Institutional Corruption Theory in Pharmaceutical Industry-Medicine Relationships: A Qualitative Analysis of Hungary and the Netherlands PDF
Preview Institutional Corruption Theory in Pharmaceutical Industry-Medicine Relationships: A Qualitative Analysis of Hungary and the Netherlands
Studies of Organized Crime 19 Anna Laskai Institutional Corruption Theory in Pharmaceutical Industry-Medicine Relationships A Qualitative Analysis of Hungary and the Netherlands Studies of Organized Crime Volume 19 Series Editor Dina Siegel Willem Pompe Institute, Utrecht University, Utrecht, The Netherlands Thisserieswillpublishtheoreticallysignificantbooksintwoprimaryareas.Oneis the political economy of organized crime and criminality whether at the transnational, national, regional or local levels (focus on financial crime, political corruption, environmental crime and the expropriation of resources from develop- ing nations). The other is human rights violations particularly in Third World countries. Manuscripts that cover either historical or contemporary issues of the above,utilizingqualitativemethodologies,areequallywelcome.Inaddition,weare particularly interested in publishing the work of sophisticated junior scholars. More information about this series at http://www.springer.com/series/6564 Anna Laskai Institutional Corruption Theory in Pharmaceutical Industry-Medicine Relationships A Qualitative Analysis of Hungary and the Netherlands 123 Anna Laskai Amsterdam, TheNetherlands ISSN 1571-5493 Studies of Organized Crime ISBN978-3-030-44789-2 ISBN978-3-030-44790-8 (eBook) https://doi.org/10.1007/978-3-030-44790-8 ©SpringerNatureSwitzerlandAG2020 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpart of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission orinformationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar methodologynowknownorhereafterdeveloped. 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ThisSpringerimprintispublishedbytheregisteredcompanySpringerNatureSwitzerlandAG Theregisteredcompanyaddressis:Gewerbestrasse11,6330Cham,Switzerland To my family Preface Pharmaceutical companies and the industry as a whole are gargantuan in size, multi-national in activity, successful in business, and vital to the global healthcare deliverystructure,butthesecompaniesareasinsidiousastheyareindispensable.The pharmaceutical industry possesses monopoly over a product of immense value— medication.Beingsmallinsizeandbigindemandmakepharmaceuticals,andthusthe pharmaceuticalsector,atriskfordeviancetoemerge,and“BigPharma”asacrim- inogenicenterprisehasbecomelessconspiracyandmoreaxiom.Muchattentionhas beenpaidtocrimesofpharmaceuticalcompanies,butsomeauthorsclaimthatwereit notforthecontributionofdoctors,thesecrimescouldnotbecommitted. Being thegatekeepers of human health, theprofession ofmedicine ismandated by social contract, specialized knowledge, authority, and autonomy to promote patient interests in the face of industry financial gain, thereby acting as a counter- vailing power to industry interests which disregard patient needs. Not only has medicine failed to do so, but explanations are few and far between, tending to suggest that the abandonment of patient interests is an individual departure from codes of proper medical conduct. This research examines the proposition of physician culpability in industry criminality, but will challenge individual procliv- itiesasthesourceofdigressionfromthemedicalmandate,askingnotonlywhyor howdoctorscontributeto,butwhytheprofessioncannotcurbindustrymalfeasance. By following the lifecycle of a pharmaceutical product and the process of delivery fromlaboratorytoprescription,therelationshipsbetweenindustryandmedicineare identifiedwithinthesystemofknowledgedevelopmentofapharmaceuticalproduct: knowledge production (medical research and development), knowledge interpreta- tion (evidence-based medicine), and knowledge application (informed clinical practice).Itisinthissystemthatindustry-medicinerelationshipsareformed,butalso withinwhichthe interestsof industry and medicine conflict. Thisbookwasoriginallywrittenasadissertationforcompletionofthedoctoral programinCulturalandGlobalCriminology.Thesubjectofconflictofinterestand undue influence within industry-medicine relationships had already been the focal point of my prior studies, and my continued fascination with the subject prompted mydesiretofurtherinvestigatethiswithinmyPh.D.research.Toassesshealthcare vii viii Preface systemactorsandtheirmotivationsrequiresnotonlyananalysisofpolicy,national healthcare spending, insurance etc., but also culture, history, ethics, human rights, andthelivedexperiencesoftheprofessionalswithinthefield.Today,thepowerof data and statistical analysis drives much of our comprehensions of the world, but knowledgeandunderstandingofcomplexsocialphenomenaalsocomesintheform of narratives and experiences of the people directly involved. Discussions and conversations help demystify subjects outside of my own knowledge area, and so withinthisresearchIadoptedthemethodofinterviewsasthebestmeansinwhich to fully understand the complexities, networks, relationships and influences mani- fest in industry-medicine relationships, as well as complement prior research with whatcanbeconsideredadeep-diveintothe“hows”and“whys”ofundueinfluence in industry-medicine relationships. It will be argued that industry influence, and the inability of the medical pro- fession to rein-in the interests of pharmaceutical companies, diverts and renders doctors incapable of achieving the institutional purpose of medicine. Employing qualitative research methodology, 84 interviews conducted in Hungary and the Netherlands between April 2015 and April 2017 construct the empirical backbone of the investigation of industry influence in medicine. Each account provided an interpretation and explanation of the realities of industry-medicine relationships, allowing for further exploration of literature, law, guidelines, and data used to