MASS MEDIA REPRESENTATIONS AS

DRUG INFORMATION FOR PATIENTS:

THE PROZAC PHENOMENON

Michael Montagne, Ph.D.

Massachusetts College of Pharmacy, 179 LongwoodAvenue, Boston, MA 02115, USAE-mail: mmontagne@mcp.edu

ABSTRACT

Results of a 20-year study of mass media representationsof antidepressant medications and their use are presented.The recent Prozac phenomenon stands out as a primaryexample of media-generated drug information for patients.Various forms of mass media are important in providingperceptions of the effects, benefits, and safety of these newantidepressant drugs. Clinical research, however, suggeststhat the latest generation of antidepressant medications isno more effective in treating depressive symptoms than thefirst generation, tricyclic antidepressants. Yet, these new anti-depressants have become the model drug not only for treatingdepression, but also for cosmetic psychopharmacology.[Translations are provided in the International AbstractsSection of this issue.]

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Copyright & 2001 by Marcel Dekker, Inc. www.dekker.com

SUBSTANCE USE & MISUSE, 36(9&10), 1261–1274 (2001)

Key Words: Prozac; Anti-depressant; Media study; Patientdrug information; Cosmetic psychopharmacology

INTRODUCTION

Patient demand for specific prescription medications is a growingphenomenon, related to the growth in general consumer consciousness. Inaddition, patient demand in a social context has been influenced greatlyby changes in the marketing of products, in the amount and nature ofdrug information directly accessible to consumers, and in the ways inwhich new prescription products and medication use problems are reportedin the mass media.

Knowledge, attitudes and behaviors involving medications are gen-erated and directed by the perceptions that people hold regarding thespecific drug products they give and take. Great differences in knowledgeand behavior can occur between patients and health professionals.1

Patients seek beneficial drug products to help them achieve their goalsof health and wellbeing. Drug users are rarely concerned about drug activityat the cellular or physiological level. They instead focus on drug effectsexhibited at physical and behavioral, or everyday life functioning, levels.Most drug consumers have their conceptual system grounded in the drugexperience itself at the behavioral and personal levels.2 Effects attributed byusers to specific drug products are the primary reason for initial or continualuse of those medications.3

Health professionals, who prescribe medications, counsel patients, andprovide drug information, tend to focus much more on the cellular andorganal levels of experience. In their perceptions of drug effects (in essence,they really focus on drug action), they often do not provide information thatthe patient or consumer needs, descriptions of drug effects at the behavioralor social level and the impact of drug use on their lives.

Health professionals’ perceptions, for example, highlight the activityof drugs at the molecular and cellular level. They assume most biologicalactivity equates directly to the basic physical and mental effects observed inusers. Health professionals seek optimal therapeutic effects, and they hopeto limit or prevent side effects. They focus, then, on organ systems and thephysiological and psychological, or clinical, responses they observe in theirpatients. Not all health professionals, however, perceive drugs in thismanner. Some of them may hold perceptions that are similar to patientsor that represent a different viewpoint of disease processes based onmind–body relationships and the power of the mind to affect physical states.

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ROLE OF MASS MEDIA IN THE

PERCEPTION OF DRUGS AND DRUG USE

Drug use is an everyday occurrence experienced by most people either

directly through the giving and taking of medicines, or indirectly through

interactions with other people about their drug experiences. We have heard

and read lately, for example, about serotonin and melatonin, natural drugs

in our body, and about new medicines, like Prozac, that have activity on

serotonin. What is the impact of various sources of information on the

creation of perceptions about drugs and drug use?

Collective social knowledge has become instrumental in the develop-

ment and transmission of perceptions about prescription medications,

including psychoactive drugs like Prozac.1,4,5 Social knowledge refers to

the cumulative knowing of something, based mostly on available informa-

tion and past experiences. What an individual or group of drug takers

knows about drugs, from reading information, listening to the media and

promotional campaigns, receiving descriptions of others’ experiences, and

recalling their own previous experiences, will affect the actual use of drugs.1

Social knowledge, individually, represents that person’s awareness and

understanding of concepts, phenomena, and events. A lack of social know-

ledge about symptoms, illness, treatments, and medications allows a con-

sumer to be affected more often by external factors and processes. Social

knowledge also has a symbolic component.1,6 The nature and meaning of

drug taking often is described, remembered, and transmitted through a

society in a symbolic form, as images, representations, or metaphors. The

imagery and symbolism of some promotional campaigns and mass media

reports may suggest that a specific medication promises to solve problems of

health and life in mythical ways.

