This research paper considers the problem of prescription of improperly checked drug and its harmful influence on human body from the perspective of Durkheim’s social theories and studies. Much information was taken from the book DES Daughters by Susan E. Bell. It provides historical overview of diethylstilbestrol use, as well as information about numerous scientific researches of this drug. Moreover, the writer’s opinion and examples of diethylstilbestrol use elucidated the problem more clearly. In this research paper the general history of DES is presented as the background and historical confirmation of Durkheim’s social theories.
The background of D.E.S. Tragedy
This research paper will pay much attention to transformation of society from mechanic to organic. This transformation was thoroughly discussed by Emile Durkheim in his works. We should apply to historical events in order to gain better understanding of his ideas.
The beginning of the 20th century was rather difficult period in the history of the USA. The country faced such a problem as lack of population. New workers were required to build up the infrastructure, to work in factories, and to develop economy and science. Moreover, thousands of people died in the World War II. The country required accession of human resources. One of the possible solutions was found in the increase of birth rate. Nancy Langston in her book Toxic Bodies supported this idea by the following: after World War II there was tremendous pressure for women to have children quickly. The government of the USA and the medication authorities tried to prevent certain diseases and to provide support of human health. Diethylstilbestrol (or DES) was proposed as a drug, which was supposed to have considerable positive effect on women’s health since it could decrease the rate of miscarriage. Doctors recommended DES to thousands of women from 1940s to 1970s. Unfortunately, insufficient experiments and investigations were held. There were no incontestable proofs of positive influence of this drug on women’s health. The Food and Drug Administration (the FDA) made a decision to prescribe DES into masses based on the strong belief that the drug would provide great benefits to society, such as decreasing expenses, saving time of medical workers, and enhancing birth rate, which directly influenced the number of population. The decision to use diethylstilbestrol belonged to medical representatives, which cared about the whole community, but not about particular individuals.
In the 1950s, medical researches proved that diethylstilbestrol had the same role as placebo in miscarriage prevention. Nevertheless, it was still prescribed to women because of strong belief of its positive effect. The number of women who addressed to their doctors, indistinctive splash of DES daughters’ cancer and pressure of society obliges the administration and medical authorities to perform additional investigations and experiments of DES influence. Doctors stopped to prescribe diethylstilbestrol only in 1970s after presentation of definite and unquestionable research results concerning its harmful effects.
DES. Effects on Women and Their Children is a background of evolution
The evolution of the society is rather long-lasting process. Community should understand it’s mistakes and faults. Durkheim stated that evolution of social mind is grounded on particular examples. The medical authorities and society needed almost thirty years and hundreds of disabled women’s lives to understand that health of particular individual is of highest priority compared to community needs. Errancy related to positive effect of diethylstilbestrol made people understand that medicine should be focused rather on personal health than on the benefits of community. The story of DES daughters reveals historical transformation from mechanical solidarity to organic solidarity of society.
Popularization of Diethylstilbestrol
In this particular research paper diethylstilbestrol is considered as a means of obtaining one join benefit for the full community. On the one hand, it is a very beneficial goal. However, on the other hand, any social alternatives should consider not only overall benefits. Durkheim in his social works showed that basic goals of mechanical society usually have noble backgrounds. These backgrounds are shown in the earliest history of using D.E.S.
Diethylstilbestrol was created in 1938 by Sir Edward Charles Dodds. The scientists were searching synthetic estrogens that could be easily and inexpensively made to treat symptoms of menopause. This drug was initially used for regulation of menopause, i.e. for production of regular menstrual cycle. DES replaced estrogen in women’s bodies and created some kind of new controllable menstrual cycle. It could be used for medicalization of pregnancy, suppression of lactation and menopause. The government and medical authorities foresaw a great benefit of this drug to society. Diethylstilbestrol was some kind of panacea, which could improve women’s health and increase birth rate. This drug could be solution to one of the greatest problems of American society at the beginning of the 20th century, which consisted in lack of people. The country needed new workers, new scientists and economists, as well as new soldiers in the post-war period.
Those intentions to increase birth rate can be explained by social theories of Emile Durkheim. According to his theory of functionalism, every community strives for social equilibrium. It means that if something happens to disrupt the order and the flow of the system, society must adjust to achieve a stable state. Different social institutions intended to find a solution to the problem of lack of labor force. The solution was found through development and implementation of new preventive measures to exclude possible illness. The government and medical authorities tried not just to treat a particular individual from a particular disease. Their efforts were directed to the whole society. They had the aim to develop and synthesize preventive medications against possible future illnesses and disorders.Durkheim relegated such intentions as characteristics of mechanical society. This society uses punitive measures for implementation of ideas directed towards obtaining benefits to the whole community. At the same time, interests of separate individuals are infringed. Moreover, lives of people could be endangered by inappropriate and even wrong treatment for the sake of the final aims’ achievement.
