Promoting opioids, a story about how to influence medical science and opinions

Key origins of the opioid crisis in the US lie in some pharmaceutical companies’ substantial efforts to sell prescription painkillers. To legitimize opioids, the companies built up a body of medical science and opinions, and channels with which to communicate. Archival searches found 876 contracts that together provide information on how Mallinckrodt, an opioid manufacturer, attempted the ghost-management of medicine. These records—available because of litigation–involved contract research organizations, medical education and communication companies, publishers, professional societies, researchers, and other people who could be Mallinckrodt’s agents. Together, they produced and circulated scientific messages to increase physicians’ comfort with prescribing opioids. This article gives an overview of that activity, as seen in the contracts and related documents

Ghost Management: How Much of the Medical Literature Is Shaped Behind the Scenes by the Pharmaceutical Industry?

Sismondo discusses how pharmaceutical companies and their agents shape multiple steps in the research, analysis, writing, and publication of articles

Clogging the machinery: the BBC's experiment in science coordination, 1949–1953

In 1949, physicist Mark Oliphant criticised the BBC’s handling of science in a letter to the Director General William Haley. It initiated a chain of events which led to the experimental appointment of a science adviser, Henry Dale, to improve the ‘coordination’ of science broadcasts. The experiment failed, but the episode revealed conflicting views of the BBC’s responsibility towards science held by scientists and BBC staff. For the scientists, science had a special status, both as knowledge and as an activity, which in their view obligated the BBC to make special arrangements for it. BBC staff, however, had their own professional procedures which they were unwilling to abandon. The events unfolded within a few years of the end of the Second World War, when social attitudes to science had been coloured by the recent conflict, and when the BBC itself was under scrutiny from the William Beveridge’s Committee. The BBC was also embarking on new initiatives, notably the revival of adult education. These contextual factors bear on the story, which is about the relationship between a public service broadcaster and the external constituencies it relies on, but must appear to remain independent from. The article therefore extends earlier studies showing how external bodies have attempted to manipulate the inner workings of the BBC to their own advantage (e.g. those by Doctor and Karpf) by looking at the little-researched area of science broadcasting. The article is largely based on unpublished archive documents

Envoûtement : fabrique et management des leaders d’opinion

La quintessence du leader d’opinionLe Dr Kessel, sourire aux lèvres, tiré à quatre épingles, médecin et professeur, la cinquantaine, monte sur l’estrade. Il porte un costume qui doit être en crêpe de coton, une chemise à rayures bleues et blanches et une cravate jaune, une tenue parfaitement adaptée aux grandes chaleurs en cette journée d’été à Philadelphie. Le Dr Kessel, qui a été présenté comme l’auteur de plus de 500 publications et « l’une des stars des neurosciences les plus brillantes ..

L’extraction des données en marge de la santé

Entre 2009 et 2013, l’Agence européenne des médicaments (AEM) a homologué quarante-huit médicaments anticancéreux. Une étude révèle qu’au moment de cette homologation, il n’y avait aucune preuve d’une amélioration de la qualité de vie ou d’une augmentation des chances de survie dans 65 % des usages pour lesquels ces médicaments avaient été approuvés. Il semble que l’AEM ait fondé ses homologations sur des espoirs et non sur des preuves. Il s’avère que ces espoirs n’étaient justifiés que dans..

Ghost-Managed Medicine

Ghost-Managed Medicine by Sergio Sismondo explores a spectral side of medical knowledge, based in pharmaceutical industry tactics and practices. Hidden from the public view, the many invisible hands of the pharmaceutical industry and its agents channel streams of drug information and knowledge from contract research organizations (that extract data from experimental bodies) to publication planners (who produce ghostwritten medical journal articles) to key opinion leaders (who are sent out to educate physicians about drugs) to patient advocacy organizations (who ventriloquize views on diseases, treatments and regulations), and onward. The goal of this ‘assemblage marketing’ is to establish conditions that make specific diagnoses, prescriptions and purchases as obvious and frequent as possible. While staying in the shadows, companies create powerful markets in which increasing numbers of people become sick and the drugs largely sell themselves. Most agents for drug companies aim to tell the truth, but the truths they tell are drawn from streams of knowledge that have been fed, channeled and maintained by the companies at every possible opportunity. Especially because those companies have concentrated influence and narrow interests, consumers and others should be concerned about how epistemic power is distributed – or ‘political economies of knowledge’ – and not just about truth and falsity of medical knowledge. In pharmaceutical companies’ ideal worlds, medical research, education and marketing would be tightly fused. Doctors trying to educate themselves would turn to companies’ agents, such as researchers and educators sponsored to spread particular messages, local sales reps hired to change doctors’ behaviour, or journalists supplied with news stories. Ghost-Managed Medicine shows that the real world of medicine is not very far from the worlds that the companies want to create. Big Pharma’s many invisible hands are busy throughout medicine, and medicine changes as a result

Remerciements

Je suis ravi qu’ENS Éditions ait décidé de publier ce volume. Je remercie l’équipe d’ENS Éditions d’avoir pris l’initiative de cette publication, Laurent Dartigues d’avoir accepté le travail de direction scientifique pour ce projet et de l’avoir mené à bien, ainsi que pour sa révision méticuleuse de la traduction effectuée avec Jean-Claude Zancarini, co-directeur de la collection Gouvernement en question(s) à ENS Éditions, Samantha Saïdi pour sa traduction généreuse, Mathias Girel, auteur de..

Amoindrir et contraindre la capacité d’agir

Changer les habitudesBien que les médecins généralistes parviennent à se leurrer sur la finalité du démarchage –, et il est étonnant qu’ils y arrivent aussi souvent – les visiteurs médicaux qui se rendent dans leur cabinet sont très clairement des vendeurs. Les tactiques de ces derniers peuvent prendre des formes très variées, et certaines ne ressemblent pas vraiment à de la vente forcée, comme la « description détaillée » qu'ils font des médicaments de leur portefeuille et qui offre, notamm..