International audienceFor several decades now, the problematic influence of economic interests on... more International audienceFor several decades now, the problematic influence of economic interests on public health practices and regulation has gained growing attention. Several conceptualizations of these processes have been put forward, including conflict of interest (COI), capture, production of ignorance, and hegemony. Drawing on an analytical review of the literature and a comparison of the notions, this chapter reflects on these different conceptualizations, the historical conditions of their development, their analytical and political implications, and their benefits and drawbacks for the social sciences. We suggest that a comprehensive analysis of influence requires an articulation of COI, ignorance, and hegemony: COI both as a reflection of the multiple channels of influence the industry has developed and as a powerful means of making visible the double-bind of scientists, experts, and regulators; ignorance as a way of exploring the asymmetries and power gradients at stake in the production and non-production of knowledge; and hegemony as a reminder of the key role processes of market construction and diverse political economies play in the logic of influence
En s’appuyant sur la notion d’interpretation, ce texte analyse la place du corps dans l’experienc... more En s’appuyant sur la notion d’interpretation, ce texte analyse la place du corps dans l’experience feminine du vieillissement. Les donnees quantitatives et qualitatives mobilisees sont issues d’un focus group virtuel reunissant, pendant deux semaines, plus de 200 femmes âgees de 20 a 70 ans. L’article souligne que le corps se manifeste avant tout comme une sentinelle : objet d’inquietude, il est a l’origine de ces « coups de vieux » aussi inattendus que douloureux. Il affirme cependant que cette experience est replacee par les participantes dans un vecu plus large et plus positif du vieillissement. Etudier ce travail d’interpretation conduit a souligner la necessite de laisser exister et de faire connaitre differentes cultures du vieillissement.
Cet article a pour ambition d’analyser la trajectoire des medicaments anti-Alzheimer (AA) a l’aun... more Cet article a pour ambition d’analyser la trajectoire des medicaments anti-Alzheimer (AA) a l’aune de la question des conflits d’interets. Il met d’abord en lumiere la constitution d’une economie politique de la promesse des medicaments AA, au sein de laquelle les strategies des laboratoires ont eu un role structurant. Il montre surtout comment l’affirmation de la problematique du conflit d’interets au cours des annees 2000 a pu remettre en cause cette promesse, ses effets sur la credibilite des savoirs, sur les hierarchies medicales, et finalement sa capacite a etre mobilisee comme un repertoire efficace d’action. Cette recherche s’appuie sur un travail documentaire et des entretiens avec des acteurs francais cles de cette histoire.
L'evidence-based medicine (EBM) est definie comme "l'utilisation consciencieuse, exp... more L'evidence-based medicine (EBM) est definie comme "l'utilisation consciencieuse, explicite et judicieuse des meilleurs preuves [evidence] pour prendre des decisions pour la prise en charge des patients". Elle est generalement presentee comme un paradigme fondant le caractere scientifique et objectif de la medecine, en rupture avec l'idiosyncrasie et la casuistique propres a l'art medical. Tant ses plus fervents defenseurs que ses plus virulents detracteurs la reduisent souvent a des dimensions techniques et (pretendument) rationnelles. Pourtant, l'EBM, qu'il s'agisse de son projet ou de sa mise en oeuvre, comporte d'irreductibles dimensions politiques. De plus, elle deplace l'incertitude, plutot qu'elle ne la reduit [premier paragraphe]
"The attribution of marketing authorizations (MAs) is the principal measure though which pub... more "The attribution of marketing authorizations (MAs) is the principal measure though which public authorities try to ensure the safety and effectiveness of drugs. Between the mid-1960s and the establishment of the European Medicines Agency in 1995, the conditions in which this public control was exercised changed radically. Whereas the evaluation of medicines used to take place at a national level, today it is primarily carried out on a European scale. This paper demonstrates that to fully understand this evolution it is necessary to consider three closely related phenomena: the growing interdependency between national entities; the emergence of a field of scientific expertise specifically related to the assessment of drugs and the transformation of its relationship to national representation; and finally the increasing autonomy of MAs and the incorporation of the decision-making process into scientific evaluation. "
Medicines regulators have generally adopted a scientistic view of medicines evaluation, which the... more Medicines regulators have generally adopted a scientistic view of medicines evaluation, which they present as an exercise that should-and indeed can-be purely ''objective,'' based only on knowledge produced through validated research protocols. The growing body of social science literature analyzing the regulation of medicines has questioned this pretense of objectivity and underlined the socio-political construction of evidence on the risks and benefits of medicines. But while the European Medicines Agency has become the dominant regulatory body in Europe and a key player at world level, very few studies have investigated its actual practices. Based on interviews with European regulators, but also on direct observations of several meetings of the European Medicines Agency's main expert committee, this article aims to analyze how regulatory knowledge is defined and then transformed into regulatory decisions. First, it describes the main characteristics of European medicines regulation and the historical definition of what can count as ''objective'' evidence on the safety and efficacy of medicines. Second, it demonstrates that experts use many different types of knowledge in building their opinions: the results of studies, but also knowledge about firms' past and present strategies, about patients' needs and future behavior, about the state of research and clinical practices, and about legal and policy-making issues. Third, it explains why, in spite of the various forms of knowledge involved, experts manage to produce consensual opinions on medicines and why these opinions are considered genuine decisions in the sector.
