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Lopes N, Tavares D, Pegado E, Raposo H, Rodrigues C. Medication use for the management of professional performance: between invisibility and social normalisation. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2024:1-18. [PMID: 38919993 DOI: 10.1080/14461242.2024.2362174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 05/27/2024] [Indexed: 06/27/2024]
Abstract
This article aims to explore pharmaceuticalisation processes in professional work contexts. The approach focuses on identifying patterns of medicine and dietary supplement use for managing work performance, and on discussing the relationship between these consumption practices and work-related pressure factors. This analysis adapts the notions of 'normalisation' to understand the extent of cultural acceptability of these practices, and the notion of 'differentiated normalisation' to capture the tension between the trend towards normalisation of such consumption and its partial social (in)visibility within work settings. Empirical support for this analysis is based on a sociological study conducted in Portugal on professions under high performance pressures. The study involved three professional groups - nurses, journalists and police officers. A mixed methods approach was used, including focus groups, questionnaires and semi-structured interviews. Overall, the results show a trend towards the use of medicines and supplements for performance management, which reveals itself as a cultural response to work-related social pressures. Such consumption coexists with irregular patterns of either occasional or long-term use, as well as heterogeneous processes of 'normalisation' and 'hidden' consumption. Conclusions point to a social interconnection between the intensification of work pressures and the pharmaceuticalisation of work performance.
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Affiliation(s)
- Noémia Lopes
- Iscte - Instituto Universitário de Lisboa, CIES-Iscte, Lisboa, Portugal
- Egas Moniz School of Health & Science, CiiEM-Egas Moniz Interdisciplinary Research Center, Caparica, Portugal
| | - David Tavares
- Iscte - Instituto Universitário de Lisboa, CIES-Iscte, Lisboa, Portugal
- ESTeSL - Escola Superior de Tecnologia da Saúde de Lisboa, Lisboa, Portugal
| | - Elsa Pegado
- Iscte - Instituto Universitário de Lisboa, CIES-Iscte, Lisboa, Portugal
| | - Hélder Raposo
- Iscte - Instituto Universitário de Lisboa, CIES-Iscte, Lisboa, Portugal
- ESTeSL - Escola Superior de Tecnologia da Saúde de Lisboa, Lisboa, Portugal
| | - Carla Rodrigues
- Iscte - Instituto Universitário de Lisboa, CIES-Iscte, Lisboa, Portugal
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
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2
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Daunt R, Curtin D, O'Mahony D. Optimizing drug therapy for older adults: shifting away from problematic polypharmacy. Expert Opin Pharmacother 2024; 25:1199-1208. [PMID: 38940370 DOI: 10.1080/14656566.2024.2374048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/25/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION The accelerated discovery and production of pharmaceutical products has resulted in many positive outcomes. However, this progress has also contributed to problematic polypharmacy, one of the rapidly growing threats to public health in this century. Problematic polypharmacy results in adverse patient outcomes and imposes increased strain and financial burden on healthcare systems. AREAS COVERED A review was conducted on the current body of evidence concerning factors contributing to and consequences of problematic polypharmacy. Recent trials investigating interventions that target polypharmacy and emerging solutions, including incorporation of artificial intelligence, are also examined in this article. EXPERT OPINION To shift away from problematic polypharmacy, a multifaceted interdisciplinary approach is necessary. Any potentially successful strategy must be adapted to suit various healthcare settings and must utilize all available resources, including artificial intelligence.
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Affiliation(s)
- Ruth Daunt
- Department of Medicine (Geriatrics), School of Medicine, University College Cork, Cork, Ireland
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Denis Curtin
- Department of Medicine (Geriatrics), School of Medicine, University College Cork, Cork, Ireland
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Denis O'Mahony
- Department of Medicine (Geriatrics), School of Medicine, University College Cork, Cork, Ireland
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
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3
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Donnelly K. Patient-centered or population-centered? How epistemic discrepancies cause harm and sow mistrust. Soc Sci Med 2024; 341:116552. [PMID: 38163402 DOI: 10.1016/j.socscimed.2023.116552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/08/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
Medical distrust is often conceived of as a problem of misinformation or ignorance. In this paper, I depart from this framework, attributing distrust instead to epistemic divergence between lay people and experts. Using data from a contraceptive side effects Facebook group and in-depth physician interviews, I find that providers employ a "body-as-subject" lens informed by population-health goals, while group members employ a "body-as-agent" lens that privileges individuality and bodily autonomy. Provider epistemologies are privileged, creating epistemic injustice and harm for patients. Ultimately, this erodes trust in providers and the medical community more broadly.
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Affiliation(s)
- Katie Donnelly
- Princeton University, 118 Julis Romo Rabinowitz, Princeton, NJ, 08540, USA.
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4
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Sultan N, Swinglehurst D. Living with polypharmacy: a narrative interview study with older Pakistanis in East London. BMC Geriatr 2023; 23:746. [PMID: 37968631 PMCID: PMC10652535 DOI: 10.1186/s12877-023-04392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/06/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Polypharmacy is a growing and major public health issue. It can be burdensome and risky for patients and costly to healthcare systems. Older adults and those from ethnic minority backgrounds are disproportionately affected by polypharmacy. This study focuses on medication practices among Urdu-speaking Pakistani patients, a significant ethnic group in the UK. Most existing research on medication practices within South-Asian communities centres on adherence, leaving the social and moral dimensions of polypharmacy unpacked. Understanding how British Pakistani patients understand and manage polypharmacy in the context of their daily lives is crucial to avoiding harmful polypharmacy. METHODS In-depth narrative interviews were conducted with 15 first-generation Pakistani patients using the Biographical Narrative Interview Method. Participants were recruited from GP practices in East London. All participants were prescribed ten or more regular medications (a pragmatic marker of 'higher risk' polypharmacy) and were aged over 50. Interviews were conducted with a bilingual researcher at home and were designed to elicit narratives of patients' experiences of polypharmacy in the context of their biographies and daily lives. RESULTS Polypharmacy is enacted through networks of interpersonal and socio-material relationships. The doctor-patient relationship and the family network held particular significance to study participants. In addition, participants described emotional bonds between themselves and their medicines, identifying them as 'forces for good'-substances which allowed them to maintain their health through the intercession of God. Meanings attributed to medicines and enacted through these social, emotional, and spiritual relationships contributed to emerging and sustaining polypharmacy. CONCLUSIONS Patients make sense of and manage treatments in culturally specific ways. Developing an understanding of how medication practices in different communities are enacted is important for informing meaningful and effective conversations with patients about their medicines. Our findings contribute to enabling the integration of culturally sensitive approaches to prescribing.
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Affiliation(s)
- Najia Sultan
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Deborah Swinglehurst
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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5
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Daunt R, Curtin D, O'Mahony D. Polypharmacy stewardship: a novel approach to tackle a major public health crisis. THE LANCET. HEALTHY LONGEVITY 2023; 4:e228-e235. [PMID: 37030320 DOI: 10.1016/s2666-7568(23)00036-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 04/10/2023] Open
Abstract
With growing global concern regarding medication-related harm, WHO launched a global patient safety challenge, Medication Without Harm, in March, 2017. Multimorbidity, polypharmacy, and fragmented health care (ie, patients attending appointments with multiple physicians in various health-care settings) are key drivers of medication-related harm, which can result in negative functional outcomes, high rates of hospitalisation, and excess morbidity and mortality, particularly in patients with frailty older than 75 years. Some studies have examined the effect of medication stewardship interventions in older patient cohorts, but focused on a narrow spectrum of potentially adverse medication practices, with mixed results. In response to the WHO challenge, we propose the novel concept of broad-spectrum polypharmacy stewardship, a coordinated intervention designed to improve the management of multimorbidities, taking into account potentially inappropriate medications, potential prescribing omissions, drug-drug and drug-disease interactions, and prescribing cascades, aligning treatment regimens with the condition, prognosis, and preferences of the individual patient. Although the safety and efficacy of polypharmacy stewardship need to be tested with well designed clinical trials, we propose that this approach could minimise medication-related harm in older people with multimorbidities exposed to polypharmacy.
