Consumer ConsiderationAides Control of Future

of Medicalization

Breanna Block

A44498484Undergraduate Student

Interdisciplinary Studies Michigan State University

Abstract

The purpose of this literature review is to expose the issueof mass distribution of cognitive enhancing drugs despite a lack in knowledge about these medications and to expose the negligence of the co-construction (Taylor 1995) that exists between society and industry. Current research does not acknowledge the effect of consumer involvement on the medicalization process; thus, I suggest that in the future social scientists should consider the relationship that might exist within the process of medicalization. I use thehistory of medicalization and of the doctor-patient relationship as well as the revolution leading to societies redefinition of health in order to explain the evolution of medicalization. I follow with a discussion of the implications of the interactions and exchanges associated with these processes and consider suggestions from secondaryliterature for future action in the biomedical field. I argue that current literature primarily focuses on

industries role in all of these exchanges, and that equal consideration should be given to the role that consumers hold. I contest suggestions from sociologists calling on government action and instead suggest that in order control the direction of pharmaceuticalization and the future of medicalization, focus needs to be directed on harnessing thepower that consumers possess in medicalization and pharmaceuticalization. I conclude that proactive consumers have the ability to construct markets that benefit society, as well as maximizing profits of industry.

Keywords:

Medicalization, Cognitive Enhancing Drugs,Pharmaceuticalization, Consumer Empowerment, Pharmaceutical

IndustryIntroduction

Industry has completely revolutionized the way society views

consumerism in order to rack in as much profit as possible.

They encouraged a system where people buy as much and as

often as possible. The implications of this system have had

serious consequences and caused a state of panic because of

a nearly uncontrollable problem that can only be fixed by

revolutionizing society once again. Many things are being

done to fix this problem. Among these is an outcry to

consumers to reconsider their spending habits, expressing

that without the consumer changes in this system are much

less likely.

Ignoring the power of the consumer, is neglecting part of

the problem itself. In the end society is the one enabling

corporations to continue this way. Limiting corporations is

only half of the battle. I argue that by empowering

consumers and creating effective citizen groups, instead of

limiting industry you are changing the market by which

industry lives by. In this review I hope to provoke

awareness of an incredibly similar issue, with the hope that

something can be done to keep another industry from running

its course on society.

The purpose of this literature survey review is to explore

the negligence of the co-construction (Taylor 1995) that

exists between society and industry, indicating a gap in

available literature from social scientists. Though a more

accurate definition is presented later, for the purposes of

this paper, the definition of co construction will consider

the potential combined efforts causing mass changes in the

way society views health. In addition, I use the following

terms throughout this paper interchangeably: consumers and

society and industry and suppliers of cognitive enhancing

medications.

I hope to stress importance of the issue that these drugs

continue to be rapidly diffused into society are being

adopted into the American way of life, even though access to

knowledge on the long term effects of medicalization and

cognitive enhancing drugs is limited. I begin by looking at

the history of medicalization in order to provide a better

idea of the interactions that have led to our current

status, examining the doctor patient relationship before and

after the legalization of direct to consumer advertising. I

then discuss literature that looks at the pharmaceutical

field and cognitive enhancing drugs in order to explain

societies redefinition of health and the reason behind an

increasing market for these medications. I discuss

implications of the wide spread distribution of cognitive

enhancing drugs and also provide current literature from

social scientists in order to identify a gap in knowledge.

I argue that society and industry are co-constructed,

however current literature is primarily focused on the

pharmaceutical industry’s effects on society. I use a

redefined health model to argue that although the literature

provides a great basis of the causation of increased demands

for cognitive enhancing drugs, it neglects to give

appropriate attention to a crucial piece of the puzzle,

which is that of the “consumer” in every exchange. I explain

that industry is strongly dependent on demands for their

products and without it, they are unable to survive.

Therefore, I argue that consumers are one of the largest

stake-holders and that they have the potential to

revolutionize medicalization by redefining the demand that

pharmaceutical industry survives by. Lastly, I suggest that

further research should consider the potential power

consumers have in medicalization and look at ways of

harnessing this power in order to make positive changes for

society.

