Pharmaceuticalization

This paper analyzes an emerging form of post-pharmaceutical health and its underlying regime of value in the global bioeconomy of regenerative stem cell-based medicine (RSCM). Animated by a vision to overcome drug-based therapies and their underlying political economies, RSCM pursues a form of regenerative health that is strikingly at odds with pharmaceutical regimes of drug research, regulation and therapy. To offer a theoretical account of these competing forms of health, the paper provides an analysis of the regimes of values that underpin pharmaceutical and regenerative health respectively. This analysis is done alongside three dimensions: the interlinkage between knowledge, technology and economic value creation; its relation to normative values and ethics; and conceptions and valuations of the biomedical subject and his/her body in biomedical research, intervention and innovation. Contrasting these two diverging regimes of health and value suggests that in RSCM the pharmaceutical logic of accumulating “surplus health” is not entirely dismissed but re-articulated in a regime based on the (re-)generation of regenerative biovalue through the extraction and ex vivo accumulation of “surplus vitality”. Finally, the article discusses “post-pharmaceutical health” as a sensitizing concept that offers new research avenues into emergent forms of health, value, and subjectivity beyond RSCM.

Cette thèse vise à comprendre comment de petites entreprises pharmaceutiques basées en Inde se développent sur un marché mondial pourtant dominé par les grandes firmes multinationales, souvent issues des Nords. Elle mobilise les outils théoriques de la géographie économique et des études du développement et s’appuie sur plusieurs sources et méthodologies : des entretiens semi-directifs menés à Ahmedabad et à Mumbai auprès de directeurs d’entreprises pharmaceutiques de taille micro, petite, et moyenne (n = 99), des entretiens non-directifs auprès d’acteurs du secteur en Inde (n = 61), et des données quantitatives issues de bases publiques et privées. Cette enquête de long cours a nécessité trois séjours de terrain pour un total de 15 mois en Inde auprès des acteurs. L’analyse identifie les marchés locaux, segments pharmaceutiques, et réseaux de production dans lesquels les petites entreprises évoluent. Les normes politiques, économiques, et juridiques leur étant diversement favorables, elles occupent de meilleures positions sur le segment des médicaments génériques et dans les pays à revenu faible et intermédiaire. Leurs stratégies commerciales évolutives et flexibles s’appuient sur des ressources encastrées dans des milieux d’affaires très actifs dans les environnements métropolitains et globalisés, construits autour d’identités territoriales et communautaires. Fortement spécialisées, capitalisant sur un important savoir-faire commercial, les petites entreprises pharmaceutiques indiennes innovent à la marge, frugalement, mais de manière originale. Leurs motivations entrepreneuriales voient se mêler des enjeux individuels et collectifs, sanitaires et matériels, locaux et globaux. Cette thèse montre généralement comment ces agents participent à la globalisation de l’Inde et façonnent des capitalismes régionaux « alternatifs », assemblages d’éthiques et de pratiques hétéroclites.

The racialization of individuals in the contemporary United States is increasingly accomplished through institutional actors, including scientists and physicians. As genetic health risks, chronic disease
treatments, and pharmaceuticals come to define Americans’ understanding of themselves, a fundamental shift is occurring in the way medicine is practiced and its role in the production of
subjectivity. Underlying these changes is an expectation of orderly bodies—of “white” bodies that exemplify social and cultural norms of biology and behavior. Fundamental to U.S. medical ideas of
normativity is that the white heteronormative subject is the standard against which disorderly and nonwhite subjects are to be judged. I explore these ideas through the history and contemporary world of sleep: the clinical production and interpretation of related scientific data, advertising use of images of sleep-disordered patients who have been “cured,” and experiences of nonwhite Americans within mainstream sleep medicine.

Pharmaceutical industry and drugs advertisement is sometimes accused of "creating diseases". This article assesses and describes the role of that industry in fostering medicalization. First, the notions of medicalization and pharmaceuticalization are defined. Then, the problem of distinguishing between harmful overmedicalization and well-founded medicalization is presented. Next, the phenomenon of disease mongering is explained and illustrated by the case analysis of medicalizing pain and suffering in three contexts: 1) the general idea of medicalizing physical pain, 2) the medicalization of grief, and 3) disease mongering of pseudoaddiction-a condition promoted in order to increase the demand for opioid pain relievers.