La délivrance des autorisations de mise sur le marché (AMM), qui repose sur l'évaluation... more La délivrance des autorisations de mise sur le marché (AMM), qui repose sur l'évaluation par les pouvoirs publics des résultats des tests et des essais menés par les laboratoires pharmaceutiques lors du développement de leur produit, est un outil central du contrôle ...
Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine
For more than a decade, the sociology of hope and expectations has gained growing influence in th... more For more than a decade, the sociology of hope and expectations has gained growing influence in the social studies of health, medicine, and healthcare. This literature has stressed the role of representations of the future—through images, metaphors, theories, or visions—in the medical sector and analyzed the translation of these discursive contents into social practices and organizations. This article builds on these results and intends to explore a dimension that has received less attention: the incarnation of medical promises. Looking at the evolving case of a particular molecule, dehydroepiandrosterone (DHEA)—which has been promoted from the mid-1990s onwards as a “fountain of youth” pill—, we emphasize that testimonies by and portrayals of those who are undergoing a treatment with uncertain risks and benefits, and representations of their bodies in the media, can play a key role in the performativity of a medical promise. We analyze this incarnation as a specific “form of veridic...
RésuméLa délivrance d’une autorisation de mise sur le marché (AMM) est le dispositif central par ... more RésuméLa délivrance d’une autorisation de mise sur le marché (AMM) est le dispositif central par lequel les autorités publiques contrôlent la sécurité et l’efficacité des médicaments. Or, du milieu des années 1960 à la création en 1995 d’une Agence européenne des médicaments, les conditions d’exercice de ce contrôle public ont radicalement changé. Alors que l’évaluation des médicaments était conduite au niveau national, elle est aujourd’hui largement européenne. Cet article montre que rendre compte de cette évolution nécessite d’analyser trois phénomènes étroitement liés : l’accroissement de l’interdépendance des entités nationales ; l’émergence d’une expertise scientifique propre à l’évaluation des médicaments et la transformation de son articulation avec la représentation nationale ; l’autonomisation de l’AMM et l’absorption de la décision par l’évaluation scientifique.
International audienceFor several decades now, the problematic influence of economic interests on... more International audienceFor several decades now, the problematic influence of economic interests on public health practices and regulation has gained growing attention. Several conceptualizations of these processes have been put forward, including conflict of interest (COI), capture, production of ignorance, and hegemony. Drawing on an analytical review of the literature and a comparison of the notions, this chapter reflects on these different conceptualizations, the historical conditions of their development, their analytical and political implications, and their benefits and drawbacks for the social sciences. We suggest that a comprehensive analysis of influence requires an articulation of COI, ignorance, and hegemony: COI both as a reflection of the multiple channels of influence the industry has developed and as a powerful means of making visible the double-bind of scientists, experts, and regulators; ignorance as a way of exploring the asymmetries and power gradients at stake in the production and non-production of knowledge; and hegemony as a reminder of the key role processes of market construction and diverse political economies play in the logic of influence
En s’appuyant sur la notion d’interpretation, ce texte analyse la place du corps dans l’experienc... more En s’appuyant sur la notion d’interpretation, ce texte analyse la place du corps dans l’experience feminine du vieillissement. Les donnees quantitatives et qualitatives mobilisees sont issues d’un focus group virtuel reunissant, pendant deux semaines, plus de 200 femmes âgees de 20 a 70 ans. L’article souligne que le corps se manifeste avant tout comme une sentinelle : objet d’inquietude, il est a l’origine de ces « coups de vieux » aussi inattendus que douloureux. Il affirme cependant que cette experience est replacee par les participantes dans un vecu plus large et plus positif du vieillissement. Etudier ce travail d’interpretation conduit a souligner la necessite de laisser exister et de faire connaitre differentes cultures du vieillissement.
