Pharmaceuticals and Society
21 Feb 2014-
TL;DR: The pharmaceutical industry is the most profitable industry in the United States and a major source of health care costs, and the industry has also been charged with influencing independent research through funding and other methods.
Abstract: Pharmaceuticals (medicines, vaccines, and biologicals) are compounds manufactured for the purpose of diagnosis, cure, mitigation, treatment, or prevention of diseases. Pharmaceuticals consume a large share (15.2 percent) of global health spending, amounting to $440 billion a year. They are critical to the effective functioning of the health system and to global development. Access to pharmaceuticals is a key barrier to medical treatment. About a third of the world population – and 50 percent of the poorest parts of Africa and Asia – lack regular access to existing medicines. Rational medicine use presents another challenge, at both social and individual levels; the overprescribing of antibiotics is an example of irrational medicine use. The pharmaceutical industry (“Big Pharma”) is the most profitable industry in the United States and a major source of health care costs. There is an ongoing debate in the United States about pharmaceutical research and development, regulation, and marketing. For example, there have been claims that pharmaceutical companies overstate the benefits and understate the dangers of new medicines, and sometimes manipulate data to mislead outside researchers, regulators, and consumers. The industry has also been charged with influencing independent research through funding and other methods.
Keywords:
medicalization;
medicine;
pharmaceuticals;
therapy
Citations
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TL;DR: In the first comprehensive analysis of the pharmaceuticalization dynamics at play in national security policy, this article unearths the detailed array of policy interventions through which governments too are becoming more deeply imbricated in the pharmaceuticalized of society.
39 citations
TL;DR: Focus group data collected in the UK is drawn on to elicit collective views on and experiences of prescription hypnotics across different social contexts and it is shown that respondents drew on a range of moral repertoires which allowed them to present themselves and their relationships with hypnotics in different ways.
Abstract: The pharmaceuticalisation of sleep is a contentious issue. Sleep medicines get a 'bad press' due to their potential for dependence and other side effects, including studies reporting increased mortality risks for long-term users. Yet relatively little qualitative social science research has been conducted into how people understand and negotiate their use/non-use of sleep medicines in the context of their everyday lives. This paper draws on focus group data collected in the UK to elicit collective views on and experiences of prescription hypnotics across different social contexts. Respondents, we show, drew on a range of moral repertoires which allowed them to present themselves and their relationships with hypnotics in different ways. Six distinct repertoires about hypnotic use are identified in this regard: the 'deserving' patient, the 'responsible' user, the 'compliant' patient, the 'addict', the 'sinful' user and the 'noble' non user. These users and non-users are constructed drawing on cross-cutting themes of addiction and control, ambivalence and reflexivity. Such issues are in turn discussed in relation to recent sociological debates on the pharmaceuticalisation/de-pharmaceuticalisation of everyday life and the consumption of medicines in the UK today.
32 citations
Cites background from "Pharmaceuticals and Society"
...…and Wolf-Meyer 2013), wider sociological debates on the medicalisation and pharmaceuticalisation of life (Abraham 2010, Bell and Figert 2012, Gabe et al. 2015, Williams et al. 2011), and other work in medical sociology (Lumme-Sandt and Virtanen 2002, Pound et al. 2005) and cognate fields…...
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TL;DR: In this article, a review of work in sociology and cognate fields regarding pharmaceutical marketing and its regulation is presented, which contributes to a better understanding of the process of pharmaceuticalization, defined as the translation or transformation of human conditions, capabilities, and capacities into opportunities for pharmaceutical intervention.
Abstract: This essay reviews work in sociology and cognate fields regarding pharmaceutical marketing and its regulation. In particular, it considers how this literature contributes to a better understanding of the process of pharmaceuticalization, defined as “the translation or transformation of human conditions, capabilities, and capacities into opportunities for pharmaceutical intervention.” The review addresses two research areas that offer productive avenues of investigations of the marketing-regulatory nexus in the context of pharmaceuticalization. The first concerns the sociopolitical mechanisms underlying development and enforcement of marketing rules. The second considers the impact of rules and enforcement schemes on corporate marketing practices and, consequently, on the shaping of pharmaceutical markets and health.
21 citations
Cites background from "Pharmaceuticals and Society"
...12335 medicalization, and expectations of doctors and patients (Abraham 2010; Williams et al. 2011; Gabe et al. 2015)....
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...medicalization, and expectations of doctors and patients (Abraham 2010; Williams et al. 2011; Gabe et al. 2015)....
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TL;DR: It is suggested that a systematic analysis of these areas leads one to consider pharmacological practice a sui generis apparatus of power, which reaches beyond the purely disciplinary and biopolitical levels to encompass molecular configurations, thereby giving rise not only to new types of government over life, but also to new struggles for life, extending from molecular to population-wide levels.
