Corporate Social Responsibility within the Pharmaceutical Industry

The pharmaceutical industry has a unique dual role within society in that the companies within the industry develop and distribute health care products in a for-profit manner. Safety and ethical concerns have resulted in an industry that is one of the most highly regulated globally. Controversies have developed around perceived conflicts of interest emerging from this dual role due to the industry’s size, influence, and primary responsibility to society as a developer and provider of innovative medicines. While public awareness of these controversies has grown, so have global concerns regarding the financial, social, and medical health of individuals. Even as the industry faces persistent and increasing criticism for improperly managing the social responsibilities attributed to its dual role, the industry has increasingly engaged in CSR activities. Presently, companies in the pharmaceutical industry are under pressure to be even more comprehensive and strategic in their approaches to CSR engagement. The purpose of this study was to examine practices and perceptions of CSR within the pharmaceutical industry. Specifically, the study sought to gain an understanding of the perceptions of middle and senior managers of why and how their companies engage in CSR. The study consisted of two qualitative and complementary research methods. The primary research method was semi-structured interviews with managers lasting up to one hour. The secondary research method involved the collection and analysis of CSR-related publications from pharmaceutical companies. A multiple source approach was used for three specific reasons: 1) triangulate and confirm validity of primary data; 2) identify new areas or gaps in the literature not previously identified; and 3) create a more well-rounded understanding of why and how the pharmaceutical industry engages in CSR. For the interview portion of the study, the population consisted of middle-to-high-level managers of multinational pharmaceutical companies operating in North America, who either had significant responsibilities related to their company’s CSR decision-making process or were participants in such programs. The study population for the publication analysis included those pharmaceutical companies whose managers participated in the interview portion of the study. Formal e-mail correspondence was used to contact and invite potential study participants who were informed of the purpose and scope of the research. Non-random, purposive sampling was used to select those within the two key groups of managers deemed to be in a position to provide rich perspectives on the CSR decision-making process within their companies; those engaged with external stakeholders and those with defined roles in CSR. A constructivist grounded theory methodology was applied to the interview process, including the interview guide and data analysis, with the end goal of creating a substantive theory. Coding and categorizing began during the collection of data, and proceeded in a non-linear fashion to allow for the constant comparing and analyzing of the data. These iterative and circular processes developed into theoretical pathways that required further examining and provided additional data. Memos and diagrams were used as markers for thoughts and creative tools to further analyze the components of the developing theory. The result was a theory constructed from multiple perspectives and woven into a multi-story narrative. Managers from eleven companies (nine brand name and two generic) participated in the study. In total, 22 interviews were completed, and consisted of fifteen Canadian managers, six American managers, and one British manager. Additionally, there were three companies where interviews were conducted with managers from both Canadian and American affiliates of the same company. The positions held by respondents within their respective companies included those directly involved in creating, implementing, and reporting on CSR programs and policies, and those distanced from, but still affected by them. The range of perspectives based upon the positions held by participants provided an insightful range of interpretations regarding CSR within the pharmaceutical industry. The resulting substantive theory and its accompanying model present an evidence-based framework for the industry’s process of CSR evolution (core category) and articulate the relationships, interactions, and influences of its four subcategories: 1) social context; 2) CSR perspectives; 3) continual development and reinforcement process (CDRP); and 4) symbiotic continuum. The substantive theory suggests that the pharmaceutical industry is in a process of institutional change, with previously taken-for-granted perspectives and strategies in conflict with, and contested within, the social context of the industry. CSR is no longer just a pragmatic/moral strategy to gain, maintain, and repair legitimacy using loosely coupled practices and structures. Logical connections and framing developed and reinforced by institutional entrepreneurs and their resources have constructed the identity of CSR as an umbrella business strategy that can universally resonate with stakeholders and thereby create greater connectedness with operational locals and stakeholders. Subsequently, CSR can be used to mitigate risks and uncertainties while also fostering a motivated and controlled workforce by reinforcing the internalization of desired meanings relating to the role of CSR. By integrating and merging internal and external conceptions of what is considered ‘right’ and how to serve the self-interest of others in addition to their own, companies capture wider social movements in an attempt to find or construct opportunities to enhance their potential for long-term success and sustainability. If these opportunities mean diverting assets and expertise to address social needs, and in so doing, result in tangible (e.g. market entrance) and intangible (e.g. motivated workforce) returns on these investments, then CSR becomes justified and legitimized by bridging the changing institutional logic

