Medications & Psychiatry

 email page    print page

All Topic Reviews
Psychiatry Under the InfluenceAlternatives Beyond PsychiatryAmerican MadnessAmerican PsychosisAn Unquiet MindAntipsychiatryBad PharmaBefore ProzacBetter Than ProzacBiological PsychiatryBipolar, Not So MuchBlack Man in a White CoatBlaming the BrainBrain Science and Psychological DisordersBrainwashedClinical Psychopharmacology Made Ridiculously SimpleComfortably NumbCompassion and Healing in Medicine and SocietyComplete Mental HealthConcise Guide to PsychopharmacologyCrackedCritical PsychiatryCultural FormulationDeconstructing PsychosisDemystifying PsychiatryDiagnosing the Diagnostic and Statistical Manual of Mental DisordersDiagnosis: SchizophreniaDiagnostic Issues in Depression and Generalized Anxiety DisorderDimensional Models of Personality DisordersDisordered Personalities and CrimeDoctoring the MindDoctors of DeceptionDrop the Disorder!DruggedDrugs for LifeEmpirical Ethics in PsychiatryEssential PsychopharmacologyEssential Psychopharmacology of Depression and Bipolar DisorderEssentials of Psychiatric DiagnosisEsssential Philosophy of PsychiatryEthics in PsychiatryEvidence-Based Treatment of Personality DysfunctionExercise-Based Interventions for Mental IllnessFinding the Right Psychiatrist:Forces of HabitHandbook of Clinical Psychopharmacology for TherapistsHappy Pills in AmericaHealing the Soul in the Age of the BrainHelping Parents, Youth, and Teachers Understand Medications for Behavioral and Emotional ProblemsHerbs for the MindHigh PriceHippocrates CriedHistory of Psychiatry and Medical PsychologyHookedHuman TrialsInfectious MadnessInspired SleepIntoxicating MindsIs It Me or My Meds?Let Them Eat ProzacLife-Threatening Effects of Antipsychotic DrugsLitLiving with Bipolar DisorderMad in AmericaMad ScienceMalignant SadnessMedicating ChildrenMedicating Modern AmericaMental Health in Asia and the PacificMind FixersMoments of EngagementMommy I'm Still in HereNatural Healing for DepressionNo One Cares About Crazy PeopleNot CrazyOrdinarily WellOur Daily MedsOverdosed AmericaPathologist of the MindPediatric PsychopharmacologyPediatric PsychopharmacologyPediatric PsychopharmacologyPharmaceutical FreedomPharmacracyPharmageddonPharmageddonPhilosophical Issues in PharmaceuticsPoets on ProzacPower HerbsPowerful MedicinesPrescriptions for the MindProfits Before People?Prozac and the New AntidepressantsProzac As a Way of LifeProzac BacklashProzac DiaryProzac on the CouchPsychiatric DiagnosisPsychiatric HegemonyPsychiatrists and Traditional HealersPsychiatry and EmpirePsychiatry and the Business of MadnessPsychiatry as Cognitive NeurosciencePsychiatry at a GlancePsychiatry in PrisonsPsychiatry ReconsideredPsychopathyPsychopharmacology Problem SolvingPsychotropic Drug Prescriber's Survival GuidePsychotropic Drugs And Popular CulturePsychotropic Drugs: Fast FactsRaising Generation RxRe-Visioning PsychiatryRecovery from SchizophreniaReligious and Spiritual Issues in Psychiatric DiagnosisRitalin NationRunning on RitalinRutter's Child and Adolescent PsychiatrySaving NormalSchizophreniaShock TherapyShock TherapyShould I Medicate My Child?ShrinksSide EffectsSometimes Amazing Things HappenStraight Talk about Psychiatric Medications for KidsSuccessful PsychopharmacologySuffer the ChildrenTaking America Off DrugsTalking Back to ProzacTextbook of Cultural PsychiatryThe $800 Million PillThe Age of AnxietyThe Anti-Depressant Fact BookThe Antidepressant EraThe Antidepressant SolutionThe Antidepressant Survival ProgramThe Big FixThe Book of WoeThe Complete Guide to Herbal MedicinesThe Conceptual Evolution of DSM-5The CorrectionsThe Creation of PsychopharmacologyThe Cult of PharmacologyThe Dream DrugstoreThe Emperor's New DrugsThe Essential Guide to Prescription Drugs 2005The Essential Guide to Prescription Drugs 2006The Making of DSM-III®The Medical Model in Mental HealthThe Medicated ChildThe Medication QuestionThe Merck DruggernautThe Mind/Mood Pill BookThe Natural Pharmacist : Natural Health Bible from the Most Trusted Alternative Health Site in the World The Pill BookThe Pill Book Guide to Natural MedicinesThe PlaceboThe Rise and Fall of the Biopsychosocial ModelThe Sedated SocietyThe Therapist's Guide to PsychopharmacologyThe Therapist's Guide to Psychopharmacology, Revised EditionThe Truth About the Drug CompaniesThe Use and Misuse of Psychiatric DrugsThe World of CaffeineThomas S. SzaszToxic PsychiatryTrouble in MindTry to RememberTry to RememberTwilight of American SanityUnderstanding Physician-Pharmaceutical Industry InteractionsUnhingedVoluntary MadnessWarning: Psychiatry Can Be Hazardous to Your Mental HealthWhat Is Mental Illness?What Psychiatry Left Out of the DSM-5What Works for Whom?Will@epicqwest.comWomen, Madness and MedicineYour Drug May Be Your Problem

