SPECIAL ARTICLE Social, cultural and ethical aspects of drug use—changes over 40 years: a personal look back Andrew Herxheimer & Emilio Sanz Received: 21 November 2007 / Accepted: 22 November 2007 / Published online: 3 January 2008 # Springer-Verlag 2007 Modern pharmacology has developed largely since this journal began 40 years ago. In that time, the types of drugs available and what we know about them have changed dramatically, as has the power of medicines to cure and to help people. Research methods and medicine regulation and control have also continued to evolve, and last but not least so have people’ s views and attitudes toward the use of medicines. Unaided memory inevitably distorts the past, so we wanted a solid starting point. We took two books from the 1960s: Drugs in Our Society [1], based on an international symposium at Johns Hopkins University in 1966, and The Medicated Society , a series of 12 lectures given in Boston in 1967 [2]. Each had distinguished contributors. We also reviewed the articles from the late 1960s and early 1970s published in Drug & Therapeutics Bulletin, which was then edited by Andrew Herxheimer, to see what issues had occupied us. Drugs in Our Society included a historical perspective on miracle cures, the limitations of drug research, and sections on drug effectiveness and safety, the roles and responsibilities of industry and government, economics and advertising, and social, legal and ethical aspects. The Medicated Society discussed some of these topics too, but went further into some specific issues—the abuse of hallucinogens and opiates, the drug approach to mental illness, contraceptive methods for population control, the effects of drugs on the foetus, and drug-induced diseases. All these aspects and examples are interconnected, and their relationships are complex. This essay tries to examine them in several different ways, looking first at the experiences of individuals in the course of their lives, and then at the ways in which different roles have determined beliefs, attitudes and behaviour, and finally we turn to some ethical aspects. Medicine at the different ages of man The use of medicines is socialised early in life. In fact, medicines are a social landmark in our Western culture. Health care could not be practised or understood without medicines: medicines are powerful symbols in Western culture—their cultural role goes far beyond their pharmaco- logical or therapeutic properties. Expectations from medi- cines and their values and symbolic roles (including their routes and types of administration, their packages and even the colour or presentation) are assimilated from an early age, become elaborated, and persist into ‘political correctness’ in adult life and old age. We consider some of these social aspects of medicines at the different ages of man. From pre-school to adolescence Probably the first relevant idea that a child encounters at home is that some objects are not good to eat or to play with because ‘they will hurt you’ or ‘make you ill’. Later they will be told that for some objects this is because they contain a dangerous substance or poison. Then, on an occasion when the child is unwell, it may be given a medicine to ‘make it better ’, and perhaps also told that the ‘right amount’ is important, because more can be danger- ous. Several international collaborative studies in the 1990s Eur J Clin Pharmacol (2008) 64:107–114 DOI 10.1007/s00228-007-0429-7 A. Herxheimer UK Cochrane Centre, Oxford, UK E. Sanz (*) Clinical Pharmacology, University of La Laguna, La Laguna 38071, Spain e-mail: ejsanz@gmail.com