Abstract
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 delivery structure, but these companies are as insidious as they are indispensable. The pharmaceutical industry possesses monopoly over a product of immense value – medication. Being
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small in size and big in demand make pharmaceuticals, and thus the pharmaceutical sector, ripe for deviance to emerge, and ‘Big Pharma’ as a criminogenic enterprise has become less conspiracy and more axiom. Much attention has been paid to crimes of pharmaceutical companies, but some authors claim that were it not for the contribution of doctors, these crimes could not be committed. Being the gatekeepers of human health, the profession of medicine is mandated by social contract, specialized knowledge, authority, and autonomy to promote patient interests in the face of industry financial gain, thereby acting as a countervailing 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 – singling out a Dr Jekyll and proposing that he is converted to Mr Hyde. This thesis examines the proposition of physician culpability in industry criminality, but will challenge individual proclivities as the source of digression from the medical mandate, asking not only why or how doctors contribute to, but why the profession cannot curb industry malfeasance. By following the lifecycle of a pharmaceutical product and the process of delivery from laboratory to prescription, the relationships between industry and medicine are identified within the system of knowledge development of a pharmaceutical product: knowledge production (medical research and development), knowledge interpretation (evidence-based medicine), and knowledge application (informed clinical practice). It is in this system that industry-medicine relationships are formed, but also within which the interests of industry and medicine conflict. It will be argued that industry influence, and the inability of the medical profession to rein-in the interests of pharmaceutical companies, diverts and renders doctors incapable of achieving the institutional purpose of medicine. Employing qualitative research methodology, 83 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, and illustrate the phenomena relayed by respondents. Favouring the view of embeddedness as an explanation of behaviour, this thesis presents a relational approach to the examination of undue industry influence and the institutional corruption of the medical profession.
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