Cet article a pour ambition d’analyser la trajectoire des medicaments anti-Alzheimer (AA) a l’aun... more Cet article a pour ambition d’analyser la trajectoire des medicaments anti-Alzheimer (AA) a l’aune de la question des conflits d’interets. Il met d’abord en lumiere la constitution d’une economie politique de la promesse des medicaments AA, au sein de laquelle les strategies des laboratoires ont eu un role structurant. Il montre surtout comment l’affirmation de la problematique du conflit d’interets au cours des annees 2000 a pu remettre en cause cette promesse, ses effets sur la credibilite des savoirs, sur les hierarchies medicales, et finalement sa capacite a etre mobilisee comme un repertoire efficace d’action. Cette recherche s’appuie sur un travail documentaire et des entretiens avec des acteurs francais cles de cette histoire.
L'evidence-based medicine (EBM) est definie comme "l'utilisation consciencieuse, exp... more L'evidence-based medicine (EBM) est definie comme "l'utilisation consciencieuse, explicite et judicieuse des meilleurs preuves [evidence] pour prendre des decisions pour la prise en charge des patients". Elle est generalement presentee comme un paradigme fondant le caractere scientifique et objectif de la medecine, en rupture avec l'idiosyncrasie et la casuistique propres a l'art medical. Tant ses plus fervents defenseurs que ses plus virulents detracteurs la reduisent souvent a des dimensions techniques et (pretendument) rationnelles. Pourtant, l'EBM, qu'il s'agisse de son projet ou de sa mise en oeuvre, comporte d'irreductibles dimensions politiques. De plus, elle deplace l'incertitude, plutot qu'elle ne la reduit [premier paragraphe]
"The attribution of marketing authorizations (MAs) is the principal measure though which pub... more "The attribution of marketing authorizations (MAs) is the principal measure though which public authorities try to ensure the safety and effectiveness of drugs. Between the mid-1960s and the establishment of the European Medicines Agency in 1995, the conditions in which this public control was exercised changed radically. Whereas the evaluation of medicines used to take place at a national level, today it is primarily carried out on a European scale. This paper demonstrates that to fully understand this evolution it is necessary to consider three closely related phenomena: the growing interdependency between national entities; the emergence of a field of scientific expertise specifically related to the assessment of drugs and the transformation of its relationship to national representation; and finally the increasing autonomy of MAs and the incorporation of the decision-making process into scientific evaluation. "
Medicines regulators have generally adopted a scientistic view of medicines evaluation, which the... more Medicines regulators have generally adopted a scientistic view of medicines evaluation, which they present as an exercise that should-and indeed can-be purely ''objective,'' based only on knowledge produced through validated research protocols. The growing body of social science literature analyzing the regulation of medicines has questioned this pretense of objectivity and underlined the socio-political construction of evidence on the risks and benefits of medicines. But while the European Medicines Agency has become the dominant regulatory body in Europe and a key player at world level, very few studies have investigated its actual practices. Based on interviews with European regulators, but also on direct observations of several meetings of the European Medicines Agency's main expert committee, this article aims to analyze how regulatory knowledge is defined and then transformed into regulatory decisions. First, it describes the main characteristics of European medicines regulation and the historical definition of what can count as ''objective'' evidence on the safety and efficacy of medicines. Second, it demonstrates that experts use many different types of knowledge in building their opinions: the results of studies, but also knowledge about firms' past and present strategies, about patients' needs and future behavior, about the state of research and clinical practices, and about legal and policy-making issues. Third, it explains why, in spite of the various forms of knowledge involved, experts manage to produce consensual opinions on medicines and why these opinions are considered genuine decisions in the sector.
La délivrance des autorisations de mise sur le marché (AMM), qui repose sur l'évaluation... more La délivrance des autorisations de mise sur le marché (AMM), qui repose sur l'évaluation par les pouvoirs publics des résultats des tests et des essais menés par les laboratoires pharmaceutiques lors du développement de leur produit, est un outil central du contrôle ...
Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine
For more than a decade, the sociology of hope and expectations has gained growing influence in th... more For more than a decade, the sociology of hope and expectations has gained growing influence in the social studies of health, medicine, and healthcare. This literature has stressed the role of representations of the future—through images, metaphors, theories, or visions—in the medical sector and analyzed the translation of these discursive contents into social practices and organizations. This article builds on these results and intends to explore a dimension that has received less attention: the incarnation of medical promises. Looking at the evolving case of a particular molecule, dehydroepiandrosterone (DHEA)—which has been promoted from the mid-1990s onwards as a “fountain of youth” pill—, we emphasize that testimonies by and portrayals of those who are undergoing a treatment with uncertain risks and benefits, and representations of their bodies in the media, can play a key role in the performativity of a medical promise. We analyze this incarnation as a specific “form of veridic...
RésuméLa délivrance d’une autorisation de mise sur le marché (AMM) est le dispositif central par ... more RésuméLa délivrance d’une autorisation de mise sur le marché (AMM) est le dispositif central par lequel les autorités publiques contrôlent la sécurité et l’efficacité des médicaments. Or, du milieu des années 1960 à la création en 1995 d’une Agence européenne des médicaments, les conditions d’exercice de ce contrôle public ont radicalement changé. Alors que l’évaluation des médicaments était conduite au niveau national, elle est aujourd’hui largement européenne. Cet article montre que rendre compte de cette évolution nécessite d’analyser trois phénomènes étroitement liés : l’accroissement de l’interdépendance des entités nationales ; l’émergence d’une expertise scientifique propre à l’évaluation des médicaments et la transformation de son articulation avec la représentation nationale ; l’autonomisation de l’AMM et l’absorption de la décision par l’évaluation scientifique.
In the context of a growing criticism on the influence of the pharmaceutical industry on physicia... more In the context of a growing criticism on the influence of the pharmaceutical industry on physicians, scientists, or politicians, Conflict of Interest and Medicine offers a comprehensive analysis of the conflict of interest in medicine anchored in the social sciences, with perspectives from sociology, history, political science, and law.
Based on in-depth empirical investigations conducted within different territories (France, the European Union, and the United States) the contributions analyze the development of conflict of interest as a social issue and how it impacts the production of medical knowledge and expertise, physicians’ work and their prescriptions, and also the framing of health crises and controversies. In doing so, they bring a new understanding of the transformations in the political economy of pharmaceutical knowledge, the politicization of public health risks, and the promotion of transparency in science and public life.
Complementing the more normative and quantitative understandings of conflict of interest issues that dominate today, this book will be of interest to researchers in a broad range of areas including social studies of sciences and technology, sociology of health and illness, and political sociology and ethics. It will be also a valuable resource for health professionals, medical scientists, or regulators facing the question of corporate influence.
ROQUEPLO (Philippe), Entre savoir et décision, l'expertise scientifique, Paris, Institut national... more ROQUEPLO (Philippe), Entre savoir et décision, l'expertise scientifique, Paris, Institut national de la recherche agronomique, coll. « Sciences en question », 1997. SETBON (Michel), Risques, sécurité sanitaire et processus de décision, Paris, Elsevier Masson, 2004. SJÖBERG (Lennart), « The Allegedly Simple Structure of Experts'
Abstract : For several years now, we have witnessed a proliferation of medical promises attesting... more Abstract : For several years now, we have witnessed a proliferation of medical promises attesting the capacity to slow down or even reverse the aging process. This article aims to historicize this phenomenon by studying the various medical attempts to reverse aging that have taken place for more than a century. By doing so, we aim to emphasize continuities in anti-aging promises (promoters' profiles, discourses, life-cycle of the promise) but also their transformations, which reflect changing conceptions of the body, the aging process, medicine, and more widely the evolution of political and cultural contexts.
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Papers by Boris Hauray
Based on in-depth empirical investigations conducted within different territories (France, the European Union, and the United States) the contributions analyze the development of conflict of interest as a social issue and how it impacts the production of medical knowledge and expertise, physicians’ work and their prescriptions, and also the framing of health crises and controversies. In doing so, they bring a new understanding of the transformations in the political economy of pharmaceutical knowledge, the politicization of public health risks, and the promotion of transparency in science and public life.
Complementing the more normative and quantitative understandings of conflict of interest issues that dominate today, this book will be of interest to researchers in a broad range of areas including social studies of sciences and technology, sociology of health and illness, and political sociology and ethics. It will be also a valuable resource for health professionals, medical scientists, or regulators facing the question of corporate influence.