Hegemony of Knowledge and Pharmaceutical Industry Strategy

Abstract

This chapter discusses some strategies pharmaceutical companies employ to establish influence and even hegemony over domains of medical knowledge: marketing products via medical research and education. The chapter thus contributes to understanding the political economy of knowledge in this industry. As a counterpart to traditional epistemology, studying the political economy of knowledge shifts attention from individual claims and their justifications to some of the forces available to shape terrains on which claims are produced, distributed, and consumed. Of pharmaceutical companies’ clinical research, 70–75% is performed by contract research organizations (CROs). CROs conduct trials with one eye to the drug approval process and the other to the marketing of products. On the basis of trial data, analyzed by pharmaceutical company statisticians and scientists, publication planners design suites of scientific manuscripts and hire ghostwriters to write them. These are then given to academic authors, who generally have had little prior connection to the research, analysis, or writing. The manuscripts are published in medical journals appropriate for the audiences the companies wish to reach. The doctors and researchers with whom companies engage most closely are generally termed key opinion leaders (KOLs). In addition to authoring manuscripts, KOLs serve companies in a number of roles, but most prominently as speakers—at professional meetings, in after-dinner and similar settings arranged by sales representatives, and in continuing medical education (CME) courses, which doctors must take to keep their licenses. Research, education, and marketing, then, are often fused.