Health Articles

 

The pharmaceuticalisation of society? a framework for analysis

Sociology of Health & Illness Vol. 33 No. 5 2011 ISSN 0141–9889, pp. 710–725doi: 10.1111/j.1467-9566.2011.01320.x The pharmaceuticalisation of society? A framework foranalysis Simon J. Williams1, Paul Martin2 and Jonathan Gabe3 1Department of Sociology, University of Warwick2Institute for Science and Society, School of Sociology and Social Policy, University ofNottingham3Centre for Criminology and Sociology, Royal Holloway, University of London Drawing on insights from both medical sociology and science and technology studies this article provides a critical analysis of the nature and status ofpharmaceuticalisation in terms of the following key dimensions and dynamics: (i)the redefinition or reconfiguration of health ‘problems' as having apharmaceutical solution; (ii) changing forms of governance; (iii) mediation; (iv)the creation of new techno-social identities and the mobilisation of patient orconsumer groups around drugs; (v) the use of drugs for non-medical purposesand the creation of new consumer markets; and, finally, (vi) drug innovation andthe colonisation of health futures. Pharmaceuticalisation, we argue, is thereforebest viewed in terms of a number of heterogeneous socio-technical processes thatoperate at multiple macro-levels and micro-levels that are often only partial orincomplete. The article concludes by drawing out some broader conceptual andreflexive issues this raises as to how we might best understandpharmaceuticalisation, based on our analysis, as a framework for futuresociological work in this field.
Keywords: medicalisation, pharmaceuticalisation, medicines, markets, consumers, futures Medicalisation is a key concept in medical sociology and has also been employed in bothprofessional and popular discourse on medicine and society. It is not a static concept,however, and there has recently been discussion among sociologists and others about thechanging engines or drivers of medicalisation (Conrad 2005, 2007), the costs ofmedicalisation (Conrad et al. 2010), the shift to a new techno-scientific era ofbiomedicalisation (Clarke et al. 2003) and other calls to rethink or go beyond medicalisation(Rose 2007, Moynihan 2002).
One key development has been a recognition of the growing importance of the pharmaceutical industry in medicalisation. While physicians are still the gatekeepers formany drugs the role of pharmaceutical promoters is increasing by aggressively targeting thepublic as well as physicians (Conrad 2007). Indeed, concerns over these trends have evenbeen voiced in a recent House of Commons Health Committee Report on the pharmaceuticalindustry, which clearly states that while ‘the pharmaceutical industry cannot be blamed for  2011 The Authors. Sociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.
Published by Blackwell Publishing Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA The pharmaceuticalisation of society? creating unhealthy reliance on, and over-use of, medicines, it has certainly exacerbated it'(2005: 4).
This article provides a further contribution to these debates through a detailed consideration of the related yet distinct notion of pharmaceuticalisation. Key questions hereinclude the following: what is pharmaceuticalisation? Is it a useful sociological concept and, ifso, in what ways? How does pharmaceuticalisation differ from and relate to medicalisation?Why, moreover, is pharmaceuticalisation important to consider now? Can particular driversand dimensions of pharmaceuticalisation be delineated and documented and what futuresociological agendas does all this signal? These are the questions we seek to address. Pharmaceuticalisation, we argue, drawing on strands of science and technology studies (STS), is most productively viewed as a complex,heterogenous socio-technical process involving a number of dimensions and dynamics. Thisprocess involves the discovery, development, commercialisation, use and governance ofpharmaceutical products centred around chemistry-based technology. It is to a furtherelaboration of these complex issues that we turn in the main body of the article.
Definition, delineation and dynamics: what is pharmaceuticalisation? Pharmaceuticalisation is a not an entirely new sociological concept. While there has been anincrease in the use of the term in recent years (see, for example, Abraham 2009a, Fox andWard 2009, Williams et al. 2009), there has been little sustained effort, to date, to define anddelineate its sociological credentials in a fashion comparable to that of medicalisation. Sowhat then is pharmaceuticalisation? At its simplest, pharmaceuticalisation denotes the translation or transformation of human conditions, capabilities and capacities into opportunities for pharmaceutical intervention.
These processes potentially extend far beyond the realms of the strictly medical orthe medicalised (Conrad 2007) to encompass other non-medical uses for lifestyle,augmentation or enhancement purposes (amongst ‘healthy' people). Relations betweenpharmaceuticalisation and medicalisation, as this suggests, are complex and contingent andinclude pharmaceuticalisation without any significant degree of medicalisation. Those takingup this term have often raised questions similar to those addressed about medicalisation andabout the legitimacy of pharmaceuticalisation, thereby engaging in an element of socialcritique. Despite this, both medicalisation and pharmaceuticalisation should ideally betreated as value-neutral descriptive terms and may include both gains and losses to society.
Furthermore, the degree or extent to which they are occurring remains open to empiricalinvestigation on a case-by-case basis. Pharmaceuticalisation, in this respect, may be partial orincomplete.
It is useful, therefore, as already noted, to frame pharmaceuticalisation as a dynamic and complex heterogeneous socio-technical process that is part of what we might call apharmaceutical regime. This can be understood as the networks of institutions,organisations, actors and artefacts, as well as the cognitive structures associated with thecreation, production and use of new therapeutics (Goodman and Walsh 1993). Such a regimehas been built around the development of pharmaceutical products since their introduction inthe 19th century and is centred on the chemistry-based technology embodied in the pill. As wediscuss below, one of the key dynamics of this regime is its continuing commercial, clinicaland geographical expansion.
