and sell the drug, too. The drug goes “generic.” Typically that means lower prices for patients - more people benefit. That’s how the system is supposed to work. But that system relies a lot on good faith - and many pharma companies have gotten very good at finding ways to extend that 20 years, making small tweaks to a drug to extend their monopoly for years.Today, I hand Drug Story over to the excellent journalist Dan Weissmann, host of the NPR podcast An Arm and A Leg. In this episode of An Arm and a Leg, Dan talks with John Green - author of the new book, Everything is Tuberculosis. Green explains a very effective drug for TB was kept under patent protection for years, making it too expensive to treat millions of people with tuberculosis, leading to thousands of unnecessary deaths worldwide. Get full access to Drug Story at www.drugstory.co/subscribe
Summary
On testosterone and Low T
Feb 1000:56:36Summary readyIt used to be that getting older meant slowing down. A little less pep, a little less zip, a little less zest. So it goes.For men, this was partly about testosterone. After 40 or so, our bodies produce less and less testosterone, the hormone that helps give men energy and vigor and sex drive. Lower testosterone was just part of growing older.But that was then! Nowadays, “Low T” is a bonafide medical condition - easily treated with a shot at your local neighborhood men’s health clinic.Today, what used to be a secret sauce of bodybuilders or cheating athletes is now downright normal. Millions of men worldwide take testosterone therapy - and not just those over 40. Check out Reddit or TikTok...It is a WHOLE THING.In this episode of Drug Story, we look at how TRT went mainstream, and how part of ordinary aging somehow became a disease.Sources for this episode[1] Male Hypogonadism (2024) STAT Pearls:Male hypogonadism is defined as inadequate testosterone production or impaired spermatogenesis, diagnosed via symptoms and low morning testosterone levels.[2] Brown-Séquard: An improbable genius who transformed medicine (2011) The Journal of Clinical Investigation: Charles-Edouard Brown-Séquard, a pioneering 19th-century scientist who rose from a difficult childhood in Mauritius is said to be the founder of modern endocrinology and neurology.[3] The life and legacy of Brown-Séquard (2017) Brain: Charles-Edouard Brown-Séquard’s insights helped show how nerves control blood vessels and laid the foundation for modern endocrinology by identifying internal secretions and early hormone therapy.[4] The “Elixir of Life” (1889) J.G. Cupples Co: In a self-report, Charles-Édouard Brown-Séquard covers his controversial self-experiments where he injected animal testicle extracts in pursuit of rejuvenation.[5] The effect produced on man by subcutaneous injections of a liquid obtained from the testicles of animal (1889) Lancet: In a 1889 Lancet article, Brown-Séquard describes his pioneering experiments with subcutaneous injections of animal testicular extracts to combat the physical and mental decline associated with aging.[6] A Brief History of Testosterone (2001) Journal of Urology: Hormone therapy became widely used to treat age and disease-related hormone decline, before risks were fully understood.[7] History of Testosterone and Therapeutic Potential (2020) Sexual Medicine Reviews: Testosterone was isolated in 1935 by the Organon group, with independent synthesis by Adolf Butenandt and Leopold Ruzicka.[8] Adolf Butenandt—Nobel Prize for Chemistry (2012) Mayo Clinic Proceedings: Adolf Butenandt isolated key sex hormones, contributing to foundational methods for steroid chemistry and earning the 1939 Nobel Prize in Chemistry.[9] Monkey business: reflections on testosterone (2012) BMJ: Testosterone is widely believed to drive masculinity, aggression, and performance, but strong evidence in humans is limited and inconsistent.[10] The male hormone (1945) Harcourt, Brace and Company: The Male Hormone was an influential book that shaped public and medical perceptions of testosterone as central to masculinity and male health.[11] Endocrines: The Use of Testosterone (1940) The New England Journal of Medicine: Dr. Joseph C. Aub’s NEJM article discusses testosterone as proven therapy for hypogonadism, with experimental applications for women and other conditions.[12] History of Doping in Sport (2001) International Sports Studies: Testosterone and anabolic steroids became central substances in performance enhancement, prompting regulatory responses and anti-doping frameworks in international sport.[13] New 'Breakfast of Champions': A Recipe for Victory or Disaster? (1988) The New York Times: Anabolic steroid use, including testosterone derivatives, was widespread in elite athletics despite known health risks and weak enforcement.