Social reactions to Valium and Prozac: a cultural lag perspective of drug diffusion and adoption.

BACKGROUND: In the sociological context, the concept of cultural lag holds that material technologies advance more rapidly than social guidelines for their use. The result can be social conflict including liability accusations and product stigmatization that have characterized several new drugs which were widely accepted initially but then publicly criticized in the lay and scientific press. OBJECTIVES: The objective was to illustrate the utility of the concept of cultural lag to technology commercialization by applying cultural lag to the social and professional environments surrounding the diffusion of the "minor tranquilizers" Librium and Valium in the United States from the 1950s to the 1970s, and the antidepressant Prozac from 1987 to 2005. The intention is to develop a perspective from which to view patterns of social acceptance followed by critique that may occur when technological advances are introduced to the marketplace. METHODS: This study systematically reviews academic, medical, and lay literature regarding the diffusion of the "minor tranquilizers" Librium and Valium in the United States from the 1950s to the 1970s, and the antidepressant Prozac from 1987 to 2005. RESULTS: The minor tranquilizers and Prozac both reveal similar patterns of initial widespread public endorsement, followed by growing public criticism and recommendations for more restrictive usage guidelines. CONCLUSIONS: Cultural lag provides a perspective from which to anticipate, view, and avoid controversies that develop from new technologies in general and pharmaceutical technologies in particular. Market demands for rapid introduction must be balanced by public education. This requires proactive encouragement of lay and professional discussions and the establishment of marketing guidelines that aid development of social consensus regarding appropriate usage.

Case history: the discovery of fluoxetine hydrochloride (Prozac).

In the early 1970s, evidence of the role of serotonin (5-hydroxytryptamine or 5-HT) in depression began to emerge and the hypothesis that enhancing 5-HT neurotransmission would be a viable mechanism to mediate antidepressant response was put forward. On the basis of this hypothesis, efforts to develop agents that inhibit the uptake of 5-HT from the synaptic cleft were initiated. These studies led to the discovery and development of the selective serotonin-reuptake inhibitor fluoxetine hydrochloride (Prozac; Eli Lilly), which was approved for the treatment of depression by the US FDA in 1987. Here, we summarize this research and discuss the many challenges that we encountered during the development of fluoxetine hydrochloride, which has now been widely acknowledged as a breakthrough drug for depression.