Disciplinary Power: Big Pharma & The Consumer Market


By Silvi Goldstein

In the past sixty years, we have seen a shift in the visibility, usage and understanding of drugs in the western world. The role of the pharmaceutical companies plays a significant part in the shaping of our contemporary drug focused society. This paper will explore the transition from a drug-centered model of drug use to disease-centered model drug usage. Furthermore, it will use Michel Foucault as an interpretive lens to better understand the notion of power and truth and its establishment by the pharmaceutical companies with relationship to the government and the consumer market. In this paper I will argue how the pharmaceutical industry acts as a form of disciplinary power; this is achieved by gaining credibility through language, acquiring power through the government systems, and indirectly implementing power over the consumers.

FROM NEUROLEPTIC TO ANTIPSYCHOTIC

In the 1950’s and 1960’s, our understandings of drugs changed dramatically. The 1960’s brought the establishment of the notoriously popular idea that drugs could ‘cure’ mental illness (Moncrieff 1). This has largely influenced the way we understand drugs today and mainly began with neuroleptics, otherwise known as anti-psychotics (Moncrieff, 238). In 1952 chlorpromazine was introduced and became a psychopharmacological revolution (Moncrieff 65). In this year, French surgeon, Henri Laborit, used chlorpromazine to aid anesthesia in surgical operations (Moncrieff 65). His description of its effects led French psychiatrists Jean Delay and Pierre Deniker to prescribe it to patients at St Anne’s Psychiatric hospital in Paris (Moncrieff 66). It was then that these French doctors “who first used chlorpromazine called it a ‘neuroleptic’. The word comes from the Greek meaning to ‘take hold of the nervous system’. The term ‘tranquillizer’ was also frequently used to describe the effects of chlorpromazine and similar drugs…”(Moncrieff 66). It was originally concluded that chlorpromazine’s best effects were found in “excited, agitated, and confusional states rather than in people with chronic schizophrenia” (Moncrieff 66). These doctors stressed early on that they did not believe that chlorpromazine acted on schizophrenic symptoms, such that it did not act on the disease process nor did it have any specific effect on the psychotic symptoms (Moncrieff 67). In fact, this drug was primarily observed to produce symptoms of Parkinson’s disease, including “reduced movement and facial expression and increased muscle tension” (Moncrieff 67).

Neuroleptic drugs are thought to act on the dopamine system, thus bringing about a theory geared toward proving the efficacy of these drugs and the effectiveness of their use with schizophrenia and psychosis. It was thought that schizophrenia was product of an overactive dopamine system, thus if you reduce the function of dopamine by use of these drugs, perhaps it would help schizophrenic symptoms. But with this, a more consistent finding showed how blocking the action at the dopamine receptors is responsible for producing Parkinson’s disease-like symptoms, not necessarily actively reducing schizophrenic symptoms (Moncrieff 65). This idea that neuroleptics would change the overactive dopamine system enabled the dopamine theory of schizophrenia to come to life. This theory is one of the major ‘chemical imbalances’ theories that looked to justify the nature and causation of mental illness (Moncrieff 65).

This change from neuroleptic to anti-psychotic commenced the beginning of a drug-focused society. Joanna Moncrieff, author of the book The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment explains how “these beliefs about the effects of neuroleptic drugs quickly disappeared, however and the drugs rapidly metamorphosed into a ‘miracle cure’ for schizophrenia” (68). Around 1958, a British book explained tranquilizing drugs as a new form of treatment that could enable psychiatrists to “wipe out the ‘symptoms of psychotic patients just as internists can use insulin for the elimination of the symptoms of diabetes’ (Himmich 1958)” (Moncrieff 86). Within a decade they were presenting neuroleptics as ‘magic bullets’ that produced improvement through acting directly on the biological basis of psychiatric disease. This is when the term “anti-psychotic” replaced the term neuroleptic.

The transition of language marks the transformation from drug-centered model of drug action to a disease centered model of drug action. The drug-centered model argues how drugs exert therapeutic effects by producing an abnormal brain state that is beneficial to a particular individual, where as the disease-centered model argues that drugs exert therapeutic effects on the disease process and thus help correct an abnormal brain state (Moncrieff 5). More specifically, we see the evolution of the neuroleptic to the ‘anti-psychotic’, such that the name was changed to fit the categorized disorder that it attempted to ‘cure’, which is fitting with the disease-centered model of drug action. According to Moncrieff, the transformation from neuroleptic as a tranquilizer to an ‘anti-psychotic’ that could cure psychosis and schizophrenia did not occur because of the overwhelming weight of supportive evidence. In fact, it occurred because the desire for it to be true molded the representation and production of the data (Moncrieff 239). Moncrieff continues by explaining how “in this way a picture was painted in which the drugs became miracle cures responsible for emptying the asylums and transforming the outlook of psychiatric conditions” (Moncrieff 239). The cure had become a means of power distributed by Big Pharma to the consumer.

