ABSTRACT
THE AIDS EPIDEMIC, SUDDENLY AND SYSTEMATICALLY, is transforming American attitudes and practices about the regulation and use of drugs. In the 1970s, as psychiatrist Gerald Klerman (1974) astutely observed, Americans were pharmacological Calvinists and psychotropic hedonists, that is, ever so cautious and sparing about the drugs they took in the pursuit of health, and ever so open and daring about the drugs they took in the pursuit of pleasure. This orientation had rather odd effects not only on personal behavior (a reluctance to go on an antibiotic, no reluctance to try the newest sensation-expanding compound) but also on the direction of public policy. With a minimum of intellectual discomfort liberals simultaneously advocated that the government keep its regulatory hands off pleasure drugs (for example, legalize marijuana and heroin) and expand the authority of the Food and Drug Administration (FDA) so that, as we shall see, drugs like thalidomide would be kept off the market. Now, in the 1980s and in the tide of the AIDS epidemic, these attitudes are being reversed. In the case of AIDS, the response is pharmacological hedonism–a willingness to try any drug with the whisper of a chance to halt the deadly progress of the infection–and there may be an insurgent psychotropic Calvinism – a mounting insistence on the fact that drugs can kill, indeed that pleasure (including sexual pleasure) is dangerous. And once again, these attitudes are restructuring 448policy. They encourage, at one and the same time, a war on drugs and a war on the FDA and other regulatory bodies–like the institutional review boards (IRBs)–that stand between the consumer and the drug manufacturer. In the course of this article, we will be focusing on the pharmacological side of this dualism, leaving to others to ponder the changes that AIDS may be bringing to psychotropic (and sexual) hedonism. The transformation in the pharmacological arena is of such critical dimensions as to well warrant full attention.