Les soins palliatifs et l’accompagnement des mourants s’inscrivent dans le mouvement plus large d’individualisation de la mort. Centrée sur la notion d’autonomie, la mort idéale se veut aujourd’hui discrète, inconsciente et hygiénique. Impensable sans une importante expertise médicale qui permet de soulager la douleur physique, de contrôler chimiquement l’angoisse et la peur, de neutraliser les odeurs et les traces de l’agonie, cet idéal suppose une tension constante entre contrôle et dépendance. Emblématique de ce que le sociologue Nikolas Rose nomme la biocitoyenneté, soit une forme de citoyenneté centrée sur une politisation de la santé individuelle et sur l’émergence de revendications identitaires reliées à des questions d’ordre biomédical, le mouvement en faveur des soins palliatifs s’inscrit en fait dans le processus global de pharmaceuticalisation caractérisant les sociétés occidentales contemporaines. Partant d’un questionnement sociologique sur l’usage croissant de la sédation profonde dans la gestion biomédicale de la fin de vie, cet article propose d’analyser le phénomène du contrôle médicamenteux de la souffrance sous l’angle de la pharmaceuticalisation. Au-delà de la thèse du déni de la mort et du refus de la douleur, il s’agira plutôt de comprendre que la sédation profonde est indissociable d’une volonté de contrôle et d’optimisation de soi propre à la biocitoyenneté. Loin d’un simple refus de la douleur, la norme de la sédation profonde indique plutôt que la douleur « improductive », c’est-à-dire celle qui ne s’inscrit pas dans une logique thérapeutique, méliorative ou expérimentale, tant à devenir socialement intolérable. La sédation profonde apparaît ainsi à la fois comme la limite et l’expression ultime de la biocitoyenneté.

In recent years, there has been a growing concern for the non-medical use of prescription drugs by young adults, e particularly college e university students. These expanding practices of pharmaceutical drug use have been associated with different phenomena such as physical e cognitive enhancement, non-medical prescription drug use e recreational use. All of these various consuming practices involve a blurring of the boundaries between curing, preventing e enhancing e between recreational e productive activities. Some studies show the importance of linking pharmaceutical drug use with broader issues among students in academic settings, such as competitiveness, pressure, stress, depression e mental health issues. The main objective of this article is to explore some of the perceptions e rationales that underlie the use of non-medical e medical prescription drugs, natural products, energy drinks e other pharmaceutical or natural substances among university students in Montreal (Canada). Focus-groups e indepth, semi-structured interviews were realized with a sample of 42 students in order to link the consumption cultures of the participants with other variables, such as their lifestyle, their experience of psychological distress e anxiety e their need of achievement. Focusing on the young population fulfills the function of sociological forecast about the future trends in the expansion of pharmaceutical drug use for the management of everyday life in contemporary Western societies.

This paper examines the consequences of a new emphasis on lifestyle in the production, marketing and consumption of pharmaceuticals. Over the past decade, a range of medicines have become available that address aspects of lifestyle, while others have been the subject of lifestyle marketing. We argue, with recourse to a broad literature from the social sciences, economics and health services research and from our study of pharmaceutical consumption, that two processes can be discerned. First, there is a domestication of pharmaceutical consumption, with drugs available via home computers, and marketing of pharmaceuticals that focuses upon private or personal conditions and addresses domestic activities such as sex and cooking. Secondly, there is a pharmaceuticalisation of everyday life as the pharmaceutical industry introduces profitable medicines for a range of daily activities and pharmaceuticals come to be seen by consumers as a ‘magic bullet’ to resolve problems of daily life. We suggest that the pharmaceuticalisation of daily life links the economics and politics of pharmaceutical production to the private lives of citizens.

Science should be a truth-seeking endeavor. However, in the real world, a significant portion of the new published biomedical knowledge, if not all, is pharmaceutical or device industry-funded. In this way, the base of evidence upon which the medical practice rests is clearly biased in the service of a profit-maximizing rationale, instead of patients´ needs. One of the main mechanisms to achieve this is the phenomenon of selective publication bias. This means that clinical research outcomes are published so long as the results are favorable to the use of the product the firm intends to promote into the market. On the contrary, if the clinical research exhibits an unfavorable risk/benefit balance, the paper is not given to publication (Rosenthal´s “the file drawer´s problem”) and remains unpublished —in secret— and out of the reach of any serious evidence assessment. In turn, selective publication bias is usually one of the effects of sponsorship bias in such a way that both of them are intertwined along with a repertoire of well-established, tried-and-true practices geared to exert a strong influence on medical prescription preferences ―such as: gifts, “perks”, occult payments, free restaurant meals, travel to industry conferences, trips to Caribbean beaches, excursions to hunting, high-end spa paid sessions, patient recruitment for clinical trials fees, speaking and “consulting” honoraria, and other demand-enhancing direct-to-physicians marketing tactics.
Drawing on a critical public health perspective, this paper explores a set of serious problems that affects (and subverts) both contemporary medicine and medical epistemology: i.e., disease mongering, over-medicalization, pharmaceuticalization, over-use, over-utilization, over-diagnosis, and over-treatment, all of which have the deliberate presence of selective publication bias as their common backdrop.
When one brings to light these complex aspects of today´s medical practice, one discovers the determinants and subjacent motives of the high prevalence of unnecessary care and, as a consequence, the growingly unfundable cost trajectory of the health care industry.
Likewise, we put into the surface the interplay between selective publication bias, the process of generating a flawed evidence base and the problem of the promotion of off-label prescriptions. In addition, we take stock of the topic of the (un)availability of orphan drugs to treat rare (or low-incidence) diseases as part of a sound public health policy design with the explicit aim to enforce a prescription drugs´ regulatory framework capable of assuring patients´ protection. 
Besides, this paper includes two studies of specific cases: 1) flibanserin and hypoactive sexual desire disorder (HSDD) in women, and 2) metilphedinate and attention deficit and hyperactivity disorder (ADHD) in infants and adolescents.
These two cases make plain the relationship between, on the one hand, the commingled phenomena of selective publication bias, sponsorship bias, disease mongering, meta-analyses, systematic reviews and other research synthesis methods manipulation practices and, on the other hand, the place of truth, money, and language in medical knowledge-creation and in the distortion of the ethical constitution of those who are (supposed to be) disciples of the forgotten and long-deceased, Hippocrates of Kos.