Abstract: Following Foucault's work on disciplinary power and biopolitics, this article maps an initial cartography of the research areas to be traced by a genealogy of pharmacological practice. Pharmacology, as a practical activity, refers to the creation, production and sale of drugs/medication. This work identifies five lines of research that, although often disconnected from each other, may be observed in the specialized literature: (1) pharmaceuticalization; (2) regulation of the pharmaceutical industry; (3) the political-economic structure of the pharmaceutical industry; (4) consumption/consumerism of medications; (5) and bio-knowledge. The article suggests that a systematic analysis of these areas leads one to consider pharmacological practice a sui generis apparatus of power, which reaches beyond the purely disciplinary and biopolitical levels to encompass molecular configurations, thereby giving rise not only to new types of government over life, but also to new struggles for life, extending from molecular to population-wide levels.
12 citations
References
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TL;DR: A systematic literature search found that among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published, and the increase in effect size ranged from 11 to 69% for individual drugs and was 32% overall.
Abstract: Background Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased. Selective publication of clinical trials — and the outcomes within those trials — can lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio. Methods We obtained reviews from the Food and Drug Administration (FDA) for studies of 12 antidepressant agents involving 12,564 patients. We conducted a systematic literature search to identify matching publications. For trials that were reported in the literature, we compared the published outcomes with the FDA outcomes. We also compared the effect size derived from the published reports with the effect size derived from the entire FDA data set. Results Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 stu...
2,176 citations
TL;DR: The distinction between education and pharmaceutical public relations is becoming obsolete, writes Neil Kendle, chief executive officer of Lowe Fusion Healthcare, in a recent issue of Pharmaceutical Marketing magazine as mentioned in this paper, so much so that Kendle cannot even say for certain which business he is in.
Abstract: What's the difference between medical education and pharmaceutical public relations? Not much, according to the people who do it. "(T)he broad distinction between healthcare PR and medical education is becoming obsolete, writes Neil Kendle, chief executive officer of Lowe Fusion Healthcare, in a recent issue of Pharmaceutical Marketing magazine. So slender is the difference between education and PR than that Kendle cannot even say for certain which business he is in. "Sometimes I describe Lowe Fusion as a 'PR consultancy', sometimes as a 'healthcare communications agency'. Sometimes I just cop out and list the things we do." (1) Here's how the business works. The pharmaceutical industry puts up the money, usually in the form of an "unrestricted educational grant." The grant goes to a for-profit medical education and/or communications company (MECC), which, in consultation with its pharma sponsor, puts together an "educational program." (2) The company and the MECC recruit academic physicians to deliver the program in return for a small cut of the grant. If the MECC is accredited by the Accreditation Council for Continuing Medical Education, it can offer the educational program on its own. If not, it must go through the CME office of a medical school, which--again for a cut of the grant--accredits the program and certifies it free of commercial bias. Then doctors, nurses and other health care workers attend the "educational program" that pharma has funded in order to satisfy the CME requirements of their professional organizations. It is, as the corporate manuals like to say, a win-win situation. The doctors and nurses get CME credits; universities get a new revenue stream; academic physicians get some extra pocket money; MECCs get a lucrative market niche (over a billion dollars a year, according to The Lancet), and the pharmaceutical industry gets to shape the minds of medical America. (3) By laundering its message through the MECCS, pharma gives up some control, but the pay-off is even better: advertisements with the appearance of objectivity. PR practitioners call this a "third-party" strategy. As Kendle puts it, "Third party sources of information, as long as they are perceived to have expertise in the area they are talking about, are much more credible sources of information than the pharmaceutical company itself." Pharma now funds over 60 percent of continuing medical education in the United States. (4) Not bothered that your doctor's education comes from pharma? Have a look, then, at the "communications" arm of this lucrative business. Here the results are scientific articles, often in peer-reviewed medical journals. The money is laundered in much the same way. Pharma pays the MECC; the MECC puts together the articles; academic physicians are paid to sign onto the articles, and the MECC places the articles in medical journals. Some academics simply sign ghostwritten articles, while others work from a draft supplied by the company. Sticklers for honesty merely take the money and write the articles themselves. Fees vary. Some academics have signed on for as little as $1,000 or $1,500 per article, including-the two faculty members at the Medical University of South Carolina who recently "authored" a ghostwritten article on Ritalin for Novartis. (5) Others command much higher fees. When the debate over second-hand smoke was heating up in the early 1990s, the tobacco industry paid a biostatistician $10,000 to write a single letter to the Journal of the American Medical Association. (6) Warner Lambert, the maker of Neurontin, a seizure drug, gave a professor at the University of Minnesota over $300,000 to write a textbook on epilepsy. (7) None of this is exactly new. What is new is the magnitude of the phenomenon, which has only become evident through recent litigation. For years, nobody really knew how much of the medical literature was ghostwritten, or even how much had originated from pharma. …
81 citations
01 Jan 2004
TL;DR: This chapter describes the main consequences of the non-rational use of medicines and describes the roles of prescribers and dispensers in promoting rational medicine use.
Abstract: By the end of this chapter you should be able to:
Describe the main consequences of the non-rational use of medicines.
Describe non-pharmacological factors that determine medicine use.
List the three main types of indicators for medicine use.
Explain the main features of educational, managerial and regulatory approaches to medicine use intervention.
List three interventions to promote rational medicine use known to be effective and three known to be ineffective.
Describe the roles of prescribers and dispensers in promoting rational medicine use.
Describe the role of patients and public education in promoting rational medicine use.
4 citations