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Drugs and the birth of scientific marketing - 4-5 juin 2012

Final conference of the Gephama research project, Berlin

Drugs are granted particular meanings within the vast constellations of industrial products whose coming into being and use rest upon complex arrangements of academic and private research, professional expertise, mass production and global commercialization. Drug companies are perceived as typical examples of modern industrialization, which are at the very forefront of capitalism. They are highly valued on stock exchanges as they promise high profits. This situation has emerged since the late 19th century, when the pharmacists increasingly lost their function to buy and sell drugs and to produce medicaments on the prescription and under the control of doctors. Parallel the products changed their image as to come into life by the research activities of pharmaceutical firms, which require high investments in research, in systematic screening and large scale clinical trials. These risky investments were and still are justified by the expectation of repayment through sales and protected by intellectual property rights and market regulation. Especially during the second half of the 20th century, the cost of research and development grew. So did competition, while the number of entirely new molecules and substances put on the market rapidly declined after the golden 1950s-1960s.

As a consequence of these constraints, marketing has evolved as a technique to identify and develop new medical markets, to secure the research investments and to increase the return on investment. The industrial transformation of drugs in the 20th century is therefore not only based on the changing scale and nature of their mode of production, but also on the fact that they have become normal goods, targets of intellectual property rights and market construction. While pharmacy, therapeutic practices and medical markets changed decisively marketing has become a central and publicly criticized practice. Much of this critique goes back to the traits that are seen to distinguish pharmaceutical from other technoscientific products. First of all, market construction and public health have often been at odd, drug safety, efficacy and access have been and still are the topic of public controversies. Secondly, the market for drugs is different in so far as third parties like the prescribing physicians, health insurances and public health institutions act as gate keepers. Thirdly : Pharmaceutical markets are strongly regulated. Had the regulation of the manufacture, sale and consumption of pharmaceuticals initially favoured professional regulatory bodies, later complex administrative agencies in charge of pre-marketing, evaluation and of the surveillance of routine uses in order to detect and limit adverse events evolved. From this perspective, the industrialization of pharmaceuticals has been a matter of changing power balance between the different actors making drugs.

The aim of this conference will therefore be to make accessible original investigations of pharmaceutical promotion as a series of local – industry-based - practices linking research, market and medicine and to discuss the transformation of drug markets and their construction during the last century. The socio-historical scenario grounding this call originates in the original research hypothesis of the ANR-DFG research project GEPHAMA, which distinguishes two regimes of promotion.

The first regime may be called that of advertisement or propaganda. It was barely specific to the drug sector and rested on the massive practice of announcements in popular as well as scientific journals hardly distinguishing physicians and patients and focusing on drugs originating in various combinations of substances included in the pharmacopoeia, usually sold without prescription. The second model is that of scientific marketing. It is based on a vast palette of promotional techniques targeting physicians rather than patients and focusing on the 'scientifically' proven properties of new proprietary substances. Given the new – industrial – mode of drug invention and production, the success (or failure) of a given pharmaceutical enterprise was largely dependent on physicians knowing about the drug in question and being prepared to prescribe it. As an effect of this transformation, firms started to develop new advertising practices. If in the past, advertising was mostly targeting the layman the new techniques of scientific marketing addressed the physician as public expert and gatekeeper of medical applications. Firms started to mobilize forms of information emphasizing the scientific dimension of their activities and products, for instance expanding the system of drug representation. However, it was only after 1945 that marketing in the narrower sense of the word (with its instruments for systematic 'research', market observation and customer surveys) was professionalized and firmly established in the pharmaceutical sector.

The new model of scientific marketing is certainly not just the product of this internal dynamics of promotional activities. It has also roots in the increasing emphasis drug regulation placed on clinical research. The consequence was a considerable blending of marketing activities and clinical investigations. At the same time, drug advertising was re-regulated with legal sanctions introduced in most European countries. During the post-war period the changing nature of therapeutic agents as well as an escalating consumption resulted in highly visible drug scandals (the Contergan scandal, the DES affair and many more), which served to open up a wide public debate about the role of marketing, during which new activist groups and alternative networks of practitioners claimed to be public health defenders. As reaction, scientific marketing started to entail channels of patient information and education advocating patients' ability to medicate him- or herself, his or her responsibility for his or her therapeutic regime, as perfectly illustrated with the trajectories of diabetics' associations or the promotion of 'life-style' drugs like the pill.

Beyond the documentation and critical evaluation of this socio-historical scenario, the aim of the conference will be to approach the issue of drug consumption through the lens of science-based market construction. Social studies of consumption often sees the practices of buying, use, and disposal of goods in the context of discourses, emotions, and rituals, and socialization. This cultural approach however tends to forget uneven powers, hierarchies and their decisive influence on the making of knowledge, expertise and medical practice.

The conference will be organized in three thematic session respectively dealing with : 1) Professionalization, media and forms of marketing ; 2) Regulation, consumption and the construction of markets ; 3) Marketing, drug uses and the redefinition of diseases. Papers may address any one of these issues through studies of firms, products or specific tools. Given the emphasis the Gephama project placed on the historical trajectory of pain killers, psychotropic drugs, hormones and anti-diabetics, priority will be given to papers investigating these drug classes.