Pharmaceuticalization can be defined as the “process by which social, behavioural or bodily conditions are treated or deemed to be in need of treatment, with medical drugs by doctors or patients” (Abraham 2010:604). According to Abraham (2010), pharmaceuticalization is currently on an upward spiral and this dramatic increase can be attributed to five different factors. These five explanations are biomedicalism, medicalization, pharmaceutical industry promotion and marketing, consumerism, and regulatory-state ideology or policy.
Each of these explanatory factors are mutually interactive but competing and it will be explained how this is in the following paragraphs. The biomedicalization thesis is based upon the idea that advances in biomedical research can explain why there is an expansion of drug treatment in our society today. Biomedicalism theorists believe that people who were previously undiagnosed or untreated for certain disorders are now able to receive necessary medication as a result of progression in medical science, but it is clear from his article that Abraham is not a biomedicalism theorist.
Abraham provides surprisingly large amounts of evidence to back up his claim that the biomedicalization thesis is not a legitimate explanation for the increase in pharmaceuticalization. Abraham criticizes the fact that a lot of the scientific literature contains uncertainties and many studies lack replicability and therefore should be rendered unreliable. He also uses the example of Attention Deficit Hyperactive Disorder (ADHD) to farther emphasize his argument.
He does this by making the point that the brain imaging done in these studies were supposed to be measuring the levels of dopamine in the brains of the subjects but these samples could not be taken from living people so were instead inferred from dopamine metabolites in the blood or urine. This poor quality of science that the biomedicalization thesis is based upon raises many questions and increases the likelihood that this is not a valid cause for the increase in pharmaceuticalization (Abraham 2010).
Abraham believes that medicalization is a more reasonable explanation for the rise in pharmaceuticalization. Pharmaceuticalization and medicalization often overlap but are nonetheless distinguishable. Medicalization can be defined as a “process by which non-medical problems become defined and treated as medical problems, usually in terms of illness or disorders” (Abraham 2010:604). The thought behind the increase in medicalization is that social deviance has gradually become redefined in a way that makes medical disorders part of the norm.
ADHD illustrates this idea because in the past 40 years, the criteria necessary to be diagnosed with this disorder has broadened drastically and some studies in the US found that almost 50% of children now meet this criteria. Another relevant disorder would be bipolar disease, which has increased 50-fold since 1980 when it was first entered into the Diagnostic and Statistical Manual of Mental Disorders (Abraham 2010). In our society today it is much more common to be diagnosed with a medical disorder and once consumers are made aware of a disorder’s existence, its regularity will skyrocket.
The main way in which consumers are informed about new drugs or diseases is from marketing and promotion done by the pharmaceutical manufacturers. Drug companies are advertising their products much more now and are over exaggerating the benefits in hopes to establish a larger consumer base. They are putting all of their resources and funds into this marketing and even spending more on this than resource and development: “In the US, industry expenditure on marketing has been about double that on R&D- US$54 billion and US$26 billion in 200, respectively” (Abraham 2010:609).
Pharmaceutical companies are even getting medical professionals on board to advertise their products either at medical symposia or in a television commercial by generously compensating them. This increased exposure to drugs makes consumers more informed about the availability of new drugs but not necessarily the risks that come along with them. In his article, Abraham mentions two forms of consumerism that have opposite effects of one another on pharmaceuticalization.
The first type that he talks about is adversarial consumerism, which occurs when people are under the impression that they have been harmed by specific drugs and therefore pursue legal actions against pharmaceutical manufacturers. Adversarial consumerism is currently rising; in 2000, US plaintiffs received 4. 85 billion US dollars to settle 27,000 lawsuits against Merck and 894 million US dollars against Pfizer to settle lawsuits about various types of arthritis drugs. These figures can be compared with the mere 10’s of millions of dollars that Eli Lilly was charged with in the 1980s.
This particular type of consumerism actually leads to a decrease in pharmaceuticalization, which is sometimes referred to as de-pharmaceuticalization (Abraham 2010). The more powerful type of consumerism is called access-oriented collaborative and it is one of the reasons that there is an increase in pharmaceuticalization in our society today. This form of consumerism occurs when patients seek access to new drugs quicker than the Food and Drug Administration (FDA) can approve them. This puts a lot of pressure on the FDA and forces them to cut approval times for highly demanded drugs (Abraham 2010).