The Aesthetics of Pharmaceutical Oral Dosage Forms

Pills Belong in a Gallery

Pharmaceutical oral dosage forms are unique in the sense that they display the intersection of visual stimuli and medical necessity.  The repetitive nature of pills creates visual patterns as well as patterns of routine in time, leading us to experience them as a prominent visual symbol for our acquired associations. The pill profiling aspect of the aesthetic qualities of medicine have been explored in relation to the use of illicit drugs like ecstasy in studies like the “Monitoring of illicit pill distribution networks using an image collection exploration framework.[1]”  This analysis proposes a pill profiling method based on “pill visual appearance, and a pill monitoring strategy that combines a discriminative and clustering model based on pill visual similarity functions. In general, visual similarity depends on different visual features such as color, texture and shape.”[2] This way of categorizing pills proves the validity of their aesthetic qualities and the weight that they carry.

In studying Pharmacology and especially Psychopharmacology, the parallels to art become almost glaring. Both art and the pharmaceutical industry use aesthetics, symbolism, color, texture, etc as tools to induce some type of thought or state change for the consumer of the media or dose. They both raise profound questions about autonomy and perception, the materiality of pills seem to embody this desire for affect through the subtle modes of manipulation we use to connect.

The fact that medicine and its vessels have psychological, political, social and other implications make them an ideal subject for artistic exploration. Works by Damien Hirst, Joseph Cornell, and Marcel Duchamp give us a unique insight to the field of pharmacology from the perspective of visual art.  Bringing medicine into the gallery; the very root of the artistic curiosity that allowed this work to surface lends its assistance to my argument that our understanding and application of the aesthetic properties of pharmaceutical oral dosage forms came in the wake of our regulation of medicine.

Jill Morton is a color Professor focusing on color’s importance in psychology and branding.  She argues that color is an undeniably influential aspect of pharmacology as people form judgment based on color.  This color theory is especially applicable to pharmacology where judgement process seems to be even more true for food or anything we orally ingest. She explains that based on a study conducted by the PhD cell of the SIES College of Management Studies (SIES COMS), and published in the International Journal of Biotechnology “people undergo a sensory experience every time we self administer a drug”.[3] Her analysis of this study leads us to conclude that color and shape of a medication influences people’s perception of the treatment before they even take it, and that these associations may be permanent.  The ability for a medicine to be an effective treatment can be affected by our level of trust in the medicine’s ability to help, which relies strongly on our perception of the medicine’s shape and color.

Another study done by Aaron S Kesselheim found that differences in shape and color of a prescription leads to discontinuation of treatment[4].  This evidence that a patient would discontinue their medication because it looks different is proof that color’s psychological effects are real and should be addressed in medicine.  They explain that “Patients react to the colour of the medicine. The colour has a placebo effect. If a depressed patient is given an anti-depressant tablet in maroon colour, he will not like it, and so the medicine will not be effective.”[5]

Nexium is an example of a pill that has been advertised by its color with the slogan “the little purple pill” since its inception.  AstraZeneca, who owns Nexium recently sued a generic brand version heartburn pill for using the same purple as them.  The case was based on color and has gained press attention leading to a surge of name brand medicines legally protecting their pill design for the safety of the patients and their business.[6]

As we acknowledge the extreme psychological importance of color it becomes apparent that there needs to be some way of regulating or calculating color accurately so that its effects may be used for practical purposes like in advertisement or road signs.  Artist and teacher Albert H Munsell understood the importance of color communication being accurate and created the Munsell Color System to precisely identifying every color that exists based on his theory of “perceived equidistance.”  This theory is what Munsell considered “the human visual systems perception” and categorizes color based on a three dimensional model that accounts for each color’s hue, value and saturation.  This system allows a logical visual relationship between colors, laying a solid platform for communication with color[7].

Without the Munsell color system there could never be an accurate way of documenting the appearance of all pills, capsules, etc.  The Color Atlas of Pharmacology documents every medicine with color charts and illustrations and is divided into four color-coded sections.  This book is used by practicing healthcare professionals to accurately identify medication, but it would be impossible to look through without noticing the visual patterns and symbols that are scattered throughout the medical jargon[8].

Before the 20th century medicine was usually produced by small scale operations under very little regulation for safety or marketing.  By the late 1880s the development of synthetic chemical methods allowed scientists to analytically alter the structure of chemical substances and the appearance of the pill[9].  By regulating pharmacology, we acknowledged that intentionality of visual experience is a factor to be considered with weight in the field of medicine.  We know that our perception of the results of a medicine can be swayed by the stigma we have surrounding it.  We are exercising a multiple layered form of perception when we think about medicine because it requires us to analyze our feelings from an “objective” point of view, think taking a Tylenol and waiting for your head to stop hurting. You acknowledge your reaction to the pain is negative, so you take a pill that you acknowledge should make the pain subside and are aware that you are waiting to feel the discomfort release. This multiple layered way of perceiving the effects of medicine also explains the placebo and nocebo phenomena which occur often in psychopharmacological studies.

