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Lecture notes - Pharmaceuticals
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Full lecture and reading notes relating to the sociology of pharmaceutical drug, development and marketing in the 20 and 21st centuries
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SOC2037 PHARMACEUTICAL CULTURESDR HANNAH FARRIMOND
WEEK 1 – INTRO
Sociology of sleeping medications
- PhD on sleeping medication use in over 65’s living alone at home
- Driven by not just wanting to be ‘active older adults’ in day, but
‘fear of the night’
- Motivated to avoid addicted identities
- Behaviour similar to illegal drug addicts eg sourcing online, sharing
Course structure
- One term, 15 credits
- 2 hours, lecture then seminar
- Compulsory readings must be done in advance of seminar
- Week 3 or 4 formative assignment, paper critique in class together,
written feedback as a group
- Summative assignments: 1) 1800-word essay, minimum 10 Harvard
references, 2 or 1.5 spaced, 50% of grade. 2) one hour exam in
summer, one question out of 4 topics, 50% marks
WEEK 1 PART 2 – THEORIES
Social theories relevant to pharmaceutical cultures
(To frame seminar readings and to reflect upon different conceptual
settings and theoretical focuses)
- Structural functionalism
- Symbolic interactionalism
- Conflict theory
- Utilitarianism
- Feminism
- Postmodernism
Structural functionalism
- Social structure as am ‘organism’, a social body
- Norms and institutions are ‘organs’
- Social evolutionism
- Prevalence of the whole over parts
- Present in sociology (from Compte to Durkheim) and anthropology
(Mauss and Malinowski)
- Pharmaceuticals- institutions, norms, macro analysis
Symbolic interactionalism
- People interacting using symbolic communications, emphasis on
subjective meanings, the empirical unfolding of social processes
- Society: the product of the everyday interactions of individuals,
shared reality that people construct as they interact with one
another, complex changing subjective meanings
- Pharmaceuticals- as symbolic interaction
Conflict theory
- Power differentials: class, gender and race conflict, historically
dominant ideologies
- Social patterns (capitalism, communism), dominant people in
society, oppressed actors
- Macro level analysis of society
- Inequality: generates conflict and social change (Karl Marx)
,SOC2037 PHARMACEUTICAL CULTURES
DR HANNAH FARRIMOND
- Pharmaceuticals- conflicts, inequality, macro analysis, social
patterns
Utilitarianism
- Exchange theory/rational choice theory, agency of the individual
rational actors
- Individuals always seek to maintain their own self-interest
- The individual has knowledge of alternatives, elites about the
consequences of various alternatives, ordering of preferences over
outcomes, a decision rule to select amongst the possible
alternatives
- Pharmaceuticals – exchange, rational choice, individuals?
Postmodernism
- anti theory, anti-method, against grand theories and ideologies,
objective truth is impossible or unachievable
- Society is ever changing
- Understanding through observation, rather than data collection
- Micro and macro level analysis
- Critical perspective
- Pharmaceutical- power, control, superstition?
Feminism
- Gender inequality
- Equal political, economic and social rights for women (defining,
establishing, defending)
- Sexuality reflects patterns of social inequality and helps to
perpetuate them
- The domination of women by men
- Pharmaceuticals – effects on women’s gender, equality and
sexuality
What is medicine and what is pharmaceutical?
+ are they the same thing? A spectrum?
+where can you obtain medicines/pharmaceuticals?
What is ‘Big Pharma’?
- Size of pharmaceuticals industry – over $900 billion a year
- Name suggests malevolent plotting and practices
- What good does the industry do?
