Pharmaceuticals Society: Critical Discourses and Debates: 3 (Sociology of Health and Illness Monographs) - Softcover

Softcover

ISBN 10: 1405190841 ISBN 13: 9781405190848

Publisher: Wiley-Blackwell, 2009

Synopsis

Drawing on the latest international sociological research, this monograph takes a critical look at contemporary developments, discourses, and debate on pharmaceuticals and society.

• Key issues covered include pharmaceuticals and medicalization and the science and politics of drug development, testing, and regulation
  
• Investigates the constructions of pharmaceuticals in professional and popular culture and the meaning and use of medications in everyday life
  
• Investigates pharmaceuticals, consumerism, and citizenship and the impact of innovation and expectations regarding pharmaceutical futures
  
• Written in a lively, accessible style, with many engaging and important insights from key international figures in the field

About this title

About the Author

Simon J. Williams teaches the Sociology of Health and Illness with particular reference to the body, health and social research methods at Warwick University.

Jonathan Gabe is Professor of Sociology in the Department of Health and Social Care at Royal Holloway, University of London.

Peter Davis is Professor, Sociology of Health and Well-Being, at the University of Auckland.

From the Back Cover

Drawing on the latest international sociological research, this monograph takes a critical look at contemporary developments, discourses and debate on pharmaceuticals and society. Key issues covered include:

• Pharmaceuticals and medicalisation
  
• The science and politics of drug development, testing and regulation
  
• Constructions of pharmaceuticals in professional and popular culture
  
• The meaning and use of medications in everyday life
  
• Pharmaceuticals, consumerism and citizenship
  
• Innovation and expectations regarding pharmaceutical futures
  
• Pharmaceuticals and the Internet

Written in a lively, accessible style, with many engaging and important insights from key international figures in the field, this timely and topical monograph will appeal to a truly interdisciplinary audience of students, academics, researchers, professionals, practitioners and policy makers with an in interest in pharmaceuticals and society.

• Pharmaceuticals and medicalisation
  
• The science and politics of drug development, testing and regulation
  
• Constructions of pharmaceuticals in professional and popular culture
  
• The meaning and use of medications in everyday life
  
• Pharmaceuticals, consumerism and citizenship
  
• Innovation and expectations regarding pharmaceutical futures
  
• Pharmaceuticals and the Internet

Written in a lively, accessible style, with many engaging and important insights from key international figures in the field, this timely and topical monograph will appeal to a truly interdisciplinary audience of students, academics, researchers, professionals, practitioners and policy makers with an in interest in pharmaceuticals and society.

Excerpt. © Reprinted by permission. All rights reserved.

Pharmaceuticals and Society

Critical Discourses and Debates

John Wiley & Sons

Copyright © 2009 Simon J. Williams, Jonathan Gabe and Peter Davis
All right reserved.
ISBN: 978-1-4051-9084-8

Chapter One

The sociology of pharmaceuticals: progress and prospects Simon J. Williams, Jonathan Gabe and Peter Davis

Introduction

Recent years have witnessed an upsurge of interest in pharmaceuticals and society, a trend which in part reflects the growing power and influence of the pharmaceutical industry over all our lives, as patients, consumers and citizens. Medicine costs the National Health Service (NHS) in England alone over 7 billion every year, 80 per cent of which is spent on branded (patented) products, with the pharmaceutical industry the third most profitable activity in the UK economy after tourism and finance (House of Commons Health Committee 2005). These figures, in turn, are part and parcel of the bigger global picture of pharmaceuticals sales which are forecast to grow by five to six per cent between 2007 and 2008 to over US $735 billion a year - with North American sales alone constituting nearly half of this market, and North American and European pharmaceutical sales together constituting over three-quarters of global pharmaceutical sales (IMS MIDAS 2008 http:// www.imshealth.com). Scarcely a day goes by, moreover, without some story or other in the media about pharmaceutical products and practices. On the one hand, newspaper headlines boast new breakthrough 'wonder drugs'. On the other hand, stories of drug crises or controversies are regularly rehearsed in the media, thereby stirring fear and fascination in the public mind as to the power of pharmaceuticals and the industry that markets and manufactures them. Clearly pharmaceuticals have an important role to play in the alleviation of human suffering and the saving of lives. They are also, however, the source of much controversy, contestation and conflict, not simply in terms of their development, testing and marketing, but in terms of their very meaning and consumption.

