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