In addition to accounts and reports in newspapers, magazines, on

television and radio (and also more recently, the Internet and related elec-

tronic media), media-generated perceptions about drugs also are derived

through advertising.7 In the United States, direct-to-consumer advertising

is an increasingly popular approach wherein drug products are promoted

for poorly or newly defined health problems. It is the promotion of the

availability and/or characteristics of a prescription drug product to the

general public through mass media. These promotional campaigns consist

of ads that inform or increase awareness about certain diseases and the

availability of treatment options, or ads that actually mention specific

products. Some drug ads, recently, are not intended to increase awareness

about a specific product, but rather, they guide or even dictate prescribing

behavior.8

THE PROZAC PHENOMENON 1263

A great deal of recent mass media activity has focused on the newantidepressant drugs (e.g., selective serotonin-reuptake inhibitors likeProzac). Many patients and health professionals believe that these newantidepressant drugs can improve a person’s way of living and evenchange the mood and feelings of healthy people, if they want to do so.Patient advocates and drug consumer groups believe and report that someantidepressant drugs produce seizures and abnormal dreams, cause patientsto become suicidal, and are misused by people who are not really sick. Areall of these ‘‘effects’’ caused solely by a substance that has activity onserotonin in our bodies?

Patients obtain information about the drugs they use from a variety ofsources. Past surveys of patient-information seeking have indicated thatmedia sources, especially print media, television, and drug advertising, aremore important than health professionals in learning about new drugs andtheir effects. As part of an ongoing study of media (US) portraits of drugsand drug use, an analysis of the images and representations of new anti-depressant drugs and their use in mass media was performed.

STUDYING MASS MEDIA REPRESENTATIONS

OF ANTIDEPRESSANTS

This study examines what we know about certain antidepressantdrugs, and how we have arrived at our current collective knowledge. Theprimary goal of this study was to identify specific media representations ofan antidepressant drug, Prozac, to examine these images in comparison withknown pharmacological and clinical information regarding this drug, and tobegin an assessment of the impact of these images on patients’s use andexperiences.

The data presented in the four tables herein come from a large scalereview and analysis of American mass media over the past two decades. Inthe larger study of media representations of drugs and drug use, a systematicidentification, collection and analysis of various media sources has beenone method for determining how people perceive drugs and drug effects.The primary sources of data are magazine and newspaper accounts andreports, drug advertisements in professional journals (and more recently,popular magazines with the advent of direct-to-consumer advertising),books for the general public, television, and a few related forms of media(e.g., theatrical plays, cinema, comics, and electronic media such as theInternet). One sub-category of data collection has been psychoactivedrugs, including antidepressants.

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For popular magazines, major newspapers from large urban cities,books, cinema, and theatrical plays, databases and abstracting serviceshave provided the universe (or nearly so) of relevant items and eventsthat have involved antidepressant drugs. For instance, the best example isthe abstracting service, Reader’s Guide to the Periodical Literature, whichidentifies and categorizes stories and reports from all major national andregional popular magazines in the US. A similar newspaper database pro-vides information for 10 major urban newspapers in the US. Information onpublished books (Books In Print), cinema, and theatrical plays come fromguides and annual reviews of these media. Most of the other data andinformation has been collected in a non-random manner, due to a lack of(or lack of access to) a database for the other forms of mass media.

For antidepressant drugs, mass media reports and accounts havebeen collected as far back as 1970. For this study, however, the focus willbe on the past 10 years, approximately the time of the introduction of thefirst selective serotonin-reuptake inhibitor, Prozac. The results presented inthe four tables are derived from this large-scale media study. In a fewinstances, the results will provide some background information on all cur-rently available antidepressants to provide a social historical context to thediscussion.

The images, representations, and metaphors uncovered in this studyare those labeled and defined by patients’ and health professionals’ based ontheir descriptions of antidepressant drugs they use. These metaphors aregenerated by different sources, identified through an analysis of massmedia, drug advertising, and societal discourse. The intended meaningand the reasons for the creation of these metaphors can vary, so it is impor-tant to note, if possible, when the source is the patient, the healer (or healthprofessional), the pharmaceutical manufacturer and promoter, the socialresearcher, or media commentators. In many instances, however, it isdifficult to know the original source of a metaphor, or there is the problemof a complex intertwining of a metaphor amongst different sources.

