Voluntary Regulation by the Pharmaceutical Industry—Which Role for the Shadow of Hierarchy and Social Pressure?

TLDR: A case study of the FSA Codex is presented and the question of why this voluntary regulation was adopted and revised is addressed, and how social pressure can trigger voluntary regulation is addressed.

Abstract: In 2004, the voluntary FSA Codex was adopted by part of the German pharmaceutical industry and was revised several times in the subsequent 10 years. The codex—as many others in OECD countries do—addresses the delicate relationship between the pharmaceutical industry and physicians. This article presents a case study of the FSA Codex and addresses the question of why this voluntary regulation was adopted and revised. In doing so, the article challenges a strong position in the literature, that voluntary regulation is dependent on the shadow of hierarchy. In addition, it addresses the question how social pressure can trigger voluntary regulation. For this case, rational-choice institutionalism and normative institutionalism in combination prove useful for identifying the driving forces and causal mechanisms of voluntary regulation.