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Affiliation(s)
- Ruth Daunt
- Department of Medicine, School of Medicine, University College Cork, and Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Denis Curtin
- Department of Medicine, School of Medicine, University College Cork, and Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Denis O'Mahony
- Department of Medicine, School of Medicine, University College Cork, and Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
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6
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Umar M. Pharmaceutical promotional activity and patient’s quality of life. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2021. [DOI: 10.1108/ijphm-02-2019-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose
The purpose of this paper is to explore the impact of these unethical promotional activities on patient’s quality of life.
Design/methodology/approach
In-depth interviews were conducted, and then quantitative method was also used on a large number of health care professionals.
Findings
Findings of the study demonstrated that unethical activities influence biased prescriptions and then it helps to misuse of medicines. The drug resistance is also affected by misuse of medicines. Misuse of medicine further affects on financial burden on patient. Drug resistance has impact on health compromise. Furthermore, finding of the study describes that drug resistance, health compromise and financial lead to the imbalance of patient’s quality of life. Overall, findings revealed that pharmaceutical unethical promotional activity to achieve sales target is also a major cause of elements that disturbs patient’s quality of life.
Originality/value
This is a research paper and not published before.
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7
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Petersen MA, Petersen IL, Poulsen C, Nørgaard LS. #studydrugs–Persuasive posting on Instagram. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103100. [DOI: 10.1016/j.drugpo.2020.103100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/07/2020] [Accepted: 12/28/2020] [Indexed: 12/23/2022]
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8
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Adams C, Curtin-Bowen M. Countervailing powers in the labor room: The doula-doctor relationship in the United States. Soc Sci Med 2021; 285:114296. [PMID: 34365071 DOI: 10.1016/j.socscimed.2021.114296] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
How do health professionals with fundamentally different philosophies toward health, and different status levels, manage power in their work relationships? This paper argues that taking a negotiated order interactionist approach, which contends that the social order shapes behavior but is continuously negotiated through social interactions, and synthesizing it with a countervailing powers perspective can yield insight into the power dynamics between health professionals. It focuses on the birth field, with attention to the relationship between two very different types of birth professionals: obstetricians and doulas. Unlike doctors, who maintain a dominant place in health care and subscribe to a biomedical perspective of birth, doulas hold a low-status position and take a holistic approach toward birth, which may cause conflict in the labor room. In-depth interviews with 43 birth doulas based in the US (May-July 2018) found that the doula-doctor relationship is a complex story of power, deference, and countervailing responses. Doulas reported that doctors are more receptive to them now than in the past but that this is an outcome of creative countervailing responses involving deferential maneuvers and direct challenges to physician authority. Doulas' strategic management of their relationships with health professionals has allowed them entry to the hospital, permitting them to represent a holistic voice in the labor room. A minority of doulas have begun to develop relationships with doctors that constitute a collaborative approach toward birth care, indicating that changes in standard care are possible. By revealing how a subordinate actor can challenge physicians and effect change in care, this study contributes to scholarship seeking to understand the nature of unequal relationships between health professionals in a context of biomedical dominance.
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Affiliation(s)
- Crystal Adams
- Department of Sociology, Siena College, Loudonville, NY, USA.
| | - Mica Curtin-Bowen
- Brigham and Women's Hospital, Division of General Internal Medicine, Boston, MA, USA
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9
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Wright JSF, Doukas D. Challenges to sovereign ambitions: forces of convergence and divergence within the global pharmaceutical sector and the UK's withdrawal from the European Union. HEALTH ECONOMICS, POLICY, AND LAW 2021; 16:256-272. [PMID: 32583755 DOI: 10.1017/s174413312000016x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This paper maps key regulatory, governance and legal challenges associated with the UK's withdrawal from the European Union (EU) in terms of convergent and divergent pressures within the global pharmaceutical sector. These include (i) convergent regulatory pressures associated with the European framework for pre-market licensing; (ii) convergent and divergent industry pressures with regard to drug discovery and manufacturing; and (iii) divergent and convergent market pressures associated with the supply, pricing and assessment of medicines. The UK's sovereign ambitions risk a loss of influence over the licensing and surveillance of pharmaceuticals under convergent regulatory and industry pressures to engage in unilateral participation in the European regime. Further, they also risk a loss of influence over processes for pricing and assessing the effectiveness of new treatment regimens under divergent market pressures from larger pharmaceutical markets outside the EU, notably the United States.
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Affiliation(s)
- John S F Wright
- Public Policy, Regulation and Governance, Institute for Public Policy and Governance, University of Technology Sydney, PO Box 123 Broadway, Sydney, NSW2007, Australia
| | - Dimitrios Doukas
- EU Law, School of Law, The University of Manchester, Oxford Road, ManchesterM13 9PL, UK
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10
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Doblytė S. ‘The almighty pill and the blessed healthcare provider’: medicalisation of mental distress from an Eliasian perspective. SOCIAL THEORY & HEALTH 2021. [DOI: 10.1057/s41285-021-00165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Escolà Casas M, Schröter NS, Zammit I, Castaño-Trias M, Rodriguez-Mozaz S, Gago-Ferrero P, Corominas L. Showcasing the potential of wastewater-based epidemiology to track pharmaceuticals consumption in cities: Comparison against prescription data collected at fine spatial resolution. ENVIRONMENT INTERNATIONAL 2021; 150:106404. [PMID: 33578067 DOI: 10.1016/j.envint.2021.106404] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/11/2020] [Accepted: 01/15/2021] [Indexed: 05/13/2023]
Abstract
While the extent of pharmaceutical consumption within a society/community is of high relevance to its health, economy and general wellbeing, this data is often not readily available. Herein, we strengthen a wastewater-based epidemiology (WBE) approach as a way to track the consumption of pharmaceuticals within the sampled community. This method is less laborious than established questionnaire or databases approaches and allows a higher temporal and spatial resolution. The WBE approach was conducted by sampling influent wastewater from two wastewater treatment plants of different size. A total of 39 targeted compounds were quantified by liquid chromatography coupled with tandem mass spectrometry. The number of prescriptions and the defined daily doses for each prescription was obtained from the reference database of The Catalan Health System to validate the wastewater-based approach. The wastewater sampling and the data inquiry were both executed during the same period (October 2019) and standardised for comparison to treatments per 1,000 inhabitants per day. The back-calculation parameters were improved from previous studies by including the faecal excretion rate of the pharmaceuticals. For prescription only pharmaceuticals, where prescription numbers are expected to be a good estimate of consumption, our WBE approach agreed with 27 out of 32 (<0.7 order of magnitude). Common over-the-counter pharmaceuticals such as acetaminophen, ibuprofen and naproxen showed much higher values for treatments per day per 1,000 inhabitant in wastewater than prescribed, reflecting the usefulness of WBE in obtaining an estimate of the total consumption i.e. with and without a prescription.