However, the medical authorities directed their attempts to reach the general benefit to the community, blenching some negative results of experiments. The social learnings of Emile Durkheim explained such events as attempts of the mechanical society to promote and move its ideas notwithstanding any obstacles. Therefore, in 1938, clinic researchers focused their attention on investigation of the effect of diethylstilbestrol on human body. It should be mentioned that at that time estrogen therapy was costly, time consuming and sometimes painful, because women could be treated only with injections, and each injection required a visit to a doctor. Prescription of diethylstilbestrol provides such benefits as saving time and money (on production), and decreasing pain. DES was taken orally, which did not require any injections and visits to doctor’s office. Moreover, diethylstilbestrol was not a patented drug, which meant it could be welcomed for clinical trial with guarded hopefulness throughout the world.
However, there were some suspicions concerning absence of diethylstilbestrol’s side effect on people’s health. The abovementioned obstacles were educes during several anima land clinical studies in1939. The animal studies showed carcinogenic effect. Clinical studies provided that about 80 percent of examined women, which took the drug, suffered from gastric intestinal distress. Medical scientists faced considerable uncertainty, because diethylstilbestrol was potentially so beneficial yet potentially so unsafe. The final decision about DES spread was imposed on the Food and Drug Administration (the FDA). It was a federal agency that enforced regulations, which required actual proofs of safety of any new medication, including diethylstilbestrol. Emile Durkheim in his studies stated that any government and the society have some kind of ‘control arm’ which can perform supervision and control over certain kinds of social activities. The FDA represents such institution in the USA in the middle of the 20th century. Only the FDA had the right to determine whether a drug is safe and to decide whether it could be prescribed to the majority of people. The administration based its decisions on consultation with pharmaceutical producers and clinical investigators. Emile Durkheim stated that characteristics and intends of mechanical society spreads on different parts and institutions, but not only on particular organization. So, ideas of gaining joint benefit were close to clinical investigators and pharmaceutical companies. The decision of possibility of D.E.S. prescription was taken jointly in background of different representatives of American community.
Social theories of Durkheim are supported by Nancy Langston in her book Toxic Bodies points to many dedicated investigators and concerned politicians who worked in the past to protect human health. The author states that the USA government and the medical administration chose the health of big business over public good, and . . . skillfully manipulated scientific uncertainty to delay regulation.
Thus, in 1941, DES prescription was approved for treatment of menopause, senile vaginitis, juvenile vaginitis and lactation suppression. The medical authorities of so called mechanical society tries to testify it’s decisions by avoiding and prevention of any possibility of distrust. They wanted the society to be totally sure concerning necessity and justifiability of their actions. It should be also mentioned that a special release for sale of diethylstilbestrol was made: after one of the most thorough investigations ever given a pharmaceutical order. Moreover, the information concerning any possible risk of taking diethylstilbestrol was not available to women because it was not included with the drug. Nancy Langston in her book Toxic Bodies noted that the medical authorities and the government of the USA did not just fail in regulation of harmful effect of DES on women’s bodies, but they had skillfully manipulated scientific uncertainty to delay regulation.
Durkheim in his works described such attempts as main characteristics of mechanical society – the society where interests of individuals are less valuable than interests of the community. Final decision of new drug popularization was taken not on the basis of precise and long-lasting researches and experiments. This decision was based on attempts to obtain general benefits to the whole community by saving time and money on unsubstantiated health improvements. Numerous factors were taken into consideration while making a decision about possibility and necessity of DES prescription. These factors are lesser pain, saving time and money, absence of patent for this drug and decreasing visits to doctors. However, there was no any incontestable confidence of positive effect and absence of negative influence on women’s health. Moreover, some medical researches showed that DES could lead to gastric intestinal distress. The Food and Drug Administration also misled millions of women and doctors by giving incorrect release to sale and by proving safety of the diethylstilbestrol.
DES Growing Popularity
It is notable that intends of the ruling leaderships of mechanical society are spreading on common people. Social characteristics are applicable to all levels of the community. So, when someone says that the society is mechanical, so representatives of different professions have characteristics of mechanical society. Not only the medical authorities realized their intends of overall benefit. Common medical workers tried to stipulate realization of the idea of joint benefit.
Doctors started to prescribe DES to women in 1941. As it was mentioned above, the Food and Drug Administration gave approval for prescription of diethylstilbestrol only to women, which had problems with menopause, senile vaginitis, juvenile vaginitis and lactation suppression. However, researches and experiments of diethylstilbestrol were not stopped after final approval of this drug by the administration. The medical scientists wanted to increase the positive influence of the drug on women’s health. The most notable researches of DES were performed and published by George Smith and Olive Watkins Smith. In 1946, they developed special treatment regime for the use of medication for pregnancy that began early, increasing dosages over time, and ended in the thirty-fifth week of pregnancy. In course of time, the drug was prescribed more widely. Susan E. Bell in her book DES Daughters stated that diethylstilbestrol was recommended not only for women, which were under high risk of miscarriage (with diabetes and those who had repeated miscarriage). DES was prescribed to women without any illnesses for increasing the possibility of having larger, healthier or happier babies. It is apparent that a policy of prevention was effective. However, doctors started to give drugs in order to prevent, but not to treat. Medical authorities did not perform one of their major functions – to make a right diagnosis and carry out a favorable treatment. Health of each particular woman was endangered because of incorrectly checked medication. Diagnosis itself should help to organize illness: identifying treatment options, predictingoutcomes, and providing an explanatory framework. It should provide guidelines for medical care of patients. Brown in his works stated that understanding diagnosis provides an important insight into how we understand disease, health, illness and the forces which shape our knowledge.
