The moral economy of the pharmaceutical industry: Legitimising prices.

The practices of pharmaceutical companies have been widely criticised by researchers and investigative journalists, yet their conduct has mostly escaped significant moral opprobrium from the wider public, health professionals and governments. This article examines one reason for this by exploring the techniques companies use when seeking to justify and legitimise their conduct - legitimising techniques that help to render their failures to adhere to accepted standards less visible. It explores these techniques by examining four cases involving pricing where the companies' conduct has, nonetheless, been questioned. It is divided into three parts. The first looks at various publicly-stated standards that provide the moral context for the industry's activities. The second examines four cases, each involving pricing, where companies' prices have been challenged as morally unacceptable, each leading to a US Government investigation. These provide a means of exploring how companies seek to justify their actions in order to maintain the appearance of conformity to accepted moral standards. The third considers some reasons why the industry's efforts at legitimation have considerable force. The analysis shows not only the character of the claims made by pharmaceutical companies in defence of their practices - claims about the health benefits of the medicine, access to it, and research and development costs, which are all often exaggerated. It also shows why the companies' legitimising tactics are typically effective.

Documenting the financialisation of the pharmaceutical industry.

The aim of this paper is to explore the growing financialisation of the pharmaceutical industry from the beginning of the 1980s onwards and to consider its implications. It examines a number of features that demonstrate the increasing influence of the financial sector on the industry, including changing patterns of shareholder ownership, the importance attached to the idea of maximising shareholder value, the pay and share options given to company chief executives and other senior managers, the use of share buybacks, the increase in the outsourcing of manufacturing and of research and development, along with the growing use of mergers and acquisitions and of new forms of borrowing to fund them. The paper examines data in relation to each of these areas in turn in order to provide evidence of the growing financialisation of the industry and to highlight some of its consequences for the industry's task of developing and manufacturing medicines that enhance population health.

Social Capital, Deprivation and Psychological Well-Being among Young Adolescents: A Multilevel Study from England and Wales.

Examining the mechanisms influencing mental health and life satisfaction simultaneously allows for a better understanding of adolescents psychological well-being. Six indicators of neighbourhood social capital (NSC), neighbourhood socioeconomic deprivation (SecD) and their association with psychological well-being among young adolescents aged 10-15 from England and Wales were investigated. Using a random sample of 5201 adolescents (7253 observations) from the UK Household Longitudinal Study merged to aggregated local area census measures, we fitted a series of multilevel models. The findings showed that not being worried about crime and friendship networks mitigated the negative effects of deprivation on adolescent's psychological well-being. These findings suggest that some forms of NSC may have a buffering and protective function, with the strongest effects in deprived neighbourhoods. We further found that psychological well-being of adolescents is dependent on both individual vulnerabilities and neighbourhood context. However caution is required if, and when public health policies are formulated to address this issue, given significant variations (27-36%) in the inter- and intra-individual psychological well-being were found among this group over time. Thus, policies designed to improve psychological well-being among adolescents should take into account the role of social processes in transmitting deprivation's effects, as well as the various forms of social capital.

The concept of medicalisation reassessed.

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.

Assessing the overuse of medicines.

The use of medicines has increased markedly in many countries over recent years, providing clear evidence of the increasing 'pharmacaeuticalisation' of society. This paper contributes to the sociological analysis of pharmaceuticalisation by starting to explore how we can begin to make judgements as to when and to what extent some medicines are being overused--an important aspect that, rather surprisingly, has not so far been the focus of attention those analysing the process. It considers the World Health Organisation's criteria for the 'rational' use of medicines, pointing to some of the issues they raise. It then develops a typology of over and underuse derived from these criteria. This provides a framework for the discussion of assessing overuse that focuses in particular on the widespread and increasing use of medicines that are not very effective for the conditions for which they are prescribed, and their use where the issue of clinical need is in doubt. Some of the factors that encourage overuse are also considered.

Challenging claims that mental illness has been increasing and mental well-being declining.

There has been a tendency by some social scientists and the media to claim that in advanced western societies like Britain and the US mental illness has been increasing and mental well-being declining over the period since the Second World War. In this paper I consider the evidence that is invoked in making such claims, along with the counter-evidence. In order to assess the evidence it is essential to take account of the different ways mental illness and mental well-being are measured and the definitions the measures embed. I argue that when the findings from studies using similar measures at different points in time are compared, there is little evidence of consistent secular increases in mental illness or declines in mental well-being. I suggest that such claims are encouraged by two main factors: first and most importantly, the major changes that have occurred in the official boundaries of mental disorder over the post-war period, which have also changed the ideas and perceptions of professionals and the public about mental health and illness; and second, the ready way in which data on mental health and illness can be used to support criticism of certain features of present-day society.

'A pill for every ill': explaining the expansion in medicine use.

This paper explores the major factors underpinning the expansion in medicine use over recent decades, using England as an example. It begins by constructing a 'progressive' model of the expansion and considers its limitations; it then uses a framework of countervailing powers to examine the contribution of key actors in the field. It examines the commercial orientation of the pharmaceutical industry and the strategies companies deploy to generate demand for their products. It explores the part played by doctors as researchers and gatekeepers to medicines, considering how features of medical knowledge and practice contribute to, rather than curtail, the expansion. It considers the role of the public as consumers of medicines, and the role of governments and insurance companies in both facilitating and controlling medicine use.

Class and gender in twentieth-century British psychiatry: shell-shock and psychopathic disorder.

This chapter explores the ways in which class and gender permeated psychiatric practice in twentieth-century Britain. It first outlines the historical context and changing character of psychiatric ideas and practice, dividing the century into four main periods - Custodialism under attack, 1890-1929; Integration and Medical Innovation, 1930-1953; Community Care and Public Sector Expansion, 1954-1973; and Privatisation and Commercialisation, 1974 to the Present. The chapter then uses the prism of two psychiatric categories - shell-shock and psychopathic disorder to examine in some detail the ways in which class and gender are embedded in psychiatric work.

Globalization and the pharmaceutical industry revisited.

This survey of the pharmaceutical industry at the beginning of the 21st century updates some of the information provided in Claudio Tarabusi and Graham Vickery's survey, "Globalization in the Pharmaceutical Industry," published in the International Journal of Health Services in 1998, which was largely based on data up to 1993. However, the purpose of the present article differs from that of Tarabusi and Vickery, which covered a wide range of aspects of the industry relevant to globalization but did not explicitly address the question of the extent to which the industry could be described as globalized. After looking at the industry in some detail, the author directly confronts the question of the appropriateness of the use of the term "globalization" for characterizing the directions in which the pharmaceutical industry has been moving.