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290 17 The Sociological Concomitants of the Pharmaceutical Industry and Medications John Abraham, University of Sussex social medical. The medicalization thesis asserts that the growth in medical conditions partly reflects medical dominance in society and the significance of the “sick role” in redefining social deviance or dysfunctionality (Conrad and Schneider 1992; Parsons 1951). One can envisage such medicalization leading to growth in drug treatment, but medicalization theorists focused primarily on interactions between the medical professions, patients , and health-care organizations. Until very recently, medicalization theorists paid very little attention to the pharmaceutical industry, the drug regulatory state, or patients as organized interests. I contend that, while medicalization can account for some of the growth in pharmaceutical markets, it is only one of a constellation of sociological factors. To compensate for this, I introduce the new concept of “pharmaceuticalization,” which I define as the process by which social, behavioral, or bodily conditions are treated, or deemed to be in need of treatment/intervention, with pharmaceuticals by doctors, patients, or both. For example, the treatment of mood with anxiolytics (tranquilizers and sleeping pills) or antidepressants; treatment of behavior such as attention deficit hyperactivity disorder (ADHD) with methylphenidate (Ritalin); treatment of erectile dysfunction with sildenafil (Viagra); or even treatment of heart-disease risk factors with cholesterol-lowering drugs, such as statins. Notably , not all pharmaceuticalization involves makPharmaceuticals are pervasive in medicine and society. The transnational industrial nature and scale of pharmaceutical markets and the level of technoscientific sophistication in pharmaceutical development in the last twenty to twenty-five years are unprecedented. Between 1960 and the early 1980s, prescription-drug sales were almost static as a percentage of GDP in most of the major Western economies, including the United States, which alone makes up about half the world’s prescription-drug sales.1 However, from the early 1980s to 2002, prescription-drug sales tripled to nearly US$400 billion worldwide, and almost US$200 billion in the United States (Angell 2004, 1–5). By 2007, global sales were approaching US$600 billion (IMS Health 2008). Pharmaceuticals also seem to be more pervasive in public discourse and media outlets than in previous decades (Applbaum 2006). Many who speak for the pharmaceutical industry in drug companies , the scientific community, or within the media assert or give the impression that the expansion of pharmaceutical markets and prescribing over the last few decades is best understood as the innovative responses of biomedical science to growing and new health needs. I refer to this as the “biomedicalism thesis,” which has long been a deep-seated part of the popular, commercial, and scientistic discourse about drug products. Conventionally, the biomedicalism thesis has been challenged by the well-established sociological concept of medicalization—the making of the The Sociological Concomitants of the Pharmaceutical Industry and Medications 291 ing the social medical. The appropriate treatment of bacterial infections, previously without effective drug remedies, with new antibiotics involves pharmaceuticalization, but not medicalization. In this chapter I suggest that, in addition to medicalization, one needs to appreciate the salience of other sociological factors to explain pharmaceuticalization—specifically, the political economy of the pharmaceutical industry, consumerism , and deregulatory state ideology. I argue that these factors, while conceptually distinct, are empirically mutually interrelated, particularly by the pharmaceutical industry’s power and influence in promoting its commercial interests. Overall, I conclude that these mutually interacting sociological factors almost certainly provide a better explanation for growing pharmaceuticalization than does the biomedicalism thesis. Biomedicalism, Medicalization, and the Pharmaceuticalization of Medicine: Response to Need or Creation of Markets? There is evidence that pharmaceuticalization is increasing along with the expansion of pharmaceutical markets. Between 1993 and 2002, National Health Service (NHS) prescriptions in England for the antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs) grew from 1,884,571 to 15,500,000; for Ritalin to treat ADHD, they grew from 3,500 to 161,800 (Department of Health 1994, 2003). In the United States, sales of the SSRI fluoxetine (Prozac) more than doubled between 1994 and 2000, sales of Viagra nearly doubled within four years of market release in 1998, and sales of Ritalin multiplied fivefold in the ten years after 1992 (Scripnews 1999, 1995; Drug Enforcement Administration 2001; Eli Lilly 2000; Timmerman 2003). In Canada, prescription of Ritalin grew fivefold between 1990 and 1995, while in New South Wales (Australia), treatment of children with drugs in 2000 was nine times the rate in 1990 (Phillips 2006, 433). Some argue that growing pharmaceuticalization reflects advances in medical science which...

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