Background

Before the eighties, perceived level of personal health was

based off of the assumption one was healthy until they felt

physically sick. If a patient experienced symptoms that

effected their perception of wellbeing and reached a level

of concern, they sought out their medical provider for an

explanation. Their provider would assess their symptoms,

apply knowledge and suggest a form of treatment. The

patients adopted the treatment until their symptoms

decreased and they returned to their original state of

perceived healthiness (Dumit, 2012).

Sociologists have been studying medicalization since the

sixties (Conrad, 2014). Most had came to the agreement that

medicalization had evolved into a complex network of social

forces. Conrad summarizes the work of most social

scientists, suggesting three main factors attributing to

medicalization, the expansion of medical jurisdiction, the

power of social movements and interest groups, and directed

organizational professional activities (creation of new

medical careers that had no reason to exist before) (Conrad,

3-4).

The doctor patient relationship was strongly dominated by

medical professionals. These entities often served as a

patients only link to knowledge about the status of their

health and therefore held a position of high authority in

society. There was a large disconnect between events and

actions occurring within pharmaceutical industry and the

events and actions occurring within society. The only link

between producer, or for the purpose of this paper,

pharmaceutical industry and patients, the consumers of

cognitive enhancing pharmaceutical products, was through

medical professionals. These entities stood as the deciding

factor for dictating what information reached its patients

and therefore had most of the control over what direction

health and treatment were going to head in. Another

conductor that existed in the process of medicalization

during this time were advocacy/patient groups who would work

to gain awareness of a human problem and could sometimes

gain recognition of that problem as a medical condition,

however these groups were not always successful (Hackett, E.

J. et al., Epstein, Steven. 1995).

Physicians decided whether or not a human problem was

considered a disease, and which of those problems deserved

medication as treatment. In addition, they decided which

method of treatment to use. If a treatment was found to

cure, decrease symptoms or improve health, industry first

had to convince doctors of the efficacy of a treatment. If

there was more than one treatment for a problem, industry

had to convince doctors that their treatment was better than

another. This power held by medical professionals existed on

both sides of the consumer supplier relationship, further

contributing to their power. Demands for assisted medical

care can be seen through the creation of many new medical

professional careers, which further strengthened their

autonomy as conductors in the process of medicalization

(Conrad, 2005).

Some felt that this system gave doctors too much control

over the medical health of their patients, movements started

popping up, aimed at giving people more of a say in their

medical decision-making. So “In 1981 pharm. Pharmaceutical

companies proposed to the FDA to open up their marketing

strategies from physicians to the consumers” (Palumbo, B.

F., Mullins, D. C. 2002). The premise was that this would

allow patients access to knowledge about disease and

treatment that they did not have access to prior. It was

thought that increased knowledge increased awareness of

health concerns and would promote a society that was much

more knowledgeable about their medical health (Palumbo, B.

F., Mullins, D. C. 2002).

There was much debate surrounding this request, and the FDA

saw very early on the potential problems that would arise,

however, it was finally agree upon and “In 1985 it was

decided that pharmaceutical companies could advertise as

long as they met with the existing standards/regulations

that were designed to protect the consumer from false or

misleading information” (Palumbo, B. F., Mullins, D. C.,

2002). Despite mixed opinion over this change, it would be

some time before any effects from this legislation would be

seen, so it became a waiting game for both parties.

The ‘golden age of doctoring’ (Conrad, 2005) began coming to

a close. Conrad suggests that the driving force of this

revolution can be traced back to pharmaceutical companies

and managed care companies who slowly established a

competitive consumer market within healthcare. As a result,

“Large numbers of patients began to act more like consumers,

both in choosing health insurance policies and in seeking

out medical services. In addition, managed care

organizations, the pharmaceutical industry, and some kinds

of physicians (e.g., cosmetic surgeons) increasingly saw

patients as consumers or potential markets” (Conrad, 2005).

In many ways it seems patients have been more than happy to

take on the role of a consumer, giving them the power to

make decisions concerning their health and wellbeing instead

of leaving your fate in the hands of a doctor.

Increased knowledge of societal health awareness appears to

be a wonderful step, however, many did not consider that the

entity now providing society health information, was the

same entity that would thrive off of their decreased

perception of health. Therefore is makes sense that for

companies, a huge conflict of interest came into question.