[14] FTC Sues Drug Companies for Unlawfully Conspiring to Delay the Sale of Generic AndroGel Until 2015 (2009) Federal Trade Commission: Pharmaceutical companies used patent litigation and settlement agreements to delay generic testosterone gel competition and maintain market exclusivity.[15] Androgen deficiency in males (2010) Expert Review of Endocrinology & Metabolism: Clinical definitions of androgen deficiency rely on serum testosterone thresholds combined with symptoms, with variability across populations.[16] The male menopause—does it exist? (2000) BMJ: Age-related testosterone decline occurs gradually and inconsistently and does not parallel the hormonal cessation observed in female menopause.[17] Evolution of Guidelines for Testosterone Replacement Therapy (2019) Journal of Clinical Medicine: Article examines how definitions, diagnoses, treatments, and follow-up recommendations for testosterone replacement therapy have evolved across major societies (ISSAM, Endocrine Society, ISSM, AUA).[18] The Hazards of Male Menopause (1997) Science: Medicalization of age-related testosterone decline outpaced clinical evidence, raising concerns about overtreatment and long-term risk.[19] Selling That New-Man Feeling (2013) The New York Times: Direct-to-consumer advertising reframed testosterone therapy as a solution for fatigue, low mood, and diminished masculinity in aging men.[20] Prevalence of hypogonadism in males aged at least 45 years: the HIM study (2008) The International Journal of Clinical Practice: A study established low measured testosterone levels prevalent among men over 45, particularly in those with obesity, diabetes, and chronic illness.[21] Testosterone Aids Older Men's Brains, UCSF Study Says (2002) Science Daily: Testosterone supplementation was associated with short-term improvements in certain cognitive measures in older men.[22] Association Between Direct-to-Consumer Advertising and Testosterone Testing and Initiation in the United States, 2009–2013 (2017) JAMA: A study finds increased exposure to testosterone advertising correlated with higher rates of testosterone testing and treatment initiation.[23] 2013 All-Star Large Pharma Marketing Team of the Year: AndroGel (2013) Medical Marketing and Media: AndroGel’s marketing strategy successfully expanded testosterone therapy into a high-revenue lifestyle pharmaceutical category.[24] The marketing of testosterone treatments for age-related low testosterone or 'Low T' (2018) Current Opinion in Endocrinology & Diabetes and Obesity: Discusses how pharmaceutical companies promoted testosterone for off-label, age-related use without strong supporting evidence.[25] “Manopause?! Aging, Insecurity and the $2 Billion Testosterone Industry” (2014) TIME: Highlights how clinics like Low T Centers exploit aging men’s fears and market testosterone as a cure-all for aging.[26] “More Men Are Seeking Out Testosterone Tests. Are They Getting Duped?” (2022) The New York Times: Reports on rising interest in testosterone testing and t...
Summary
On Xanax and anxiety
Feb 300:45:41Summary readyDo you feel that?That doubt and dread and worry?That’s anxiety - and lucky for you, there’s a pill for that.It’s called Xanax. And it works. Really well. And really fast.Prescribed for panic attacks and anxiety, one dose of Xanax usually kicks in within 15 or 30 minutes. Just like that, a sense of calm sets in, and your concerns fall away. It’s not a high, more like the opposite. You feel relaxed, your brain stops racing. It does the trick.Which is why Xanax is also super dangerous. Because of how well it works, and the way it works, Xanax is highly addictive. It brings such relief that one pill every once in a while turns into a little nibble every night. It tricks people into thinking that their concerns and worries can disappear with just one dose. Which is why Xanax is among the most counterfeited and abused drugs in the world right now.Writing this episode, I started thinking that Xanax was a perfectly fine drug that is sometimes a problem. But as I dug in, I realized that Xanax, like all benzodiazepines, is a trickster. It promises to be an easy, even fun way to push our anxiety aside. But as much as it brings relief, it also brings consequences - which can turn deadly.In this episode of Drug Story, we look at the idea of anxiety as a disease - a common human problem that can become, for some, a treatable condition. And we consider what “treatment” means, for good and for bad.Sources for this episode[1] Quitting Xanax: One Writer's Story (2024) Vogue Magazine: Martha McPhee details her seventeen-year dependence on Xanax, originally prescribed for panic attacks.[2] Fear and fitness: An evolutionary analysis of anxiety disorders (1994) Ethology and Sociobiology: Anxiety evolved as a defense mechanism with subtypes adapted to specific threats; anxiety disorders arise from dysregulated defenses.