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Affiliation(s)
- M Escolà Casas
- Catalan Institute for Water Research (ICRA), Emili Grahit 101, 17003 Girona, Spain; Universitat de Girona, Plaça de Sant Domènec 3, 17004 Girona, Spain
| | - N S Schröter
- Catalan Institute for Water Research (ICRA), Emili Grahit 101, 17003 Girona, Spain; Universitat de Girona, Plaça de Sant Domènec 3, 17004 Girona, Spain; Forensic Science of the Institute for Interdisciplinary Studies (IIS) of the Faculty of Science, Universiteit van Amsterdam, Science Park 904, 1098XH Amsterdam, the Netherlands
| | - I Zammit
- Catalan Institute for Water Research (ICRA), Emili Grahit 101, 17003 Girona, Spain; Universitat de Girona, Plaça de Sant Domènec 3, 17004 Girona, Spain
| | - M Castaño-Trias
- Catalan Institute for Water Research (ICRA), Emili Grahit 101, 17003 Girona, Spain; Universitat de Girona, Plaça de Sant Domènec 3, 17004 Girona, Spain
| | - S Rodriguez-Mozaz
- Catalan Institute for Water Research (ICRA), Emili Grahit 101, 17003 Girona, Spain; Universitat de Girona, Plaça de Sant Domènec 3, 17004 Girona, Spain
| | - P Gago-Ferrero
- Catalan Institute for Water Research (ICRA), Emili Grahit 101, 17003 Girona, Spain; Universitat de Girona, Plaça de Sant Domènec 3, 17004 Girona, Spain
| | - Ll Corominas
- Catalan Institute for Water Research (ICRA), Emili Grahit 101, 17003 Girona, Spain; Universitat de Girona, Plaça de Sant Domènec 3, 17004 Girona, Spain.
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12
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Glinert LH. Communicative and Discursive Perspectives on the Medication Experience. PHARMACY 2021; 9:pharmacy9010042. [PMID: 33671135 PMCID: PMC8006053 DOI: 10.3390/pharmacy9010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 11/29/2022] Open
Abstract
Taking the ‘medication experience’ in the broad sense of what individuals hear and say about their medication, as well as how they experience it, this paper explores diverse research on medication information available to patients and their modes and capacities for interaction, including personal circles, doctors and pharmacists, labeling and promotion, websites, and the patient’s own inner conversations and self-expression. The goal is to illustrate, for nonspecialists in communication, how the actors, messages, mediums, genres, and contextual factors within a standard ethnographic and social semiotic model of discourse and communication are operating, not always effectively or beneficially, to mediate or construct a patient’s medication experience. We also suggest how disparate insights can be integrated through such a model and might generate new research questions.
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Affiliation(s)
- Lewis H Glinert
- Middle Eastern Studies and Linguistics, Dartmouth College, NH 03755, USA
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13
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Bertotti AM, Mann ES, Miner SA. Efficacy as safety: Dominant cultural assumptions and the assessment of contraceptive risk. Soc Sci Med 2020; 270:113547. [PMID: 33455813 DOI: 10.1016/j.socscimed.2020.113547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/15/2020] [Accepted: 11/19/2020] [Indexed: 12/17/2022]
Abstract
To reduce rates of unintended pregnancy, medical and public health associations endorse a contraceptive counseling model that ranks birth control methods by failure rate. This tiered model outlines all forms of birth control but recommends long-acting reversible contraceptives (LARC) to eliminate user error and increase continuation. Our critical discourse analysis of gynecology textbooks and medical recommendations examines how gendered and neoliberal ideas influence risk assessments underlying the tiered contraceptive counseling model. Specifically, we explore how embodied, lifestyle, and medical risks are constructed to prioritize contraceptive failure over adverse side effects and reproductive autonomy. We find that the tiered model's focus on contraceptive failure is justified by a discourse that speciously conflates distinct characteristics of pharmaceuticals: efficacy (ability to produce intended effect) and safety (lack of unintended adverse outcomes). Efficacy discourse, which filters all logic through the lens of intended effect, magnifies lifestyle and embodied risks over medical risks by constructing two biased risk assessments. The first risk assessment defines ovulation, menstruation, and pregnancy as hazardous (i.e., embodied risk); the second insinuates that cisgender women who do not engage in contraceptive self-management are burdensome to society (i.e., lifestyle risk). Combined, these assessments downplay side effects (i.e., medical risks), suggesting that LARC and other pharma-contraceptives are worth the risk to protect cisgender women from their fertile bodies and to guard society against unintended pregnancy. Through this process, ranking birth control methods by failure rates rather than by side effects or reproductive autonomy becomes logical as efficacy is equated with safety for cisgender women and society. Our analysis reveals how technoscientific solutions are promoted to address social problems, and how informed contraceptive choice is diminished when pharma-contraceptives are framed as the most logical option without cogent descriptions of their associated risks.
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Affiliation(s)
- Andrea M Bertotti
- Department of Sociology and Criminology, Gonzaga University, Spokane, WA, 99258, USA.
| | - Emily S Mann
- Department of Health Promotion, Education, and Behavior and Women's and Gender Studies Program, University of South Carolina, Discovery I, Room 547, 915 Greene Street, Columbia, SC, 29208, USA.
| | - Skye A Miner
- Department of Sociology. McGill University, Room 712, Leacock Building, 855 Sherbrooke Street West, Montreal, Quebec, H3A 2T7, Canada.
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14
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Elliott AL, Liu Y, Egan KL, Striley CW, Cottler LB. Exposure to Medicines in the Family Medicine Cabinet: Is It a Harbinger of Later Opioid Dependence? Subst Use Misuse 2020; 55:1709-1715. [PMID: 32394779 PMCID: PMC8442636 DOI: 10.1080/10826084.2020.1756856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Despite research on prescription opioids and dependence being a national priority, little is known about the association between several potential adolescent risk factors and later opioid dependence among those who use opioids non-medically. Objectives: To investigate the association between lifetime opioid dependence and adolescent self-perceived health, health beliefs (thinking there was a pill for everything), health behaviors (onset of alcohol use before 15, onset of prescription opioid use before 15) and parental health practices (having opioids in the family medicine cabinet at age 14, parental suggestions to take pills when sick). Methods: A sample of 343 community members who non-medically used prescription opioids in the past 12 months were recruited for the Prescription Drug Misuse, Abuse, and Dependence Study and retrospectively assessed for adolescent risk factors of lifetime opioid dependence (DSM-IV). Results: Logistic regression revealed the strongest predictor of lifetime opioid dependence was having a prescription opioid in the family medicine cabinet at age 14. Those who grew up believing there was a pill for everything and those who initiated alcohol use before 15 were 1.83 and 1.78 times as likely, respectively, to meet dependence criteria than their counterparts. Demographics and other adolescent predictors were not associated with opioid dependence. Conclusions: Findings suggest several adolescent exposures can be targeted to reduce opioid dependence. Through their behavior, parents can reduce their teens' risk for opioid dependence.
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Affiliation(s)
- Amy L. Elliott
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Kathleen L. Egan
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
| | - Catherine W. Striley
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Linda B. Cottler
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
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15
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Wilson N, Pope C, Roberts L, Crouch R. Limited pharmaceuticalisation: a qualitative case study of physiotherapist prescribing practices in an NHS Trust in England following the expansion of non-medical prescribing in the UK. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:643-659. [PMID: 31845366 DOI: 10.1111/1467-9566.13050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Over the last quarter century, non-medical prescribing in the UK has grown significantly; eight non-medical professional groups now have authority to prescribe a wide range of medicines, suggesting it could be a potent driver of pharmaceuticalisation. In this article, we present data from a case study of physiotherapists' prescribing practices. UK physiotherapists have had legal rights to prescribe medicines since 2005, but relatively little is known about the contribution they make to expanding patient access to medicines. We approached our study through a lens of governmentality to capture the mentalities and micro-practices governing physiotherapist non-medical prescribing. Ethnographic methods were used to gather data from an outpatient orthopaedic service in an NHS Trust in England employing physiotherapist prescribers. From the data, we identified a grid of intelligibility - an organising framework formulated by powerful discourses and technologies of government through which physiotherapist prescribing was acted into being. A primary effect of this grid was the constitution of new physiotherapist subjectivities, mostly as non-prescribers of medicines contrary to policy intentions, underpinned by a familiar and enduring template of medical professionalism.