The behavior of the actively observant mind which is engaged when self administering a pill is surprisingly analogous to the type of analytical thinking that takes place in an art gallery.   The difference, however, is that in this case instead of analyzing a piece of art in a gallery setting and the way it makes us feel or think, we are analyzing a pill and the way it makes us feel and think in our own daily settings.

The introduction of the readymade art piece brought commonplace objects from daily life into the gallery setting, shifting the relationship between the real world and the art world dramatically.  This interest in taking an object from everyday life and putting it on a pedestal to digest and contemplate its meaning with the same intensity as a piece of fine art is the platform I will use to explore the aesthetically implied importance of medicine.

The readymade “Pharmacie” by marcel Duchamp shows his associations with the colors of pharmaceutical bottles and how this universal human tendency to create associations to understand and categorize the world around us with color applies to pharmacology[10].  I would go so far as to argue that this tendency to categorize when applied to medicine yields an even more profound response within us as we are aware of medicines ability to affect us physically and emotionally; leading us to imbue colors used in pharmacology with the notion of being affected, or feeling different. This piece specifically speaks to the red and yellow colors of pill bottles that Duchamp, like many other people who take medicine, associate with pharmacies.  He painted these colors on an acquired painting of trees and presented the piece with the title “Pharmacie” leaving the viewer with just enough material to identify their own associations with pharmacology[11].  I found it particularly interesting that Duchamp used the colors in such an indirect way as a pill bottle already presents itself as a particularly interesting readymade object for this master of ready made art to explore directly.  This being said however, Duchamp’s influence paved the way for artists like Joseph Cornell and Damien Hirst to use the motif of pharmacies and their symbolic inhabitants as a topic of artistic exploration.

Joseph Cornell’s investigation of pharmacology follows the notion that these objects are acknowledged as having a somewhat magical transformative affect on the human body or mind and their aesthetic qualities may or may not reflect the associations we have with it.  Cornell’s religious preference of Scientific Christianity bans the use of medicine, giving him a unique outside perspective of the pharmaceutical world and its aesthetic qualities[12].  His perspective also emphasizes the relationship between spirituality or religion and medicine.  Cornell’s pieces show us that the very idea of medicine as a way of transforming properties of our bodies that we can attribute to a specific feeling is quite a magical notion. His work shows an appreciation of the effects of pharmaceuticals by celebrating them aesthetically.  He positions the contents of his boxes in a way that injects every object with a profound significance.[13]  The way the medicine is arranged in the boxes like a shrine also speaks to Cornell’s spiritual idea of medicine.  He prompts us to see pharmacology with all of our notions of the spiritual, transformative properties it may hold, and to acknowledge and wonder about the significance of each bottle or pill.  The cabinets seem to suggest that religion and medicine are of the same category, both cures or remedies.  This notion of medicine being comparable to religion was discussed by Karl Marx as he stated that “Religion is the opium of the people.”  Marx argues that religion is a type of remedy for the people of this world to deal with their struggles, hopelessness and oppression[14].  This is a concept that Cornell seems to be playing with as he presents medical “remedies” in a religious arrangement.  He may be countering Marx’s argument in reaction to the development of modern medicine, suggesting that medication has replaced spirituality or religion as our crutch.

Joseph Cornell’s work was a crucial stepping stone and inspiration for the intensely critical works of Damien Hirst.  His medicine cabinets and pharmacy installations forced viewers to see the shapes and colors and textures of pharmaceutical oral dosage forms from an abstract perspective, leaving the viewer to contemplate the concrete associations they have with these properties that make up our modern pharmaceutical world.  His positioning of the substances according to the location of the effects felt on the body speaks to Cornell’s work in the sense that he is using symbolism and composition to imply the significance of each object present.  Hirst presents the dosage forms in grids in front of a mirrored shelf with each pill spaced equally with the intention of putting the focus on the patterns created by the pills and their aesthetic properties[15].  He gives us a simple repetitive image so that we may recognize the pills individually with attention and care being given to the variations in color shape size and texture.  Presented as a work of art in a gallery the medical significance of the colors, shapes and markings on the pills begin to fall away.  They become abstract, non-representational, to reveal the symbolic weight that these vast patterns imply when we are given the chance to see them out of their usual context.  The repetition of taking pills on a schedule in relation to time is exemplified visually through these patterns and our own experiences.