MEDIA REPRESENTATIONS OF

DEPRESSION AND PROZAC

The results of this analysis of mass media representations of Prozacportray an extensive and deeply-rooted cultural awareness of this drug. Overthe past 20 years, the greatest frequency of magazine and newspaperaccounts and reports of antidepressant use has peaked during threetime periods (see Table 1). The first time period (1977–78) represented aprevious time of increased societal concern about depression, and the

THE PROZAC PHENOMENON 1265

tricyclic antidepressants were the only drugs of choice. The second timeperiod (1980–82) represented a period during which a new (second) genera-tion of antidepressant drugs (tetracyclics and others like trazodone) wereintroduced to great expectations, that eventually were not fulfilled. The thirdand most recent climax of media interest about antidepressants representedthe Prozac phenomenon.

Magazine and newspaper reports of antidepressant use, includingProzac, occurred with greatest frequency in the months of March andOctober (Table 1). An explanation for October is apparent, in theNational Depression Screening Day takes place nationally early in thatmonth and other health and politically related events (in anticipation oflocal and national elections in early November) also occur with regularity.No explanation has been ascertained yet as to why so many antidepressantstories occur in the month of March.

Much of the focus of reporting and subsequent societal response toProzac in particular represented a renewed emphasis on the disease, depres-sion, by federal health agencies, health professional organizations, andpatient advocacy groups. While neurophysiologic and clinical researchhave centered on a biological basis for this disease, usually pertaining toneurotransmitter malfunction or genetic causes, the popular media hastaken almost any published study (regardless of the nature of inquiry orsoundness of methodology) and reported new personal, psychological, andsocial causes for depression (see Table 2). Thus, through the popular media,segments of the general public have come to think and believe that depres-sion is caused by leisure/pleasure time (holidays and vacations), or urban,technological, and industrial 20th century living, or even by a specific age orgender.

By the spring of 1990, Prozac was on the cover of Newsweek, Time,and the New Yorker, major popular magazines, being proclaimed as the newwonder drug and a new weapon in the fight against depression. In fact, theappearance of a Prozac capsule floating over a dry landscape on the coverNewsweek was the first time any prescription pharmaceutical product

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Table 1. Highest Frequency of Mass Media

Reports on Antidepressants by Year and Month

Year Month

1977–1978 March1980–1982 October1990–1994 (Prozac)

(and any drug other than heroin, cocaine, or marijuana) had occurred onthat magazine’s cover in its history. Prozac exploded into the mass mediaand the public’s consciousness thereafter (1992–94) with a number of pop-ular books (e.g., Listening to Prozac, Talking Back to Prozac, and ProzacNation), a theatrical play (Prozac Sisters), electronic video game (VirtualProzac), and talk-show visits by enthused therapists (one, a psychologist inWenatchee, Wash., was even called the ‘‘Pied Piper of Prozac’’ for encourag-ing about 20–25% of that town’s adults to try the drug).

In these media reports, Prozac was referred to primarily as the HappyPill, the Feel-Good Pill, and the Personality Pill. It was also presentedin some accounts as an ‘‘upper’’ (mood elevator or stimulant) and as‘‘speed’’ (slang term for amphetamines). Drug givers and takers employeda variety of images and metaphors to understand and describe their reasonsfor using Prozac and for the effects they experienced (see Table 3). Thesemetaphors for Prozac the drug range from those commonly applied to mostnew drugs (e.g., magic bullets, cure, safety net) to those seemingly unique tothis drug (e.g., like insulin for my mind/mood). The Prozac experience,effects attributed to this drug, represents a range of changes from thosewith some pharmacological or clinical basis (e.g., enhanced mood, betterlife) to those that have no known physiological basis (e.g., spiritual awaken-ing, or a new personality, especially in asymptomatic or non-diseased users).