Related Topics
Profits Before People?Review - Profits Before People?
Ethical Standards And the Marketing of Prescription Drugs
by Leonard J. Weber
Indiana University Press, 2006
Review by David M. Wolf, M.A.
Jan 15th 2008 (Volume 12, Issue 3)

This thoughtful book of business ethics knows its purposes: "an effort to understand the proper place of commercial interests in marketing prescription drugs" (p 4) and "to consider the kinds of concerns and standards and marketing-related practices that the public can legitimately demand" (of the pharmaceutical industry) (p. 8). Medical professionals, in particular, will want to read this book; so too will people worried about the effects of big pharmaceutical companies on health care for Americans. Ideally, that should include just about everybody, but as a practical matter perhaps, particularly students in business or medicine, policy makers and legislators, those in advertising and media, and people working for pharmaceutical manufacturers.

It is clear from the statement of those purposes that their purview is broadly conceived, and accordingly, Weber's treatment is suitably detailed, even at times complex. The book contains a great deal; think of it as a textbook despite a concise treatment in 197 pages with notes, plus index.

The author alludes to an increasingly critical climate in which big pharmaceuticals market their products to medical practitioners and to the public. Weber says most Americans are persuaded that profits, not the health and welfare of people, is the prime concern of prescription-drug manufacturers. The case for this is more assumed than demonstrated, held as part of our common experience. The ethical focus of the book is meant to answer the following general questions: What are the harms, and what can be done to mitigate the harms of commercial marketing of prescription drugs?

The book's structure has three parts: I-- "Limits of Commercial Interests" about ethics in profit-making business and the various "stakeholders" of the big pharmaceuticals; II-- "Marketing to Healthcare Professionals"; and III-- Marketing to the Public" which is mostly concerned with "DTC," direct-to-consumer advertising.  The topics themselves actually press with increasing urgency as the focus moves from initially esoteric ethical analysis to the real effects of television ads on consumers.

The first part "provides a framework" to understand the ethical responsibilities of pharmaceutical companies. Much of that framework is laying a basis for ethics itself as inherent in profitable enterprise. "Business ethics" is not an oxymoron, Weber shows. Ethics is not only good for business it is good business. The tattered adage, "The business of business is business," has been falsified by experience and today's "business philosophy" (p. 13). Furthermore, the ethics of business is not about individuals or their charity so much as it requires the commitments of entire organizations. These responsibilities must be lawful but necessarily go beyond the law to encompass "higher" ethical standards, those in which harms to all stakeholders are avoided or minimized.

Meeting these higher ethical demands while also preserving profits is how the conflicts and difficulties arise; Weber makes the kinds of philosophical distinctions needed to chart these domains. The most important distinction is simply to recognize that prescription drugs are not like other commodities, because they are prescribed, not freely chosen by consumers.

Another important distinction in Part I. is "stakeholder" a metaphor displaced from "shareholder" and a new locution widely used and accepted now in business parlance. Without this named category, Weber's analysis wouldn't be possible. His essay on "stakeholders" is a good one, but he defines "stakeholder" quite broadly, even including "those who have not voluntarily associated themselves" with the pharmaceutical company "at all."  Later, he fully supports this when it becomes clear how much prescription drug marketing penetrates the lives of us all, even without our informed consent.