This, in turn, alerts us to both upstream (macro) level processes concerning the development, testing and regulation of pharmaceuticals and downstream (micro) processes  2011 The Authors Sociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd Simon J. Williams, Paul Martin and Jonathan Gabe pertaining to the meaning and use of pharmaceuticals in medical practice and everyday life.
As with medicalisation, pharmaceuticalisation is potentially at least a bidirectional process inwhich de-pharmaceuticalisation remains possible, though in practice, even in cases of drugwithdrawal, it is more likely to be a matter of one type of drug or generation of drugsreplacing another or a decline in usage rather than the complete phasing out of suchinterventions altogether, particularly if de-medicalisation does not occur as well. The historyof pharmaceutical drug development, indeed, is one in which new drugs are often designed tooffset the adverse effects of previous ones. Furthermore, we can identify social resistance tothe process of pharmaceuticalisation as medicine use encroaches ever further, as well as itsadvocacy by patients and clinicians in completely new areas.
Pharmaceuticalisation therefore is a multidimensional, multi-level concept that lends itself to a variety of different perspectives. It is to a fuller explication of these dimensions anddynamics of pharmaceuticalisation that we now turn. In doing so, we wish to focus on recentchanges in the pharmaceutical regime that are making the use of drugs more expansive orpervasive, despite limited scientific evidence and a decline in pharmaceutical innovationregarding any genuine or significant therapeutic advances. What Busfield (2010) dubs theprogressive or scientific account of this expansion, in other words, the account based onprofessional or pharmaceutical industry appeals to advances in pharmacology, scientificprogress and benefits to patient or public health, is of limited explanatory value here, as sheconvincingly shows. At the same time we hope to demonstrate not simply the value ofpharmaceuticalisation as a social scientific concept and the light that different theoreticalperspectives shed on these processes but the reasons why pharmaceuticalisation is becomingincreasingly important. Such a framework, we argue, can then be used to establish criteria formeasuring the extent of pharmaceuticalisation in any given case.
Trends and transformations There are at least six key sociological dimensions to explore concerning trends andtransformations in the pharmaceuticalisation of society.
Selling sickness? The redefinition and reconstruction of health problems as having apharmaceutical solutionThe first way in which an expansion of the pharmaceutical regime is visible is in the massivegrowth of drug markets internationally and in particular in the USA and Europe. As aconsequence, pharmaceutical solutions to health problems have become much morewidespread. Undoubtedly the pharmaceutical industry is one of the most profitable industriesin the world with leading companies reportedly enjoying profits of 25 per cent for most of the1990s (Law 2006). Worldwide pharmaceutical sales now amount to over US$700 billion ayear, with North American sales alone constituting around half of this market and NorthAmerican and European sales amounting to three-quarters of all sales (IMS 2010). Althoughstarting from a lower base, sales in middle-income countries such as China, India and Brazilare now increasing at a faster rate than in countries like the USA or the UK (Busfield 2010).
Moreover there has been a phenomenal growth in pharmaceutical sales since the 1980s.
While prescribed drug sales in the US, for example, remained fairly stable as a percentage ofGDP from 1960 to 1980, they tripled between 1980 and 2000, thereby transforming whatlooked like a ‘good' business into a ‘stupendous' one (Angell 2005: 3–5). Similarly the globaldrugs bill increased thirty fold between 1972 and 2005 (Law 2006). Overall, though, thedistribution of pharmaceutical sales across the world remains uneven – a picture which  2011 The AuthorsSociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd The pharmaceuticalisation of society? reflects the more chronic health problems of those in affluent (ageing) societies who requirelong-term medication. This is supported by the types of pills which have been most regularlyproduced and prescribed in the West – for example statins to reduce cholesterol. Such apattern thus underlines Busfield's (2003) contention that westernisation rather thanglobalisation is a more accurate description of the development of the pharmaceuticalindustry at present.
It is not simply, however, a case of the manufacture of drugs but the marketing, if not manufacture, of disorders for these drugs to treat. Pharmaceutical companies, as Conradnotes, ‘are now marketing diseases, not just drugs' (2007: 19). Moynihan has been aparticularly vocal critic on this count (Moynihan 2002, Moynihan and Henry 2006; see alsoBlech 2006). He contends that some forms of medicalising ordinary life may now better bedescribed as disease mongering or selling sickness – that is, ‘widening the boundaries oftreatable illness in order to expand markets for products' (Moynihan 2002: 886).
Pharmaceutical companies, it is claimed, are ‘actively involved in sponsoring the definition ofdiseases and promoting them to both prescribers and consumers': a process in which thesocial construction of illness is being replaced by the ‘corporate construction of disease'(2002: 886). This involves: (i) turning ordinary ailments into medical problems; (ii) seeingmild symptoms as serious; (iii) treating personal problems as medical; (iv) seeing risks asdiseases; and (v) framing prevalence estimates to maximise potential markets (Moynihan2002).
In support of these contentions, in recent years a range of studies has appeared on conditions ranging from erectile dysfunction (Lexchin 2006) to restless leg syndrome(Woloshin and Schwartz 2006). As with medicalisation, however, these processes may resultin various forms of resistance, as Teifer's (2006) study of female sexual dysfunction suggests.
These critiques are undoubtedly important and valuable. Compared to both medicalisation and pharmaceuticalisation, however, disease mongering is clearly a value-laden rather than avalue-neutral term with an in-built element of normative judgement and social critique. Bothmedicalisation and pharmaceuticalisation, in contrast, as noted earlier, are ideally value-neutral descriptive terms with potentially positive and negative faces that remain open toempirical investigation on a case-by-case basis. While disease mongering thus captures animportant range of issues pertinent to the broader concept of pharmaceuticalisation, itsanalytic value is clearly restricted. Pharmaceuticalisation, on the other hand, may or may notinvolve elements of disease mongering on the part of the pharmaceutical industry, thoughoften this is the case.
