Medicine, Health Care and Philosophy

, Volume 16, Issue 2, pp 295–304 | Cite as

The dominance of big pharma: power

  • Andrew Edgar
Scientific Contribution


The purpose of this paper is to provide a normative model for the assessment of the exercise of power by Big Pharma. By drawing on the work of Steven Lukes, it will be argued that while Big Pharma is overtly highly regulated, so that its power is indeed restricted in the interests of patients and the general public, the industry is still able to exercise what Lukes describes as a third dimension of power. This entails concealing the conflicts of interest and grievances that Big Pharma may have with the health care system, physicians and patients, crucially through rhetorical engagements with Patient Advocacy Groups that seek to shape public opinion, and also by marginalising certain groups, excluding them from debates over health care resource allocation. Three issues will be examined: the construction of a conception of the patient as expert patient or consumer; the phenomenon of disease mongering; the suppression or distortion of debates over resource allocation.


Consumerism Expert patient Habermas Lukes Patient advocacy groups 


  1. Abraham, J. 2010. Pharmaceuticalization of society in context: Theoretical, empirical and health dimensions. Sociology 44(4): 603–622.CrossRefGoogle Scholar
  2. Applbaum, K. 2006. Pharmaceutical marketing and the invention of the medical consumer. PLoS Medicine 3(4): 445–447.CrossRefGoogle Scholar
  3. Bachrach, P., and M.S. Baratz. 1962. Two faces of power. The Americun Political Science Review 56(4): 947–952.CrossRefGoogle Scholar
  4. Batt, S. 2005. Marching to different drummers: Health advocacy groups in Canada and funding from the pharmaceutical industry, Toronto, ON: Women and Health Protection ( Accessed 30th Sept 2010).
  5. Berenson, A. 2008. Drug approval. Is disease real?’ New York times, 14th January, 2008, (available through Accessed 30th Sept 2010).
  6. Buttle, F., and J. Boldrini. 2001. Customer relationship management in the pharmaceutical industry: The role of the patient advocacy group. International Journal of Medical Marketing 1(3): 203–214.CrossRefGoogle Scholar
  7. Dahl, R. 1957. The concept of power. Behavioral Science 2(3): 201–215.CrossRefGoogle Scholar
  8. Elliot, C. 2001. Six problems with pharma-funded bioethics. Studies in History and Philosophy of Biological and Biomedical Sciences 23: 125–129.Google Scholar
  9. Habermas, J. 1970. On systematically distorted communicative competence. Inquiry 13: 360–375.CrossRefGoogle Scholar
  10. Habermas, J. 1974. The public sphere: An encyclopedia article (1964). New German Critique 3#: 49–55.CrossRefGoogle Scholar
  11. Habermas, J. 1976. Theory and practice. Boston MA: Beacon Press.Google Scholar
  12. Habermas, J. 1996. Between facts and norms: Contributions to a discourse theory of law and democracy. Cambridge, MA: Polity Press.Google Scholar
  13. Habermas, J. 2001. On the pragmatics of social interaction. Cambridge, MA: MIT Press.Google Scholar
  14. Heath, I. 2006. Combating disease mongering: Daunting but nonetheless essential. PloS Medicine 3(4): 448–451.CrossRefGoogle Scholar
  15. Healy, D. 2006. The latest mania: Selling bipolar disorder. PLoS Medicine 3(4): 441–444.CrossRefGoogle Scholar
  16. InterPeres. 2004. Rethinking development: Promoting global justice into the 21st century. Ottowa, ON: InterPares.Google Scholar
  17. Jones, K. 2008. In whose interest? Relationships between health consumer groups and the pharmaceutical industry in the UK. Sociology of Health & Illness 30(6): 929–943.CrossRefGoogle Scholar
  18. Lukes, S. 2005. Power: A radical view, 2nd ed. London: Palgrave Macmillan.Google Scholar
  19. Marx, K., and Engels, F. 1976. The communist manifesto. In Their collected works, vol. 6, (1845–1848). London: Lawrence and Wishart.Google Scholar
  20. McClure, S.M., et al. 2004. Neural correlates of behavioral preference for culturally familiar drinks. Neuron 44(2): 379–387.PubMedCrossRefGoogle Scholar
  21. Moyhihan, R., and D. Henry. 2006. The fight against disease mongering: Generating knowledge for action. PLoS Medicine 3(4): 425–428.Google Scholar
  22. Pesse, M., P. Erat, and A. Erat. 2006. The network is the customer: Setting the stage for fundamental change in pharmaceutical sales and marketing. International Journal of Medical Marketing 6(3): 165–171.CrossRefGoogle Scholar
  23. Tiefer, L. 2006. Female sexual dysfunction: A case study of disease mongering and activist resistance. PLoS Medicine 3(4): 436–440.CrossRefGoogle Scholar
  24. Weber, M. 1991. Politics as a vocation. In From Max Weber: Essays in sociology, ed. H.H. Gerth, and C. Wright Mills, 77–128. London: Routledge.Google Scholar
  25. Wiggins, D. 2002. Needs, values, truth: Essays in the philosophy of value, 2nd ed. Oxford: Oxford University Press.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Centre for Applied EthicsCardiff UniversityColum DriveUK

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