Weber cites a set of ethical principles, "The Clarkson Principles" promulgated by a group of scholars in 1999. These provide a firm foundation for his case concerning the ethical responsibilities of the pharmaceutical industry. There are seven principles and they apply to the range of stakeholders by and through the actions of managers. Weber interprets and expands upon these principles, supporting and proscribing various approaches and methods of management.

It's not surprising that Weber's analysis is plainly based in the rich possibilities inherent in this recent distinction "stakeholder." The latter is somewhat dominant in recent years as a way of seeing the corporate reality, that is, it provides in itself a meta-map or a new way to divide up the domain of any enterprise and its supporting environment: hence, the prominent place of the Clarkson Principles in Weber's volume.

 This reviewer did find in reading his Introduction and Part I a characteristic caution, or perhaps hesitation, in the language Weber uses. He writes "may be" and "should be" where a declaring verb belongs.  Other times, he is needlessly but intentionally repetitious when he wants to give emphasis to important points. In such instances, he would have been better served by stating enthymematic propositions, that is, making stronger, better inferences. There is also a recurring vagueness about the use of some terms, such as "common" and even the prime distinction "stakeholder." If this is Weber's chosen way of proceeding, it nonetheless gives an initial impression of fear--the sense he is treading too lightly among controversies, sees them more as a mine field than fields worth mining for ore.

Whatever the source of these reserves of assertion, Weber finds his feet with increasing sureness in Part II and Part III. Part II is about the impact of big pharmaceuticals on scientific integrity and medical professionalism. The ways in which prescription drugs are marketed to physicians, leads to conflicts of interest for medical professionals, researchers, and others involved. Weber sorts out how to resolve or at least minimize these conflicts.

The really important idea Weber brings to light has to do with a fateful flaw in the industry's code of ethics and conduct. That error is a reliance on a distinction between gifts to professionals for their own use--disallowed by the code--and gifts of benefit to patients, mostly permitted (with qualifications). Weber makes a cogent case that the distinction breaks down and that in practice the code is failing to create a climate of ethical conduct. The entire medical profession is affected adversely, research is compromised, and drugs are sold using outright manipulation, nor rational persuasion.

Chief among the gifts permitted, both in terms of influence and dollar value, are the massive quantities of "free samples," that is, expensive new drugs without charge, given doctors. Weber reports that in 2001 the industry distributed a colossal $12 Billion of these drug samples. The unethical implications of this feigned largesse are not easily apparent, but Weber outlines them effectively and in detail. He lays out an agenda for action and identifies eleven sets of practices that need attention. What is at stake is the integrity of medical practice itself and the quality of care provided to the nation. Weber promotes higher ethical standards as the primary means by which to protect both. He then concludes Part II with standards to protect, as well, the scientific integrity of clinical trials, an area systematically distorted by industry exploitation and chicanery.

Part III is most readable and its analysis most laudable. "Marketing to the Public" makes it clear why the US is now ranked 22nd among the 23 industrial nations of the earth in life expectancy (just ahead of Czech Republic). The healthcare system is "by far the most expensive" (p. 143), and no small portion of these high (and increasing) costs is prescription drugs. The fundamental ethical consideration is that consuming medications is not like buying and using other products and services. The essential distinction derives from the fact that prescription drugs are not often free choices by consumers: they result from doctor's choices, and increasingly, from confusing interactions between marketers, endless TV ads, drug companies, researchers and the FDA. The public needs access to clear and reliable information, but pharmaceutical companies thwart this need in their quest for larger profits. Yet, profits must be accommodated, says Weber. How these conflicts are resolved has everything to do with the "higher ethical codes" whose need and outlines he articulates.

© 2008 David M. Wolf

David M. Wolf, M.A. has been leading a Philosophy Evening twice- monthly for the past year at Yoga Bookstore & Cafe in Honesdale, PA. He is the author of Philosophy That Works, a book about the foundations of knowledge, truth, and philosophy; you can read sections at Google Book Search or Chapter One at David is presently working on a new novel, and a growing collection of sonnets, and other works.

Comment on this review


Welcome to Metapsychology.

Note that Metapsychology will be moving to a new server in January 2020. We will not put up new reviews during the transition. We thank you for your support and look forward to coming back with a revised format.

We feature over 8300 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than twenty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from for purchases through this site, which helps us send review copies to reviewers. Please support us by making your purchases through our Amazon links. We thank you for your support!

Join our Google Group!

Interested in becoming a book reviewer for Metapsychology? To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716