This is where we initially witness the pharmaceutical companies gaining power over societal values of health and wellness. With this transition from drug-centered drug action to disease-centered drug action, Big Pharma is now the producer of a truth because drugs are what will cure us of all and any aliments. Michel Foucault, author of the paper Psychiatric Power, provides helpful insight into a model of power. He distinguishes between sovereign and disciplinary power and explains how, “whereas sovereign power is expressed through the symbols of the dazzling force of the individual who holds it, disciplinary power is a discreet, distributed power; it is a power which functions through networks and the visibility of which is only found in the obedience and submission of these on whom it is silently exercised” (22). The power held by the pharmaceutical companies begins at the initial formation of language that acknowledges a drugs ability to cure a specific disease.

When a drug gives us a cure, the drug becomes the power holder over our will to life. When we use drugs as a means to find a cure, we imply that there is a ‘normal’ bodily state that drugs will help us return to. This truth, then, is defined and characterized by the companies that create and distribute the remedies for disorders. Foucault speaks to this idea and provides a framework for understanding truth. He argues that our conception of truth is dominated by a specific concept of knowledge. He explains how, “showing that scientific demonstration is basically only a ritual, that the supposedly universal subject of knowledge is really only an individual historically qualified according to certain modalities, and that the discovery of truth is really a certain modality of the production of truth…”(Foucault 238). By assuming a truth in the disease-centered model of drugs, we assume truth in the pharmaceutical companies. We buy into a façade of ‘cures’, which were once created by a large corporation with intention to advertise to a consumer in order to gain profit.

Around the 1980’s, the industry started to promote certain ‘diseases’ and diagnoses, thus allowing the drug market to advocate for particular conditions. Moncrieff describes how along side with depression, “drug companies have organized campaigns to promote a number of entities such as panic disorder, social anxiety disorder, premenstrual dysphoric disorder, compulsive buying disorder and intermittent explosive disorder” (59). This corporate industry advertising is what speaks to the consumers, educates the consumers, and affirms truth for the consumers. These disorders and diseases founded on a drug specific cure are what our society has turned to for medical truth, knowledge and assistance. Foucault explains how, “The crisis is the reality of the disease becoming truth, as it were. And it is precisely then that the doctor must intervene” (44). This is where we see disciplinary power emerges in the context of our lives: the drugs become a truth to our physical existence and will to live, the pharmaceutical companies provide the drugs, and doctors dish them out to us as means for a cure. Furthermore, Foucault continues to writes how, “on the pretext of curing him of the illness inflicted on him by the servant, one slips into this kind of opening a medication that is medication within the delirium, a medication that within the delirium will enable him to escape the illness caused by the servant, and which is a medication for the delirium since he is actually given medicine that, by claiming his humors, by calming his blood, by discharging all the congestions of his blood system, etcetera, ensures the cure” (19). The cure is thus a means of distributed power to the maker of the drugs, the pharmaceutical companies.

MANIPULATING THE GOVERNMENT

We continue to see the pharmaceuticals act as a form of disciplinary power, notoriously influencing health care in unimaginable ways. After establishing specific language that entails a form of truth, Big Pharma gains power through the government, which then later provides power in the consumer market. An example of how Big Pharma creates our known truth can be understood through the Medicare prescription act of 2003. According to a study by the Center for Public Integrity, “congressmen are outnumbered two to one lobbyist for an industry that spends roughly 100 million dollars a year on campaign contributions and lobbying expenses to protect its profits” (Under the Influence: How The Lobbies Rule America). The Medicare prescription bill, also known as the most expensive bill ever placed before the House of Representatives, was pushed through in the middle of the night after most of the country had gone to bed. The only witnesses to this bill were congressional staffers, hundreds of lobbyists, and the U.S. representatives. According to Congressman Walter Jones of North Carolina, “the pharmaceutical lobbyists wrote the bill. The bill was over a thousand pages and it got to the members of the house that morning and we voted for it at about three a.m. in the morning” (Under the Influence: How The Lobbies Rule America). It was voted this early in the morning because pharmaceutical lobbyists did not want this to be publicized during prime time television.