Another important vehicle for pharmaceutical market expansion is direct-to-consumer (DTC) advertising. To date this is limited to countries such as the USA and New Zealand,although attempts to overturn the ban, or at least to change the rules to enablepharmaceutical companies to provide more ‘information' to patients, continue in Europe.
This has engendered both fierce opposition and counter-claims by the European Federationof Pharmaceutical Industry Associations (Moynihan and Cassels 2005). Nonetheless, one ofthe great ironies of DTC advertising, as Conrad and Leiter (2004) note, is that it extends therelationship between drug companies, physicians and consumers in ways that return us to theadvertising of patent medicines in the past, when drug manufacturers had a direct andindependent relationship with consumers. This shift is explored further below, along with arange of other ways of marketing disorders as well as drugs, including what Angell (2005)appositely dubs ‘marketing masquerading as education' and ‘marketing masquerading asresearch'.
 2011 The Authors Sociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd Simon J. Williams, Paul Martin and Jonathan Gabe Changing forms of governance: globalisation and the new role of regulatory agencies inpromoting innovationThe second important dimension of pharmaceuticalisation is manifest in the changingrelationship between regulatory agencies and the pharmaceutical industry. This has threecomponents; firstly, reforms that have reduced the regulatory hurdle and increased thedependency of regulatory agencies on industry; secondly, new policies that have increased therole of regulatory agencies in promoting drug innovation; and thirdly, the globalisation ofestablished models of governance based on the interests of the pharmaceutical industry in thedeveloped world.
Important sociological work on the science and politics of medicines regulation has occurred over the past two decades. Abraham (1995, 2009a, 2009b, 2010, Abraham andDavis 2005), for example, has been at the forefront of these developments through detailedempirical case studies of the regulation of medicines such as anti-inflammatories,antidepressants and sleeping tablets and comparative analyses of regulatory institutions andprocesses. This work has provided evidence of a corporate bias and privileged access bypharmaceutical companies to regulatory bodies such as the Food and Drug Administration(FDA) in the USA and the Medicine and Health Care Products Regulatory Agency(MHRA) in the UK. Other work in this area has focused on regulatory responsiveness topatients' demands for the accelerated approval of new drugs (Daemmrich 2004) and thefragmentation of expert authority and its consequences for regulatory decision-making(Gabe and Bury 1996a). This research raises questions about the extent to whichpharmaceutical regulation is failing to act in the interests of public health: a failure that iscamouflaged by claims that regulators can promote the interests of the pharmaceuticalindustry and the interests of public health simultaneously, when they are, in fact, in conflict(Abraham 2009b: 66).
At the same time there are clear signs that the relationship between the pharmaceutical industry and state regulatory agencies is getting even closer. For example, the industry hasbeen required to pay most of the cost of funding of regulatory agencies – a 100% funding forthe MHRA since 1989, with similar trends in the EU (70% funding) and the USA (50%funding) since the mid-1990s. In return it has seen a significant reduction in the regulatoryreview times for new patentable drugs, which have tumbled by half in the USA since 1993,with similar dramatic falls evident in Europe (Abraham 2009b: 60). Furthermore, newmeasures, such as fast-tracking approval of drugs for ‘serious' or ‘life-threatening' conditionswith less data than would normally be expected to demonstrate safety or efficacy has resultedin around 14 per cent of new drugs receiving such approval over the last 15 years in the EU(Garattini and Bertele 2001). While reductions in review times may be in the interests ofpatients who need these drugs as soon as possible, the upshot of these changes, as Abraham(2009b) rightly stresses, is that they leave regulatory agencies vulnerable to the pressures ofthe market. In effect, these agencies are encouraged to compete with each other by makingthemselves attractive to drug companies who have come to be defined, in keeping withneoliberal ideology, as the regulator's ‘customers'. Having said this, it is important torecognise that the pharmaceutical industry broadly supports the existing regulatory regimedespite the high cost associated with compliance. This is for a number of reasons, includingthe consumer confidence that is associated with a rigorous regulatory regime and the highbarrier to market entry this poses for new entrants.
In recent years a number of the major international drug regulatory agencies, including the FDA and the European Medicines Evaluation Agency, have started to play an increasingrole in supporting pharmaceutical innovation. New activities such as the FDA's critical pathinitiative explore how new forms of regulatory science and technology used in the drug  2011 The AuthorsSociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd The pharmaceuticalisation of society? approval process can be developed to streamline the route to market. This change in the roleof regulators from guardians of the public health to also having a key role in promotinginnovation has to be set against the background of the continuing productivity crisis in thepharmaceutical industry (Hopkins et al. 2007, Nightingale and Martin 2004) which sees mostof the innovation coming from the small biotech companies rather than the largepharmaceutical multinationals. The latter are facing a crisis as new drugs are not beinglicensed fast enough to replace those whose patents have expired (Law 2006).
At the same time there has been a globalisation of the dominant western regulatory system through such initiatives as the International Conference on Harmonisation, which bringstogether regulators from Europe, Japan and the USA with the aim of creating greaterharmonisation in the interpretation and application of regulatory guidelines for drugdevelopment and approval. There are two main drivers of this expansion of the westernregulatory model: (i) the opening-up of new markets for global pharmaceutical companies tosell their products in emerging economies, such as India; and (ii) the outsourcing ofimportant aspects of the drug development process to developing countries where the costs ofclinical trials are much lower. However, this is not a simple repeat of the drug dumping in the1970s and 1980s, as minimum standards of clinical care and safety are now required to enablethe data collected in non-western clinical trials to be useful for drug approvals in NorthAmerica and Europe. This shift to testing new drugs in developing countries has also beenaccompanied by the globalisation of manufacturing and, to a lesser extent, the process ofdrug discovery itself through investment in new research facilities in countries like China(Kuemmerle 1999).