Unfortunately, since companies are ultimately responsible to

their shareholders, the desire for increases in sales

revenue is often taken care of long before patients needs,

leaving the companies in a moral conflict (Palumbo, B. F.,

Mullins, D. C., 2002). Pressures to survive in a competitive

market often overcome pressures to manufacture pristine

medication, especially because financial costs to bring new

medications to manufacture are very high. However, “In 2007

global pharmaceutical sales reached $712 billion with North

America accounting for nearly half of the total sales”

(Petryna, A. 2009). It appears that profit may no longer be

an issue for many of these companies, and yet we are still

not seeing changes in the moral economy of these firms.

Social scientists make note of societal changes regarding

health that have been occurring in the past twenty years.

“The world of medicine has to some significant degree been

refashioned in ways that impinge (variably) upon the

everyday experiences and practices of people around the

globe” (Epstein, 503). Today, patients are still going to

doctors when they get sick, however, they now go to their

doctor for routine checkups regardless of whether they are

feeling sick or not. The most obvious difference is that in

some cases, patients are coming to their doctors with a

preconceived notion of not only the diagnosis they expect to

receive but also their person recommendation or demands for

a particular medication they would like to be prescribed

based on this self diagnosis.

Conrad and Dumit have both suggested that the engines of

medicalization are shifting from the medical profession and

social movements to biotechnology (drug industry),

consumers, and corporate industry – with medical

professionals increasingly taking more of a secondary role

as gatekeepers to health”(Conrad, 2014). This decreased

respect for medical professional knowledge could cause some

problems in the future considering that often the

medications with the highest consumer demand are not well

understood from a long-term health perspective. Though the

medications have made it through regulation, nothing is

known about the health implications of their long-term use.

Yet, medicalization continues to diffuse into the American

way of life, but I pose the question whether society is

aware of the risks they are taking by leaving the fate of

their well being in the hands of industry, especially once

one comes to the realization that providing for societies

well being comes second to the growth of their firm. What is

more alarming is that often, patients never think to

question the credibility of the information they receive

from pharmaceutical firms. The increasing adoption of

pharmaceutical and drug interventions for various human

issues is what many are referring to as the

“pharmaceuticalization” of medicine (Dumit, 2012) and

(Conrad, 2014). The widespread adoption of this process can

be indicated by the rate at which acceptance of this medical

revolution is being taken up by society.

Literature suggests that diffusion and adaption to these

revolutions have an underlying confounding driving force,

pointing toward the entities that perhaps have the most at

stake in pharmaceuticalization, pharmaceutical companies.

Therefore I shift the discussion for a moment to consider

the other side of this debate from a new perspective. As

mentioned, pharmaceutical companies make money by selling

medications affecting the lives of its customers and

therefore are pressured to provide the most effective

treatments for numerous conditions at the same time.

The process they must go through in order to bring these

treatments to market includes getting FDA approval based on

the results of clinical trials conducted on the medication.

If the FDA approves, they grant the company a patent. “The

patent time is limited and pharmaceutical companies are

therefore constitutionally insecure, continually losing

their products and needing to come up with a constant stream

of new drugs to be thoroughly tested through clinical

trials” (Dumit, 2012). These trials are expensive, so like

anyone else conducting clinical research, companies are

financially restricted to running trials on medications that

contribute to revenue. They measure the value of a

medication or condition based on the total number of

potential sales that medication is likely to generate, and

cannot afford to manufacture medications for a condition

unless there is a large demand for its treatment.

Another thing that social scientists make note of is that

more research is being done to identify human conditions

than it is to heal them. “Often no studies are conducted to

determine when it would be better or safer to stop giving a

medication to a patient, even while there are very few

studies of the long-term effectiveness or safety of those

medications. These studies [don’t] interest drug companies

because they would shrink the market” (Dumit, 2012). This

decision may not be all that humane, however it is a crucial

fact of business planning. Without more pressure to provide

for the wellbeing, it is hard for any business to neglect

their profits and no one wants to risk giving away their

clientele, especially when they have an easier more viable

option.

Unfortunately, “The issue at stake for marketers is how to

continue to grow the market big enough and fast enough to

keep up with investors’ expectations, which they often do by

stretching evidence from clinical trials (Dumit, 2012).