The work “Cradle To Grave in sickness and in health” is a perfect example of the power of the pill as a symbol.  This piece was created by Pharmacopeia, a medical-art collaboration between artists Susie Freeman and David Crithley and family doctor, Liz Lee, in 2001[16].  The British Museum commissioned them to be part of their ethnographic exhibit called ‘Living and Dying.’  This exhibit displayed different ways of avoiding and fighting illness, danger and trouble[17].  It also delved into an investigation of people’s dependence on relationships with spiritual powers and the world around us, naturally bringing the topic of religion into the discussion. The collective set out to create a piece that showed how our western society responds to sickness and how we preserve our sense of wellbeing. The final piece consists of two long rows of pills sewn into netting, mapping one man and one woman’s life by their pill intake from birth to death.  These two pill diaries were composited from statistics of pill intake in Britain and the personal data of four different men and women with each gauzy net containing over 14000 pills[18].  The piece displays the fantastic patterns that the pills make in relation to when in the person’s life they were taken. The piece simultaneously is making a shocking statement about the intrusion of the pharmaceutical industry on western life.

“Cradle To Grave” demonstrates our relationship to medicine in a visual way which stood out in the gallery among the interpretation of the theme by other artists.  Many of the other pieces in the exhibit show that their culture invokes the help of spirits or gods to protect and cure them[19].  The presence of these massive pill diaries among spiritual imagery made our western society question its relationship to our sense of wellbeing.  This stark contrast shows us that maybe we are missing a sense of spirituality, it asserts that instead we have become heavily medicated.  The piece embodied the idea of the medicalization of ordinary life. What happens when we rely on medicine for every sensation that may be unsatisfactory? It brings up questions of morality when it comes to certain cases, which symptoms deserve to be treated? Which should be left as normal characteristics? This piece is a perfect example of the political and social power that the aesthetic symbol of medicine or pills carry.  The gallery is the perfect place for pills to be acknowledged and contemplated because the space encourages open minded observation and further thought.  One leaves a gallery with a shifted perspective and buzzing mind.

Works Cited

@Pharmalot, E.S. (2016) Maker of generic version of Nexium goes blue to settle litigation – STAT. Available at: https://www.statnews.com/pharmalot/2016/01/04/generic-drugs-astrazeneca-heartburn/ (Accessed: 19 May 2016).

AstraZeneca (no date) NEXIUM® (esomeprazole magnesium). Available at: https://www.purplepill.com/home.html (Accessed: 19 May 2016).

Brut, B., Estate, T.B., London and Issues, U. (2015a) Thousands of pills – cradle to grave by Pharmacopoeia at the British museum. Available at: http://www.urban75.org/blog/thousands-of-pills-cradle-to-grave-by-pharmacopoeia-at-the-british-museum/ (Accessed: 19 May 2016).

Camargo, J., Esseiva, P., González, F., Wist, J. and Patiny, L. (2012) ‘Monitoring of illicit pill distribution networks using an image collection exploration framework’, Forensic science international., 223, pp. 298–305.

Campbell, P. (2016a) LRB · Peter Campbell · at the British museum: Living, dying and enlightenment. Available at: http://www.lrb.co.uk/v26/n02/peter-campbell/at-the-british-museum(Accessed: 19 May 2016).

Cornell, J. (2016) Joseph Cornell biography, art, and analysis of works. Available at: http://www.theartstory.org/artist-cornell-joseph.htm(Accessed: 19 May 2016).

‘Cradle to grave’, in sickness and in health « Pharmacopoeia (no date) Available at: http://www.pharmacopoeia-art.net/articles/in-sickness-and-in-health/ (Accessed: 19 May 2016).

Healy, M. and Times, L.A. (2014) Pill look different? Shape and color changes may prompt lapses. Available at: http://www.latimes.com/science/sciencenow/la-sci-sn-generic-medication-lapses-20140714-story.html (Accessed: 19 May 2016).

Joseph Cornell | Untitled (pharmacy) | the met (1950) Available at: http://www.metmuseum.org/art/collection/search/490179 (Accessed: 19 May 2016).

Ltd, S. (no date) Selected artworks: 57 results for medicine cabinets. Available at: http://www.damienhirst.com/artworks/catalogue?category=14(Accessed: 19 May 2016).

Lüllmann, H., Mohr, K., Hein, L., Bieger, D., Luellmann, H. and Lullmann, H. (2005) Color Atlas of pharmacology. 3rd edn. Stuttgart: Thieme Medical Publishers.

Marx, A contribution to the critique of Hegel’s philosophy of right 1844(no date) Available at: https://www.marxists.org/archive/marx/works/1843/critique-hpr/intro.htm(Accessed: 19 May 2016).

