Ethical Transparency and Government Regulation of Canada's Medical Research Industry
Poitras, Geoffrey, Meredith, Lindsay, Forum on Public Policy: A Journal of the Oxford Round Table
I. The Medicalization of Society
Medicalization is a social process where the medical profession extends its authority over matters not directly concerned with the analysis and treatment of biophysical disorders. In this definition, the medical profession includes not only practising doctors and associations of doctors but also: the pharmaceutical industry, providing the drugs that are an essential component of modern medicine; the academic institutions and journals involved in training doctors and sponsoring essential research activities; and, the government granting agencies and other sponsors that supply essential funding to the research conducted by the medical profession. (4) Significantly, because the source of capital for the pharmaceutical industry is the global financial markets, the primary motivations of this important player in the medical profession differ from those of the other players. The implications of this difference are the substance for a legion of studies on the marketing networks of the pharmaceutical companies and the sophisticated efforts involved in selling products. The differing motivations within the medical profession create an ethical dilemma for government regulators: how to balance public health concerns with the need to restrict the economic footprint of the regulatory framework on an industry that produces and distributes some of the most important products of modern science?
The concept of medicalization has a history going back, at least, to the 1950's when Thomas Szasz, Barbara Wootton and others attacked the advance of psychiatry beyond the treatment of well defined mental disorders into areas of dysfunctional behaviour related to crime and delinquency. (5) For Szasz and Wootton, 'science' was replacing traditional areas of social morality as the means distinguishing between the "undeniably mad" from those "who are simply unable to manage their lives". The distinction between 'mentally incompetent' and 'sinful' needs to be determined by social values. Allowing 'medical science' to encroach on this decision focuses attention on the individual instead of the environment as the source of the problem. As Wootton observes: "Always it is easier to put up a clinic than to pull down a slum." While insightful, the early contributions by Szasz and Wootton only examined the narrow confines of psychiatry where the social implications of medicalization are readily discernible. During the 1970's, the extension of these initial notions to a wider field of applications was initiated by Eliot Freidson and Irving Zola where the connection between medicalization and social control was established. (6)
See Table 1: Top 20 Pharma Products in Advertising (2005)
The identification of medicine as an institution of social control can be traced to Talcott Parsons. (7) As such, development of the connection between social control and medicalization was consistent with traditional sociology where social control is a central concept. The observation that medicine had "nudged aside" or "replaced" religion as the dominant moral force in the social control of modern societies was a central theme in medicalization research surveyed in the influential 1992 review by Peter Conrad ("Medicalization and Social Control"). The lack of cohesion in this research is reflected in the considerable effort Conrad dedicates to the search for a precise definition of 'medicalization'. (8) Driven by the remarkable evolution of the medical profession in the last two decades, it is becoming gradually apparent that the medicalization concept is too diverse to be analysed with a unifying methodology. (9) In particular, analytical advantage is gained if medicalization is dichotomized into two categories: social medicalization, dealing with the type of social control issues that originate with Szasz and Wootton; and, economic medicalization, dealing with the creation of markets for medical technology and professional services. …