Skip to main content
SpringerLink
Log in

How Pharmaceutical Industry Employees Manage Competing Commitments in the Face of Public Criticism

  • Original Research
  • Published:
Journal of Bioethical Inquiry Aims and scope Submit manuscript

Abstract

The pharmaceutical industry has been criticised for pervasive misconduct. These concerns have generally resulted in increasing regulation. While such regulation is no doubt necessary, it tends to assume that everyone working for pharmaceutical companies is equally motivated by commerce, without much understanding of the specific views and experiences of those who work in different parts of the industry. In order to gain a more nuanced picture of the work that goes on in the “medical affairs” departments of pharmaceutical companies, we conducted 15 semi-structured interviews with professionals working in medical departments of companies in Sydney, Australia. We show that this group of pharmaceutical professionals are committed to their responsibilities both to patients, research participants, and the public and to their companies. Despite the discrepancies between these commitments, our participants did not express much cognitive dissonance, and this appeared to stem from their use of two dialectically related strategies, one of which embraces commerce and the other of which resists the commercial imperative. We interpret these findings through the lens of institutional theory and consider their implications for pharmaceutical ethics and governance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Angell, M. 2004. The truth about the drug companies: How they deceive us and what to do about it. New York: Random House.

    Google Scholar 

  • Biedenbach, T. 2011. The power of combinative capabilities: Facilitating the outcome of frequent innovation in pharmaceutical R&D projects. Project Management Journal 42(2): 63–80.

    Google Scholar 

  • Blind, K. 2012. The influence of regulations on innovation: A quantitative assessment for OECD countries. Research Policy 41(2): 391–400.

    Article  Google Scholar 

  • Califf, R.M., D.A. Zarin, J.M. Kramer, R.E. Sherman, L.H. Aberle, and A. Tasneem. 2012. Characteristics of clinical trials registered in ClinicalTrials.gov, 2007–2010. The Journal of the American Medical Association 307(17): 1838–1847.

    Article  CAS  Google Scholar 

  • Charmaz, K. 2006. Constructing grounded theory: A practical guide through qualitative analysis. London: Sage.

    Google Scholar 

  • DeMartino, J.K. 2012. The Physician Payment Sunshine Act. Journal of the National Comprehensive Cancer Network 10(3): 423–424.

    Google Scholar 

  • DiMaggio, P.J. 1991. Constructing an organizational field as a professional project: U.S. art museums. In The new institutionalism in organizational analysis: 1920–1940, ed. W.W. Powell and P.J. DiMaggio, 267–292. Chicago: University of Chicago Press.

    Google Scholar 

  • Dingel, M., A. Hicks, M. Robinson, and B. Koenig. 2012. Integrating genetic studies of nicotine addiction into public health practice: Stakeholder views on challenges, barriers and opportunities. Public Health Genomics 15(1): 46–55.

    Article  PubMed  CAS  Google Scholar 

  • Eisenstein, E., R. Collins, B. Cracknell, et al. 2008. Sensible approaches for reducing clinical trial costs. Clinical Trials 5(1): 75–84.

    Article  PubMed  Google Scholar 

  • Elliot, C. 2010. White coat, black hat: Adventures on the dark side of medicine. Boston: Beacon Press.

    Google Scholar 

  • Forbes, T., J. Hallier, and L. Kelly. 2004. Doctors as managers: Investors and reluctants in a dual role. Health Services Management Research 17(3): 167–176.

    Article  PubMed  Google Scholar 

  • Gatrell, J., and T. White. 1996. Doctors and management—the development dilemma. Journal of Management in Medicine 10(2): 6–12.

    Article  PubMed  CAS  Google Scholar 

  • Glynn, M.A., and M. Lounsbury. 2005. From the critics’ corner: Logic blending, discursive change and authenticity in a cultural production system. Journal of Management Studies 42(5): 1031–1055.

    Article  Google Scholar 

  • Goodrick, E., and T. Reay. 2011. Constellations of institutional logics: Changes in the professional work of pharmacists. Work and Occupations 38(3): 372–416.

