In Corporate Science and the Husbandry of Scientific and Medical Knowledge by the Pharmaceutical Industry, Alastair Matheson expresses an interest into the process by which scientific and medical knowledge becomes constructed, and how this supposedly truth oriented knowledge might be unduly influenced by the commercial interests of the pharmaceutical industry. Matheson considers the possibility of scientific knowledge being generated according to a commercial function via marketing. Since medical knowledge is the means by which medical patients are determinately treated, it is no wonder that it becomes the interest of the pharmaceutical company to manage and control the scientific discourse by which that medical knowledge is constructed.
The introduction of a new drug into the market is accompanied by a ‘product canon’ by which a set of propositions are utilized to establish the nature of the drug, the biology of the drug, and the areas of medicine in which it is used. This product canon emerges from clinical trials, and cannot at any point be separated from the marketing goals of the pharmaceutical company. The company constructs a narrative in which a medical ‘puzzle’ is identified and then associated with the emergent drug. The latter is described as a solution for that puzzle. These interests and discourses, initially operating within the pharmaceutical company, inevitably extend themselves into the public discourses of academic science and clinical medicine. By therein influencing the construction of medical knowledge according to the normative commercial aims of the pharmaceutical company, the latter is more easily able to implicitly penetrate into the domain of drug regulators, purchasers, and prescribers.
A central way by which the pharmaceutical industry expresses an influence upon the construction of medical knowledge is through publication planning. Initially, the understanding of a disease is reformulated, or the pathology is identified in what had hitherto been understood as the realm of normalcy. The drug narrative is constructed logically, and with a good story that is to be substantiated by clinical trials and published data. It is the job of a publication planner to oversee the evolution of medical discourse from this first stage of narrative construction, through to the design and execution of clinical trials, and all the way to the publication of data. The publication planner supervises the communication of knowledge from one stage to the other insofar as it can be managed and made consistent with the normative commercial interests of the pharmaceutical industry.
Matheson uses the term ‘meta-science’ to describe how the operation of science can be understood to an external end. Since KOL’s are often advised what to study, where to go, with whom to interact, and what to say, and medical societies and journals are often considerably dependent upon funding from the pharmaceutical industry, it becomes more clear precisely how that industry might influence the construction of medical knowledge according to commercial interests. Contributions to discourse from the pharmaceutical industry might nurture ‘soft’ knowledge and opinion by focusing scientific attention upon self-supporting investigations intended to confirm the initially generated narrative rather than conduct genuinely concerned science.
Matheson hopes to remind the reader about the complex status of scientific norms, and hopes therefore to reevaluate the degree to which the maxim of scientific truthfulness might become compromised by the cultural differences between academic and pharmaceutical values by which knowledge is constructed. By apparently internalizing and committing to commercially driven narratives, these compromising calculations on behalf of the pharmaceutical industry become implicit to many of the people to whom scientific discourse becomes extended and engaged with, and Matheson imagines this to therefore create a kind of double-think on the subject. Consequently, the pharmaceutical industry conducts clinical research according to generated commercial narratives with the potential to compromise the objectivity of science and medical knowledge.
In Ghosts in the Machine: Publication Planning in the Medical Sciences, Sergio Sismondo investigates more thoroughly into the process of publication planning. By treating research as a resource by which researchers and practitioners can have their opinions influenced, pharmaceutical companies have, according to Sismondo, apparently propelled clinical research into the ‘marketing era.’ This change was especially affected by the emergence of ‘content research organizations’ (CRO’s) that produce data to be made available for analysis by the companies in whose name the data was produced. Publication planners supervise the design of clinical research to be conducted by these organizations, the analysis of this data by pharmaceutical company physicians, the papers written by medical writers, as well as the final publication of those papers. For this reason, Sismondo suggests that publication planning might be considered to be the ‘ghost management’ of medical research and publication.
There is an emphasis on research design on behalf of publication planners insofar as there is a need to market or create an understanding of an unmet need, otherwise referred to as disease-mongering or selling sickness. The main goal of publication planners is therefore to integrate research with marketing strategies, managing the communication between different parties involved in order to control knowledge flow in the interests of pharmaceutical companies. Planning must, after all, generate revenue through the publication of information that is able to increase sales. Scientific standards are not, however, by any means disregarded, for they nevertheless maintain what is counted as ethical as well as ensure the successful publication of information by medical journals. Where exactly do medical journals stand with respect to industry sponsored papers?
From the perspective of medical journals, industry sponsored papers remain to be considered as a well-funded and well-constructed report of clinical trials that incidentally happen to provide a valuable source of revenue for the journals themselves. It appears to Sismondo that there herein exists an accepted conflict of interest. There is an emphasis here by medical journals upon the ‘rules’ of science and publication that, insofar as they are followed, allow for the scientific knowledge to be legitimized. There apparently exist a set of rules describing how conduct and reporting ought to safeguard scientific and authorial legitimacy. These rules are increasingly treated as formulaic. Planners often designate very specific responsibilities to the authors, and pressure them with quickly impending deadlines, so that a non-contribution is inevitably what acts as the authorial endorsement of a manuscript. The entire process from creating to establishing discourse is divided amongst many different departments, each of which are assigned increasingly mechanical work so as to reduce the degree of analysis done by each respective group. This does not however mean that the whole process is independent of normative decision-making, which is probably introduced by the pharmaceutical industry and overseen by the publication planners.
According to Sismondo, the adventures of the pharmaceutical industry into medical research represent the most prominent and largest connections between industry and academy wherein corporate science arises. Furthermore, Sismondo doubts the extent to which formal rules are able to address conflicts of interest and enforce standards of science, for it appears as though the rules instead act as a means of deferring responsibility from the individual parties participating in the process. How can each particular group be held ethically responsible if all the right rules were followed? Lastly, the way by which these rules can be interpreted is considerably flexible, and the knowledge produced along the way can therefore nevertheless be shaped and influenced by the conflicting interests of those engaged with those aforementioned rules.
In How Pharmaceutical Industry Funding Affects Trial Outcomes: Causal Structures and Responses, Sismondo emphasizes many of the issues discussed in the article mentioned above. Pharmaceutical funding of clinical trials appears to be correlated with positive results in publications aligned with the interests of those companies. Since controlled clinical trials are the most reliable source of medical information, it is no wonder that pharmaceutical companies have begun to produce such results in quantity. The pharmaceutical influence in the process of knowledge construction and discourse, from clinical trials to publication, is relatively unseen. The emergence of CRO’s facilitated the opportunity for ghost management on behalf of public planners who influence and engage with KOL’s on a regular basis.
Sismondo suggests that sponsorship is able to cause researchers to see the pharmaceutical companies with which they interact in a more favorable light, and to therefore often feel unrecognized obligations. Furthermore, there are a considerable amount of trials performed after a drug is already on the market, and are therefore intended to simply familiarize the public with the product. Scientific articles that result are written for particular audiences and with particular purposes. Sismondo suggests the pharmaceutical industry becomes isolated from research, since the major problems arise from a too close relation between the two. Unfortunately, the professor finds if difficult to imagine clinical research as being removed from pharmaceutical interests while remaining that which it is today.