The Academic Exchange How did you get interested in addiction?

Professor Peter Brown I did a project two years ago on the relationship of culture and men’s health and obesity. In developed countries, there’s a serious mortality gap. At least in term of years of life, women do better than men. For example, in the U.S., retired white men are the highest risk group for suicide—higher even than teenagers. This mortality gap relates, in part, to male privilege in terms of access to consumer goods. Many males use their privileged status to buy alcohol and cigarettes, things that harm their health. Then I did a project with the School of Public Health and Grady Hospital on untreated tuberculosis and treatment compliance with HIV. Most of the men with active tuberculosis were hiv positive due to drug use. So I began to see that tb was also a problem of addiction. The underlying issues again were social and had to do with addiction and inequality.
There’s a tremendous opportunity in recognizing the sociological and cultural factors underlying addiction, because it’s related to a whole host of other markers of ill health. The overall culture of science and medicine, though, tends to see this social stuff as “noise” and focus on technological solutions.

AE What is the cultural ecological model that you use in your study
of disease?

PB This is a standard model in medical anthropological theory. Health can be seen as a marker of social processes that present particular threats to the individual. Humans have a dual system of inheritance—genetic and cultural. And though humans adapt genetically, cultural evolution is much faster and more important in understanding human behavior. Basically, cultural ecology describes the interactions among cultural systems and the local environment: human interactions, economic ones, settlement patterns, belief systems, and behaviors. Diseases, including addiction, are simply part of the environment.

AE What is the relationship between inequality and addiction?

PB Generally, societies that are more egalitarian in income structure—ones with less inequality—have better overall population health. Societies with more social cohesion have better health; the buzzword these days is “social capital.” But it’s very complicated. Even in relatively rich societies that have good access to health care, like Britain, there is this huge gap between the health of the rich and poor. My guess is that it has a lot to do with people’s perceptions of personal success or failure. In some ways the American dream sets up false expectations.

Sweden is interesting because it has a high level of general health markers and a high percentage of cigarette smokers. This suggests that smoking is not a one-to-one correlation with cancer. Swedes probably smoke less and do other healthy things more frequently. They’re not stressed out and chain smoking. They have more socially fulfilling lives.

AE Does treating addicts with medicinal drugs just change who profits from addiction in our society, from black market dealers and the prison industry to doctors and the pharmaceutical industry?

PB On one hand, that cynical view has some merit. On the other hand, state regulation has benefits—on the quality of the legal drug, for example. The Soviet Union has a terrible problem right now with alcohol abuse—lots of death from alcohol poisoning and adulterated vodka, black-market vodka. It may be
that in places where it’s less of a black-market problem, people can manage their addictions in a healthier way.

Part of my other interest is in Italian studies. I’ve been studying Mafia culture in Sicily. I’d much rather these exorbitant profits be made by the white collar gangsters, the pharmaceutical companies, than by organized crime. Ultimately, there will be health benefits. And if you know who is profiting, you can ask: are there limits to what profitability should be? And at what point do we have a public health disaster that makes us think about the ethics of profiting from human misery?

The drug companies have a public face and can be shamed. And they’re generally good people who want to improve people’s health. The Mafia doesn’t want
to do that. Cigarette companies don’t want to do that. I think there may be real opportunities now if people realize that the “War on Drugs” using a military battle plan against drug supply has failed. But I’m not sure policy makers really understand that or that Americans are as embarrassed as they should be about the complete social failure reflected in our high rate of incarceration. There
is something dreadfully wrong in a society that has such a high percentage of people who are in prison and kids growing up with the expectation that at some point they will be in prison.

Peter Brown is a medical anthropologist.