The new book ‘Side Effects: The Social Ecology of Adverse Drug Reactions,’ by sociologist Jason Schnittker and former Ph.D. student Duy Do, makes the case that side effects are a product of social, cultural, and institutional forces.
3 min. read
Prescription drug labels list 70 side effects on average, and Jason Schnittker, chair of the Department of Sociology in the School of Arts & Sciences, says with a laugh that by the end of a TV pharmaceutical ad, he doesn’t even know what the medication is for. Since he started co-writing a book about side effects, he has found that friends and colleagues are eager to share information about their specific prescriptions and experiences, indicating the wide interest in side effects—and their mysteriousness.
In this book, Schnitter and Do argue that molecular explanations for side effects are insufficient, contending instead that such effects are a product of social, cultural, and institutional forces. They show that awareness of side effects increases the likelihood that someone will experience them, that individuals with higher baseline anxiety experience more of them, and that the Food and Drug Administration may downplay them when the therapeutic value of a medication is strong or compelling.
“Drugs have active ingredients that can produce side effects, but a lot of this has to do with the expectations people have about pharmaceuticals,” Schnittker says. “When people take drugs now, they think they’re really powerful and they’re very effective, and that effective drugs will have a lot of side effects.”
For example, one study found that 32% of men who were aware that beta-blockers could cause erectile dysfunction experienced this side effect, whereas among men who were unaware of this possibility, only 13% experienced erectile dysfunction.
Many people are familiar with the placebo effect, but this book gets into the nocebo effect: side effects that show up as frequently in the placebo arm of a trial as in the active arm. Schnittker and Do found that the largest nocebo effect is for headaches, whereas the lowest is for hypertension and liver function—outcomes that involve objective assessments. In some clinical trials of statins used to lower cholesterol, rates of muscle pain are the same in the placebo and active arms.
Schnittker notes that side effects can go together: Someone taking a statin may experience pain and depression, but the depression could be a result of the pain.
But he notes that biologists, chemists, and even pharmacologists have rarely investigated the origins of side effects, as their concern is with the therapeutic effect. He became interested in side effects in part because of a study published in JAMA in 2018 that found that 37% of U.S. adults take medications that list depression as a potential adverse effect.
The book also argues that side effects should be taken more seriously. A child born today is expected to spend at least 12 years taking five or more prescription drugs simultaneously, in part because of pharmaceutical cascades—when people start taking one medication to treat the side effects of another one. Many people also resist vaccines not because of perceived ineffectiveness but because of the expectation of side effects, Schnittker notes.
“It’s very easy in the present moment—whether you’re a patient, a physician, a regulator, a pharmaceutical manufacturer—to dismiss pharmaceutical side effects, short of really serious ones like liver toxicity and cardiac events,” he says. “But part of our argument in the book is that lots of people are actually suffering from these symptoms. After cost, it’s the No. 1 reason people stop taking their medications, and that’s very detrimental to them to do that.”
“If we want to improve health outcomes in the U.S.—make all our treatments work even better than they do and improve well-being while we’re doing it, we need to take side effects and their origins more seriously,” Schnittker says.
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