Only doctors and medical institutions have right to make investigation of patient’s condition, define health and prescribe treatment. This right is given to them by official authorities and society. Diagnosis itself represents a link between society, the medical authorities and individuals. It gives an understanding about what is accepted by society as normal condition and what condition should be treated. The American medical authorities decided to treat even healthy women in order to make their children healthier. Moreover, ability to make a right diagnosis is a vanishing characteristic of professional medicine: the ability to construct a medical diagnosis from a complaint and physical or biological findings sets the doctor apart from the lay person and other professionals, confirming the medical practitioner’s greater knowledge and status, as well as medicine’s authority. In case of DES approval and its further prescription to women, the medical authorities and doctors educe themselves as unprofessionals, which could not be trusted by people.
In his works, Ivan Illich provides explanations of connection between preventive measures and failure of medical workers to make a right diagnosis and to prescribe the right treatment: once a society organizes for a preventative disease-hunt, it gives epidemic proportions to diagnosis. This ultimate triumph of therapeutic culture turns the independence of the average healthy person into an intolerable form of deviance.
Development of the Society and Doubts Concerning DES
Society undergoes considerable changes in the course of time. According to Durkheim, human mind and deeds transform from orientation on community needs to personal orientation (Wallace, 35). Scientists perform new experiments and investigations in order to improve human life and health. These processes lead to new researches of diethylstilbestrol and its influence on health.
William Dieckmann performed several clinical investigations of diethylstilbestrol in the 1950s. The scientist proved that DES was no more effective than a placebo in preventing miscarriage. It means that this drug did not perform its main function – stipulation of childbirth. However, it was still prescribed to women of different age. Susan E. Bell in her book DES Daughters stated that only after DES was identified as the first trans placental carcinogen in 1971 did FDA officials finally circulate a warning to physicians to stop prescribing it during pregnancy.
Transformation of mechanical society into organic society is closely connected with Durkheim’s term ‘anomie’. This term relates to condition of social structure when personal needs, such as to be healthy and to be able to give birth to healthy children, are no longer regulated by common norms. Therefore, people are left without moral guidance in the pursuit of their goals. The Food and Drug Administration recognized its mistakes in providing approval for unsubstantiated drug. The FDA no longer regulates and prescribes use of DES by pregnant women. Durkheim named such a state of social affairs.
The evolution can not be stopped immediately. The medical administration did not only recognize its mistakes. It tries to make more thorough examinations of them in order to obtain better understanding of the caused harm. Durkheim stated that such intends are one of the main characteristics of the organic society. So, the future studies proved that diethylstilbestrol was not only useless in treatment of miscarriage, but this drug led to considerable health problems of pregnant women and their children. Arthur Herbst performed medical investigations and linked prenatal exposure to DES and reproductive tract cancer in DES daughters. Nancy Langston in her book Toxic Bodies stated thatdiethylstilbestrol caused significant increase (< 0.01%) in cancer in young women who were exposed before birth. According to Susan Bell, about 28 percent of DES daughters were unable to conceive after a year of unprotected intercourse, compared to 16 percent of women not exposed to DES and about 24 percent of DES daughters were never pregnant compared to 18 percent of women not exposed to DES. DES women also suffer from ectopic pregnancy, having lower possibility to give birth to a full-term infant. Moreover, there is a high incidence (> 90%) of non-cancer reproductive abnormalities in both male and female offspring.
Repairing the Damage Done
Durkheim stated that final point of transformation from mechanical society to organic one is turning their attention from community to individuals and reimbursing the damage done to individuals by society (Wallace, 67). The medical authorities diverted their attention from DES problem in the middle of 1970s. Medical and biomedical scientists performed manifold researches and experiments all over the country. These experiments were carried out by both private cancer organizations and state health departments. Different public education programs were developed and implemented in San Francisco area. The government and medical authorities tried not only to recognize their awful mistake of approval and prescription of diethylstilbestrol to women. They tried to find the way to recompense the damage done to individual’s health. At the present moment, millions of dollars are provided for treatment of illness connected with using DES, as well as for further experiments of this medication influence. There are considerable changes not only in understanding of the role of personal health in the community. Great socio-technological changes were made in medical sphere: informatisation of medicine, where the body is seen as a system of information networks … evidence-based practice…information once restricted to medicine is now available to the lay web-surfer, and the doctor-patient relationship becomes a meeting of experts.
This research paper presented a case study of how prescription of DES was used as an example of serious health problems of particular people which can arise from the negligence of the medical authorities and intends of the society to obtain benefit for the whole society but not to provide benefits for particular personalities. The history ofdiethylstilbestrol consumption, experiments of this drug, its approval and prohibition by the FDA reflected a path of the medical authorities and the whole American community from mechanical to organic society. The history of DES usage from 1940s till 1970s reveals that the abovementioned transformation of social consciousness and medicine was done at heavy cost of harmed health of several generations of Americans.