“This provides new opportunities for manufacturers to create

the data they want and to arbitrage it in the context of

regulatory drug approval” (Petryna, 2009). Sadly, this is

only a small fraction of the work being done to increase

profit and drive demands.

What is worse is that facts are the most prevalent and

sometimes the only facts about our health that are

available. If clinical trials are too expensive for

industry, it is reasonable to assume that they are too

expensive for other entities as well. “Today, the majority

of clinical research endeavors are industry sponsored. In

1980, industry funded 32 percent of clinical research. By

2000, the figure had soared to 62 percent” (Petryna, A.

2009). Even if more consumers sought out to perform research

that would question the credibility of industry-funded

information, it is unlikely they could generate enough

funding to conduct a study of equal magnitude.

However, that is not yet the issue at stake. With the

exception of some academics, most of society is quite

unaware of what is really going on here. They assume that

once a drug has been approved by the FDA that it is

completely safe, however, such notoriety is nearly

impossible to achieve until more information can be gathered

about the long-term effects of these medications. “As a

general public we know little about the design of research

protocols, the conditions under which trials are carried

out, or the dependability of the evidence about a drug’s

benefits and risks” (Petryna, A. 2009). Ulitimately, we are

left with

Liturature

Current literature provides potential suggestions to solve

this problem, such as requesting government assistance in

conducting research for low demand medications, policy

changes limiting pharmaceutical companies, and restricting

the distribution of cognitive enhancing drugs. I consider

these suggestions from social scientists and discuss issues

with these ideas. I conclude with a suggestion to social

scientists to consider looking at the relationships within

the process of medicalization from a new perspective.

Many people feel that science is something like a “free

market of knowledge” (Sismondo 2010). That is, “they assume

that ideally all production, distribution, and consumption

of knowledge is voluntary, and that it is free from

regulation, interference, or fraud. Moreover, a number of

people take science to largely meet that ideal. We should

not lose sight of ways in which it does not meet that ideal.

In fact, our most successful knowledge regimes are nothing

like free markets, and depend on that fact” (Sismondo,

2010).“There is a persistent and uncritical belief in the

power of neuroscience and its technologies that is feeding a

growing neuro-inspired marketing industry focused on

analyzing consumers' perceptions and tastes, and predicting

their behavior” (Abi-Rached, 2008).

There is literature that considers the implications of rapid

diffusion of pharmaceutical cognitive enhancing drugs,

“Companies based in neuroscience, while in the pursuit of

profit, fail to acknowledge the “ethical, medical, and legal

dilemmas” that can rise from the use of neuro-technology,

and the “rapidly growing neuro-economies.” Therefore, now is

a good time to bring people together to discuss how

neuroscience will be incorporated into our lives as it grows

influence” (Abi-Rached, 2008). Farah takes these suggestions

one step further indicating that a solution might be reached

by concerned the government “Neuroscientists have paid

little attention to the social implications of their field,

and now is critical time to create communication between

scientist and policy makers” (Farah, 2002).

One logical explanation for all of this madness would be to

discontinue the distribution of these medications, however

we can’t because there is such a demand for these cognitive

enhancing drugs. This demand includes people with ADHD and

Narcolepsy, but also all of the people using these

medications for off label use, such as college kids and

athletes. “In sum, enhancement is not just a theoretical

possibility. Enhancement of mood, cognition and vegetative

functions in healthy people is now a fact of life, and the

only uncertainties concern the speed which new and more

appealing enhancement methods will become available and

attract more users” (Farah, 2002).

This relates to the concept of path dependency, which says

that once decisions are made, they will continue to affect

future decisions on that original idea (Mahoney, 2000). If

these medications suddenly become unavailable a black market

for cognitive enhancement would erupt, causing numerous

health and safety risks. Not to mention an increased rate of

criminal activity. Thus it is safe to say that once these

medications were distributed the future of cognitive

enhancing drugs was forever changed. Therefore any arguments

suggesting discontinued manufacturing of these drugs might

want to consider implications that could arise.

There is literature suggesting that pharmaceutical companies

have staggered away from their focus on the health of

society, but other sociologists argue that this was never

their focus. Pharmaceutical companies need to profit in

order to survive. This is why they only focus on mediations

that have a large market or why they create markets if they

need to in order to get profits. In fact, some

pharmaceutical companies say it is not their fault they

aren’t making medications for certain types of diseases

because they can’t until a larger demand exists for these

neglected health issues (Dumit, 2012).