So, what was about this Medicare bill is so noteworthy? The bill’s legislation, prompted by the pharmaceutical lobby groups, prohibited Medicare and the federal government from using it’s vast purchasing powers to negotiate lower prices directly from the drug companies. Ron Pollack, executive director of Families U.S.A., a non-partisan health care watch dog group, explains how ““they key goal [in the legislation] was to make sure there would be no interference in the drug companies ability to charge high prices and continue to increase those prices” (Under the Influence: How The Lobbies Rule America). Moreover, pharmaceutical lobby groups were willing to go to extreme lengths to pass this bill. Voting machines, which are typically regulated to fifteen minutes, were open for three hours during the hearing. This is when lobbyist and representatives of the bill made rounds twisting politician’s arms to get the votes they wanted. Walter Jones explains how lobbyists and representatives threated Republican House of Representative Nick Smith that they would, “work against his son who wanted to run for his seat when he retired. I saw a woman, a member of the house, a lady crying when they came around her trying to get her to change her vote. It was ugly” (Under the Influence: How The Lobbies Rule America). The bill became notorious for the longest roll call in the history of the House of Representatives as it eventually passed late into dawn.

Beginning at language, drug companies gain power by furthering our disease-centered model of drugs and creating ‘cures’ for specific disease through the use of drugs. Then, in order to secure its power, drug companies spend millions of dollars lobbying for their cause in our U.S. government. Through manipulation and deceit, drug companies pass a bill that will influence all constituents in the U.S. The people of this society are then forming knowledge about health and wellness through the information and truth provided by the government that was manipulated by the powerful pharmaceutical companies. Foucault explains this concept of disciplinary power when he says how, “the core of this disciplinary system, does not himself appear…”(22). Formidable drug companies discretely hold power through the government, thus influencing the consumers’ conception of truth indirectly.

CONTROLLING THE CONSUMER

After Big Pharma has gained power through the truth-producing agents in our society, it gains the ability to use power over the consumer. Foucault talks about how power is never external. When people choose to medicate they think that they are in control of their lives by focusing on their health. A façade emerges, creating an image that the consumer is re-taking control, thus gaining a sense of individual power. However, this in turn is really just giving power back to Big Pharma. Drug companies work through direct-to-consumer drug advertising, which can be defined as “an effort (usually via popular media) made by a pharmaceutical company to promote its prescription products directly to patients” (Ventola “Pharmacy and Therapeutics”). The U.S. and New Zealand are the only countries that allow Direct to consumer pharmaceutical advertising (Ventola “Pharmacy and Therapeutics”).

With this ability to promote directly to consumers, the industry began advertising to an untouched market: children. It began funding campaigns to extend medicalization and drug treatment to childhood behavior problems by promoting the diagnosis of attention deficit hyperactivity disorder (A.D.H.D) (Moncrieff 59). A.D.H.D is now the second most frequent long-term diagnosis made in children, preceding asthma (Schwarz “The Selling of Attention Deficit Disorder”). According to Alan Schwarz, author of the New York Times article entitled “The Selling of Attention Deficit Disorder”, “the rise of A.D.H.D diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade long campaign by pharmaceutical companies to publicize the syndrome to promote the pills to doctors, educators, and parents” (Schwarz “The Selling of Attention Deficit Disorder”). This campaign by drug companies resulted in a 700% increase during the 1990s in the use of psychstimulants with the US consuming nearly 90% of the world’s supply of the drugs (Diaz, Lecture 7). Moreover, the production of Ritalin has increase more than sevenfold within an eight year period, 90% of it being consumed in the U.S. (Diaz, Lecture 7).