support,verify,andillustratethephenomenarelayedbyrespondents.Favouringthe view of embeddedness as an explanation of behaviour, this book presents a rela- tionalapproachtotheexaminationofundueindustryinfluenceandtheinstitutional corruption of the medical profession. The profession of medicine and the phar- maceutical industry, although commonly seen as two separate actors within the pharmaceuticalproductdeliverychainareinfacthighlyinterdependent,tothepoint that understanding the role of industry in medicine as limited to drug production, manufacture, and distribution, while that of medicine steers scientific knowledge development, definition of illness and treatment, and clinical practice is no longer valid.Increasinginterdependencyinallareasofthemedicineslifecyclebetweenthe pharmaceutical industry and the profession of medicine brings with it the oppor- tunity for conflicts of interest to emerge. These conflicts are between the profit incentives of the pharmaceutical industry and the interests of autonomy and authorityoverthepracticeofmedicine bythemedicalprofession.More oftenthan not, the interests of the pharmaceutical industry trump those of medicine. In cases ofpharmaceuticalindustrycriminality,therearethosewhoturntotheprofessionof medicineashaving theduty andknowledge tocurbindustry devianceandact asa countervailing power to the interests of the pharmaceutical industry. The inability of physicians to do so is explained as the result of the extraordinary amount of influence exerted by the pharmaceutical industry over medical professionals man- ifesting in industry-medicine relationships; pharmaceutical industry funding of medical research and development, industry funding of continuing medical edu- cational events, and direct-to-physician industry advertising. Preface ix Industry-medicine relationships, as corrosive to medical professional autonomy and authority, have not enjoyed too much attention from scholars outside of medicine. While criminological inquiry pursues the crimes of the pharmaceutical industry, or crimes of the individual doctor, medical sociology shows a preoccu- pation with the relationship between the medical profession and the state, and physician-patientrelationships.Apart frombeinglargelyrestricted totheacademic medical discourse, industry influence is taken to be understood as an external influentialforcewhichinfiltratesmedicalpracticeandthemindsofdoctors.Thisis done by either controlling medical professional behaviour by holding hostage and conditionallyreleasingthefinancesneededformedicalresearch,development,and education, or by way of using the seductions offinancial gain to distort the inde- pendence and dutiful behaviour of physicians. These explanations prefer the over- andundersocialized viewofman,limitingtheunderstandingofdeviancetothatof professional dependency on industry funding, and individual greed. This research looks beyond such simplified explanations, which ultimately end up locating deviance within the mind of the individual, or as some sort of supra-individual corruptiveforcewhichcannotberesisted.Behaviour,however,isembeddedwithin the social networks and relationships among actors in their efforts to achieve societal goals, the complexities of which require interactions between actors in possession of the different knowledge and capabilities needed to achieve goal attainment. It is in these relationships that conflict of interest manifests, and cor- ruption emerges. Regarding industry influence in medicine, the inability of medi- cine to act as a countervailing power to industry is seen to be a problem of institutional corruption, defined as manifest when an institution is rendered inca- pableofachieving,orisdivertedfromachievingitsinstitutionalpurposeasaresult of ethical, legal, systematic, and strategic influence. This research examines the inability of the medical profession to achieve its institutional purpose by applying the theory of institutional corruption, asking the question: how have industry-medicine relationships induced the institutional corruption of the medical profession? This book includes detailed introductory and theoretical chapters, where the subjectsofpharmaceuticalindustrycriminality,whitecollarandcorporatecrime,as wellasorganizationalcriminologyarediscussed,bothintermsoftheresearchthat has been conducted so far, but also where both research and theory should be furtherinvestigated.Advocatinganorganizationalandinstitutionalapproachtothe study of crime and corruption rather than an approach that would place the indi- vidual at the centre of its focus, the theory of institutional corruption is dissemi- nated,andIscrutinizehowitmightapplyto,andhelpunderstandtheorganizational forces at play in conflict of interest, unethical conduct and criminal behaviour. Subsequently, the analytical chapters present the findings of extensive empirical research conducted in Hungary and the Netherlands, where industry-medicine relationships are mapped out along the pharmaceutical product lifecycle. These chapters examine accounts of respondents from both the industry and healthcare sectors, who describe how these relationships form, what their dynamics are, as well as what this means for the goal attainment activities of both pharmaceutical x Preface companies and medical professionals. As such this book is intended for criminol- ogists,socialscientists,medicalsociologistsandscholarsoflawandethics,butalso for professionals in both the pharmaceutical and healthcare sectors, as well those who are active in compliance. This book is also intended for those who are gen- erally interested in the structure and process of medicines development and the complexitiesoftherelationshipswithin.Itisinourcommoninteresttoraisepublic awareness of such anomalies in a sector on which our lives may depend. With increased understanding, public participation and research, we can address these issues and better safeguard patient well-being. Amsterdam, The Netherlands Anna Laskai
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