Price Incentives and Consumer Payment Behaviour

In this paper we estimate the effect of particular price incentives on consumer payment patterns using transaction-level data. We find that participation in a loyalty program and access to an interest-free period, both of which lower the price of credit card use, tend to increase credit card use at the expense of alternative payment methods, such as debit cards and cash. Specifically, we find that a loyalty program increases the probability of credit card use by 23 percentage points and access to the interest-free period increases the probability by 16 percentage points. Interestingly, the pattern of substitution from cash and debit cards is different in each of these cases. A loyalty program reduces the probability of cash use by 14 percentage points and has little effect on debit card use, while access to the interest-free period has little effect on cash use but reduces the probability of debit card use by 19 percentage points. We find these effects to be economically significant and large enough that they can help to explain observed aggregate payments patterns. An implication is that the Reserve Bank reforms of the Australian payments system are likely to have influenced observed payment patterns.consumer choice; retail payment systems; price incentives; loyalty programs

Adjusting for Confounders with Text: Challenges and an Empirical Evaluation Framework for Causal Inference

Leveraging text, such as social media posts, for causal inferences requires the use of NLP models to 'learn' and adjust for confounders, which could otherwise impart bias. However, evaluating such models is challenging, as ground truth is almost never available. We demonstrate the need for empirical evaluation frameworks for causal inference in natural language by showing that existing, commonly used models regularly disagree with one another on real world tasks. We contribute the first such framework, generalizing several challenges across these real world tasks. Using this framework, we evaluate a large set of commonly used causal inference models based on propensity scores and identify their strengths and weaknesses to inform future improvements. We make all tasks, data, and models public to inform applications and encourage additional research

Causes of death in people with coeliac disease in England compared with the general population: a competing risk analysis.

INTRODUCTION: Quantifying excess cause-specific mortality among people with coeliac disease (CD) compared with the general population accounting for competing risks will allow accurate information to be given on risk of death from specific causes. METHOD: We identified from the Clinical Practice Research Datalink all patients with CD linked to Office for National Statistics between 1998 and 2012. We selected controls by frequency matching from the registered general practice population within 10-year age bands. We calculated the adjusted cumulative incidence (including adjustment for competing risks) and excess cumulative incidence for different causes of death up to 10 years from diagnosis. RESULTS: Of the 10 825 patients with CD, 773 died within the study period. The overall mortality rate among patients with CD was 128/10 000 person years compared with 153/10 000 in controls (HR=0.94 95% CI 0.84 to 1.01). We found no overall difference in the cumulative incidence of respiratory disease, digestive disease or cancer related death among cases and controls. The adjusted cumulative incidence of death from cardiovascular deaths was slightly lower compared with those without CD diagnosis (CD 0.32% vs controls 0.41%) with a corresponding excess cumulative incidence of -0.08% (95% CI -0.13 to -0.04). However, patients with CD had 0.15% excess risk (95% CI 0.03 to 0.27) of deaths from non-Hodgkin's lymphoma from the general population baseline risk. CONCLUSIONS: Overall, people with CD have no major excess risk of cancer, digestive disease or respiratory disease related or cardiovascular mortality compared with the general population. These findings should be reassuring to patients with CD and clinicians managing their care

Chemotherapy-induced amenorrhea: a prospective study of brain activation changes and neurocognitive correlates

Chemotherapy-induced amenorrhea (CIA) often occurs in pre- and peri-menopausal BC patients, and while cancer/chemotherapy and abrupt estrogen loss have separately been shown to affect cognition and brain function, studies of the cognitive effects of CIA are equivocal, and its effects on brain function are unknown. Functional MRI (fMRI) during a working memory task was used to prospectively assess the pattern of brain activation and deactivation prior to and one month after chemotherapy in BC patients who experienced CIA (n=9), post-menopausal BC patients undergoing chemotherapy (n=9), and pre- and post-menopausal healthy controls (n=6 each). Neurocognitive testing was also performed at both time points. Repeated measures general linear models were used to assess statistical significance, and age was a covariate in all analyses. We observed a group-by-time interaction in the combined magnitudes of brain activation and deactivation (p = 0.006): the CIA group increased in magnitude from baseline to post-treatment while other groups maintained similar levels over time. Further, the change in brain activity magnitude in CIA was strongly correlated with change in processing speed neurocognitive testing score (r=0.837 p=0.005), suggesting this increase in brain activity reflects effective cognitive compensation. Our results demonstrate prospectively that the pattern of change in brain activity from pre- to post-chemotherapy varies according to pre-treatment menopausal status. Cognitive correlates add to the potential clinical significance of these findings. These findings have implications for risk appraisal and development of prevention or treatment strategies for cognitive changes in CIA