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Affiliation(s)
- Nicky Wilson
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lisa Roberts
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Robert Crouch
- School of Health Sciences, University of Southampton, Southampton, UK
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16
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Mulinari S, Vilhelmsson A. Revisiting the pharmaceuticalisation of pandemic influenza using Lukes' framework of power. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:327-341. [PMID: 31602672 DOI: 10.1111/1467-9566.13006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The power of social actors to drive or block pharmaceutical uptake has been a concern in sociological debates on pharmaceuticalisation, including in the case of pandemic vaccination. We build on Steven Lukes' three-dimensional view of power to explore the 2009 H1N1 pandemic vaccination in Sweden and Denmark - two similar countries that arrived at conflicting vaccination strategies. Drawing on interviews with members of each country's pandemic steering group and on document analysis, we explore three consecutive stages of pandemic vaccination response: planning, vaccine procurement and the vaccination campaign. The paper makes two contributions to studies of pharmaceuticalisation and pandemics. Conceptually, we advocate the suitability of Lukes' framework over the 'countervailing powers' framework repeatedly used to model power in the pharmaceutical field. Empirically, our study confirms that government-appointed experts steered pandemic planning in both countries, but we show that the state, industry and the WHO also exerted power by enabling and constraining experts' decision-making, including by keeping some information secret. Furthermore, we argue that mass vaccination in Sweden was a pervasive expression of state power, in Lukes' sense, since it rested on keeping latent the tension between many individuals' health interests and the state's interests in protecting social and economic functioning.
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Affiliation(s)
- Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| | - Andreas Vilhelmsson
- Department of Sociology, Lund University, Lund, Sweden
- Division of Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Reichenpfader U, Wickström A, Abrandt Dahlgren M, Carlfjord S. 'In the hospital all is taken care of': a practice-theoretical approach to understand patients' medication use. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:50-64. [PMID: 31423622 DOI: 10.1111/1467-9566.12985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Drawing from case examples of medication review implementation in three hospital settings in Sweden, this article examines patients' medication use. Based on a practice theory approach and utilising data from interviews with patients and participant observation, we reconstruct three practices of everyday medication use centring on accepting, challenging or appropriating medication orders. This article argues that patients' medication practices are embedded in wider practice arrangements that afford different modes of agency. Reconceptualising patients' medication use from a practice-based perspective revealed the meaning-making, order-producing and identity-forming features of these practices. Also, we illustrated how different modes of agency were achieved in patients' medication practices, suggesting a fluidity of both the meanings attached to and the identities related to medication use. Our findings have practical implications as these practices of medication use can be transformed when altering the arrangements they are embedded in, thus going beyond the clinical encounter.
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Affiliation(s)
- Ursula Reichenpfader
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anette Wickström
- Department of Thematic Studies - Child Studies, Linköping University, Linköping, Sweden
| | | | - Siw Carlfjord
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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18
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Vallée M. The countervailing forces behind France's low Ritalin consumption. Soc Sci Med 2019; 238:112492. [DOI: 10.1016/j.socscimed.2019.112492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 07/31/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
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Glasdam S, Oute J. Professionals’ involvement of relatives – only good intentions? JOURNAL OF ORGANIZATIONAL ETHNOGRAPHY 2019. [DOI: 10.1108/joe-01-2018-0003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore how, and under what conditions, professionals involve relatives in clinical practice.
Design/methodology/approach
Two cases were constructed from two studies in Denmark, theoretically inspired by Bourdieu’s concepts of doxa and position and analyzed with focus on the involvement of relatives from the perspective of professionals.
Findings
Support to relatives in practice is rarely included in the way that treatment and care are organized in healthcare. Professionals’ views of the involvement of relatives were characterized by the values of neoliberal ideology and medical-professional rationality, in which relatives are not regarded as a subject of care and support in clinical practice. The involvement of relatives aimed to ensure patients’ participation in randomized clinical trial and to help professionals to care for patients when the professionals were not absolutely needed. Professionals were relatively higher positioned in the clinic than relatives were, which allowed professionals to in – and exclude relatives. Neoliberal ideology and medical-professional rationality go hand in hand when it comes to patient treatment, care and the involvement of relatives; it is all about efficiency, treatment optimization and increased social control of the diagnosed patient. These neoliberal, organizational values consolidate doxa of the medical field and the positions that govern the meeting with patients’ relatives – if it takes place at all.
Originality/value
The results put into perspective how the combination of neoliberalism and medical logic work as an organizing principle in contemporary healthcare systems, and challenge a normative, humanistic view on involving patients’ relatives in the medical clinic.
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Sales P, Murphy F, Murphy S, Lau N. Burning the candle at both ends: motivations for non-medical prescription stimulant use in the American workplace. DRUGS: EDUCATION, PREVENTION AND POLICY 2019. [DOI: 10.1080/09687637.2019.1606895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Paloma Sales
- Institute for Scientific Analysis, San Francisco, CA, USA
| | - Fiona Murphy
- Institute for Scientific Analysis, San Francisco, CA, USA
| | - Sheigla Murphy
- Institute for Scientific Analysis, San Francisco, CA, USA
| | - Nicholas Lau
- Institute for Scientific Analysis, San Francisco, CA, USA
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Bertotti AM, Miner SA. Constructing contentious and noncontentious facts: How gynecology textbooks create certainty around pharma-contraceptive safety. SOCIAL STUDIES OF SCIENCE 2019; 49:245-263. [PMID: 30841787 DOI: 10.1177/0306312719834676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Using critical discourse analysis, we examine how seven popular gynecology textbooks use sociolinguistic devices to describe the health effects of pharma-contraception (intrauterine and hormonal methods). Though previous studies have noted that textbooks generally use neutral language, we find that gynecology textbooks differentially deployed linguistic devices, framing pharma-contraceptive benefits as certain and risks as doubtful. These discursive strategies transform pharma-contraceptive safety into fact. We expand on Latour and Woolgar's concept of noncontentious facts by showing how some facts that are taken for granted by the medical community still require discursive fortification to counter potential negative accusations from outside the profession. We call these contentious facts. Our findings suggest that a pro-pharma orientation exists in gynecology textbooks, which may influence physicians' understanding of pharmaceutical safety. As such, these texts may affect medical practice by normalizing pharma-contraceptives without full considerations of their risks.
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Affiliation(s)
- Andrea M Bertotti
- Department of Sociology and Criminology, Gonzaga University, Spokane, WA, USA
| | - Skye A Miner
- Department of Sociology, McGill University, Montreal, QC, Canada
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22
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Deprescribing in Geriatric Medicine: Challenges and Opportunities. J Am Med Dir Assoc 2018; 19:919-922. [DOI: 10.1016/j.jamda.2018.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 11/18/2022]
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Salter B, Salter C. The politics of ageing: health consumers, markets and hegemonic challenge. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:1069-1086. [PMID: 29740838 DOI: 10.1111/1467-9566.12743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In recent years ageing has travelled from the placid backwaters of politics into the mainstream of economic, social and cultural debate. What are the forces that have politicised ageing, creating a sustained opposition to the supply side hegemony of pharmaceuticals, medicine and state which has historically constructed, propagated and legitimised the understanding of ageing as decline in social worth? In addressing this question, the paper develops Gramsci's theory of hegemony to include the potentially disruptive demand side power of consumers and markets. It shows how in the case of ageing individuals acting in concert through the mechanisms of the market, and not institutionalised modes of opposition, may become the agents of hegemonic challenge through a combination of lifecourse choice and electoral leverage. In response, the hegemony is adapting through the promotion of professionally defined interpretations of 'active ageing' designed to retain hegemonic control. With the forces of hegemony and counter-hegemony nicely balanced and fresh issues such as intergenerational justice constantly emerging, the political tensions of ageing are set to continue.