Mediation: the (re)framing of health problems in the media and popular culture as havinga pharmaceutical solutionEverything these days, it seems, is mediated one way or another. In particular, as the earlierdiscussion of disease mongering suggests, media involvement, witting or unwitting, facilitatesprocesses of pharmaceuticalisation. Wooloshin and Schwartz (2006), for example, in theirstudy of news coverage of restless leg syndrome, suggest the media have been co-opted intodisease mongering about this condition given stories that: (i) exaggerated the prevalence ofthe disease and the need for treatment (with drugs such as ropinirole); and (ii) failed toconsider the problem of over-diagnosis (2006: e170).
Kroll-Smith (2003), too, in a provocative article on the social construction of sleepiness in popular culture, points to the critical role the media now play in processes of medicalisationand, by extension, pharmaceuticalisation: extra-institutional, textually mediated forms ofauthority are cast in the rhetoric of medicine yet are far removed from the traditional doctor–patient relationship.
To the extent, then, that the media, directly or indirectly, are complicit in these processes of disease mongering and in so far as framing problems in this way promotes pharmaceuticalinterests, mediation of this kind is clearly important in relation to pharmaceuticalisation. Themedia, however, are not so much creators or catalysts as conveyors and amplifiers of theseprocesses over time; the drivers of which lie elsewhere. Perhaps the clearest example of this isDTC advertising where the media become effectively a marketing tool in the service ofpharmaceutical interests, alongside other forms of marketing masquerading as education,information or research (Angell 2005). These techniques include the voices of both expertsand patients, as well as celebrity endorsements and offers of symptom based self-testing.
This, in turn, provides diagnostic validity to the condition in question and the proposedpharmaceutical solution on offer – albeit with the proviso, ‘Ask your doctor if [drug x] isright for you'. It also creates the impression that this is a condition that could happen to  2011 The Authors Sociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd Simon J. Williams, Paul Martin and Jonathan Gabe anyone (Conrad 2007: 18), thereby ensuring fertile ground for potential market expansion ofthe kind discussed earlier.
Moreover, as Martin (2006) notes, drugs are imbued with personalities or thought of as person-like, as a key marketing tool alongside tablet or capsule design, and educationalmaterials, all of which are designed to connect with the potential consumer via television orthe printed media. The overwhelming emphasis, especially with psycho-pharmaceuticals, ison whether they ‘can make the consumer a better person, an enhanced person, or … morelike the person they really are without the interference of mental disorder, (Martin 2006: 276,see also Rose 2007).
The media, nonetheless, are no mere puppets of pharmaceutical interests. Media coverage of pharmaceuticals may be contradictory or condemnatory, oscillating between oppositionalextremes of both idealisation on the one hand, and demonisation on the other (Seale 2002). Atemporal pattern may be discerned here, with early media coverage of new drugs such asProzac and Viagra being largely uncritical if not celebratory in tone and content. If or whenunwelcome side effects become apparent, however, or misuse of some kind (by doctors,patients or consumers) is detected, then negative or critical portrayals soon follow. This isclearly demonstrated by the changing media coverage of benzodiazepines over time (Gabeand Bury 1996b). Rarely, it seems, do the media present a balanced portrayal of the risks andbenefits contained in a single substance (Seale 2002: 148): doubtless as a product, in part, ofthe imperative for newsworthy stories.
Clearly then, evidence can be found in which the media both promote and challenge pharmaceutical products and interests. This, moreover, includes critical stories or mediaexpose´s about the interests and activities of drug companies, which raise questions ofneoliberal corporate bias (see above) and disease mongering (see above).
Other so-called new media are also important to consider here, not simply in terms of access to pharmaceutical information or support via the Web, but in terms of the purchase ofpharmaceutical products online, thereby effectively bypassing the traditional doctor–patientrelationship. Fox and Ward (2009), for example, in their study of the pharmaceuticalisationof daily life, identify two broad processes at work. These are: first, a domestication ofpharmaceutical consumption through computer-mediated access and consumption inthe home, particularly in the bedroom (e.g. Viagra and Cialis for sexual potency) and thekitchen (for example, Xenical, Alli and Apidex for weight loss); and second, thepharmaceuticalisation of everyday life, as pharmaceuticals are treated as magic bullets for arange of day-to-day life problems. As with other media, however, these processes are farfrom straightforward. Indeed, the internet may provide both new channels for thepharmaceuticalisation of daily life (Fox et al. 2005a) and new spaces or forums forchallenging or reworking prevailing understandings and practices. This is clearlydemonstrated in the case of pro-anorexia websites (Fox et al. 2005b).
In all these diverse ways, then, we can speak of the mediation of pharmaceuticals in which the media fills both celebratory and critical roles in the process of pharmaceuticalisation. Theinternet, in particular, may represent a new forum for resistance of various kinds but weshould not underestimate the extent to which this supposedly democratic new digital mediumsimply reproduces existing power relations and opportunities for the medicalisation andpharmaceuticalisation of everyday life.
