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Medical Humanities Blog

On the Pharmaceuticalization of Society

Posted: 10 Mar 2011 08:16 AM PST

Simon J. Williams (Univ. of Warwick), Paul Martin (Univ. of Nottingham) and Jonathan Gabe (Univ. of London) have a new article out in Sociology of Health and Illness entitled The pharmaceuticalisation of society? A framework for analysis. Here is the Abstract:

Drawing on insights from both medical sociology and science and technology studies this article provides a critical analysis of the nature and status of pharmaceuticalisation in terms of the following key dimensions and dynamics: (i) the redefinition or reconfiguration of health 'problems' as having a pharmaceutical solution; (ii) changing forms of governance; (iii) mediation; (iv) the creation of new techno-social identities and the mobilisation of patient or consumer groups around drugs; (v) the use of drugs for non-medical purposes and the creation of new consumer markets; and, finally, (vi) drug innovation and the colonisation of health futures. Pharmaceuticalisation, we argue, is therefore best viewed in terms of a number of heterogeneous socio-technical processes that operate at multiple macro-levels and micro-levels that are often only partial or incomplete.

The article concludes by drawing out some broader conceptual and reflexive issues this raises as to how we might best understand pharmaceuticalisation, based on our analysis, as a framework for future sociological work in this field.

This is an important article, as it suggests a number of issues relevant to what Richard DeGrandpre terms "behaviorial pharmacologism" that are often not centered in current discourse on conflicts of interest. Namely, while one issue is whether money flowing from pharmaceutical corporations privileges the preference of one drug over another (i.e., brand-name vs. generic), the larger issue for those interested in population health and inequalities is whether the enormous sums of money flowing collectively from the pharmaceutical industry privilege pharmaceutical responses to population health concerns.

While the former has tended to occupy the lion's share of the debate, it is the latter that is of more concern to me for the simple reason that the SDOH evidence base strongly supports the idea that pharmaceuticals simply are not prime determinants of health and its distribution in human populations. On to the caveats: this is not to say that the concern over privileging one very expensive drug over a less expensive but equally effective drug is unjustified. This is not to say that pharmaceuticals play no role in shaping health and its distribution in populations. This is not to say that the relative effect size pharmaceuticals contribute to health is equivalent in the global North and the global South.

This is to say that in both the global North and in the global South, the social epidemiologic evidence strongly suggests that health interventions that focus on whole population approaches to ameliorating upstream and macrosocial pathways to health like income, housing, transportation, stigmatization and discrimination, violence, environment are of much greater relative priority to health and its distribution than pharmaceuticals. Hence the ethical concern over the pharmaceuticalization of society is a very, very serious one.

Thoughts?

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