These reports typically emphasized those sensational cases of drug useproblems or successes, in order to sell newspapers or airtime, present apolitical agenda, or encourage a moral stance. In the case of Prozac, atten-tion created by newsmagazine cover stories, best selling books, numerous

THE PROZAC PHENOMENON 1267

Table 2. Reasons for Depression

(in Mass Media Accounts)

Neurotransmitter (organic) malfunction

Other illnesses/medical conditionsGeneticOther drug use/misuseStressors of life/lifestyle (modern, urban)

Holiday seasonWinter (daylight hours)Summer vacations

Women (esp. post-partum)Children (of the 1980s and 1990s)Traumatic events (in personal life)

Later years (aging)

episodes of talk-shows, and other mass media seems to have resulted in both

a definition of Prozac and its effects, and an a notion of complete health

professional support, that arguably generated motivation in patients, and

any sufferers of supposedly the symptoms of depression, to seek prescrip-

tions for this drug.

Media accounts suggested that Prozac did a lot more than just influ-

ence the amount of serotonin in a person’s body, extending notions about

the indications of use beyond those recognized and accepted by most health

professionals (see Table 4). For users, this drug obviously relieved condi-

tions such as depression and PMS, and certain symptoms such as anxiety.

Users, however, also reported that Prozac produced other types of effects,

such as: elevated or changed mood, nervousness, anorexia, insomnia,

enhanced performance, a sense of calmness, reversed shyness, reduced and

enhanced sex drive, changed personality even in non-depressed people

(‘‘comestic psychopharmacology’’), enhanced spirituality, mania, drowsiness,

tremor, dizziness, weight gain and weight loss, a feeling of being ‘‘out of it’’

emotionally, excessive laughing or weeping, and a loss of concentration.9,10

Early media reports (1990–94) referred to Prozac as the pill that will ‘‘cheer

you up without side effects’’ and described ‘‘how science will let you change

your personality with a pill.’’11

In March 1994, Eli Lilly, after making untold millions of dollars from

the sale of Prozac (in fact, one of two new large buildings attached to the

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Table 3. Metaphors for Prozac and the Prozac Experience

Prozac as [is] Prozac experience as [is]

Magic bullet/wonder drug Life change (newer/better life)Cure/lifesaver Happiness/feel-goodPoison Moral weaknessControl Racing (speeding)

Speed (stimulant) New personality (better person)Upper/elevator Spiritual awakeningTool/vehicle/weapon Social control

Prison ImprisonmentLightness/darkness Battle/war (against depression)Support/crutch/safety net Survival

Fuel/tonic Nightmare/losing one’s mindGenetic correctorOther drugs (insulin,

antibiotics)

Mental peace/escape to pleasantsetting (Prozac Moment)

original skyscraper at the site of their corporate headquarters inIndianapolis is referred to by employees as the ‘‘House that ProzacBuilt’’), launched an astonishing advertising campaign. The campaign’sinformational, or perhaps promotional, focus was to condemn and suppo-sedly counter the ever-growing role of mass media in exaggerating the drug’smagical power and stunning effectiveness.12

A more recent popular book of anecdotal accounts from Prozac users,almost a decade after the drug’s introduction, has suggested diagnostic uses(though not approved indications) including: attention deficit hyperactivitydisorder, obesity, chronic fatigue syndrome, ulcers and other gastrointes-tinal disorders, and chronic pain.9 The ‘‘clinical’’ rationale for these uses, asstated by a promotional blurb on the book’s back cover, is that ‘‘in thesepages, the real experts – those who are taking antidepressants now – offerfrank testimonies that explore what it is like for them to take Prozac.’’ In thelatter part of 1997, advertising by Eli Lilly emphasized and celebrated the10th anniversary of this breakthrough drug discovery.

IMPACT OF MASS MEDIA ON PROZAC’S

EFFECTS AND USE

Mass media heightens public concern and interest about certain typesof drug use, through its ability to provide opportunities for the expression ofexpert and lay viewpoints and by structuring meanings into recognizableimages and conceptions.13,14 Knowledge about depression and its treatmentis created through a process in which fragmentary, restricted knowledge iscontinually transformed into certain and consistent fact. This allows for the

THE PROZAC PHENOMENON 1269

Table 4. Medical Versus Lay Views of Uses for Prozac

Medical views Lay views

Depression Mood changeAnxiety Personality changeEating disorders Weight lossGambling and other addictions Performance enhancement

Obsessive-compulsive disorder Excessive laughing/weepingChild behavioral disorders Shyness/hypersensitivityPMS (post-menopausal syndrome) Aggressiveness

Loss of concentrationPsychological problems in animals (pets)

creation of technical and moral realities that are given form and meaning

through collective social knowledge and beliefs, which can be invoked to

encourage certain behaviors.