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Murano MC. Medicalising short children with growth hormone? Ethical considerations of the underlying sociocultural aspects. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:243-253. [PMID: 28852938 PMCID: PMC5956020 DOI: 10.1007/s11019-017-9798-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In 2003, the Food and Drug Administration approved the use of growth hormone treatment for idiopathic short stature children, i.e. children shorter than average due to an unknown medical cause. Given the absence of any pathological conditions, this decision has been contested as a case of medicalisation. The aim of this paper is to broaden the debate over the reasons for and against the treatment, to include considerations of the sociocultural phenomenon of the medicalisation of short stature, by means of a critical understanding of the concept of medicalisation. After defining my understanding of medicalisation and describing both the treatment and the condition of idiopathic short stature, I will problematise two fundamental issues: the medical/non-medical distinction and the debate about the goals of medicine. I will analyse them, combining perspectives of bioethics, medical sociology, philosophy of medicine and medical literature, and I will suggest that there are different levels of normativity of medicalisation. Ultimately, this study shows that: (1) the definition of idiopathic short stature, focusing only on actual height measurement, does not provide enough information to assess the need for treatment or not; (2) the analysis of the goals of medicine should be broadened to include justifications for the treatment; (3) the use of growth hormone for idiopathic short stature involves strong interests from different stakeholders. While the treatment might be beneficial for some children, it is necessary to be vigilant about possible misconduct at different levels of medicalisation.
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Affiliation(s)
- Maria Cristina Murano
- Department of Culture and Communication, Linköping University, 581 83, Linköping, Sweden.
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Ballantyne PJ, Norris P, Parachuru VP, Thomson WM. Becoming a 'pharmaceutical person': Medication use trajectories from age 26 to 38 in a representative birth cohort from Dunedin, New Zealand. SSM Popul Health 2018; 4:37-44. [PMID: 29349271 PMCID: PMC5769117 DOI: 10.1016/j.ssmph.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/31/2022] Open
Abstract
Despite the abundance of medications available for human consumption, and frequent concerns about increasing medicalization or pharmaceuticalization of everyday life, there is little research investigating medicines-use in young and middle-aged populations and discussing the implications of young people using increasing numbers of medicines and becoming pharmaceutical users over time. We use data from a New Zealand longitudinal study to examine changes in self-reported medication use by a complete birth cohort of young adults. Details of medications taken during the previous two weeks at age 38 are compared to similar data collected at ages 32 and 26, and by gender. Major drug categories are examined. General use profiles and medicine-types are considered in light of our interest in understanding the formation of the young and middle-aging 'pharmaceutical person' - where one's embodied experience is frequently and normally mediated by pharmaceutical interventions having documented benefit/risk outcomes.
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Affiliation(s)
- Peri J. Ballantyne
- Department of Sociology, Trent University, 1600 West Bank Drive, Peterborough, Canada, K9L 0G2
- Leslie Dan Faculty of Pharmacy, University of Toronto, Canada
| | - Pauline Norris
- School of Pharmacy, University of Otago, Room 505a, Fifth Floor, Dunedin 9054, New Zealand
| | | | - W. Murray Thomson
- School of Dentistry, University of Otago, PO Box 56, Dunedin, New Zealand
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Madureira Lima J, Galea S. Corporate practices and health: a framework and mechanisms. Global Health 2018; 14:21. [PMID: 29448968 PMCID: PMC5815179 DOI: 10.1186/s12992-018-0336-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 01/26/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Global Burden of Disease estimates that approximately a third of deaths worldwide are attributable to behavioural risk factors that, at their core, have the consumption of unhealthful products and exposures produced by profit driven commercial entities. We use Steven Lukes' three-dimensional view of power to guide the study of the practices deployed by commercial interests to foster the consumption of these commodities. Additionally, we propose a framework to systematically study corporations and other commercial interests as a distal, structural, societal factor that causes disease and injury. Our framework offers a systematic approach to mapping corporate activity, allowing us to anticipate and prevent actions that may have a deleterious effect on population health. CONCLUSION Our framework may be used by, and can have utility for, public health practitioners, researchers, students, activists and other members of civil society, policy makers and public servants in charge of policy implementation. It can also be useful to corporations who are interested in identifying key actions they can take towards improving population health.
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Affiliation(s)
- Joana Madureira Lima
- Department of Sociology, University of Oxford, Manor Rd Building, Manor Road, Oxford, OX1 3UQ, UK.
| | - Sandro Galea
- School of Public Health, Boston University, 715 Albany St, Boston, MA, 02118, USA
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Murphy F, Murphy S, Sales P, Lau N. Examining social supply among nonmedical prescription stimulant users in the San Francisco Bay Area. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:68-76. [PMID: 29414488 DOI: 10.1016/j.drugpo.2017.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 09/18/2017] [Accepted: 11/09/2017] [Indexed: 11/24/2022]
Abstract
In the US, prescription stimulants are prescribed for a variety of conditions including attention deficit hyperactivity disorder (ADHD) and narcolepsy. Over the last two decades, dramatic increases in stimulant prescriptions have led to greater availability and increased risk for diversion and nonmedical use. Our own and other investigators' findings indicate that many drug "suppliers" do not fit into the traditional image of drug "dealers." These suppliers typically do not identify themselves as "dealers," but instead understand their drug distribution as sharing with people they know. Coomber and colleagues' (2007; 2013) concept of "social supply" raises the question: When friends supply or facilitate supply of drugs to friends, is this really dealing? Further, if dealing and supplying are distinct kinds of social transactions, should different types of criminal justice approaches be applied? Social supply extends our understanding of drug dealing as a complex social activity. In this article, we examine the issue of social supply among nonmedical users of prescription stimulants. We conducted a 36-month National Institute on Drug Abuse-funded project to conduct a qualitative, mixed methods study of 150 adult nonmedical prescription stimulant users in the San Francisco Bay Area. We explore intersecting factors, including life stage and social location, that contribute to decisions to use prescription stimulants nonmedically, motivations to use, knowledge about risks and benefits of prescription stimulant use, any adverse health or social consequences experienced, availability, acquisition and diversion of prescription stimulants, and differences in attitudes and behaviours. For this analysis, we rely on participants' narratives concerning prescription stimulant acquisition practices and how they understood these interactions, purchases, and exchanges with the suppliers of prescription stimulants in their social networks. The authors argue that acknowledging the distinction between social supply and "proper" drug dealing would redress the disparity between drug sharing and profiteering particularly regarding criminal sentencing.
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Affiliation(s)
- Fiona Murphy
- Institute for Scientific Analysis, 390 4th Street, Suite D, San Francisco, CA 94107, USA.
| | - Sheigla Murphy
- Institute for Scientific Analysis, 390 4th Street, Suite D, San Francisco, CA 94107, USA.
| | - Paloma Sales
- Institute for Scientific Analysis, 390 4th Street, Suite D, San Francisco, CA 94107, USA.
| | - Nicholas Lau
- Institute for Scientific Analysis, 390 4th Street, Suite D, San Francisco, CA 94107, USA.
