The marketing of sex hormones
You don’t have to be a very keen observer to notice that today hormones are everywhere: not only in our language but also in hospitals, chemists’ shops, even in women’s dressing-cases. The introduction of the hormonal model of the body has been very successful, particularly for women. Women all over the world take hormonal pills to control their fertility, for menstrual or menopausal problems, or as abortifacients. The hormones estrogen and progesterone have become so popular that they have developed into the most widely used drugs in the history of medicine (Wolffers et al. 1989).
How can we understand this success story? What intrigues me most is that it is the female body that became increasingly subjected to hormonal treatment. What about men and hormones? Maybe we might be inclined to think of a male conspiracy: women take the pills, while men cash the bills. We might consider the enormous profits of pharmaceutical firms. To be honest, I am not very much attracted to these types of explanations, particularly because they do not give us any insight in how the medicalization of women’s bodies takes place. Recently, feminist scholars have suggested that feminist inquiry should go “beyond the inadequate but often terminal analysis that men are the problem” (Clarke 1990a:10; Haraway 1988:575). Interpretations of the successes of science and technology, whether they are framed in terms of the interests of men or pharmaceutical firms, suffer from the same problem: they consider interests as a given, a reality that does not need any further explanation.1 However, if we adopt the view that the natural world is not objectively given, it seems inconsistent to make an exception for the social world. I am more in favor of an approach that enables us to conceptualize both worlds as social constructions that are continuously shaped and transformed by human actions. Interests, just as facts, are not objectively given but collectively created.
What I would like to know is how interests are shaped together with the technology-in-the-making, in this case the making of hormones into drugs. I chose to focus on clinical trials as a specific site where the shaping of technologies and interests takes place. A crucial aspect of the pro-cess of drug development is that one specific working pattern is selected from a large number of possibilities. This selection process takes place in specific
test procedures (clinical trials) in which the drug profile—as it were, the “nature” of the drug—is defined (Vos 1989:278). The question that emerges now is how and when this testing takes place. Social studies of medical technologies provide two strands of explanation for how we can understand the development of medical technologies such as drugs. The sequential or linear model of technology development assumes that technologies are thoroughly tested before being adopted. This model suggests that the testing procedure in which the final drug profile is selected takes place prior to the marketing of drugs. More recent studies of the development of medical technologies suggest, however, that technologies are usually adopted before they have been thoroughly tested. This literature suggests that the diffusion of new drugs occurs together with research and testing (Bell 1986:5).
The adoption of this model of technology development enables us to understand technologies and interests as products of mutual alliances and dependencies among the groups involved in the testing and marketing of medical technologies. In this view hormonal drugs are neither ready-made laboratory products that are subsequently marketed to their audiences, nor are they compounds simply discovered in nature. The specific “nature” of the drug and the interests that become embodied in it are shaped in the networks of the different groups that called hormonal drugs into existence. I describe how the making of hormonal drugs took place in the triangle of the laboratory, the pharmaceutical industry and the clinic, with clinical trials and advertising strategies as major marketing devices. To understand how these groups transformed sex hormones into specialized drugs, I shall focus once again on The Netherlands. This chapter begins with a brief description of the position of the Dutch pharmaceutical company Organon. Next I analyze in detail the promotion of sex hormones by Organon and Laqueur, focusing on the specific patterns of medical therapeutics for women and men that emerged from this joint venture.