Patients, consumers and the life world: the creation of new social identities and themobilisation of patient or consumer groups around drugsIt is one thing to map these macro-level processes to do with the regulation of medicines andrelated questions of market expansion and mediation but this of course gives rise to further  2011 The AuthorsSociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd The pharmaceuticalisation of society? important questions about the role of patients or consumers in these processes of (de-)pharmaceuticalisation. Much has been written in recent years about the increasingly active, ifnot critical, role patients and consumers play in their own healthcare. Previous sociologicalwork on the meaning and use of medicines (for example, Gabe and Lipshitz-Phillips 1984,Williams and Calnan 1996) has been joined by a variety of other recent work in whichattention has increasingly focused on users of pharmaceuticals as knowledgeable reflexiveactors, assessing risks and benefits and making informed choices about their treatment(Stevenson et al. 2002, 2009). These developments, in turn, are reflected and reinforcedthrough current health policies in both the USA and the UK that construct patients asexperts, particularly the chronically ill, working in partnership with healthcare professionals(Taylor and Bury 2007). Furthermore, there have been attempts to reclassify someprescription-only medicines as over-the-counter (OTC) (House of Commons 2005), andpolicies to make the arrangements for the prescribing and supplying of medicines moreflexible, including delimited prescribing by nurses and pharmacists (Weiss and Sutton 2009).
And these in turn chime with broader trends towards a knowledge-based society in whichhealth-related information and products are readily available on-line at the click of a mouse(Nettleton et al. 2005).
On the one hand the rise of the articulate or information rich consumer, and associated forms of patient expertise, suggest the potential for various challenges or forms of resistanceto pharmaceuticalisation. On the other hand, however, these developments may themselvesfuel or facilitate further processes of pharmaceuticalisation, including patient-driven demandfor pharmaceuticals (of which more in the next section of this article), with or without the aidof DTC advertising and other forms of ‘marketing' on the part of the pharmaceuticalindustry. Certainly there is evidence, as we have already seen, of new forms ofpharmaceutical consumption through computer-mediated access which effectively bypasstraditional patient-professional relations and existing forms of governance (Fox and Ward2009, Fox et al. 2007, Seale 2005). This in turn suggests that consumerism is an importantdriver of pharmaceuticalisation, with or without the aid of professional input or industryinfluence.
As with all other areas of consumerism in health care, however, professional expertise of various kinds is still valued in people's decision-making regarding medicines, even in cases ofOTC products – see for example Stevenson et al.'s (2009) recent study of consumerengagement with pharmacists regarding OTC medicines. In keeping with medicalisationtherefore, these processes of pharmaceuticalisation, including the recourse to pharmaceuticalexpertise, amount to what, in Habermasian terms, may be viewed as the ‘colonisation of thelife world' (see, for example, Scambler 2006).
Related questions arise regarding not simply the implications of these processes for individual subjectivity or selfhood (cf. Rose 2007) but the multiple ways in which patientsand consumers of medicines act collectively to represent their interests as members of self-help groups, patient advocacy organisations or health social movements in the public sphere(Brown et al. 2004, Gibbon and Novas 2008, Kelleher 2004). These issues are furthercomplicated when some of these groups, with pharmaceutical company support, press forearly access to as yet unlicensed medicines while others demand that pharmaceuticalcompanies remove what they claim to be unsafe drugs from the market. Overall, theapparent power of patient activism or collective consumer mobilisation may therefore‘significantly depend on whether it is supporting or contravening the fundamental interests ofthe pharmaceutical industry' (Abraham 2009a: 113). This may go some way to explaining theapparent meagre success of citizen activism in battles against pharmaceutical companies overdrug injury to patients, compared with the success of patient groups seeking access to drugs  2011 The Authors Sociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd Simon J. Williams, Paul Martin and Jonathan Gabe in alliance with pharmaceutical manufacturers (Abraham 2009a). The latter includes recenthigh-profile cases, attracting considerable media attention, of demands to obtain new drugson the National Health Service for breast cancer (Herceptin), multiple sclerosis (BetaInterferon) and (early onset) Alzheimer's disease (Aricept).
Whether or not such success amounts to the industry ‘capture' of consumer groups' agendas is a subject of ongoing debate. Jones (2009), for example, in her recent research onhealth consumer groups and the pharmaceutical industry in the UK, finds little to confirmthe notion of industry capture. Further questions also arise here, however, regardingpharmaceutical companies' attempts to educate or inform patients and consumers and theirconvergence with expert patient agendas. ‘Expert patient' discourses have proved particularlyuseful in various pharmaceutical campaigns on this front, both in countries where DTCadvertising is permitted and in others, as in Europe, where it is not. Appeals to expertpatients serve a dual purpose: legitimising pharmaceutical education campaigns on the onehand, while challenging the ban on DTC advertising by characterising patients as informedconsumers about drugs on the other hand. Viewed in this more critical light the industry, itappears, wishes to ‘use patients as a means of de-regulation and market expansion, withoutregard to wider health interests' (Abraham 2009a: 114).
It therefore appears that trends toward consumerism in healthcare and associated developments such as the expert patient programme, in the main are congruent with, ratherthan a challenge to, the interests of the pharmaceutical industry. Indeed, patients andconsumers may actively and willing collaborate in processes of pharmaceuticalisation,particularly when much needed treatments are sought. Any increase in the critical reflexivityand expertise of consumers, moreover, needs setting in the context of a ‘medical association–industry–government complex', which as Abraham contends, is ‘in the interests of thepharmaceutical industry, and at the expense of consumer ⁄ patient interests' (2009a: 112,Abraham and Lewis 2002). While patient or consumer challenges are still possible, and whileindustry capture of consumer group agendas remains a topic of ongoing debate, the powerand influence of the pharmaceutical industry is clearly extensive and should not beunderestimated.