[3] A history of anxiety: from Hippocrates to DSM (2022) Dialogues in Clinical Neuroscience: Traces the understanding and classification of anxiety from ancient Greek and Roman philosophy to the DSM, noting Greco-Roman recognition of anxiety as a medical condition and early cognitive-behavioral approaches.[4] Should You Be Upset? Cicero on the Desirability of Emotion (2022) Antigone Journal: Examines Cicero’s views on whether suppressing or embracing emotions is desirable.[5] Cicero and the state-trait theory of anxiety: Another case of delayed recognition (1983) American Psychologist: H.J. Eysenck argues Cicero anticipated the modern distinction between anxious temperament and temporary anxious states.[6] The Effects of Stoic Training and Adaptive Working Memory Training on Emotional Vulnerability in High Worriers (2021) Cognitive Therapy and Research: Results from a study show that practicing Stoicism significantly reduces rumination and boosts self-efficacy.[7] Seneca (2024) Stanford Encyclopedia of Philosophy: Lucius Annaeus Seneca was a Roman philosopher who shaped stoicism and contributed to the concept of mindfulness and use of the present to manage emotions. [8] The developmental origins of anxiety (2004) Nature: Early developmental mechanisms establish a predisposition to anxiety through the interplay of genetic and environmental factors. While anxiety is a biological adaptive response to danger it becomes pathological when interfering with normal life. [9] DSM-III and the transformation of American psychiatry: a history (1993) The American Journal of Psychiatry: American psychiatry transitioned from a biopsychosocial model to a research-based medical model following the publication of the Diagnostic and Statistical Model.[10] The Feminine Mystique (1963) National Humanities Center: In her 1963 seminal writings, Betty Friedan wrote about a pervasive dissatisfaction and feeling of emptiness among American housewives.[11] Barbiturates: A Blessing and a Menace (1947) Journal of the American Pharmaceutical Association: A 1947 journal article aptly describes the nature of barbiturates as both a blessing and menace describing their medical importance as sedatives and their ability to be misused. [12] Listening to the Past: History, Psychiatry, and Anxiety (2005) The Canadian Journal of Psychiatry: 19th–early 20th century treatments for anxiety included the use of bromides, alcohol, opiates, and later barbiturates for relief.[13] How Was Anxiety Treated in the 1900s? (2023) Connect by ManagedMinds: Historically, anxiety has been treated by asylums, rest cures, early psychotherapy, and modern psychiatric medications like SSRIs.[14] The history of benzodiazepines (2013) The Consultant Pharmacist: Leo Sternbach discovered one of the first benzodiazepines, Valium, in 1955.[15] The Launch of Xanax (1989) Drug Information Journal: Upjohn Company ran a successful marketing strategy using targeted psychiatrist outreach and consistent messaging to establish Xanax’s market position.[16] Listening to Xanax (2012) New York Magazine: This article explores “functional anxiety” in high-achieving urban professionals and Xanax’s role.[17] The Great American Xanax Legacy (2018) VICE: Xanax has become a force in modern culture including hip-hop music where the brand drug is commonly name dropped and featured in songs. [18] The APA Task Force report on benzodiazepine dependence, toxicity, and abuse (1991) The American Journal of Psychiatry: Benzodiazepines are rarely abused alone but are often used alongside alcohol or opioids in substance abuse.[19] F.D.A. Requires Stronger Warning Label for Xanax and Similar Drugs (2020) The New York Times: In 2020, the Food & Drug Administration added a warning label to all benzodiazepines cautioning against misuse and abuse of the drug.[20] Balancing the Risks and Benefits of Benzodiazepines (2021) JAMA: Reviews benefits, risks, and strategies for rational prescribing following FDA labeling changes.[21] FDA Drug Safety Communication (2020) The U.S. Food & Drug Administration: FDA warning to highlight risks of abuse, addiction, dependence, and withdrawal for all benzodiazepines.[22] A Review of Alprazolam Use, Misuse, and Withdrawal (2018) Journal of Addiction Medicine: There is high misuse liability of alprazolam and more severe withdrawal compared to other benzodiazepines.[23] Alprazolam: Good for Some, Not Good for All! (2023) Journal of Clinical Psychopharmacology: Alprazolam poses high risk for addiction and difficult withdrawal given its pharmacological properties. [24] Benzodiazepine use, abuse, and dependence (2005) The Journal of Clinical Psychology: While there are few addiction cases from prescribed use of benzodiazepines, pharmacologic dependence can occur with long-term therapy.[25] Benzodiazepine Tapering American Society of Addiction Medicine: Clinical guidelines recommend gradual tapering when discontinuing benzodiazepines. Get full access to Drug Story at www.drugstory.co/subscribe
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