Ghost-Managed Medicine: Big Pharma's Invisible Hands

Abstract

Hidden from the public view, the many invisible hands of the pharmaceutical industry and its agents channel streams of drug information and knowledge from contract research organizations to publication planners, key opinion leaders, patient advocacy organizations, and onward. The goal of this ‘assemblage marketing’ is to establish conditions that make specific diagnoses, prescriptions and purchases as obvious and frequent as possible. While staying in the shadows, companies create powerful markets in which increasing numbers of people become sick and the drugs largely sell themselves. Most agents for drug companies aim to tell the truth, but the truths they tell are drawn from streams of knowledge that have been fed, channeled and maintained by the companies at every possible opportunity. Especially because those companies have concentrated influence and narrow interests, consumers and others should be concerned about how epistemic power is distributed – or ‘political economies of knowledge’ – and not just about truth and falsity of medical knowledge. This work draws on presentations at industry conferences, especially ones where pharmaceutical companies interact with communication, marketing and other agencies. Participants at these interface conferences describe goals, practices and concerns; in the process, they reveal a lot about how the industry works. Some of the book’s other data is taken from publications that also serve as interfaces between the industry and adjacent actors, and from interviews with people engaged in pharmaceutical marketing.