    Article  Google Scholar 

  • Ham, C., J. Clark, P. Spurgeon, H. Dickinson, and K. Armit. 2011. Doctors who become chief executives in the NHS: From keen amateurs to skilled professionals. Journal of the Royal Society of Medicine 104(3): 113–119.

    Article  PubMed  Google Scholar 

  • Hemminki, E., H. Toiviainen, and L. Vuorenkoski. 2010. Co-operation between patient organisations and the drug industry in Finland. Social Science and Medicine 70(8): 1171–1175.

    Article  PubMed  Google Scholar 

  • Hoffman, A.J. 1999. Institutional evolution and change: Environmentalism and the U.S. chemical industry. Academy of Management Journal 42(4): 351–371.

    Article  Google Scholar 

  • Horikawa, H., M. Tsubouchi, and K. Kawakami. 2009. Industry views of biosimilar development in Japan. Health Policy 91(2): 189–194.

    Article  PubMed  Google Scholar 

  • Iedema, R., P. Degeling, J. Braithwaite, and L. White. 2004. “It’s an interesting conversation I’m hearing”: The doctor as manager. Organization Studies 25(1): 15–33.

    Article  Google Scholar 

  • Kesselheim, A.S., M.M. Mello, and D.M. Studdert. 2011. Strategies and practices in off-label marketing of pharmaceuticals: A retrospective analysis of whistleblower complaints. PLoS Medicine 8(4): e1000431.

    Article  PubMed  Google Scholar 

  • Kitchener, M. 2002. Mobilizing the logic of managerialism in professional fields: The case of academic health centre mergers. Organization Studies 23(3): 391–420.

    Article  Google Scholar 

  • Laeeque, H., H. Boon, N. Kachan, J. Cohen, and J. D’Cruz. 2006. The Canadian Natural Health Products (NHP) regulations: Industry perceptions and compliance factors. BMC Health Services Research 6: 63. doi:10.1186/1472-6963-6-63.

    Article  PubMed  Google Scholar 

  • Lee, M., and J. Kohler. 2010. Benchmarking and transparency: Incentives for the pharmaceutical industry’s corporate social responsibility. Journal of Business Ethics 95(4): 641–658.

    Article  Google Scholar 

  • Lexchin, J., L. Bero, B. Djulbegovic, and O. Clark. 2003. Pharmaceutical industry sponsorship and research outcome and quality: Systematic review. British Medical Journal 326(7400): 1167B–1170B.

    Article  Google Scholar 

  • Mackenzie, F.J., C.F.C. Jordens, R.A. Ankeny, J. McPhee, and I.H. Kerridge. 2007. Direct-to-consumer advertising under the radar: The need for realistic drugs policy in Australia. Internal Medicine Journal 37(4): 224–228.

    Article  PubMed  CAS  Google Scholar 

  • Martin, E. 2006. Pharmaceutical virtue. Culture, Medicine and Psychiatry 30(2): 157–174.

    Article  PubMed  Google Scholar 

  • Meyer, R.E., and G. Hammerschmid. 2006. Changing institutional logics and executive identities: A managerial challenge to public administration in Austria. The American Behavioral Scientist 49(7): 1000–1014.

    Article  Google Scholar 

  • Montgomery, K. 2001. Physician executives: The evolution and impact of a hybrid profession. Advances in Health Care Management 2: 215–241.

    Article  Google Scholar 

  • Montgomery, K., and A.L. Oliver. 2009. Shifts in guidelines for ethical scientific conduct: How public and private organizations create and change norms of research integrity. Social Studies of Science 39(1): 137–155.

    Article  PubMed  Google Scholar 

  • Morse, J.M. 1994. “Emerging from the data”: The cognitive processes of analysis in qualitative inquiry. In Critical issues in qualitative research methods, ed. J.M. Morse, 23–42. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Moynihan, R., I. Heath, and D. Henry. 2002. Selling sickness: The pharmaceutical industry and disease mongering. British Medical Journal 324(7342): 886–890.

    Article  PubMed  Google Scholar 

  • Nelson, A.J. 2005. Cacophany or harmony? Multivocal logics and technology licensing by the Stanford University Department of Music. Industrial and Corporate Change 14(1): 93–118.

