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This chapter demonstrates that the conventional categorization of food components into “macronutrient,” “micronutrient,” “toxin,” “medicine,” and so on works well from a distance, but on greater magnification, the boundaries between these categories blur. When viewed through a geometric lens, however, a new structure falls into focus, which emphasizes not the chemical identity of the food component but the target-like perspective of optimal intakes. The chapter structures its argument around three interlinked themes: (1) the distinction between “nutrient” and “toxin” is fuzzy and sometimes imaginary; (2) the phenomenon of “self-medication” in nonhuman animals can involve compounds that are conventionally classified either as nutrients or natural “medicines”; and (3) even when a compelling case can be made for distinguishing a “toxin” from a “nutrient,” the biological impacts of the toxin depend on the levels of nutrients in the food relative to the intake target for those nutrients.

Studies of intestinal parasites show that the Budongo chimpanzees live with numerous gut nematodes which they tolerate well. Self-medication is achieved by swallowing the leaves of Aneilema aequinoctiale, which are encountered along trails in the forest. These leaves have hooked trichomes, which physically remove worms from the gut wall. In addition, chimpanzees eat termite soil for medicinal purposes. Deaths are described together with a necropsy report (in Appendix D). The danger of transmission of human diseases to chimpanzees is constant.

A commercial and consumer society began emerging in Germany before the First World War, and the German chemical and pharmaceutical industry was the most advanced in the world. By 1933, therefore, Germans had increasing expectations when it came to satisfaction of material demands and desires. While the Nazis placed arms production before consumer goods, marketing toward popular demand and need for pharmaceuticals continued through the Third Reich. Patients preferred doctors who would write prescriptions, but dispensing chemists and retail stores were also sources of drugs for self-medication. German Jews often resorted to an overdose of barbiturates or opiates to die a less painful death on their own terms. The military and industry used methamphetamines and other stimulants to enhance—not unproblematically—the performance of soldiers and workers. The SS, private industry, and the military also conducted often lethal drug tests on concentration camp prisoners.

This chapter focuses on the emergence of a new kind of drugstore that offered a cheaper, friendlier alternative to the doctor's office. As physicians struggled to justify the high cost of their services, they faced increased pressure to compete with the new “toothpaste temples” appearing on American urban street corners. Entrepreneurs such as Charles Walgreen and Louis Liggett blended modern science and salesmanship into a commercial health culture that was met with scorn by physicians and even professional pharmacists. That hostility reflected the role of these drugstores in preserving and extending the American tradition of self-medication. This chapter first considers the transformation from the old-time pharmacy to the new-style drugstore and how such drugstores achieved their retail dominance. It then discusses the goods and services that the drugstores offered, their investment in advertising and marketing, and their connection to the pharmaceutical industry. It also examines the controversy surrounding the corner drugstore's practice of handing out prescriptions for over-the-counter medications and concludes with an assessment of its relationship with patient-consumers.

The notion that people take drugs to alleviate emotional pain rings intuitively true with patients, treatment providers, and many others. Often referred to as a “self-medication” view of addiction, this notion has had interesting ups and downs through the years. This chapter follows this notion through these cycles to obtain a better understanding of the flaws inherent in a naive, original version of the theory. It also paves the way for a better informed and more useful modern interpretation. The chapter then considers the notion that prolonged drug use triggers long-term changes, or “adaptations,” in brain function. These adaptations would come online when addictive drugs cause excessive activity of brain reward circuitry and would attempt to counter the rewarding drug actions.

The second chapter, Exercise, considers the rhythm of our bodies in motion and the complicated relationships between exercise and illness, as both a necessity and a joy. Like eating, the significance of exercise is redefined by illness, and the body is maintained, challenged, and re-known through it. Exercise regimes can provide control, treatment and an alternative form of medication so that through physical activity bodies feel strong, independent, and free in spite of illness. But ill bodies are prone to overexertion, and exercise can reinforce their dependence and vulnerability as well as their strength. For Anna, who has depression, exercise has become a form of self-medication. Running and cycling regularly make her feel less depressed, so she tries to be physically active at least four times a week. Disruption to this routine can cause her mood to plummet quickly, showing the dependence that she has on her body.