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Nurse practitioners as a solution to transformative and sustainable health services in primary health care: A qualitative exploratory study. Collegian 2017. [DOI: 10.1016/j.colegn.2016.12.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Warren-Jones A. Health care and health innovation in Europe: regulating for public benefit or for commercial profit? HEALTH ECONOMICS, POLICY, AND LAW 2017; 12:403-409. [PMID: 28414005 DOI: 10.1017/s1744133117000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Amanda Warren-Jones
- Director, SIBLE - Health;Senior Law Lecturer,Sheffield University School of Law,Bartolome House, Sheffield,UK
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Senier L, Lee R, Nicoll L. The strategic defense of physician autonomy: State public health agencies as countervailing powers. Soc Sci Med 2017; 186:113-121. [PMID: 28622609 PMCID: PMC5531602 DOI: 10.1016/j.socscimed.2017.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
Advances in genetic testing and the aggressive marketing of genetic tests by commercial diagnostic laboratories have driven both consumer demand and the need for unbiased information about how tests should guide healthcare delivery. This paper uses the countervailing powers framework to explore the role of state public health agencies as arbiters of quality and safety, specifically through their efforts to encourage physicians to follow evidence-based recommendations for screening for hereditary cancers. Social scientists have often viewed actions by the state to regulate cost, quality, or safety as a threat to physician autonomy. This paper draws on case studies from two US states-Michigan and Connecticut-to better understand the specific role of state public health agencies, and especially whether their activities to encourage adherence to evidence-based recommendations bolster or subvert the interests of other parties in the healthcare arena. We find that lacking authority to compel provider to follow evidence-based recommendations, they improvised ways to foster compliance voluntarily, for example, by emphasizing the role of the physician as gatekeeper, thus affirming the importance of physician autonomy and clinical judgment. Both states also used public health surveillance data to make rare diseases visible and illustrate gaps between recommendations and practice. Finally, they both showed that following evidence-based recommendations could align the professional and market interests of healthcare stakeholders. Both states employed similar strategies with similar effects, despite substantial differences in the regulatory climate and organizational capacity. Taken as a whole, their activities orchestrated a countervailing response that checked the profit-seeking motives of commercial laboratories. Our findings demonstrate that rather than eroding physician autonomy, state action to monitor healthcare quality and encourage adherence to evidence-based recommendations can actually reinforce physician authority.
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Affiliation(s)
- Laura Senier
- Department of Sociology & Anthropology, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States; Department of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States.
| | - Rachael Lee
- Department of Sociology & Anthropology, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States
| | - Lauren Nicoll
- Department of Sociology & Anthropology, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States
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Abstract
Medicalisation has been an important concept in sociological discussions of medicine since its adoption by medical sociologists in the early 1970s. Yet it has been criticised by some sociologists, in part because it seems too negative about medicine, and modified or replaced by others with concepts deemed more relevant like biomedicalisation and pharmaceuticalisation. My aim in this paper is to reassess the concept and consider whether it still has value in exploring significant aspects of the role of medicine in present-day society. I start with an archaeology of the concept's development and the different ways it has been used. This covers some familiar ground but is essential to the main task: examining criticisms of the concept and assessing its value. I conclude that the concept continues to have a crucial and productive place in sociological analyses of medicine and that the process of medicalisation is still a key feature of late-modern social life and culture.
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Bowers B, Redsell SA. A qualitative study of community nurses' decision-making around the anticipatory prescribing of end-of-life medications. J Adv Nurs 2017; 73:2385-2394. [PMID: 28423478 DOI: 10.1111/jan.13319] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2017] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to explore community nurses' decision-making processes around the prescribing of anticipatory medications for people who are dying. BACKGROUND Community nurses frequently initiate the prescribing of anticipatory medications to help control symptoms in those who are dying. However, little is known about their decision-making processes in relation to when they instigate anticipatory prescribing and their discussions with families and General Practitioners. DESIGN A qualitative interpretive descriptive enquiry. METHODS A purposive sample of 11 Community Palliative Nurses and District Nurses working in one geographical area participated. Data were collected between March and June 2016 via audio recorded semi-structured interviews and analysed inductively using Braun and Clarke's thematic analysis. RESULTS Three themes were identified: (1) Drugs as a safety net. Anticipatory medications give nurses a sense of control in last days of life symptom management; (2) Reading the situation. The nurse judges when to introduce conversations around anticipatory medications, balancing the need for discussion with the dying person and their family's likely response; (3) Playing the game. The nurse owns the decision to initiate anticipatory medication prescribing and carefully negotiates with the General Practitioner. CONCLUSION Nurses view pain control through prescribed medication as key to symptom management for dying people. Consequently, they own the role of ascertaining when to initiate discussions with families about anticipatory medicines. Nurses believe they advocate for dying person and their families' needs and lead negotiations with General Practitioners for medications to go into the home. This nurse led care alters the traditional boundaries of the General Practitioners-nurse professional relationship.
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Affiliation(s)
- Ben Bowers
- Hinchingbrooke Health Care NHS Trust, Huntingdon, Cambridgeshire, UK
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Beyond ubiquity: Unravelling medicalisation within the frame of health insurance and health-policy making. SOCIAL THEORY & HEALTH 2017. [DOI: 10.1057/s41285-017-0035-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kumar V, Singh A, Tewari MK, Kaur S. Comprehension and compliance with the discharge advice and quality of life at home among the postoperative neurosurgery patients discharged from PGIMER, Chandigarh, India. Asian J Neurosurg 2016; 11:372-377. [PMID: 27695540 PMCID: PMC4974961 DOI: 10.4103/1793-5482.144190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PROBLEM STATEMENT Neurosurgical patients require special care not only in the hospital but also after their discharge from the hospital. Comprehension and compliance to the instructions given by the doctors/nurses at the time of discharge is important in home care of these patients. Many such patients suffer from various co-morbidities. Variable periods of convalescence affect health-related quality of life in these patients. PURPOSE OF THE STUDY To determine the degree of compliance of neurosurgery patients and their family caregivers with the discharge advice given by the consultantsTo evaluate the quality of life of these patientsTo know the problems faced by these patients at home. MATERIALS AND METHODS This cross-sectional interview-based descriptive study was conducted in 2010 in Chandigarh. These patients were visited at their home. A scale was evolved to evaluate comprehension and compliance to the advice given at the time of discharge, according to the criteria developed by Clark et al. Lawton Brody instrumental activity of daily life and Spitzer quality of life index were used to assess patients' quality of life after the operation. Verbatim responses were recorded for the purpose of qualitative research. RESULTS Overall, 58 patients and their caregivers were interviewed at home. Mean age of the patients was 38.9 years. Out of 37 patients, 35 showed good comprehension and 33 patients had a good compliance with the instructions given for medication. The condition of 74.1% patients improved after the operation. Depression was reported in 31% of the patients. Many (36.2%) patients had to quit their job due to the disease. Almost half (47.4%) of the patients were independent in daily activities of their life while being evaluated on Barthel activity of daily life index. CONCLUSION AND RECOMMENDATIONS It is in the long term that the true complexity and impact of operations become apparent. After operation, such patients are likely to have a range of physical, emotional, cognitive, behavioral, and social problems, which may result in difficulties for both patients and their family caregivers. Provision of mechanism of prioritized follow-up care to the operated bedridden neurosurgery patients should be made.
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Affiliation(s)
- Vishal Kumar
- Department of Community Medicine, School of Public Health, PGIMER, Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine, School of Public Health, PGIMER, Chandigarh, India
| | | | - Sukhpal Kaur
- National Institute of Nursing Education, PGIMER, Chandigarh, India
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Thomas F. Young people's use of medicines: Pharmaceuticalised governance and illness management within household and school settings. Soc Sci Med 2016; 165:150-158. [PMID: 27522566 DOI: 10.1016/j.socscimed.2016.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 11/25/2022]
Abstract
Recent decades have witnessed a significant rise in the use and 'misuse' of pharmaceutical medicines. Without significant behavioural change, the adverse health and environmental impacts resulting from medicine misuse will be most felt by today's young people. Yet despite real concerns surrounding pharmaceutical sustainability, insights into the ways that understandings of, and expectations to take medicines are communicated to, and taken up by young people remain limited. This paper draws on research focused around everyday home and school settings, to examine how understandings and norms relating to medicine use become embedded within the lives of young people. Between May 2014-January 2015, fifty students (aged 11-14) from one secondary school in England participated in focus groups and forty-three in interviews. Two focus groups were held with parents (n = 10). Findings demonstrate that attitudes towards medicine use were bound up with notions of parental responsibility, risk, peer governance and social acceptability, labour-related expectations, and processes of regulation within the school. Indeed, it was clear that medication use was often a compromised solution in response to wider structural pressures and demands and that such thinking was embedded at an early stage in the life course. The study found that few opportunities arose for open and informed discussion relating to responsible medicine use. Such circumstances demonstrate that any attempts to change medicine-related attitudes and behaviours should be considered within the wider social and structural contexts that govern their use.