    Article  Google Scholar 

  • Pache, A.-C., and F. Santos. 2011. Inside the hybrid organization: An organizational level view of responses to conflicting institutional demands. Cergy-Pontoise Cedex: ESSEC Business School. http://www.essec.edu/faculty/showDeclFileRes.do?declId=9761&key=__workpaper__.

  • Reay, T., and C.B. Hinings. 2009. Managing the rivalry of competing institutional logics. Organization Studies 30(6): 629–652.

    Article  Google Scholar 

  • Scott, W.R. 2008. Approaching adulthood: The maturing of institutional theory. Theory and Society 37(5): 427–442.

    Article  Google Scholar 

  • Scott, W.R., M. Reuf, P. Mendel, and C.A. Caronna. 2000. Institutional change and health care organization: From professional dominance to managed care. Chicago: University of Chicago Press.

    Google Scholar 

  • Shapin, S. 2008. The scientific life: A moral history of a late modern vocation. Chicago: University of Chicago Press.

    Book  Google Scholar 

  • Suddaby, R., and R. Greenwood. 2005. Rhetorical strategies of legitimacy. Administrative Science Quarterly 50(1): 35–67.

    Google Scholar 

  • Tabarrok, A. 2009. From off-label prescribing towards a new FDA. Medical Hypotheses 72(1): 11–13.

    Article  PubMed  Google Scholar 

  • Thornton, P.H. 2004. Markets from culture. Stanford: Stanford University Press.

    Google Scholar 

  • Trouiller, P., P. Olliaro, E. Torreele, J. Orbinski, R. Laing, and N. Ford. 2002. Drug development for neglected diseases: A deficient market and a public-health policy failure. Lancet 359(9324): 2188–2194.

    Article  PubMed  Google Scholar 

  • Wager, E., and A. Herxheimer. 2003. Peer review and the pharmaceutical industry. In Peer review in health sciences, ed. F. Godlee and T. Jefferson, 130–139. London: BMJ Books.

    Google Scholar 

  • Wang, N., W.L. Lipworth, J.E. Ritchie, K.M. Williams, and R.O. Day. 2010. Eliciting views of Australian pharmaceutical industry employees on collaboration and the concept of Quality Use of Medicines. Internal Medicine Journal 41(4): 314–320.

    Article  CAS  Google Scholar 

  • Wazana, A. 2000. Physicians and the pharmaceutical industry: Is a gift ever just a gift? The Journal of the American Medical Association 283(3): 373–380.

    Article  CAS  Google Scholar 

  • Wertheimer, A., and J. Norris. 2009. Safeguarding against substandard/counterfeit drugs: Mitigating a macroeconomic pandemic. Research in Social and Administrative Pharmacy 5(1): 4–16.

    Article  PubMed  Google Scholar 

  • Zaharia, R., and M. Ghenghea. 2011. Corporate social responsibility in the pharmaceutical industry: The Romania’s case. Transformations in Business and Economics 10(2B [Special Issue: S1]): 730–740.

    Google Scholar 

Download references

Funding Acknowledgement

This research was funded by a National Health and Medical Research Council Postdoctoral Fellowship [630726] and the University of California Academic Senate.

Conflict of Interest

The authors have no conflicts of interest.

Author information

Authors and Affiliations

  1. Australian Institute of Health Innovation, University of New South Wales, AGSM Building (Level 1), Paddington, NSW, 2052, Australia

    Wendy Lipworth

  2. Centre for Values, Ethics and the Law in Medicine, University of Sydney, Medical Foundation Building (K25), Sydney, NSW, 2006, Australia

    Wendy Lipworth, Kathleen Montgomery & Miles Little

  3. Anderson Graduate School of Management, University of California, Riverside, CA, USA

    Kathleen Montgomery

Authors
  1. Wendy Lipworth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kathleen Montgomery
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miles Little
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wendy Lipworth.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lipworth, W., Montgomery, K. & Little, M. How Pharmaceutical Industry Employees Manage Competing Commitments in the Face of Public Criticism. Bioethical Inquiry 10, 355–367 (2013). https://doi.org/10.1007/s11673-013-9449-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11673-013-9449-4

Keywords

Search

Navigation