Yet, the majority of research argues that public policies

should be made to regulate these drugs or even

pharmaceutical companies more. Bartfai and Lees suggest that

“If it does not fulfill society's needs, it will not be

successful. Because of its critical role in society, it is

very much the government's business to step in when it is

unable or fails to fulfill society's needs” (Bartfai & Lees,

2010). However this may not solve problems with societies

needs. Not to mention that without knowledge of the long-

term effects of these drugs, it is nearly impossible to

implement lasting and effective policies. It is important to

realize that since pharmaceutical companies cannot survive

without profit and that they will always follow the market.

Something that many people forget is that big pharma is not

set out to ruin the world. Their goal is not to medicate

society, it is to create profit, and they make more money

the more prescriptions they sell. The implications of these

medications almost always come second to the profit they

will make off of them.

If the goal of pharmaceutical companies was to improve

health, they would be looking for treatments that take

people out of a risk category, and off medications which are

directly profiting pharmaceutical companies; a bad business

model from any logical sense. “Often no studies are

conducted to determine when it would be better or safer to

stop giving a medication to a patient, even while there are

very few studies of the long-term effectiveness or safety of

those medications. These studies don’t interest drug

companies because they would shrink the market” (Dumit,

2012). It is reasonable to make the assumption that if

policies were made to limit pharmaceutical industry that

firms would simply find another large potential market to

sell to and who knows what new issues that would bring for

society.

Even some pharmaceutical companies argue that it’s not their

fault they can’t provide medications for more diseases, “Of

400 disease entities identified, only 50 are commercially

attractive by todays requirements of return on investment.

Society needs to find a way to make diseases more

commercially attractive if it wants pharma to invest in

treating any of the other diseases. Pharma can only afford

to do research on treatments that have a chance of becoming

massively huge markets because they have a need to grow in

order to survive (Dumit, 22). Unfortunately, potential risk

of side effects are not enough to get these firms to

reconsider manufacturing these medications and even if they

are reconsidering it, no one wants to be the first one to

make the move.

In addition, Sismondo suggests that certain institutions and

technologies can become issues that should be considered by

non-experts as well as experts in the field. “If it is to be

made to work at its best, scientific and technical knowledge

needs to be seen as situated in social and material spaces.

It is, in short, constructed” (Sismondo, 2010). “Until all

of these influences are appropriately recognized and

incorporated in social analyses, most policies designed to

restore the professional ideal have little chance of

success” (McKinlay and Marceau, 2002). Before any real

changes can be expected, we need to first be sure we

understand the problem as a whole.

Conrad suggests that, “In a culture of increasingly market-

driven medicine, consumers, biotechnological corporations,

and medical services interact in a complex way that affect

social norms in changing definitions of behaviors and

interventions. The relationship between normative changes

and medicalization runs in both directions” (Conrad, 11).

However, if there is reason to believe relationships run in

both directions today, there is reason to argue that perhaps

these relationships have always existed.

After a review of current literature on medicalization and

the pharmaceuticalization of cognitive enhancing drugs,

discussed suggestions from social scientists, and argued the

inefficiency of these suggestions, I identify a crucial gap

in this literature. A lot of the literature looks at the

role the pharmaceutical industry and biotechnology in

general have played in the medicalization of cognitive

enhancing drugs, but there is not a lot of literature

considering the role that consumers have in the creation of

demand for these drugs. This could imply that the process of

medicalization may not be constructed by pharmaceutical

companies, but could at the same time be constructed by

other forces as well, to say that medicalization is actually

a process that is co-constructed by multiple forces (Taylor,

P. 1995).

Current research does not acknowledge the effect of consumer

involvement on the medicalization process; thus, I suggest

that in the future social scientists should consider the

relationship that might exist within the process of

medicalization. The literature I have looked at describes

the relationship between pharmaceutical companies and

medicalization, however, it is interesting that it has yet

to consider the possibility that the process of

medicalization is actually co-constructed and that consumers

may have a strong relationship with the process of

medicalization.