In spite of a growing literature on pharmaceuticalization, little is known about the pharmaceutical industry's investments in research and development (R&D). Information about the drugs being developed can provide important context for existing case studies detailing the expanding – and often problematic – role of pharmaceuticals in society. To access the pharmaceutical industry's pipeline, we constructed a database of drugs for which pharmaceutical companies reported initiating clinical trials over a five-year period (July 2006–June 2011), capturing 2477 different drugs in 4182 clinical trials. Comparing drugs in the pipeline that target diseases in high-income and low-income countries, we found that the number of drugs for diseases prevalent in high-income countries was 3.46 times higher than drugs for diseases prevalent in low-income countries. We also found that the plurality of drugs in the pipeline was being developed to treat cancers (26.2%). Interpreting our findings through the lens of pharmaceuticalization, we illustrate how investigating the entire drug development pipeline provides important information about patterns of pharmaceuticalization that are invisible when only marketed drugs are considered.

In November 2016, the Colombian government and the Revolutionary Armed Forces of Colombia (FARC) signed a peace agreement to end a 52-year war. In the context of the peace deal implementation, I ethnographically traced entanglements of biomedicine, public health and the armed conflict across shifting temporalities and realities of war and peace. Through an exploration of past, present and future (dis)entanglements of war and leishmaniasis – a vector-borne disease known by many in Colombia as “the subversive disease” or the “guerrilla disease” – this article traces a discourse that frames health problems, like leishmaniasis, only as scientific or technological challenges. Drawing on STS critiques of future-oriented timelines in technoscience and the concept of pharmaceuticalization, I argue that the expectations embedded in technoscientific innovation problematically limit the possibilities of disentangling leishmaniasis and war in post-conflict Colombia. In contrast, ethnographically exploring how health policies and biomedicine have nurtured violence and exclusion helps us destabilize the warfare-loaded meaning and experience of leishmaniasis. This approach enables us to move beyond imaginaries of technoscientific peacemaking, which I define as the excessive trust endowed to technoscience to (re)build a peaceful future, especially when we are faced with failures in understanding the involvement of technoscience in the production and perpetuation of violence.

In recent decades pharmaceutical consumption has skyrocketed, growing from $43 US billion in 1985 to over $1,143 billion in 2017. In trying to understand the source of this growth, social scientists have identified the key actors driving medication use and the processes through which they are driving it. However, much less attention has been devoted to understanding the forces that constrain medication consumption. This information is crucial for developing a deeper understanding of medication consumption, one that explains how context mediates the ability of key actors to shape medication consumption. To address this gap, I examine France’s low consumption of psychostimulants to treat ADHD symptoms. France is a strategic case to analyze because it diverges dramatically from comparative cases: while 7% of U.S. children are medicated with psychostimulants, the same is true for only 0.2% of French children. To explain the French case I use the theory of countervailing powers. Informed by interviews with key informants, the French medical literature on psychostimulants and secondary sources, I explain how the state, medical experts and consumers have acted as countervailing forces against pharmaceutical interests. In doing so, I provide deeper insight about how context can limit the pharmaceutical industry’s power.