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Affiliation(s)
- Felicity Thomas
- Centre for Medical History, University of Exeter, Rennes Drive, Exeter, EX4 4RJ, UK.
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36
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The 2013 cholesterol guideline controversy: Would better evidence prevent pharmaceuticalization? Health Policy 2016; 120:797-808. [PMID: 27256859 DOI: 10.1016/j.healthpol.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 01/08/2023]
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Ballantyne PJ. Understanding Users in the 'Field' of Medications. PHARMACY 2016; 4:E19. [PMID: 28970392 PMCID: PMC5419342 DOI: 10.3390/pharmacy4020019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/04/2016] [Accepted: 05/03/2016] [Indexed: 12/30/2022] Open
Abstract
The numbers of medicinal drugs available for human consumption have increased rapidly in the past several decades, and physician prescribing practices reflect the growing reliance on medicines in health care. However, the nature of medicines-as-technology makes problematic taken-for-granted relationships among actors involved in the delivery, or who are the recipients of medicines-reliant health care. In this article, I situate the medicine user in the 'field' of medications-where interests, actions and outcomes are continually negotiated among and between the various players-physicians, pharmacists, government regulatory bodies, the pharmaceutical industry and users of medicines. The objective of the paper is to illuminate the complex context in which the medicine-user-the target of the pharmacy profession's service to the public-accesses and uses medicines.
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Affiliation(s)
- Peri J Ballantyne
- Department of Sociology, Trent University, 1600 West Bank Drive, Peterborough, ON K9J 0G2, Canada.
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Cooper JA, Moriarty F, Ryan C, Smith SM, Bennett K, Fahey T, Wallace E, Cahir C, Williams D, Teeling M, Hughes CM. Potentially inappropriate prescribing in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria. Eur J Clin Pharmacol 2016; 72:583-91. [PMID: 26820292 PMCID: PMC4834102 DOI: 10.1007/s00228-015-2003-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study is to establish the prevalence of potentially inappropriate prescribing (PIP) in middle-aged adults (45-64 years) in two populations with differing socio-economic profiles, and to investigate factors associated with PIP, using the PROMPT (PRescribing Optimally in Middle-aged People's Treatments) criteria. METHODS A retrospective cross-sectional study was conducted using 2012 data from the Enhanced Prescribing Database (EPD), covering the full population in Northern Ireland and the Health Services Executive Primary Care Reimbursement Service (HSE-PCRS) database, covering the most socio-economically deprived third of the population in this age group in the Republic of Ireland. The prevalence for each PROMPT criterion and overall prevalence of PIP were calculated. Logistic regression was used to investigate the association between PIP and gender, age group and polypharmacy. RESULTS This study included 441,925 patients from the EPD and 309,748 patients from the HSE-PCRS database. Polypharmacy was common in both datasets (46.7 % in the HSE-PCRS and 20.3 % in the EPD). The prevalence of PIP was 42.9 % (95%CI 42.7, 43.1) in the HSE-PCRS and 21.1 % (95%CI 21.0, 21.2) in the EPD. Age group, female gender and polypharmacy were significantly associated with PIP in both populations (p < 0.05) and polypharmacy had the strongest association. CONCLUSIONS PIP is common amongst middle-aged people with the risk of PIP increasing with polypharmacy. Differences in the prevalence of polypharmacy and PIP between the two populations may relate to heterogeneity in healthcare services and different socio-economic profiles, with higher rates of multimorbidity and associated polypharmacy in more deprived groups.
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Affiliation(s)
- Janine A Cooper
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland. .,HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Frank Moriarty
- HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Cristín Ryan
- School of Pharmacy, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - Tom Fahey
- HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Emma Wallace
- HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Caitriona Cahir
- Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland.,Economic and Social Research Institute, Whitaker Square, Sir John Roberson's Quay, Dublin 2, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Mary Teeling
- Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - Carmel M Hughes
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.,HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
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Chuong KH, O'Doherty KC, Secko DM. Media Discourse on the Social Acceptability of Fecal Transplants. QUALITATIVE HEALTH RESEARCH 2015; 25:1359-1371. [PMID: 25595150 DOI: 10.1177/1049732314568199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Advances in human microbiome research have generated considerable interest in elucidating the role of bacteria in health and the application of microbial ecosystem therapies and probiotics. Fecal transplants involve the introduction of gut microbes from a healthy donor's stool to the patient and have been documented as effective for treating Clostridium difficile infections (CDIs) and some other gastrointestinal disorders. However, the treatment has encountered regulatory hurdles preventing widespread uptake. We examined dominant representations of fecal transplants in Canadian media and found that fecal transplants are often represented as being inherently disgusting or distasteful (the "ick factor"). This "ick factor" is used to construct different messages about the treatment's social acceptability and legitimacy. We conclude that an over-emphasis on the "ick factor" constrains public discourse from a more nuanced discussion of the social challenges, scientific concerns, and regulatory issues surrounding the treatment.
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Thomas F, Depledge M. Medicine ‘misuse’: Implications for health and environmental sustainability. Soc Sci Med 2015; 143:81-7. [DOI: 10.1016/j.socscimed.2015.08.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/12/2015] [Accepted: 08/14/2015] [Indexed: 01/20/2023]
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Davis C. Clarity, constructive debate and progress in developing methodological and conceptual frameworks for understanding pharmaceuticalization: A reply to Abraham. Soc Sci Med 2015; 131:218-20. [DOI: 10.1016/j.socscimed.2015.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
There is evidence from some countries of a trend towards increasingly aggressive pharmacological treatment of patients with advanced, incurable cancer. To what extent should this be understood as a progressive development in which technological innovations address previously unmet needs, or is a significant amount of this expansion explained by futile or even harmful treatment? In this article it is argued that while some of this growth may be consistent with a progressive account of medicines consumption, part of the expansion is constituted by the inappropriate and overly aggressive use of drugs. Such use is often explained in terms of individual patient consumerism and/or factors to do with physician behaviour. Whilst acknowledging the role of physicians and patients' expectations, this paper, drawing on empirical research conducted in the US, the EU and the UK, examines the extent to which upstream factors shape expectations and drive pharmaceuticalisation, and explores the value of this concept as an analytical tool.
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Affiliation(s)
- Courtney Davis
- Department of Social Science, Health and Medicine, School of Social Science and Public Policy, King's College London, Strand, London WC2R 2LS, UK.
