Our society’s relationship with drugs is marked by the effort to standardize their composition and use through science. We assume that the scientific method is applied straightforwardly to all biomedical research, including the discovery and testing of pharmaceuticals. We therefore regard pharmaceuticals as legitimate children of science.
A growing chorus of researchers and journalists challenge this assumption on empirical grounds. They show that pharmaceutical research is widely corrupted by marketing agendas. The evidence is incontrovertible, however, the process by which this corruption occurs isn’t straightforward. Alastair Matheson, in a brilliant study of the role of industry in the construction of scientific and medical knowledge, says: “Outright scientific falsifications or conscious deceptions are rare… When subtle violations or distortions…do occur, they are often not the result of conspiracy or intent, but arise simply from an accumulation of selective or biased constructions” (2008, p. 374).
The process by which “biased constructions” come about is not innocent, but Matheson’s point is well taken: Intention and collective agency often don’t coincide. Conspiracies are rare. Institutions and professions instead develop normative trajectories that seem to work independently of the wills and intentions of individual member actors. Self-evidence and other forms of implicit knowledge mediate the interface between individual managers and the institution, and this disposition enables and even drives the reproduction of existing practices.
In the case of capitalist firms, reproduction means growth. Activities that contribute to expansion are selected (in a Darwinian sense) for entitlement. Marketing is the function and practical philosophy most expert in and devoted to corporate expansion. As a discipline, marketing was cultivated for this purpose. Reckless, unethical expansion can occur when a firm’s reigns are handed over to the marketing department. This risk is especially pronounced in healthcare and in pharmaceuticals, which are often referred to as “ethical drugs.”
Perhaps we shouldn’t be surprised that company research and development (R&D) divisions have fallen prey to marketing imperatives. The audacious reach outwards into the public realm of scientific knowledge in campaigns to pervasively “ghost manage” the conduct of medical research (Sergio Sismondo’s term), to rig clinical trials and conceal damaging trial data, to influence prescribing practices through publication and medical education, among a growing list of similar incursions into the public interest, may also not be wholly unexpected, but it is shocking.
To address the problem of the colonization of pharmaceutical science by marketing, we’ll have to confront the conundrum of where collective agency ends and individual responsibility begins. Lawyers and bioethicists tend to focus on individual action and intention rather than on how social norms and processes are implicated in the growth of harmful systems. Social scientists, by contrast, study phenomena at a level of collective abstraction at which individual agency and intention disappear.
Our approach to the problem must be tested against the practical need to reform healthcare. The pharmaceutical industry owns a 20-25 percent stake in worldwide health, meaning the percentage of healthcare budgets devoted to paying for medications. If we add the medical device industry, which operates on the same principles as pharmaceuticals, the number is much larger. Both industries are growing rapidly, claiming larger portions of healthcare. They are concentrated almost entirely in the West. Nineteen of the 20 largest pharmaceutical companies are American or European (#18, Takeda Pharmaceuticals, is Japanese). The new administration intends to reform healthcare. The pharmaceutical segment deserves highest priority. How can we participate?
Recommended academic reading:
Healy, David. The Engineers of Human Souls & Academia. Epidemiologia e Psichiatria Sociale (2007), 16(3):205-11. Available at: http://www.psychiatry.univr.it/page_eps/docs/2007_3_Healy.pdf
Matheson, Alastair. Corporate Science and the Husbandry of Scientific and Medical Knowledge by the Pharmaceutical Industry. BioSocieties (2008), 3:355–382. Available at: http://www.palgrave-journals.com/biosoc/journal/v3/n4/full/biosoc200839a.html
Social Studies of Science Special Issue on Intersections of Pharmaceutical Research and Marketing. Edited by Sergio Sismondo. Vol. 34, No. 2, April 2004. Introduction available at: http://post.queensu.ca/~sismondo/Maneuvers.pdf
- Pharmaceutical Marketing, Capitalism, and Medicine: A Primer (Part I/III)
- Pharmaceutical Marketing, Capitalism, and Medicine: A Primer (Part II/III)
- Pharmaceutical Marketing, Capitalism, and Medicine: A Primer (Part III/III)
- Cases for Overhauling Pharmaceutical Governance
- Warning Label Spin: Further Reflections on What the FDA is Up Against