It seems mass media is becoming the primary source of drug informa-

tion for many consumers. Little is known about many symptom states

and conditions that sometimes are considered diseases. In the real world

of medication use, humans often are not rational in making decisions to

use drugs. Patients often are not aware, or made aware by health profes-

sionals, of all possible treatment options in arriving at a therapeutic plan.

Access to information about drugs and their uses also is limited or

controlled by the producer of the drug product. There appears to be asym-

metry of medication information and its dissemination, a lack of objective

information, and uncertainty in the definition, recognition, and diagnosis

of diseases states. Many patients lack motivation to practice consumer

behaviors such as seeking information, exercising independent judgment,

and understanding costs.

This phenomenon of labeling drugs, drug taking, and drug users has

had an impact on the use of drugs in medical contexts. For instance, it has

been argued that the ritual of prescribing in a patient–physician encounter

has a significant symbolic component which can be beneficial, such as the

case of placebogenic phenomenon, or detrimental to optimal patient care,

as in the case of increased patient demand for drugs and inappropriate

prescribing.15 The act of taking a drug fulfills an ingrained habit: the

need to take something when confronted with illness. The culturally-based

interpretation of depressive symptoms and responses to them provides for

additional symbols that attach meaning to, and thus understanding of, the

depression experience. And the healer’s act of prescribing a drug enhances

and solidifies the interaction, reinforces the healer’s power to cure, and

provides the patient with a sense of satisfaction and resolution to the

problem.

Media-generated representations of antidepressant drugs are influen-

tial in the development of conceptions and attitudes toward specific

prescription products and of meanings that are attributed to their effects.5,16

These meanings, structured and expressed as symbols or metaphors, assist

drug users, health professionals, and general society in perceiving and

describing drug-taking experiences, and in actually directing drug-taking

behaviors. These meanings also are reflected in social drug policy, societal

discourse especially media accounts and promotional campaigns, and

drug laws and regulations. The meanings therefore are very important in

constructing social realities of antidepressant drug use, either personally or

at the societal level.

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With the dominance of biological reductionism in medicine andhealth care, there often are attempts to define problematic human behaviorssolely or ultimately in biological or biochemical terms. Medicalizationmay mystify the diagnosis and treatment of certain conditions, especiallythose with poorly-defined symptom states or diagnostic criteria.4,10 Theprocess of prescribing or suggesting a specific medication may reduce uncer-tainty and frustration for both the patient and physician, and it identifies thesolution to the problem. In essence, the symptom states become more clearlydefined in biological terms, and the diagnosis of a specific disease becomeseasier.

Imagery and symbolism of antidepressant drug advertisements cangenerate ideas in health professionals’, and also patients’, minds that prob-lems of health and life are easily or magically resolved by a substance.8,17

There are many examples of antidepressant medications being promoted for‘‘problems of life,’’ including the inability to cope with ordinary tension andemotional pressures, difficulties in personal relationships, stressful occupa-tions, and living in urban settings or industrial societies.7 The notion devel-ops in consumers’ minds that there is a pill for every problem; whether it bea personal problem such as irritation caused by heavy rush-hour traffic,tension and stress from one’s job, or the inability to have daily bowel move-ments; or a social problem such as child abuse, drug use ‘‘epidemics’’, oreven certain criminal behaviors.

What do we truly know about specific antidepressant drugs, likeProzac, and how do various pharmaceutical and social factors influenceconstruction of personal and societal knowledge about them? The Prozacphenomenon is one example of the extraordinary variety of drug effects thatusers can attribute to a single chemical agent. By examining the nature andmeaning of known actions and effects for this drug, the relationship ofeffects between levels of experience (from cellular to behavioral to social),and the process of constructing and transforming this social knowledge, wecan gain a better understanding of reasons for drug use and the developmentof drug-use problems.

Fluoxetine, referred to mostly by its brand name Prozac, acts atthe cellular level by inhibiting serotonin reuptake at the presynaptic neuro-nal membrane.18 Serotonin is a neurotransmitter, an inhibitor of activityand behavior, as well as a regulator of blood flow, food, temperatureand sex drives, and it also affects many other tissues and organ systems.Fluoxetine also binds with receptors in other neurotransmitter systems.Its precise mechanism of action, however, is still unknown. In fact, mechan-isms of action are unknown for all chemical types of antidepressants.Behavioral pharmacology studies suggest it has almost no dependenceliability, though accounts of some users suggest otherwise. Long-term

THE PROZAC PHENOMENON 1271

clinical outcomes and other effects from extended medical use have not

been assessed in well-designed experimental studies for any of the promoted

indications.

