Working in health and more precisely around pharmaceutical products is a complex situation due to the highly controversial actions of the pharmaceutical industry. To sketch things in a slightly over simplistic manner, researchers have to choose side: either you are a pure academic sociologist and generally oppose the capitalist pharmaceutical industry or you collaborate with the industry and take for granted a certain number of assumptions.
I feel I sit between both chairs. On the one hand my research lab displays a sociological orientation working independently from the pharmaceutical industry and my supervisors are not known for their support to the pharma world. On the other hand, my sponsoring institution is a consultancy working directly for the industry. This potential issue had not arisen so far, but since I have started working on theoretical concepts of medicalisation and pharmaceuticalisation, I see the topic has become hotter.
The efficacy of pharmaceutical treatments is in many ways the centre of disagreement. In his book ‘Limits to Medicine, Medical nemesis: the Expropriation of Health, Illich unwillingly exposed the dilemma. (Illich I. 1976) He argued that many treatments, especially newer ones harm society more than they help. However, he admitted that a number of pharmaceutical discoveries were in fact fundamentally positive, citing infections like malaria or syphilis for which medical treatments were found to be efficacious. To me, by entering the field of comparative health research he puts his argumentation at risk of being falsified due to advancing knowledge and contradictory evidence.
After having worked in health economics for over three years I understand that measuring efficacy of medical treatments is not a straight forward black or white science. It is necessarily embedded in theoretical assumptions, methodological biases and limitations of a number of sorts. Treatments initially appearing as efficacious in a particular indication can be demonstrated harmful ten years down the line and/or can be proven efficacious later in another indication following complementary investigations. Because of the pharmaceutical industry’s financial interests, the controversy will remain between those defending the product and those opposing it.
When I first entered the medical field of osteoporosis and knew only very partially the existing literature, I started with the reading of pro-pharmaceutical industry publications (including the report I mentioned in a previous post, Hernlund et al. 2013). As most observers, I was sensitive to the argument of a tremendous treatment gap: older people were denied efficacious treatments. So my initial research question was formulated as follow: there are fully recognised efficacious treatments available to treat a well known harmful and costly disease: why are treatment uptake rates low and now declining? This was the argumentation I supported at one of my first conference presentations, the SMi Safe Geriatric Medicine Summit in 2013 in London.
As I went on reading I understood the other side of the controversy alongside the limitations associated with the efficacious characteristics of treatments against osteoporosis as well as the concepts of disease mongering (pejorative way of describing the role of the pharmaceutical industry in the increasing place of health in life). I also acknowledge that I don’t have the knowledge nor the willpower to engage in this endless and highly technical debate. It is for this reason that I have decided to take an almost anthropological stand at the situation and avoid the question of efficacy.
When anthropologists study the role of shamans or sorcerers in societies (technological or traditional societies – yes there are still such practices in Western countries nowadays!), they do not argue the effectiveness of the spiritual procedure; either because the researcher considers in a slightly cynic way that such beliefs are kinda retarded or because he/she voluntarily chooses a neutral position. Adopting such a position in our modern societies on the topic of pharmaceuticals suggests that I put medicines at the same level as an exorcist procedure. Because I work in an environment completely devoted to the assessment of pharmaceuticals’ effectiveness, it makes it delicate to adopt an external position. Sorry for the comparison, it is as if I was anthropologically questioning the usage of exorcism as I simultaneously worked as priest assistant! It is complex, yet surely not impossible.