In recent years, there has been a growing concern for the non-medical use of prescription drugs by young adults, e particularly college e university students. These expanding practices of pharmaceutical drug use have been associated with different phenomena such as physical e cognitive enhancement, non-medical prescription drug use e recreational use. All of these various consuming practices involve a blurring of the boundaries between curing, preventing e enhancing e between recreational e productive activities. Some studies show the importance of linking pharmaceutical drug use with broader issues among students in academic settings, such as competitiveness, pressure, stress, depression e mental health issues. The main objective of this article is to explore some of the perceptions e rationales that underlie the use of non-medical e medical prescription drugs, natural products, energy drinks e other pharmaceutical or natural substances among university students in Montreal (Canada...

Since the beginning of the 20th century environmental health researchers have known about the association between toxicant exposure and disease. However, that knoweldge has not been well integrated into mainstream medicine. Shedding light on why is the focus of this paper. To shed light on this issue I analyze the 2011 American Academy of Pediatrics’ clinical practice guidelines for ADHD, focusing specifically on the omission of environmental health research pertaining to ADHD symptoms and exposures, such as lead and mercury. I found that while there environmental researchers have been documenting the link between lead and ADHD for over forty years, the American Academy of Pediatrics completely omitted this research from its 2012 clinical practice guidelines. Moreover, I argue this omission can be traced to competitive pressues to protect medical jurisdiction, and a reductionist worldview that emphasizes treatment over prevention. This is the first attempt to analyze the way clinical practice guidelines help reinforce and perpetuate dominant medical perspectives. Moreover, to shed explanatory light, this paper offers a synthetic explanation that combines materialist and ideological factors. Beyond the specific case of ADHD, this paper has implications for understanding how and why environmental health research is omitted from other materials produced by mainstream medicine, such as materials found in the medical school curriculum, continuing medical education, medical journals, and on the medical association websites.

Treating oneself is a controversial practice: scorned in the name of the health risks it runs, self-treatment may also be praised in the name of the independence it expresses. The messages of public health authorities are at the heart of the controversy, emphasizing risk one moment and their potential for patient responsibility the next. Such contradictory injunctions also affect the practices of care providers.

The uses and meanings of self-medication vary over time and across geographical and social space. Its definitions make reference to this diversity, ranging from using only medications available without a prescription to their various applications in a self-care regimen. Research on these differentiated uses of medicines and care methods has made it possible to identify much-discussed processes in the academic field, including pharmaceuticalization, therapeutic innovation, and ways of circulating knowledge and products. [...]

Papers are sought on the following themes :
1) Self-medication through history
2) Public policy and its controversies
3) Social and regional determinants of self-medication
4) Products defined according to how they are distributed
5) Practices challenging the relationship with health care providers
6) Meanings in question

For more information, please visit http://automedication.sciencesconf.org/

Coronary artery disease (CAD) has dominated mortality for most of the past century, not just in Europe and North America but worldwide. Treatments for CAD, both pharmaceutical and surgical, have become leading sectors of the healthcare economy. This paper focuses on the therapeutic landscape for CAD in the United States. We hope to add texture to the broader conversation of pharmaceuticalization explored in this issue by situating pharmaceutical therapies as just one element in the broader therapeutic terrain, alongside cardiac surgery and interventional cardiology. Patients with CAD must navigate a therapeutic landscape with three intersecting paths: lifestyle change, pharmaceuticals, and surgery. While pharmaceuticals are often seen as a quick fix, a way of avoiding more difficult lifestyle changes, it is surgery and angioplasty that promise patients the quickest fix of all. There also is another option, often overlooked by analysts but popular among physicians and patients: inaction. The U.S. context is often critiqued as a site of excessive treatment with respect to both drugs and procedures, and yet there is deep stratification within it – over-treatment in many populations and under-treatment in others. People who experience the serious risks of CAD do so in a racialized terrain of durable preoccupations with difference and unequal access to care. While the pharmaceuticalization literature disproportionately attends to lifestyle drugs, which some observers consider to be medically inappropriate or unnecessary, CAD does remain the leading cause of death. Thus, the stakes are high. Examination of the pharmaceuticalization of CAD in light of surgical treatments and racial disparities offers a window into the pervasiveness and persuasiveness of pharmaceuticals in an increasingly consumer-driven medicine, as well as the limits of their appeal and their reach.

This chapter examines the way government funding activities influence the pharmaceuticalization of ADHD. To shed light on this issue I focus on the New Zealand case, whose consumption of ADHD medications grew significantly during the 1990s. This paper explores how consumption was shaped by government funding policies, including those affecting medication cost and those affecting access to healthcare professionals. Additionally, it examines how government decisions have sought to steer consumption towards lower-cost medications. The paper also considers how the influence of funding activities is itself shaped by the surrounding economic context, and the activities of regulatory agencies. Beyond elucidating the New Zealand case, this analysis provides a better understanding of how governments can mediate the pharmaceuticalization process more generally.