The US Food and Drug Administration (FDA) has warned some

pharmaceutical companies about claims they have made for certain

antidepressant drug effects in their advertising. While not approved for

such indications by the FDA, companies still have promoted these drugs

for symptoms of PMS relief, chronic low-grade depression, weight loss

and gain, and post-partum depression. One antidepressant (Zoloft) has

been promoted for treating patients suffering from depression after

heart attacks, though the company’s research suggests their drug

actually produces rapid heartbeat, chest pain, and variations in blood

pressure.19

Despite theories about the relationship between the neurotransmitter

serotonin and depression, the biochemical causes of depression are unclear

and no useful biochemical test or marker for depression has been identified

or developed. Most recent clinical reviews of Prozac and related third-

generation antidepressants have found that they are no more effective

in alleviating the symptoms of depression than the first-generation

tricyclic antidepressants.10 They offer symptomatic relief, but no cure.

Fluoxetine also has become the model drug in ‘‘cosmetic psychopharmacol-

ogy,’’ the alteration of personality and behavior by ‘‘normal’’ healthy

people.

These days, virtually everyone diagnosed with depression is treated

with an antidepressant medication. Most depressed patients are initially

resistant to taking drugs, but eventually they are induced to do so and

come to accept a biological explanation for their condition. A great deal

of societal attention has been focused on this drug. Media reports describe

how scientific insights into the brain are raising the prospect of made-

to-order, off-the-shelf personalities. Personal, social, and cultural effects

attributed to fluoxetine, under its brand name, may, in fact, have little to

do with the drug’s activity on certain physiological systems.

Future research must focus on the growing impact of mass media

accounts on both patients’ and health professionals perceptions of anti-

depressant drugs. While the generation of media representations of anti-

depressant drugs is clearly connected to users’ perceptions, their actual

dependence on these notions with regard to decisions to use, or not to

use, these drugs still remains unclear. And the ultimate impact of these

perceptions on actual experiences with antidepressant drugs may be

the foundation to understanding the future of treatment approaches to

depression.

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REFERENCES

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drugs and drug use. In: Contested Ground: Public Concern and Private

Interest in the Regulation of Pharmaceuticals, Davis, P., Ed.; Oxford

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2. Morris, L.A.; O’Neal, E. C. Judgement’s About a Drug’s Effectiveness:

The Role of Expectations and Outcomes. Drugs, Health Care 1975,

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3. Arluke, A. Judging Drugs: Patients’ Conceptions of Therapeutic

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84–88.

4. Lennard, H.L. Mystification and Drug Misuse. Jossey-Bass: San

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5. Montagne M. The culture of long-term tranquillizer users. In:

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Substances. Drug Intell. Clin. Pharm. 1976, 10, 624–30.

THE PROZAC PHENOMENON 1273

16. Rhodes L.A. ‘‘This Will Clear Your Mind’’: The Use of Metaphors forMedication in Psychiatric Settings. Culture Med. Psychiatry 1984, 8,49–70.

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18. Feighner, J.P.; Boyer, W.F., Eds. Selective Serotonin Re-UptakeInhibitors. Wiley: New York, 1996.

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THE AUTHOR

Michael Montagne, R.Ph., Ph.D., is Rombult Distinguished Professor ofPharmacy at MCPHS. He has taught and performed research for over20 years on the social and historical aspects of drug use and drug discovery.He has co-authored books on drug development (Searching for MagicBullets: Orphan Drugs, Consumer Activism, and Pharmaceutical Development,1994 and Clinical Research in Pharmaceutical Development, 1996) and hasstudied drug use and drug advertising from a sociological perspective(‘‘Drug Advertising and Promotion,’’ Journal of Drug Issues, Volume 22,Spring, 1992). He teaches courses on ‘‘Drugs and Society,’’ ‘‘Pharmacoepi-demiology,’’ and ‘‘Drug Education.’’ His current research focuses on thegrowing alternative therapy movement in the US and on literacy issues inmedication use.

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