From treatment to enhancement? The use of drugs for non-medical purposes and thecreation of new consumer marketsThese discussions of consumerism in turn mesh with another important set of developmentsregarding the pharmaceuticalisation of everyday life in the guise of drugs for enhancementpurposes among healthy people. The desire to improve ourselves in one way or another, ofcourse, is as old as human history. What has changed, however, are the means of doing so,including the use of pharmaceuticals. Enhancement itself, however, remains a contested term,not least because it is frequently employed to denote going beyond treatment or health tobecome ‘better than well' (Elliot 2003): distinctions which themselves are socially constructedand changeable over time. What constitutes a disease or disorder worthy of treatment andwhere to draw the line between these forms of therapy and other forms of enhancementamongst healthy people is no simple matter.
Conrad (2007), for example, usefully refers to three main types of biomedical enhancement: firstly, normalisation, where biomedical enhancements are used to bring thebody in line with what doctors or patients deem to be normal or with socially expectedstandards; secondly, repair, in which biomedical interventions are used to restore orrejuvenate the body to its previous condition; and thirdly, augmentation, in order to improveor boost life performance in ways that confer the user with a competitive edge (2007: 87–9).
Context, of course, is also important to consider in the sense that the very notion of  2011 The AuthorsSociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd The pharmaceuticalisation of society? enhancement inheres ‘not in the biomedical composition of the intervention, but in when andhow it is used' (Conrad 2007: 89). Enhancement, moreover, represents a social temptation ina culture that values ‘bigger, faster and more' and where competitive difference amongstotherwise similar individuals offers personal advantage and social rewards for those whohave ‘an edge' (Conrad 2007: 89).
These issues are particularly important for our purposes, as they shed further valuable light on both the drivers and dynamics of pharmaceuticalisation and its relationship tomedicalisation. Not all forms of enhancement are for non-medical purposes, as the forgoingdiscussion of enhancement as normalisation or repair indicates. The medical profession,moreover, is now involved in many forms of enhancement, including cosmetic surgery andthe use of some prescribed medicines (such as human growth hormone) for enhancementpurposes. Pharmaceuticalisation nonetheless may occur in the absence of any significantdegree of medicalisation, or medical involvement, as in the case, for example, of the non-medical use of pharmaceuticals amongst healthy people for enhancement purposes.
One issue attracting considerable attention on this count at the moment is the promise of a new era of cognitive enhancement drugs designed to boost alertness, concentration, memoryand other aspects of cognitive functioning. A flurry of recent reports and articles has emergedin response to these developments, in which the ethical, legal and social implications ofcognitive enhancement drugs and the degree to which they should be regulated loom large(Academy of Medical Sciences 2008, British Medical Association 2007, Office of Science andTechnology 2005). Consider, for example, a recent controversial commentary, provocativelyentitled ‘Toward responsible use of cognitive enhancing drugs by the healthy', whichappeared in Nature (Greely et al. 2008). Many drugs used to treat psychiatric andneurological conditions such as methylphenidate (attention deficit hyperactivity disorder),Ritalin and Aricept (Alzheimer's) and modafinil (narcolepsy), it is noted, also improvecognitive performance amongst the healthy and are being re-marketed for this purpose,particular on ‘university campuses around the world' (Greely 2008: 702). Cognitiveenhancement, these authors state, has ‘much to offer individuals and society', includingextending work productivity and delaying normal and pathological age-related cognitivedecline. A ‘proper societal response', therefore, they conclude ‘will involve makingenhancements available while managing their risks' (2008: 702).
Given neither the medical nor the social risks of such cognitively enhanced futures are understood at present, caution is indeed needed here when evaluating the use of such drugsamongst healthy people (Williams and Martin 2008). Critically, attempts to reconstruct theuse of medicines as enhancement can be understood as another example of the move tocreate new drug markets through direct relationships with consumers that lie outside thecontrol of the medical profession. The prospect of cognitive enhancement, therefore, clearlydemonstrates pharmaceuticalisation and the ways in which any such pharmaceuticalisation may take usbeyond medicalisation.
Pharmaceutical futures in the making: drug innovation and the colonisation of healthfuturesOur sixth and final set of issues concerns questions of innovation, imagination and themaking of pharmaceutical futures. Recent work in the sociology of expectations has drawnattention to the key role of the future in shaping the present. In particular, it highlights thedynamic role that expectations play in attracting support and investors and buildingmutually binding obligations or communities of hope or promise (Brown 2003, van Lente1993). It also shows how these expectations differ between various groups or stakeholders  2011 The Authors Sociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd Simon J. Williams, Paul Martin and Jonathan Gabe (such as scientists, the industry, consumers, policy communities, patients and publics), andhow the futures envisaged are contingent, contested and fought over (Brown and Michael2003, Hedgecoe and Martin 2003). In the process this work emphasises the considerablehope that patients, both individually and collectively, invest in future pharmaceuticalbreakthroughs in the treatment of their conditions (Novas 2006).
Take, for instance, the field of pharmacogenetics and pharmacogenomics (that is, the use of genetic or genomic knowledge to predict drug reactions). This field has engendered muchspeculation about a new era of personalised or tailor-made medicine with prevention andtreatment geared to an individual's genetic profile. This, in turn, holds the promise of greatlyreducing adverse drug reactions that are commonly associated with current one-size fits allinterventions. In addition, by targeting drugs at particular genotypes it is argued that theeffectiveness of treatment will be enhanced.
Such pharmaceutical innovation also forms the basis for much policy planning and the imagining of future healthcare scenarios (Department of Health 2003). In this waypharmacogenetics can be thought of as colonising the future and crowding out otheralternative paths for development. This pharmaceuticalisation of the future may help tomaintain the hegemony of a dominant biomedical discourse that constructs investment andinnovation in the search for new medicines as the best way of improving human health.