My suggestion to social scientists is to focus on research

on “responsible citizens” or ideal advocacy groups. I focus

on individual human actors – how consumers’ decisions shape

the overall system. Some focus may also look at the

organizational structures of corporations and measure how

they are changing under medicalization in order to recognize

that both of these things are going on simultaneously.

Academic literature from marketing journals not only

considers consumers role,

“Arguing that increasing use of information and

communication technologies (ICT) is shifting market power

from suppliers to consumers, the ensuing consumer

empowerment is presented as an unintended consequence of

marketing. Marketing implications arising from this consumer

empowerment are examined in terms of a process where control

and management by suppliers over consumer access and

enablement are increasingly difficult” (Pires, G.

D., Stanton, J., Rita, P. 2006). Judging by this information

we can see that consumers do it fact play a role in these

exchanges and that they may have a lot more power than they

realize.

However, this potential power should not be overlooked.

Industry is very aware of the role consumers play, and they

are already learning how to use the power laypeople have in

society for their personal benefit. “Cases show the

influence of corporations and markets in the constitution of

group-ness. For example, Carlos Novas has described how

pharmaceutical company websites may deliberately emulate the

‘look and feel’ of sites produced by patient organizations,

in an attempt to create a sense of ‘community’ between

affected persons and the company” (Epstein, 512). It is a

well known fact that relationship between industry and

social groups has been very intertwined.

Patient groups are a driving force in medicalization and

therefore a blinking target that pharmaceutical companies

seek to gain control of. In some cases they have succeeded

and appear to be manipulated by big pharma. “Spokespeople

from such groups often take strong stances supporting

pharmaceutical research and treatment, raising the question

of where consumer advocates begin and pharmaceutical

promotion ends. This reflects the power of corporations in

shaping and sometimes co-opting advocacy groups” (Conrad,

2005). In cases such as this, social groups are only

contributing to the problem of increasing demand for

pharmaceutical drugs, however, I argue that these forces can

be denied.

I believe the right group could be successful in gaining

support and funding to conduct research that can compete

with pharmaceutical companies, or at the least gain further

information about this topic in general. Future research

from social scientists might look into groups that Ralph

Nator has helped to establish since the seventies, some of

which are still in action today. Another avenue social

scientists might consider is the work being done by Hess.

This work is not considered academic, however, they are

conducting really nice research and are starting to gain

more acceptance from the field of academia (Hess, J. D.,

2009).

This literature review has worked to expose the issue of

mass distribution of cognitive enhancing drugs despite a

lack in knowledge about these medications and to expose the

negligence of the co-construction that exists between

society and industry. Current research does not acknowledge

the effect of consumer involvement on the medicalization

process; thus, I suggest that in the future social

scientists should consider the relationship that might exist

within the process of medicalization. I have looked at the

history of medicalization and of the doctor-patient

relationship as well as the revolution leading to societies

redefinition of health in order to explain the evolution of

medicalization. I have followed with a discussion of the

implications of the interactions and exchanges associated

with these processes and consider suggestions from secondary

literature for future action in the biomedical field. I

argue that current literature primarily focuses on

industries role in all of these exchanges, and that equal

consideration should be given to the role that consumers

hold. I contest suggestions from sociologists calling on

government action and instead suggest that in order control

the direction of pharmaceuticalization and the future of

medicalization, focus needs to be directed on harnessing the

power that consumers possess in medicalization and

pharmaceuticalization. I also suggest potential avenues to

consider, such as groups associated with Nator and the work

of Hess. I conclude that proactive consumers have the

ability to construct markets that benefit society, as well

as maximizing profits of industry.

References

Abi-Rached, Joelle M. 2008. “The Implications of the New

Brain Sciences. The ‘Decade of the Brain’ Is over but

Its Effects Are Now Becoming Visible as Neuropolitics

and Neuroethics, and in the Emergence of

Neuroeconomies.” EMBO Reports 9.12 (2008): 1158–1162.

PMC. Web. 2 Dec. 2014.

Arnason,Vilhialmur. 2013. “Scientific citizenship in a

democratic society.” Public Understanding of Science

November 2013 vol. 22 no. 8 927-940. doi:

10.1177/0963662512449598. Epub 2012 Jul 24.