This monograph is both a reflection of and response to this upsurge of interest in pharmaceuticals and society, casting further critical sociological light on these developments, discourses and debates. It is possible, in this respect, to point to a variety of themes and issues which taken together demonstrate both progress in sociological research on pharmaceuticals over the years and future prospects.

Medicalisation and pharmaceuticalisation; doctors, disorders and drugs

The first and perhaps most long-standing sociological theme has centred on the role of pharmaceuticals in the medicalisation of society. When Illich (1975), way back in the 1970s, talked of the iatrogenic effects of modern medicine and how the consumption of medical products helped sponsor a 'morbid society', a key target of his critique was our 'over-reliance' or 'dependence' on drugs as well as doctors. Others more fully or squarely located within medical sociology, particularly North American medical sociology, have also taken up these themes, albeit in a less radical or libertarian way than Illich. Specific emphasis has been placed by these authors on the expansion of medical jurisdiction and control over more and more areas of our lives, in the name of health and illness (Zola 1970, Freidson 1970, Conrad and Schneider 1980a,b). The role of the pharmaceutical industry within these processes, nonetheless, remained a somewhat muted or neglected theme in the medicalisation literature of the 1970s through to the 1990s, with sociological attention focusing on the power and influence of medicine in the social construction of disease and decisions about its treatment. More recent work, however, has begun to reappraise these processes in the light of current trends and developments regarding the medicalisation of society. Conrad (2005, 2007, Conrad and Leiter 2004), for example, in updating his previous work in this area (Conrad 1992, Conrad and Schneider 1980a,b), has pointed to what he terms the 'shifting engines' or 'drivers' of medicalisation over time - see also Clarke et al. (2003) for a somewhat different line or emphasis on transitions from medicalisation to so-called 'biomedicalisation'. Whilst the definitional centre of medicalisation remains with doctors, Conrad argues, the primary drivers of medicalisation now pertain to consumerism, managed care markets and developments in biotechnology, including the pharmaceutical industry.

Other more critical commentators (many of whom, significantly, are not sociologists), have taken these arguments one or more steps further, claiming that what may once have been regarded as medicalisation is now best seen as outright 'disease-mongering' in which the helping hand of the pharmaceutical industry looms large. Critics such as Moynihan (Moynihan 2002, Moynihan and Henry 2006, Moynihan et al. 2002) and Blech (2006), for example, through a series of case studies, have shown how pharmaceutical companies in collaboration or conjunction with doctors, pressure groups and the media, are no longer simply manufacturers of drugs but of diseases for these drugs to treat! - see also Law (2006) on 'Big Pharma'. A recent issue of the Public Library of Science - Medicine, for instance, devoted a whole section to essays on this very issue, including case studies of a range of diseases or disorders from ADHD (Phillips 2006) through erectile dysfunction (Lexchin 2006) and female sexual dysfunction (Tiefer 2006) to bipolar disorder (Healy 2006). These critiques, to be sure, are important. Not all forms of medicalisation, however, involve disease-mongering. Nor do all forms of medicalisation entail pharmaceuticals or processes of pharmaceuticalisation. Ideally, medicalisation should be considered as a value-neutral term that simply denotes the making or turning of something into a medical matter, the merits of which are open to empirical investigation depending on the case in question (Conrad 2007, 1992). Medicalisation, as such, may have positive and negative or light and dark faces, involving both gains and losses for the parties involved.