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Rico-Alba I, Figueras A. The evolution of Reference Drug Lists and Clinical Practice Guidelines in the public health system of a middle-income country. Br J Clin Pharmacol 2015; 78:410-21. [PMID: 25099259 DOI: 10.1111/bcp.12337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 01/25/2014] [Indexed: 11/30/2022] Open
Abstract
AIMS The aims were to analyze the dynamics of the medicines formulary in a middle-income country and to analyze the concordance of the included medicines with the national Clinical Practices Guidelines (CPG). METHODS Medicines and their indications of use included in the Mexican Reference Drug List (Mex-RDL) from 1996 to 2013 were analyzed. The top 10 indications with the highest number of medicines in 2013 were analyzed retrospectively until 1996 in order to identify the increase in the number of medicines to treat each one, as well as the progressive specificity of the indication according to the International statistical Classification of Diseases (ICD-10). The concordance between the CPG and medicines approved for the top 10 indications was studied. RESULTS The number of medicines included in the Mex-RDL kept constantly growing from 454 drugs in 1996 to 811 in 2013. Up to 26.3% of these medicines were approved to treat only 10 indications (1.5% of all possible indications of use). Many of these new medicines had been approved for more and more specific indications, while the oldest ones had been approved for general indications. Up to 27.6% of the medicines approved for these top 10 indications do not appear in the updated recommendations of the specific CPG for those indications. CONCLUSIONS During the last 18 years, the new medicines and indications included in the Mex-RDL were redundant and concentrated into few similar clinical conditions. This is a factor that promotes an irrational use of these medicines and, thus, unnecessarily raises the price of health care, undermines the quality of the health system and probably increases the uncertainty of treatments.
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Affiliation(s)
- Israel Rico-Alba
- Health Sciences School, University of the Valley of Mexico, Mexico City, Mexico; Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Barcelona
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Dao A, Nichter M. The Social Life of Health Insurance in Low- to Middle-income Countries: An Anthropological Research Agenda. Med Anthropol Q 2015; 30:122-43. [DOI: 10.1111/maq.12191] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Amy Dao
- Department of Sociomedical Sciences; Columbia University
| | - Mark Nichter
- School of Anthropology; University of Arizona; Tucson
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Gabe J, Williams S, Martin P, Coveney C. Pharmaceuticals and society: power, promises and prospects. Soc Sci Med 2015; 131:193-8. [PMID: 25727500 DOI: 10.1016/j.socscimed.2015.02.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jonathan Gabe
- Royal Holloway, University of London, Egham, Surrey TW20 0EX, United Kingdom.
| | | | - Paul Martin
- Sheffield University, Sheffield S10 2TU, United Kingdom
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Dohnhammar U, Reeve J, Walley T. Patients' expectations of medicines--a review and qualitative synthesis. Health Expect 2015; 19:179-93. [PMID: 25639697 DOI: 10.1111/hex.12345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND An increasing part of prescribing of medicines is done for the purpose of managing risk for disease and is motivated by clinical and economic benefit on a long-term, population level. This makes benefit from medicines less tangible for individuals. Sociology of pharmaceuticals includes personal and social perspectives in the study of how medicines are used. We use two characterizations of patients' expectations of medicines to start forming a description of how individuals conceptualize benefits from risk management medicines. SEARCH STRATEGY AND SYNTHESIS We reviewed the literature on patients' expectations with a focus on the influences on expectations regarding medicines prescribed for long-term conditions. Searches in Medline and Scopus identified 20 studies for inclusion, describing qualitative aspects of beliefs, views, thoughts and expectations regarding medicines. RESULTS A qualitative synthesis using a constant comparative thematic analysis identified four themes describing influences on expectations: a need to achieve a specific outcome; the development of experiences and evaluation over time; negative values such as dependency and social stigma; and personalized meaning of the necessity and usefulness of medicines. CONCLUSIONS The findings in this synthesis resonate with previous research into expectations of medicines for prevention and treatment of different conditions. However, a gap in the knowledge regarding patients' conceptualization of future benefits with medicines is identified. The study highlights suggestions for further empirical work to develop a deeper understanding of the role of patients' expectations in prescribing for long-term risk management.
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Affiliation(s)
- Ulrica Dohnhammar
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Joanne Reeve
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Tom Walley
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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Vilhelmsson A. The devil in the details: public health and depression. Front Public Health 2014; 2:192. [PMID: 25353013 PMCID: PMC4196509 DOI: 10.3389/fpubh.2014.00192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/29/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andreas Vilhelmsson
- Department of Clinical Sciences, Division of Social Medicine and Global Health, Faculty of Medicine, Lund University, Malmö, Sweden
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Fisher JA, Cottingham MD, Kalbaugh CA. Peering into the pharmaceutical "pipeline": investigational drugs, clinical trials, and industry priorities. Soc Sci Med 2014; 131:322-30. [PMID: 25159693 DOI: 10.1016/j.socscimed.2014.08.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 01/30/2023]
Abstract
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.
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Affiliation(s)
- Jill A Fisher
- Department of Social Medicine, University of North Carolina at Chapel Hill, 333E MacNider Hall, CB #7240, Chapel Hill, NC 27599-7240, USA.
| | - Marci D Cottingham
- Department of Social Medicine, University of North Carolina at Chapel Hill, 324 MacNider Hall, CB #7240, Chapel Hill, NC 27599-7240, USA.
| | - Corey A Kalbaugh
- Department of Epidemiology, University of North Carolina at Chapel Hill School of Public Health, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, USA.
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Sax P. The shaping of pharmaceutical governance: the Israeli case. Isr J Health Policy Res 2014; 3:16. [PMID: 24914409 PMCID: PMC4049385 DOI: 10.1186/2045-4015-3-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 05/12/2014] [Indexed: 11/10/2022] Open
Abstract
This article focuses on governance of the pharmaceutical sector in Israel. It traces the relationships between the state, industry, and sick funds from before the establishment of National Health Insurance (NHI) in 1995 to the beginning of this decade, in particular as they have grappled with the challenge of making national formulary decisions in a rational manner. Subsequent to the introduction of NHI there have been shifts in the modes and mix of governance. This research shows empirically that a relatively complex mix of hierarchical and network modes of governance can be successfully established over an extended period of time when flexibility is maintained through the implementation process. The system for defining and updating a standard basket of health services has coped well with the challenge of managing a range of difficult and potentially volatile stakeholder relationships in the pharmaceutical sector and of distancing ministers from controversies of funding and listing decisions. Government has succeeded in containing drug costs whilst still maintaining a basket of reimbursable drugs that, from an international perspective, is comprehensive and technologically advanced. On the other hand, network arrangements appear to have delayed the introduction of suitable accountability relationships and hindered their development. The state has traditionally played an intermediary role between unavoidable corporate interests of industry and sick funds, with little transparency and to the detriment of more pluralistic access to decision making. Governance arrangements in Israel appear to limit the potential and incentive of the state and the sick funds to realize their potential countervailing powers in subsidy and pricing decisions.
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Affiliation(s)
- Philip Sax
- PHARMA Drug Bulletin, Centre for Drug Studies, Jerusalem 9262807, Israel
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Mulinari S. Regulating drug information in Europe: a pyrrhic victory for pharmaceutical industry critics? SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:761-777. [PMID: 23094890 DOI: 10.1111/j.1467-9566.2012.01528.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Informed by recent sociological debates on pharmaceuticalisation, this article examines the evolution of the current EU legal proposal on prescription drug information to patients, as well as the surrounding controversies. In 2008 the European Commission proposed the relaxation of the existing rules governing drug information provision to patients by the pharmaceutical industry. Critics of the industry's influence over health policy and markets, including consumer organisations, industry-independent patient organisations and health professionals, rejected the Commission's proposal, claiming that the industry cannot be considered a reliable source of patient information due to inherent financial conflicts of interest. Since these critics were at least partially successful in rallying opinion against the Commission proposal, they functioned as countervailing forces to promotion-driven pharmaceuticalisation. Even so, as a watered-down version of the proposal moved through the European Parliament it was further modified to ultimately resemble the Swedish system that was held up as a high-quality example of industry-based information provision. Yet this article contends that the Swedish system displays evidence of corporate bias. Significantly, basing EU policy on a drug information system not resistant to corporate bias risks creating practices that violate the legally mandated mission of EU drug regulation, which is to 'promote and protect public health'.
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