However, the reality of how new pharmaceutical technologies are translated into practice israther more complex.
Certainly, pharmacogenetic data of the kind described above is now feeding into all stages of the research and development process (Webster et al. 2004). At present, however, progressremains slow and uneven and there appears to be little evidence of widespread benefits of thekind envisaged by these expectations (Hopkins et al. 2007: 8). At the same time thesedevelopments have generated a range of concerns from diverse constituencies, includingpotential worries about over-segmented (that is, unprofitable) markets, the proliferation ofgenetic testing and the racial politics they stimulate (Hedgecoe 2004, Hedgecoe and Martin2003). Even the very notion of personalised medicine is something of a misnomer (that is, it isneither especially personalised nor tailor-made). It is also important to bear in mind that theclinical acceptability and utility of genomic-based therapies has to be placed in the context ofparticular regimes of treatment and practice. For example, Barr and Rose (2009) found intheir study of the pharmacogenomics of antidepressant medications that there wasconsiderable ambivalence regarding the use of antidepressant medication amongst patientswith depression and a commonplace tendency to conflate a pharmacogenomic test forantidepressant medication with a genetic test for depression.
Furthermore, despite much talk of a medicinal biotechnology revolution, in which pharmaceutical innovation looms large, evidence drawn from a variety of empiricalindicators highlights a major productivity crisis in the industry (Hopkins et al. 2007,Nightingale and Martin 2004). Despite the rise in potential drug targets flowing fromgenomics, a very significant increase in research and development expenditure since the1970s, and the aforementioned neoliberal acceleration of regulatory approval times over thepast 20 years, pharmaceutical innovation has actually been static or declining world wideover the past two decades (as measured by the number of new chemical entities approved in agiven year, or the number of new patented drug compounds launched on the world market)(Hopkins et al. 2007, Law 2006). This is not to say that biotechnology will not deliver onthese counts in the future. However, rather than producing revolutionary changes, medicinalbiotechnology appears to be following a well-established path of slow, incrementaltechnological diffusion (Nightingale and Martin 2004). Caution, at the very least, is therefore  2011 The AuthorsSociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd The pharmaceuticalisation of society? needed with respect to the pharmaceutical present if not to pharmaceutical futures inthe making.
Viewed in this light, then, one may perhaps be forgiven for asking why the belief in the biotechnology revolution remains so influential. Expectations, in part at least, provide theanswer. They are critical to the very processes of technological change, successful orotherwise. Or, to put it more strongly, the claims underpinning the biotechnology revolutionmay best be viewed as ‘rhetorical devices employed to generate the necessary political, socialand financial capital to allow perceived promise to emerge' (Hopkins et al. 2007: 21).
Sociologists and other social scientists studying these processes, moreover, are far frominnocent bystanders. Indeed, one of the reflexive messages the sociology of expectationsteaches us is the need to examine our own expectations and their role in the very co-production of the field in question, including the various pharmaceutical futures we professto analyse.
Where then, returning to the questions posed at the beginning of this article, does this leaveus? What is pharmaceuticalisation? Is it a useful sociological term? Why is it important toconsider it now? And what remains to be done in terms of future sociological researchagendas? Pharmaceuticalisation, we have argued, can be understood as a dynamic and complex heterogeneous socio-technical process that is part of the long-term and ongoing constructionof the pharmaceutical regime, including distinct socioeconomic activities and diverse actorssuch as clinicians, patients or consumers and regulators. These activities contribute to theoverall dynamics of pharmaceuticalisation and are part of the ongoing process of thepharmaceutical industry, extending its power and reach. The extent of pharmaceuticalisationwill therefore vary from case to case and depends on the context and the interplay betweenparticular sets of actors in any one case.
Six key sociological dimensions of pharmaceuticalisation have been identified as a framework for analysis, namely: (i) the redefinition or reconfiguration of health problems ashaving a pharmaceutical solution; (ii) the changing relationship between state regulatoryagencies and the pharmaceutical industry; (iii) the mediation of pharmaceuticals in popularculture and daily life; (iv) the creation of new techno-social identities and the mobilisation ofpatient or consumer groups around drugs; (v) the use of drugs for non-medical(enhancement) purposes and the creation of new consumer markets, and finally; (vi) druginnovation and the colonisation of health futures, albeit in an industry plagued by a majorcrisis over productivity and innovation.
Looking over these sociological dimensions of pharmaceuticalisation a number of common features are apparent, notably: a) the expansion of drug markets outside traditionalareas, including new medical indications and conditions, new territories in developingcountries and new applications in healthy individuals; b) the increasing dominance of stateregulatory and public health agendas; c) increasing moves to bypass the dominance of themedical profession through reconstructing the role of patients and consumers and creatingmore direct relationships with these groups; and d) the colonisation of the life world,everyday life and health futures by pharmaceutical solutions. We suggest that, takentogether, these are important recent changes that provide a comprehensive picture ofpharmaceuticalisation that is distinct from medicalisation in important respects and ofparticular relevance to contemporary developments. These changes can be thought of as an  2011 The Authors Sociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd Simon J. Williams, Paul Martin and Jonathan Gabe important shift in the types both of markets and applications targeted by the pharmaceuticalindustry and a transformation in the socio-technical relationships between key actor groups,with industry increasingly dominating regulatory agencies, bypassing medical control andreconstructing the role of patients and consumers. This highlights the analytic value ofpharmaceuticalisation as a specific sociological concept that is of increasing relevance. Inparticular, it is valuable in drawing attention to the work of the pharmaceutical industry asone of the key actors in contemporary biomedicine, providing an analytical framework forempirical and theoretical research and helping to prompt a shift in the gaze of medicalsociology.