How is it that a syndrome of this sort could grow at such rapid rates in such a short period of time? Supporting this growth with wide arms, the drug companies marketing has stretched the image of classic A.D.H.D. to incorporate relatively normal behaviors like impatience and carelessness, while overstating the pills’ benefits (Schwarz “The Selling of Attention Deficit Disorder”). The primary A.D.H.D. patient advocacy group, Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) was founded in 1987 to offer support for the condition and its treatment with Ritalin. Schwarz explains how “a 1995 documentary on PBS detailed how CHADD did not disclose its relationship with drug companies to either the Drug Enforcement Administration, which it was then lobbying to ease government regulation of stimulants, or the Department of Education, with which it collaborated on an A.D.H.D. education video” (Schwarz “The Selling of Attention Deficit Disorder”). Shire, the drug company that originally made Adderall, paid the group a total of 3 million dollars from 2006 to 209 to fund CHADD’s bimonthly magazine that was distributed to doctors’ offices across the nation (Schwarz “The Selling of Attention Deficit Disorder”). Furthermore, after disclosing their records to the public, CHADD historically received about 1 million a year from pharmaceutical company grants and advertising. This was one-third of CHADD’s annual revenue (Schwarz “The Selling of Attention Deficit Disorder”).

The research used to formulate validity in drug companies sales of A.D.H.D were just as tainted as the advocacy group that was using this research to advertise. Big Pharma pays big bucks to get researchers on their side. Professor Jaime Diaz, professor in neurobiology and behavior in the psychology department at the University of Washington, speaks to this. Diaz explains how while completing his doctorate at the University of California, Los Angeles he was asked to work for a big time pharmaceutical company. The company promised him a large some of money totaled in research support and resources. He denied the offer knowing that his contract would admit the drug company to only publish the research they sought. This, Diaz says, is not ethical science. Moreover, Schwarz affirms this deceptive behavior specifically with A.D.H.D research. In 2008, a senate investigation revealed the lack of efficacy behind Dr. Joseph Biederman research, a well-known child psychiatrist at Harvard University. Schwarz explains how “Dr. Biederman’s research on many psychiatric conditions had been substantially financed by drug companies including Shire. Those companies also paid him 1.6 million in speaking and consulting fees. He has denied that the payments influence his research” (“The Selling of Attention Deficit Disorder”). This is tremendously concerning, for Dr. Biederman’s firm promotion of psycho-stimulants equipped drug companies with the published empirical research needed to create the most successful, powerful advertisements. He gave the mass advertisement of these drugs credibility. Furthermore, “The Food and Drug Administration has cited every major A.D.H.D drug — stimulants like Adderall, Concerta, Focalin and Vyvanse, and nonstimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times” and has also “repeatedly instructed drug companies to withdraw such ads for being false and misleading, or exaggerating the effects of the medication” (“The Selling of Attention Deficit Disorder”). But, this has not changed the soring profits for the A.D.H.D. drug industry. In 2012, sales of stimulant medication were close to 9 billion dollars, “more than five times the 1.7 billion a decade before, according to the data company IMS health” (“The Selling of Attention Deficit Disorder”).

When our medical knowledge is founded on a capitalistic ideal with the intention to make profit for large corporations, we are left with a corrupt conception of truth. Drug companies catering to the average consumer presents a disguise of control. Bob Goodman, MD Columbia University Medical Center says, “Big Pharma normalizes even the most obscure health disorders and presents them as common” and “in order to make a profit you are disease mongering, in other words making population medicalizing something that is just really part of everyday life” (Big Bucks, Big Pharma). Big Pharma advertises using commercials with people who are worried, insecure, afraid, and troubled to promote drugs that will bring this person back to ‘normal.’ It extends an illusion to the consumer that the decision to be ‘normal’ is only a pill away. The consumer then wants to correct oneself in order to return to a state of normalcy, because this is what drug companies have told us is the suitable thing to do. The pill becomes a delusion of control for the average consumer. The disease-centered model of drug use is able to exist because drug companies face little competition, “The nature of reality can be more or less accurately represented, and sometimes it is misrepresented because it does not fulfill the requirements of the parties that produce official ‘knowledge’. If these parties are powerful and there are no equally powerful groups to challenge them, then the false knowledge becomes established as real knowledge” (Moncrieff 238). The way we are taught to conceive of ‘normalcy’ and understand diagnoses is a product of the pharmaceutical powerhouse. When there are few other ‘normal’ philosophies to compete with the drug-centered theory, we have limited ways to combat this off-putting, deceptive truth provided by drug companies. Foucault follows up with this idea when explaining how, “This inaccessible authority without symmetry or reciprocity, which thus functions as the source of power, as the factor of the order’s essential dissymmetry, and which determines that this order always derives from a non reciprocal relationship of power…(3). This dissymmetry in power leads the consumer to be a vessel for spreading the knowledge provided by drug companies around to other consumers. Without another equally powerful group to challenge the pharmaceutical companies, constituents are stuck with assuming the knowledge provided by these corporations is a legitimate form of truth.