Whatever the merits of the case for outright disease mongering, one key vehicle for the expansion of pharmaceutical markets is of course direct-to-consumer advertising (DTCA): a development which to date is limited to countries such as the USA and New Zealand. On the one hand, this may be viewed as an entirely new development or departure. On the other hand, an instructive parallel and precursor may be found in the guise of patent medicine advertising in the past. Conrad and Leiter's chapter, for example, sheds valuable further light on these issues. Taking two advertising exemplars as its case studies - the late 19th century Lydia E. Pinkham's vegetable compounds for 'women's complaints' and contemporary Levitra for 'erectile dysfunction' (ED) - instructive parallels are drawn by these authors between the patent medicine era and the DTCA era. One of the great ironies of DTCA in this respect, Conrad and Leiter argue, is that it extends the relationship of drug companies, physicians and consumers in ways that rehearse or return us to a situation similar to Lydia Pinkham's day, when the drug manufacturers had a direct and independent relationship with consumers. Whilst the extravagant claims of Pinkham are now constrained by law, moreover, we must also contend with the fact that modern advertising has become far more subtle and sophisticated in its attempts to persuade or convince consumers that its products are the right ones in an increasingly competitive pharmaceutical marketplace. The pharmaceutical industry and consumers, Conrad and Leiter conclude, are increasingly important players in medicalisation, facilitated in part by the advent (or return to) DTCA.

Another key factor or player in these medicalising processes, of course, as Conrad and Leiter's chapter on DTCA clearly attests, are the media. Previous sociological studies, for example, have demonstrated both celebratory and critical media discourses on drugs, depending on the media, format and drug in question, the relative 'newness' of the drug to the market, and its 'newsworthiness'. For example, when benzodiazepine tranquillisers were first prescribed in the 1960s they generally received an enthusiastic welcome in the UK and US media and were proclaimed as heralding a new therapeutic era. As their popularity grew, however, their therapeutic value ceased to be newsworthy and a more critical coverage developed, drawing on the comments of a small but growing band of professional and lay critics. Initially, in the 1970s, this concern focused on claims about their overuse as a 'chemical crutch' for personal problems, before shifting in the 1980s and 1990s to claims about these drugs' 'addictive' potential, (Gabe and Bury 1996a, 1996b), with users portrayed in the local and national UK press as innocent victims, through no fault of their own, who then tried to withdraw and embark on a 'return journey' to normality (Gabe et al. 1991). Moreover, through these forms of mediation and marketing, drugs may come to take on personalities of their own, achieving some sort of quasi-mythic or celebrity status in the popular imagination, construed or constructed as the archetypal hero or villain (see for example Martin 2007, Nelkin 1995).

Some of these issues, for instance, are addressed in Williams and colleagues' chapter on newspaper coverage of the wakefulness-promoting drug Modafinil (brand name Provigil). Constructions of this drug in the print news media, these authors show, range from largely uncritical endorsement of its clinical applications as a 'breakthrough' or 'wonder drug' for a growing list of sleepiness-related conditions, to somewhat more cautious or critical coverage of its wider (potential) uptake as a lifestyle drug of choice, or in sport or military contexts. Again, we see here, in the guise of this wakefulness-promoting drug, the now familiar if not commonplace rehearsal of concern over the blurring or shifting boundaries between 'treatment' and 'enhancement', and the broader articulation of cultural anxieties about a move to a 24/7 society in which sleep becomes increasingly optional if not obsolete. A notable feature of the chapter, in this respect, is the authors' preference for the term 'pharmaceuticalisation' rather than medicalisation in order to capture these concerns in the press: concerns, that is to say, to do with the potentially widespread use and uptake of pharmaceuticals for diverse purposes which extend far beyond the realms of medicine or the strictly medical.

Another prime expression of the mediation of pharmaceuticals, of course, concerns the Internet or cyber-space/culture - see, for example, Miah and Rich (2008). This includes not simply access to information on pharmaceuticals via Internet searches, but the purchase of pharmaceuticals through online or e-pharmacies and the sharing of information and support through Internet chat rooms and online forums of various sorts (Fox et al. 2005a,b). In these and other ways, new opportunities for the mediation of pharmaceuticals are opening up in all our lives, for better or worse, routes that may very well bypass the traditional doctor-patient relationship altogether. Some of these issues, for example, are taken up in Fox and Ward's chapter on the pharmaceuticalisation of daily life - as with Williams et al.'s chapter, the preference for pharmaceuticalisation over medicalisation is once again notable. Taking as their problematic the new emphasis on lifestyle in the production, marketing and consumption of pharmceuticals and drawing on a diverse array of sources - including literature from social science, economics and health services research, together with their own research on pharmaceutical consumption - Fox and Ward identify two broad processes at work here. First, a domestication of pharmaceutical consumption, through computer mediated access and consumption within the home, particularly the bedroom and the kitchen. Second, the pharmaceuticalisation of everyday life, as pharmaceuticals come to be seen by consumers as 'magic bullets' for a range of everyday daily life problems. The domestication of pharmaceutical consumption and the pharmaceuticalisation of life, in this respect, become a complex mixture or heady brew of factors, including the biological effects of the drug on the body, the legitimacy of the problem or disorder in question, the willingness of consumers to adopt the technology as a 'solution' to a problem in their lives, and the corporate interests of the pharmaceutical industry. For these authors social relations surrounding contemporary pharmaceutical production and consumption 'link the world of business to the private world of citizens, forging new diseases and treatments from the very fabric of daily life'.

