Conceptual Tools for the Analysis of Bioeconomic Fairness and Efficiency

This paper discusses three concepts from medical sociology - pharmaceuticalisation, corporate bias and the permissive principle – showing how these conceptual tools can be used to analyse bioeconomic fairness and efficiency in relation to the development, regulation and consumption of pharmaceuticals. The three concepts reveal the problematic impacts of the influence and interests of the pharmaceutical industry at various levels of the development, regulation and subsequent use of pharmaceuticals – and, as such, various possible examples of bioeconomic inefficiency and unfairness. First, the paper discusses the concept of pharmaceuticalisation which enables analysis of the social forces that can shape the new or widening usages of pharmaceuticals. It suggests that if social forces, such as medicalisation, consumerism or deregulatory ideology are driving widening or new use of pharmaceuticals then pharmaceuticals in specific contexts might be said to be inefficient solutions. Next, the paper shows how the concept of corporate bias enables analysts to engage with the question of the interests served in pharmaceutical development and regulation. The paper highlights how, due to corporate bias, regulation can work unfairly in the interests primarily of the pharmaceutical industry and to the detriment of patient and public health. Finally, the paper discusses the permissive principle, where benefits are assumed to outweigh risks in pharmaceutical regulation. The presence of permissiveness means that pharmaceutical products that lack benefit or are unsafe may nevertheless achieve regulatory approval – potentially meaning inefficient spending or use of healthcare resources, as well as unfairly serving commercial interests over patient and public health interests.