Moncrieff explains how, “the way that vested interest have embedded themselves into the fabric of our knowledge about psychiatric drugs demonstrates the symbiosis between power and knowledge” (237). When we follow this idea that drugs will ‘cure’ us, we end up taking prescription medication that often has many unwanted effects. In order to alleviate the symptoms of one medication, we often times add on more drugs. Patients have to be prescribed drugs to reduce the physical and psychological consequences of their psychiatric medication. Many people on neuroleptics are also taking “statins, antidiabetic medication and anti-obesity drugs to alleviate the metabolic disturbance cause by some of the newer neuroleptics” (Moncrieff 242). So we live in a symbiotic relationship with the powerhouse that tells us to ‘cure’ ourselves with medication, and end up relying on other medication to alleviate symptoms of the original drug one started on. This develops a parasitic relationship between the user and the drug companies.

POWER, KNOWLEDGE, & TRUTH

The principle form of mental health treatment transformed our views of drugs from “chemical restraints to chemical cures” (Moncrieff 238). We have reduced individuals that exist with unique life forms and special life stories to biochemical items, invalidating personal narrative and experience when it comes to suffering and health issues. The individual experience is denied when we reduce life experiences to chemical cures. Moncrieff explains the drug companies to “presents itself as an objective, impartial body of knowledge determined only by the facts of the world, whereas it actually conveys a partial view of human experience and activities that are motivated by particular interests” (237). When we preach medicalization as a form of normative truth, we suffer the consequences of succumbing to a myth that tells us our bodies are unable to help themselves on their own. Saying that drugs can ‘fix’ our bodies and that we need drugs to combat the chemical imbalances of our brains is absurd in its own meaning, such that by placing foreign chemicals into our body we are causing the true ‘chemical imbalance’.

“The institution of psychiatry, aided and abetted by the pharmaceutical industry and ultimately backed by the state, has constructed a system of false knowledge about the nature of psychiatric drugs. This ideology acts to obscure the actual effects these drugs produce” (Moncrieff 237). The rampant use of drugs in our society, and the lengths the pharmaceutical companies have gone to establish drugs as a chemical cure, is what Foucault categorizes as a form of disciplinary power. We must limit the role, influence, and power of the drug industry in health care; however there is a space for a balanced market for drug use in westernized health and wellness. This balanced space will be further explored in future writing on the subject matter. Where drugs do fit into physical and mental health is a significant question that should be addressed and given more thought in future writings. Meanwhile, it is vital to acknowledge the rampant power the industry holds and the accepted truth through knowledge it projects to our society. The pharmaceutical companies have indirectly applied an immense amount of power over our western health care. This has proved to be a form of disciplinary power because drug companies have worked through the government and then to the consumer to act as a discrete, pervasive form influence over our medical system. As Foucault would say, disciplinary power is an optimum state that “consequently, will have become habit” (25). We rarely question the use of drugs in our society, and consequently they have become a habitual part of most of the westernized world.

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Cited

 

Big Bucks, Big Pharma: Marketing Disease and Pushing Drugs. Prod. Ronit Ridberg. By Ronit Ridberg, Loretta Alper, Jeremy Earp, and Sut Jhally. 2006. Media Education Foundation. Web. 8 June 2014. <http://www.mediaed.org/cgi-bin/commerce.cgi?preadd=action&key=224#filmmaker-about>.

Diaz, Jaime. “Lecture Slides and Materials for Week 7.” Canvas. N.p., 14 Feb. 2014. Web. 8 June 2014. <https://canvas.uw.edu/courses/884672/discussion_topics/1902652>.

Foucault, Michel. Psychiatric power: Lectures at the college de france, 1973–1974. Vol. 1. Macmillan, 2008.

Moncrieff, Joanna. The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. Basingstoke: Palgrave Macmillan, 2008. Print.

Schwarz, Alan. “The Selling of Attention Deficit Disorder.” The York Times. N.p., 14 Dec. 2013. Web. 9 June 2014. <http://www.nytimes.com/2013/12/15/health/the-selling-of-attention-deficit-disorder.html>.

Under the Influence: How The Lobbies Rule America. Perf. Steve Kroft. 60 Minutes, 2007.

Ventola, C. Lee. “Direct-to-consumer pharmaceutical advertising: therapeutic or toxic?.” Pharmacy and Therapeutics 36.10 (2011): 669.

 

 

 

 

 

 

 

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