Self-medication with cannabis seems to be prominent currently, and rising in popularity. Outside the realm of modern medicine, patients find access to a wide range of cannabis varieties and administration forms. The emerging interest in studying these phenomena has already provided important insight into several aspects regarding the medicinal use of cannabis that patients find effective and desirable. Conversely, the absence of quality control or guidance by a trained physician may leave patients exposed to severe medical and legal risks. In this chapter, the clinical and scientific evidence available on herbal cannabis use is balanced against the social aspects of self-medication in order to better understand the user characteristics of the patients involved. Such data are crucial for finding how to increase positive health outcomes regarding cannabis use, by building a bridge between patients’ needs and the demands of modern medicine.

This chapter discusses insect behavioral responses to parasites. Dividing behaviors conceptually into those that occur before and after infection, we start by reviewing the evidence that insects identify and avoid potentially infectious environments to minimize negative consequences of infection. Behavioral responses following infection according to their adaptive value to either the insect host or to the parasite will then be considered. One section covers sickness behaviors proposed to benefit the host by conserving energetic resources during infection; another section discusses evidence for altered host behavior as a parasite adaptation enhancing parasite survival or transmission. The mechanistic link between behavior and immunity in insects is briefly discussed, and provide a summary of methods and techniques becoming standard to studying behavior of model insect species in the context of infection. The chapter concludes by discussing future directions in the study of insect behavioral responses to parasites.

Insects need to ingest nutrients at appropriate levels to attain a balanced diet and maximize fitness. They do so by integrated responses that involve physiological mechanisms for sensing current nutritional needs, releasing systemic signals, and producing specific appetites for key required nutrients. Historically, the study of insect feeding behavior was appreciated for its importance in the understanding and control of crop pests and disease vectors. However, current evidence has shown that some mechanisms regulating feeding are highly conserved in animals, from insects to humans, bringing additional interest in insects as models in medicine. The study of insect feeding behavior and nutrition has also given rise to an integrative modelling approach called the geometric framework for nutrition. This approach has proven useful beyond the insects, and allows the understanding of the impact of multiple nutrients on individuals and their interactions in populations, communities, and ecosystems.

The Great Fire of Pittsburgh devastated the city, in the process consuming the old wooden Smithfield Street Bridge, leaving only the piers in the river. With John already at work on a similar structure across the river, and with the city desperate to rebuild, John received the contract to rebuild the Monongahela crossing almost immediately. His Allegheny Aqueduct was opened afterward to universal acclaim, after which he retreated to Saxonburg to recuperate and plunged wholeheartedly into his next big obsession: the water cure. Despite devoting much of his life to science, John was always distrustful of doctors and traditional medicine, and he relied increasingly on his own theories and practices, many of which we would now call deluded at best. Thankfully, John soon returned to what he was undoubtedly good at and set about rebuilding the Monongahela Bridge. Again, the effort was immense and the results spectacular. The bridge was finished and opened the following spring, by which time John was widely acknowledged as one of the foremost suspension bridge engineers in the world.

Despite significant progress since the 2000s, malaria remains in Africa a major health problem for families who, in the absence of medical coverage, have to manage all the health problems occurring among household members. For economic reasons, the practice of self-medication is important, facilitated by a very active informal drug market. Thus, understanding the malaria burden in sub-Saharan Africa requires a dual approach combining quantitative measures estimating the extent of observed phenomena, and a qualitative ethnographic approach to better understand households’ management of these health issues. This chapter describes fifteen years of interdisciplinary research incorporating medical anthropological and social epidemiological approaches to explore ways of managing malaria in families and access to medicines outside the control of medical facilities. This was a collaborative research project, first conducted in parallel and then jointly as part of a European programme concerning pharmaceutical markets and Artemisinin-based combination therapies. Analyses and findings presented in this chapter based on surveys in Senegal and Benin highlight the impact that such a combined approach may have in improving the adaptation of malaria control strategies to people’s life contexts.

Pharmaceutical policy should not discriminate between legitimate and illegitimate drug users, meaning that patients should have access to drugs for medical and non-medical purposes. This principle supports greater access to deadly and addictive drugs. But even if one doesn’t accept the argument that people should have legal access to deadly and addictive drugs, people should at least be permitted to access safe and non-addictive drugs for medical and non-medical uses. People have especially urgent claims to access drugs that protect people from harm and save lives. And there is a role for prescription requirements in limited cases. Dangerous and addictive drugs should remain behind the counter to prevent children and mentally incompetent people from accessing them. Finally, antibiotics should be regulated by a prescription system because antibiotics misuse could violate others’ rights.