Morton, J. (2013a) Color psychology in medicine | Munsell color system; Color matching from Munsell color company. Available at: http://munsell.com/color-blog/color-psychology-medicine-jill-morton/(Accessed: 19 May 2016).

Pharmacy (no date) Available at: http://www.toutfait.com/unmaking_the_museum/Pharmacy.html (Accessed: 19 May 2016).

Society, A.C. (2005) Top pharmaceuticals: Introduction: EMERGENCE OF PHARMACEUTICAL SCIENCE AND INDUSTRY: 1870-1930. Available at: http://pubs.acs.org/cen/coverstory/83/8325/8325emergence.html (Accessed: 19 May 2016).

[1] Camargo, J., Esseiva, P., González, F., Wist, J. and Patiny, L. (2012) ‘Monitoring of illicit pill distribution networks using an image collection exploration framework’, Forensic science international., 223, pp. 298–305.

[2] et al.

[3] Morton, J. (2013) Color psychology in medicine | Munsell color system; Color matching from Munsell color company. Available at: http://munsell.com/color-blog/color-psychology-medicine-jill-morton/(Accessed: 19 May 2016).

[4] Healy, M. and Times, L.A. (2014) Pill look different? Shape and color changes may prompt lapses. Available at: http://www.latimes.com/science/sciencenow/la-sci-sn-generic-medication-lapses-20140714-story.html (Accessed: 19 May 2016).

[5] Morton, J. (2013b) Color psychology in medicine | Munsell color system; Color matching from Munsell color company. Available at: http://munsell.com/color-blog/color-psychology-medicine-jill-morton/(Accessed: 19 May 2016).

[6] @Pharmalot, E.S. (2016) Maker of generic version of Nexium goes blue to settle litigation – STAT. Available at: https://www.statnews.com/pharmalot/2016/01/04/generic-drugs-astrazeneca-heartburn/ (Accessed: 19 May 2016).

[7] Morton, J. (2013b) Color psychology in medicine | Munsell color system; Color matching from Munsell color company. Available at: http://munsell.com/color-blog/color-psychology-medicine-jill-morton/(Accessed: 19 May 2016).

[8] Lüllmann, H., Mohr, K., Hein, L., Bieger, D., Luellmann, H. and Lullmann, H. (2005) Color Atlas of pharmacology. 3rd edn. Stuttgart: Thieme Medical Publishers.

[9] Society, A.C. (2005) Top pharmaceuticals: Introduction: EMERGENCE OF PHARMACEUTICAL SCIENCE AND INDUSTRY: 1870-1930. Available at: http://pubs.acs.org/cen/coverstory/83/8325/8325emergence.html (Accessed: 19 May 2016).

[10] Pharmacy (no date) Available at: http://www.toutfait.com/unmaking_the_museum/Pharmacy.html (Accessed: 19 May 2016).

[11] Joseph Cornell | Untitled (pharmacy) | the met (1950) Available at: http://www.metmuseum.org/art/collection/search/490179 (Accessed: 19 May 2016).

[12] Cornell, J. (2016) Joseph Cornell biography, art, and analysis of works. Available at: http://www.theartstory.org/artist-cornell-joseph.htm (Accessed: 19 May 2016).

[13] Joseph Cornell | Untitled (pharmacy) | the met (1950) Available at: http://www.metmuseum.org/art/collection/search/490179 (Accessed: 19 May 2016).

[14] Marx, A contribution to the critique of Hegel’s philosophy of right 1844 (no date) Available at: https://www.marxists.org/archive/marx/works/1843/critique-hpr/intro.htm(Accessed: 19 May 2016).

[15] Ltd, S. (no date) Selected artworks: 57 results for medicine cabinets. Available at: http://www.damienhirst.com/artworks/catalogue?category=14 (Accessed: 19 May 2016).

[16] ‘Cradle to grave’, in sickness and in health « Pharmacopoeia (no date) Available at: http://www.pharmacopoeia-art.net/articles/in-sickness-and-in-health/ (Accessed: 19 May 2016).

[17] Campbell, P. (2016b) LRB · Peter Campbell · at the British museum: Living, dying and enlightenment. Available at: http://www.lrb.co.uk/v26/n02/peter-campbell/at-the-british-museum(Accessed: 19 May 2016).

[18] Brut, B., Estate, T.B., London and Issues, U. (2015b) Thousands of pills – cradle to grave by Pharmacopoeia at the British museum. Available at: http://www.urban75.org/blog/thousands-of-pills-cradle-to-grave-by-pharmacopoeia-at-the-british-museum/ (Accessed: 19 May 2016).

[19] ‘Cradle to grave’, in sickness and in health « Pharmacopoeia (no date) Available at: http://www.pharmacopoeia-art.net/articles/in-sickness-and-in-health/ (Accessed: 19 May 2016).