Conclusion: The Haunted Pharmakon

1 Howard Brody and Donald W. Light, ‘The Inverse Benefit Law: How Drug Marketing Undermines Patient Safety and Public Health’, American Journal of Public Health 101, no. 3 (2011): 399–404.

2 See, e.g. Donald W. Light, Joel Lexchin and Jonathan Darrow, ‘Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs’, Journal of Law, Medicine & Ethics 14, no. 3 (2013): 590-610; Jacoline C. Bouvy, Marie L. De Bruin and Marc A. Koopmanschap, ‘Epidemiology of Adverse Drug Reactions in Europe: A Review of Recent Observational Studies’, Drug Safety 38, no. 5 (2015): 437–453.

3 The phrase ‘moral microclimates’ is Emily Martin’s. For Martin, these moral microclimates operate as spaces from which pharmaceutical employees are able to actively engage in defining the meaning of their own work. See Emily Martin, ‘Pharmaceutical Virtue’, Culture, Medicine and Psychiatry 30, no. 2 (2006): 157–174. Our interviews with KOLs, and the justificatory schemes they use, are presented in more detail in Sergio Sismondo and Zdenka Chloubova, ‘“You’re Not Just a Paid Monkey Reading Slides”: How Key Opinion Leaders Explain and Justify Their Work’, BioSocieties 11, no. 2 (2016): 199–219.

4 As I mentioned before, doctors who see sales reps frequently are more confident of their ability to remain independent than are those who avoid seeing them. Brian Hodges, ‘Interactions with the Pharmaceutical Industry: Experiences and Attitudes of Psychiatry Residents, Interns and Clerks’, Canadian Medical Association Journal 153, no. 5 (1995): 553–559.

5 Marc Rodwin, Conflicts of Interest and the Future of Medicine: The United States, France and Japan (Oxford: Oxford University Press, 2011).

6 Peter Doshi, Kay Dickerson, David Healy, S. Swaroop Vedula and Tom Jefferson, ‘Restoring Invisible and Abandoned Trials: A Call for People to Publish the Findings’, British Medical Journal 346 (2013): f2865.

7 The phrase stems from the US Supreme Court justice Louis Brandeis, who wrote that ‘[s]unlight is said to be the best of disinfectants; electric light the most efficient policeman’. See Louis D. Brandeis, Other People’s Money – And How Bankers Use It (New York: F.A. Stokes, 1914).

8 Jeanne Lenzer, ‘Two Years of Sunshine: Has Openness About Payments Reduced Industry Influence in Healthcare?’, British Medical Journal 354 (2016): i4608.

9 Jason Dana and George Loewenstein, ‘A Social Science Perspective on Gifts to Physicians from Industry’, Journal of the American Medical Association 290, no. 2 (2003): 252–255.

10 I owe this point to Shai Mulinari, who is studying transparency as applied to pharma in a number of European countries.

11 Lars Jørgensen, Peter C. Gøtzsche and Tom Jefferson, ‘Index of the Human Papillomavirus (HPV) Vaccine Industry Clinical Study Programs and Non-industry Funded Studies: A Necessary Basis to Address Reporting Bias in a Systematic Review’, Systematic Reviews 7, no. 1 (2018): 8.

12 See, e.g. Office of the Inspector General, ‘Health Care Fraud and Abuse Control Program Report’ <http://oig.hhs.gov/reports-and-publications/hcfac/index.asp#pdf> [accessed 14 July 2011].

13 For some excellent overviews of conflicts of interest between the pharmaceutical industry and medicine, see Joel Lexchin, Doctors in Denial: Why Big Pharma and the Canadian Medical Profession Are Too Close for Comfort (Toronto: James Lorimer, 2017); Marc Rodwin, Conflicts of Interest and the Future of Medicine: The United States, France and Japan (Oxford: Oxford University Press, 2011).

14 A related proposal is made by Lynette Reid, and Matthew Herder, ‘The Speakers’ Bureau System: A Form of Peer Selling’, Open Medicine 7, no. 2 (2013): e31.

15 A version of this proposal was put forward by Stan Finkelstein and Peter Temin to address another problem: drug pricing. See Stan Finkelstein and Peter Temin, Reasonable Rx: Solving the Drug Price Crisis (Upper Saddle River, NJ: FT Press, 2008).

16 For example, Arthur Schafer ‘Biomedical Conflicts of Interest: A Defence of the Sequestration Thesis – Learning from the Cases of Nancy Olivieri and David Healy’, Journal of Medical Ethics 30 (2004): 8–24; Marcia Angell, The Truth About the Drug Companies: How They Deceive Us and What to Do About It (New York: Random House, 2005).

17 For example, Marcia Angell, The Truth About the Drug Companies: How They Deceive Us and What to Do About It (New York: Random House, 2005).

18 For example, James Robert Brown, ‘Medical Market Failures and Their Remedy’, in Martin Carrier and Alfred Nordmann, eds, Science in the Context of Application, (Dordrecht: Springer Publishing, 2011), 271–281.