Bartfai, T. & Lees, G. 2010. Pharma TARP: A Troubled Asset

Relief Program for Novel, Abandoned Projects in the

Pharmaceutical Industry. The Scientific World Journal. 11. 454-

457. DOI 10.1100/tsw.2010.185

Callon, Michel. 1999. “The Role of Lay People in the

Production and Dissemination of Scientific Knowledge.”

Science, Technology, and Human Values. 4(1): 81-94.

Conrad, Peter. 2005. “The Shifting Engines of

Medicalization.” Journal of Health and Social Behavior 46(1), 3-

14.

Conrad, Peter & Bergey R. M. 2014. “The impending

globalization ADHD: Notes on the expansion and growth

of a medicalized disorder”. Social Science & Medicine.

122: 31-42.

Dumit, J. 2012. Drugs for Life. How Pharmaceutical Companies Define Our

Health. Duke University Press.

Elam, M.,Bertilsson, M. 2003. “Consuming, Engaging and

Confronting Science The Emerging Dimensions of

Scientific Citizenship” European Journal of Social

Theory May 2003 vol. 6 no. 2 233-251.

Ernst & Young LLP. 2006. “Contract Research: Contracted for

Trouble?” R&D Directions 12 (5).

Hackett, E. J. et al., Epstein, Steven. 1995 “The

Construction of Lay Expertise: AIDS Activism and the

Forging of Credibility in the Reform of Clinical

Trials.” 1995. Science, Technology, and Human Values.

20(4): 408-437.

Farah, Martha J. “Emerging Ethical Issues in Neuroscience”

Nature Neuroscience 5, 1123 - 1129 (2002)

doi:10.1038/nn1102-1123

Greenly H, Sahakian B, Harris J, Kessler RC, Gazzaniga M,

Campbell P & Farah MJ. 2008. “Towards responsible use

of cognitive enhancing drugs by the healthy” Nature.

2008 Dec 11;456(7223):702-5. Doi: 10.1038/456702a.

Harding, Sandra 1996. “Re-Thinking Standpoint Epistemology.

In Feminism and Science. Oxford University Press. 1996.

Hackett, E. J., Amsterdamska, O., & Lynch, M. (Eds.). 2007.

“Patient Groups and Health Movements.” Pp. 499-540 in

Handbook of Science and Technology Studies 3rd ed. Cambridge: MA:

MIT Press.

McKinlay, John B. and Lisa D. Marceau. 2002. "The End of the

Golden Age of Doctoring." Inter-national Journal of

Health Services 32(2): 379-416.

Hess, J. D. 2009. “The Potentials and Limitations of Civil

Society Research: Getting Undone Science Done”

Sociological Inquiry 79(3): 306–327.

Palumbo, B. F., Mullins, D. C. 2002. “The Development of

Direct-to-Consumer Prescription Drug Advertising

Regulation.” Food and Drug Law Journal 57(3): 423-443.

Web.

Mahoney, J. 2000. "Path Dependence in Historical Sociology",

Theory and Society 29:4, pp. 507–548.

Petryna, A., 2009. “When Experiments Travel: Clinical Trials and the

Global Search for Human Subjects”. Princeton: Princeton

University Press.

Pires, G. D., Stanton, J., Rita, P. 2006. “The internet,

consumer empowerment and marketing strategies”. Emerald

Group Publishing Limited. European Journal of

Marketing. 2006. 40(9-10)936-949.

Schermer, M. 2008. Enhancements, Easy Shortcuts, and the

Richment of Human Activities. Bioethics, 2008 22: 335-

363. dio: 10.1111/j.1467-8519.2008.00657.

Sismondo. S. 2010. “The Political Economies of Knowledge”.

An Introduction to Science and Technology Studies.

Theory of Medical Bioethics (2012) 33:233–235. DOI

10.1007/s11017-011-9197-6.

Taylor, P. 1995. “Co-Construction and Process: A Response to

Sismondo's Classification of Constructivisms”. Social

Studies of Science. Vol. 25, No. 2 (May, 1995), pp. 348-359

Wright, L. T., Newman, A., & Dennis, C. (2006). Enhancing

consumer empowerment. European Journal of Marketing,

40(9/10), 925-935. doi:10.1108/03090560610680934.

Elliott, Kevin. (2014).“Financial Conflicts of Interest and

Criteria for Research Credibility”. Erkenntnis. June

2014, Volume 79(5): 917-937.