6_Medications and the Pharmaceutical Industry - Cohen et al

6_Medications and the Pharmaceutical Industry - Cohen et al...

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Unformatted text preview: 280 The Social Organization of Medical Care blockbuster drugs in the SSRI class, has spurred intensive efforts by pharmaceutical companies to market new products: in 2000 some 103 mol— ecules were under development as psychotropic candidates, particularly as antiwdementia drugs, antidepressants, anxiolytics or addiction treat— ments (Pharmaceutical Research and Manufac— turers of America, 2000). CHANGES IN PHARMACEUTICAL MARKETING PRACTICES Among the many sociocultural determinants of the popularity of various medications, especially psychotropic medications, pharmaceutical mar- keting practices have frequently been mentioned, although until a decade ago, there has been sur— prisingly little study of just how and to what ex— tent these practices have impacted upon physi— cians (see Prather, 1991; review by Lexchin, 1993). Recently, an exhaustive meta-analysis showed that most gifts and incentives increase physician prescribing for the promoted drug, while simultaneously having a negative impact upon physicians’ knowledge (Wazana, 2000). Advertisements in medical journals, visits to physicians using sophisticated persuasion tech— niques (Roughead et al., 1998), and symposia sponsorship constitute the bulk of promotional activity. More recently, there has been recent growing use of direct—to—consumer advertising (DTCA) in mass~rnedia, a formerly prohibited practice but now fully allowed in the USA and New Zealand and beginning in other western na— tions. In 1999, the pharmaceutical industry in the USA spent $13.9 billion on‘drug promotion, one- fifth more than the previous year. Of this amount, $1.8 billion went to DTCA—triple what was spent three years before (IMS Health, 2000b). Despite such estimates, total promotional spend— ing remains unknown because these data—~if re leased by manufacturers—may be classified under other less conspicuous headings; indica— tions exist that promotional spending may ap— proximate or even exceed true research spending. Direct—to—consumer advertising, via openly persuasive publicity slogans—mostly on televi- sion—or industry-funded “educational” cam— paigns on the identification and lifelong drug THE INTERNET . 1N THE CONSTR or KNOWLEDGE MEDICATIONS treatment of various troubles, is a harbinger for a major transformation in the significations and roles of medications in society—moving them even further out of the domain of medical mys- _ tique and into the mass market as lifestyle prod- ucts. The transformation of a prescription drug from strictly a tool of medical practice to a prod- uct that may be sought or declined on the basis not only for “lay knowledge” but, more pre— cisely, consumer product knowledge, could have profound implications given the ways in which such knowledge is obtained, perceived, and ap- plied. Direct—to—consumer advertising may also be expected to transform the doctor-patient rela- tionship as increasing numbers of patients arrive at the consultation with not only explanatory frameworks regarding their troubles, but also the proposed solution: a prescription for a drug named by the consumer (Lexchin, 1999). Studies suggest that most physicians respond positively to these requested prescriptions (Wilkes et al., 2000). A marketing executive observes that “DTC advertising is now being used in virtually all phases of a product’s life cycle, from launch to patent expiration” (cited in IMS Health, 2000b). A major part of promotional activity in general is aimed not at consumers or medical prescribers, but at entire institutions: governments and other regulatory agencies, lobby groups concerned with specific illnesses, universities and other re- search bodies. Rarely is this promotional activity described in the scientific literature though some serious independent or journalistic investigations exist (e.g. Fried, 1998; Medawar, 1999; Silver- stein, 1999). The evidence is mounting, however, _ of persistent and expanding influence of pharma- , , ._ ceutical companies in the formulation of indus— trial health policies affecting their business, and in influencing what kind of research will be done, how it will be done, and how (or whether) it will be reported (Medawar, 1992; Walker, 1994; Abraham, 1995; Lehrman and SharaV, 1997). The title of a recent editorial in a medial1 journal illustrates growing medical concern 0V5}: the issue: “Scientific harassment by pharmaceutl’ cal companies: Time to stop” (Hailey, 2000): In these circumstances, it remains an open questhn whether the pharmaceutical induStry seiVes health systems or whether health systems Serve the pharmaceutical industry. An exemplary sign ( Internet has already 5 entific and commerci medications (Cobert et al., 1999)——-and t have that the interac represented by this n meanings and uses ( rent recognition. A n has been to facilitat tion as a prominent knowledge about m an enormous change Where such knowleo scientific, health prc manufacturing CXpt even more so with rt tions, used as they a1 term—by emotiona have been particular other actors (COl’lt McCubbin and Cohi The Internet has : thorized sources in general public, enal logue with physicia Goldsmith even sugg not have time to se: information from it, tients to update the own field, [which] i traditional informat 2) The Internet ha Create mutual suppc ; vironments that all« 3 tiVe safety in comp Circumstances. Such letin boards, news have clearly contrib consumer” class 0 Vices: people who a; Cpnsumers, who ac t‘01}8 and the best , their complex issue and Support, who ...
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