LECTURE 2 – PHARMACEUTICAL DEVELOPMENT
History of Pharmakon
- Pharmakon – cure and poison (good/bad)
- Pharmakoi – human scapegoat (ritual of social purification)
- Pharmakeus- sorcerer, magician
- Hygeia- daughter of the god of medicine (Asclepius), associated with
the prevention of sickness and the continuation of good health
History of pharmaceuticals
- Plant extracts, mineral and animal preparations to treat diseases,
this was a common feature of all cultures
,SOC2037 PHARMACEUTICAL CULTURES
DR HANNAH FARRIMOND
- The science of pharmacology involves understanding the effect of
these substances, this is traditionally allied to the practise of
medicine which then gradually acquired a distinct individuality
- By the mid-20th century pharmacology had ceased to be a
‘handmaiden to therapeutics’, became a separate discipline with its
own action agenda and set of questions
- 19th century discoveries such as alkaloids, opium, strychnine,
quinine, nicotine, cocaine
- After WW2, the mass production of antibiotics (broad spectrum
especially), oral contraceptives, corticosteroids, antihistamines and
amphetamines
Pharmacology 1.0 (Flower 2012)
- Pharmacologists are ignorant about the intimate mechanism of
action of any drug work on receptors (Elrich, Langley)
- Clarke (1930s), the principles of pharmacological agonism (binds to)
and antagonism (blocks)
- Blockbuster drugs eg beta blockers, ACE inhibitors, neuromuscular
blocking drugs
- Revolutionised therapy and saved money
Pharmacology 2.0
- The post-millennium period
- Biologics- most biologics are large molecules eg antibodies, chimeric
proteins, modified proteins, macromolecules (therapeutic potential
of siRNA and micro-RNA)
- Gene delivery: used successfully to replace a faulty NADPH oxidase
enzyme in the neutrophils of patients with the X-linked chronic
granulomatous disease
- Are genes drugs? Reapplication of existing drugs?
History: profit and development
- 1960s-1980s, stagnant prescription drug sales
- 1980s-2002, prescription drug sales tripled to nearly $400 billion
worldwide, and almost $200 billion in the US (Angell, 2004: 1-5)
- Eg 1993-2002, NHS prescriptions in England for antidepressant
drugs from 2 million to 15 million for SSRI’s
- 1994-2000 (US) sales of the SSRI, fluoxetine (Prozac) and Viagra,
more than doubled
- HUGE INCREASE IN PRESCRIBING even though very few new drugs
Theories of pharmaceuticalisation
- Conceptualised as: the ‘pharmaceuticalisation” of life (Abraham
201-, Williams 2009, Fox and Ward 2009) or the ‘pharmaceutical
person’ (Marin 2006)
- Williams et al (2009b: 37) define pharmaceuticalisation as ‘the
transformation of human conditions, capacities or capabilities into
pharmaceutical matters of treatment or enhancement”
- Links private lives of citizens to economics and politics of
pharmaceutical production (Fox and Ward 2009)
What is driving pharmaceuticalisation (Abraham 2010)
5 biosociogical explanatantory factors:
1. Biomedicalism, is found to be a weak explanatory factor
, SOC2037 PHARMACEUTICAL CULTURES
DR HANNAH FARRIMOND
2. Medicalisation, ‘pharmaceuticalisation’ – the process by which
social, behavioural or bodily conditions are treated or deemed to be
in need of treatment, with medical drugs by doctors or patient
(Abraham 2010). Medicalisation – ‘a process by which non-medical
problems became defined and treated as medical problems, usually
in terms of illness or disorders’ (Conrad 2005), is about defining
diseases and bringing them into the scope of medicine,
pharmaceuticalisation is about characterising them as problems
solvable by pills
- Is pharmaceuticalisation just a form of medicalisation \? No – you
can have pharmaceuticalisation without medicalisation eg an
existing disease becomes treatable by pills, can involve other
technologies than pills eg equipment, genetic modification BUT both
are driven by global pharmaceutical industrial complex.
3. Pharmaceutical industry promotion and marketing
- Direct-to-consumer advertising (limited to US as illegal in other
Western cultures)
- Marketing strategies to redefine/reclassify risks and disease-
boundaries
- Drugs in supermarkets and pharmacies, can be over the counter or
online
- Advertising to doctors/prescribers to increase prescription/move to
their brand (sometimes without evidence)
4. Consumerism
- Domestic pharmaceuticalisation, can include lifestyle drugs, diets
and supplements but also consumer resistance eg patient groups
suing big Pharma
5. Regulatory-state ideology or policy
Which is the most important driver?
- Abraham (2010): NOT BIOMEDICINE! There has been increase in
ability to diagnose and new medical tests but…
pharmaceuticalisation occurs even when medical evidence is weak
or contrary
- He argues the medicalisation-pharmaceuticalisation complex is
responsible – via marketing, expansion of disease categories,
interfering with regulation
- Also consumers as more active agents
- Eg Viagra = marketing, come consumer demand (although not from
all) and available over the counter
Critique of pharmaceuticalisation theories
- Theories focus on big industrial complex and the totality of pill-
taking
- Less focus on ‘everyday lives’ of people, pills interwoven in a variety
of practises, not just taking therapeutics but wider ‘technologies of
the self’ (Foucault)
- Attention on active resistance (eg suing companies) less on
mundane practices of not taking medicines (eg non-compliance) or
avoiding mediation altogether
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