In our “From the Archive” series, we highlight articles from throughout the publication history of the journal. This week, we feature Emily Martin’s 2006 piece “Pharmaceutical Virtue” (accessible in full here.) Martin’s article was featured in a special issue from volume 30 exploring pharmaceutical cultures. Explore the full special issue here.
Emily Martin’s “Pharmaceutical Virtue” tracks the changing ethic of the pharmaceutical industry and pharmacological research from the mid-20th century through today. To assess the shifting moral economy of this industry, Martin draws on interviews with retired, key figures in pharmaceutical sales and development active in the 1950s through 1970s. She then weighs their perspectives on the benefits and aims of the industry against those of contemporary pharmaceutical employees, including sales representatives and advertising workers. The latter group of individuals is increasingly faced with growing public “vilification” for aggressive marketing (and price-gauging.) Nevertheless, today’s sect of pharmaceutical workers strive to see the virtues in an industry which promises new treatments and potential cures.
Martin begins by analyzing interviews from the cohort of pharmaceutical industry workers from the 1950s-70s, here alongside the history of pharmaceutical research and its transformation into a powerful economic machine. Martin finds that the industry’s ability to provide a range of new tools to physicians, at a time when many health concerns had unsatisfactory or limited treatment options, allied the pharmaceutical industry with more “noble” biomedical or clinical research. Companies placed rigorous emphasis on training physicians to see the minute differences between medical conditions in order to best treat them. For instance, “Ativan’s marketing strategy was designed specifically to train doctors to prescribe it to reduce daytime anxiety,” Martin writes, “mixing that anti- anxiety benefit with the tranquilizing benefit of a sleep aid…would be confusing to doctors and make it harder to remember that they should prescribe the drug for daytime anxiety.”
Thus the pharmaceutical representatives and workers of the 1950s-1970s served as allies to the medical profession by helping them distinguish between medical conditions in ways productive for successful (and specific) treatment. There was no direct-to-consumer marketing: only direct, and informative, exchanges between physicians and pharmaceutical sales representatives. Educational materials distributed from the companies at this time had few references to the drugs being marketed and were free of advertisements. Instead they were aimed at better informing physicians and clinicians who would then provide improved overall care, drawn from a wider range of treatments made available by the companies.
The contemporary pharmaceutical industry suffers a less symbiotic relationship with the public and the medical profession, Martin observes. Clinical trials’ move overseas, often to developing countries, and the rigorous marketing and profiting off life-saving medications like anti-retrovirals, has generated significant ire against the industry. Even the industry’s funding for consumer advocacy outreach and educational programming is, while rosy on the surface, another means by which to court consumers. Educational materials are now penned largely for patients, not physicians, partially severing the physician from the care exchanges that occur between companies, clinicians, and patients.
In this climate, however, Martin finds that many pharmaceutical representatives and workers find dignity and virtue in their work by considering more minute interactions between individual patients or patient populations and the drugs themselves. One representative informant cites an elderly woman who, upon seeing the representative’s bag labeled with the name of the woman’s chronic pain medication, remarked in tears that the drug had changed her life. Another worker, who develops advertisement copy for a pharmaceutical company, notes that the stigma of mental illness is reduced because the available psychotropic drugs are so potent that they are able to restore even a very ill person to a functional life. An advertisement designer added that drugs reduce the blame on the patient, particularly for mental illness, and remove stigma by illustrating that illness is physiological rather than the result of a personal defect.
In sum, like the pharmaceutical workers of the 1950s-1970s, contemporary employees aspire to see the virtues in their industry. Changes in the fabric of pharmaceutical marketing, and other aspects which complicate the moral position of these companies, make this increasingly difficult. However, today’s representatives locate the social good in their work through examples that underscore the potential for improvement amongst patients. This shift in focus from physicians/pharmaceutical companies to patients/companies– while still indicative of the consumer relationship of buyers with companies–offers today’s pharmaceutical workers a positive vision of their work and the potential of new pharmaceuticals to improve human health and quality of life.