Regulation; science, politics and the pharmaceutical industry

If medicalisation and pharmaceuticalistion constitute one key strand of sociological research on pharmaceuticals and society over the years, then the science and politics of the pharmaceutical industry, including issues of development, testing and regulation, constitute another rich seam of work. Abraham (1993, 1995, 1997, 2002, 2007, Abraham and Davis 2005, Abraham and Lewis 2002, Abraham and Reed 2001, Abraham and Sheppard 1999), for example, has been at the forefront of this research over the past 15 to 20 years, documenting through detailed empirical case study work and comparative analysis elements of controversy and corporate 'bias' which, at one and the same time, demonstrate the inadequacies of existing regulatory practices and procedures, and the need for more rigorous and robust policy interventions at the institutional and legislative levels. These include the development of independent drugs testing by regulatory authorities, increased patient and public representation on regulatory committees and more frequent and thorough oversight of regulatory performance by the legislature - see also Busfield's (2007a) recent sociological analysis of scientific 'fact making' in the clinical trials of drugs and in post-approval drugs assessment, and the subsequent Abraham (2007)-Busfield (2007b) debate.

Many of these issues were explicitly taken up and addressed by the House of Commons Health Committee (2005) Report on The Influence of the Pharmaceutical Industry. Whilst rightly noting how pharmaceuticals may be a force for the good in contributing to the health of the nation, the report is nonetheless peppered with references to a 'failing' regulatory system, to 'lax oversight' and to practices on the part of the pharamaceutical industry which 'act against the public interest', given the power and influence of marketing forces. Recommendations cover several key areas, including the licensing process, with greater transparency and independent assessment of evidence, improved Medicine and Health Care Products Regulatory Agency (MHRA) mechanisms for restraints on medicines promotion, tougher restrictions and greater vigilance to guard against 'excessive' or 'inappropriate' prescribing, and a fundamental review of the MHRA itself.

In revisiting these issues, Abraham's chapter provides both a timely review of 20 years of sociological research on pharmaceutical development and regulation and a reassertion of the importance of a realist empirical research programme for the investigation of these issues, based on the notion of 'objective interests' - i.e. the objective interests of pharmaceutical companies in profit maximisation and the objective interests of patients/public health in the optimisation of the benefit-risk ratio of drugs. Drawing on international comparisons of drug regulation, Abraham shows how commercial interests have biased the science of drug testing and review away from patients and the public in favour of the industry: a process, he argues, which is best characterised as 'neo-liberal corporate bias'. Far from being the 'inevitable by-product' of technoscientific progress in pharmaceuticals, moreover, these international comparisons are valuable in demonstrating considerable scope for improvement. Similarly, the lowering of technoscientific standards for drug safety across the EU, US and Japan is not, Abraham argues, an inevitable price to be paid for faster development of therapeutically valuable medicines, but more plausibly a consequence of the international spread of neo-liberal corporate bias in pharmaceutical regulation.

(Continues...)

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Edition details

• Publisher: Wiley-Blackwell
• Publication date: 2009
• Language: English
• ISBN 10: 1405190841
• ISBN 13: 9781405190848
• Binding: Paperback
• Edition number: 1
• Number of pages: 170
• Editor: Simon J. Williams, Jonathan Gabe, Peter Davis