Book Review

On Speed: The Many Lives of Amphetamine

N Engl J Med 2008; 359:2182-2183November 13, 2008

Article

On Speed: The Many Lives of Amphetamine
By Nicolas Rasmussen. 351 pp., illustrated. New York, New York University Press, 2008. $29.95. ISBN: 978-0-8147-7601-8

In this book, Nicolas Rasmussen tackles a topic that is important to the readership of the Journal. Unfortunately, he appears to be biased from the start, and his bias leads him to conclusions that do little to solve many of the problems he raises in the book. For example, Rasmussen begins by stating in the introduction: “Ultimately, this book is about the way age-old human fantasies of magical cures and elixirs of youth live on in the age of science-based pharmaceuticals. It is about the place drugs have come to occupy in our culture, and the role they play in medicine. It approaches these general questions through the remarkable and unique history of amphetamine, or `speed' as it has long been known colloquially.” Rasmussen concludes his introduction by saying, “The story of amphetamine encapsulates America's love affair with pharmaceuticals, and that story now needs to be told.”

I agree that the story of amphetamines should be told, but Rasmussen's story often appears to be unfocused and based on the conclusion that amphetamines (and many other medications) produce more harm than good, should not be used, or — at most — should rarely be used. For example, he begins by describing the origins of “scientific medicine” and the experiments with amphetamines that Gordon Alles began in the 1920s. Rasmussen goes on to describe how Benzedrine, an amphetamine, was marketed to treat depression, and how amphetamines were given to soldiers throughout World War II, supposedly to improve their performance and to prevent them from sleeping. However, he gives a selective review of the amount of Benzedrine that was used, and he presents notes from medical officers in the field. He describes how the British and German military, in postwar summaries, reported that amphetamines compromised the soldiers' ability to perform complex tasks, whereas the U.S. military did not arrive at similar conclusions until the mid-1950s. A more balanced presentation would have provided information about the factors that contributed to these different conclusions.

Rasmussen presents a lengthy description of how amphetamines were used in the practice of medicine but were also abused and diverted. Later in the book, he describes how the supply of amphetamines grew until the early 1970s, when the Bureau of Narcotics and Dangerous Drugs (a predecessor of the Drug Enforcement Administration) classified all amphetamines as Schedule II drugs. As a result of this change, production quotas that limited the manufacture of amphetamines were imposed, which caused a decline in their use. In his story, Rasmussen goes back and forth between sections on the abuse of stimulants and the medical uses of stimulants and selective serotonin-reuptake inhibitors for the treatment of depression. He asserts that these medical uses of amphetamines led to what he calls “the medicalization of social problems.” Instead of giving a balanced view of how medications, with psychosocial interventions, may actually benefit many patients with psychiatric disorders, he states, “Perhaps we should consider that the problem lies instead in a sick social system fundamentally at odds with natural human capacities and fulfillments.”

Rasmussen concludes that harm reduction should be used to combat illicit drug use and that the United States should adopt “the sort of national health insurance systems” that “deliver equally good or better health at a fraction of the cost.” Although these approaches have merit, he brings them up only at the very end of his book. In his conclusion, he says nothing about how proven medications such as methadone, used in conjunction with proven psychosocial treatments, may also be important interventions for some patients with opiate and other substance-use disorders. Instead, he states, “All these factors together mean that the drug industry, in its normal course of business, still generates a constant threat to society: thanks to company marketing, the wrong drugs may be prescribed to the wrong people, or excessive drugs to suitable people.” However, it is also true that the pharmaceutical industry is helping to develop the right drugs for the right people, and this should be acknowledged. If Rasmussen had put more thought into how harm reduction and the implementation of a national health service might work in the United States, his book would have been much more useful.

Michael A. Dawes, M.D.
University of Texas Health Science Center at San Antonio, San Antonio, TX 78229
dawes@uthscsa.edu