It would be wrong, however, to overstate the speed or scope of pharmaceuticalisation. As mentioned in the introduction, the expansion of the pharmaceutical industry and its productsand markets has been happening for over a century, although this has arguably intensified inthe last few decades. Furthermore, as we have stressed, the complex relationship between theindustry, the state and the medical profession places real structural limits on the extent towhich drug companies can operate outside the control of either government or medicine, asboth provide vital sources of legitimation. State sanction through the regulatory processplays a key role in both regulating market entry and ensuring consumer confidence, while themedical profession's role as gatekeeper is rooted in mediating the sick role and regulatingpeople's access to healthcare. Finally, there are important sources of resistance to theexpansion of pharmaceutical markets from the media, government, medicine, patients anddiverse publics thereby making de-pharmaceuticalisation a possibility in principle, ifinfrequent in practice.
We conclude, however, in a more reflexive vein concerning both these sociological engagements with pharmaceuticalisation and our own role in them. To the extent thatsociologists have sought to engage with these matters to date, with or without explicitreference to the notion of pharmaceuticalisation, they have clearly done so from a variety ofdifferent theoretical perspectives, including political economy or realist approaches, elementsof both strong or weak social constructionism, various strands of scholarship in STS andother, more avowedly Foucauldian and Habermasian concerns with questions of governanceand colonisation, respectively.
It is not our intention in this particular article to arbitrate or adjudicate these matters or to provide some sort of grand theoretical synthesis. To do so may well be premature, if notunnecessary, at this particular juncture. To the extent, moreover, that pharmaceuticalisationis a multi-level and multidimensional concept, there is strength or merit in this theoreticaleclecticism. Keeping our theoretical options open, in other words, may well be wise at thispoint. There are also significant opportunities here, through concepts linked to multi-leveland multiple dimensions, such as pharmaceuticalisation, to foster further fruitful linksbetween ongoing work in medical sociology and STS on these matters.
Future research agendas might, therefore, consider a number of key issues, including studies of the role of industry in expanding pharmaceutical markets to cover new diseases,disorders and other non-medical conditions, the changing role of regulatory authorities, thereconstruction of the role of patients and consumers in the development and use of drugs andthe way in which the life world, everyday life and health futures are being colonised bypharmaceutical solutions. In doing so, sociologists must also be reflexive about their own rolein the creation or, to borrow a much favoured term from STS, the co-production of thesevery matters concerning both the pharmaceuticalisation of society to date and the contestedor colonised futures to which they speak.
 2011 The AuthorsSociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd The pharmaceuticalisation of society? Address for correspondence: Simon J. Williams, Department of Sociology, Universityof Warwick, Coventry CV4 7ALe-mail: [email protected] Abraham, J. (2009a) The pharmaceutical industry, the state and the NHS. In Gabe, J. and Calnan, M. (eds) The New Sociology of the Health Service. London: Routledge.
Abraham, J. (2009b) Sociology of pharmaceuticals development and regulation: a realist empirical research programme. In Williams, S.J., Gabe, J. and Davis, P. (eds) Pharmaceuticals andSociety: Critical Discourses and Debates. Oxford: Blackwell.
Abraham, J. (2010) On the prohibition of conflicts of interest in pharmaceutical regulation: precautionary limits and permissive challenges. A commentary on Sismondo and O'Donovanand Lexchin, Social Science and Medicine, 70, 648–51.
Abraham, J. and Davis, C. (2005) Risking public safety: experts, the medical profession and ‘acceptable' drug injury, Health, Risk and Society, 7, 379–95.
Abraham, J. and Lewis, G (2002) Citizenship, medical expertise and the regulatory state in Europe, Sociology, 36, 67–88.
Abraham, J.W. (1995) Science, Politics and the Pharmaceutical Industry. London: University College London Press.
Academy of Medical Sciences (2008) Brain Science, Addictions and Drugs. London: AMS.
Angell, M. (2005) The Truth about Drug Companies. New York: Random House.
Barr, M. and Rose, D. (2009) The great ambivalence; factors likely to affect service user and public acceptability of the pharmacogenomics of antidepressant medication. In Williams, S.J.,Gabe, J. and Davis, P. (eds) Pharmaceuticals and Society: Critical Discourses and Debates.
Oxford: Blackwell.
Blech, J. (2006) Inventing Diseases and Pushing Pills. London: Routledge.
British Medical Association (2007) Boosting Your Brain Power: Ethical Aspects of Cognitive Enhancements. London: BMA.
Brown, N. (2003) Hope against hype: accountability in biopasts, presents and futures, Science Studies, 16, 3–2.
Brown, N. and Michael, M. (2003) A sociology of expectations: retrospecting prospects and prospecting retrospects, Technology Assessment and Strategic Management, 15, 3–18.
Brown, P., Zavestoski, S., McCormick, S., Mayer, B., et al. (2004) Embodied health movements: new approaches to social movements in health, Sociology of Health and Illness, 26, 1, 50–80.
Busfield, J. (2003) Globalization and the pharmaceutical industry revisited, International Journal of Health Services, 33, 581–603.
Busfield, J. (2010) ‘A pill for every ill': explaining the expansion in medicine use, Social Science and Medicine, 70, 931–41.
Clarke, A, Fishman, J., Fosket, J.R., Mamo, L. and Shim, J. (2003) Biomedicalization: technoscientific transformations of health, illness and US biomedicine, American SociologicalReview, 68, 161–94.
Conrad, P. (2005) The shifting engines of medicalization, Journal of Health and Social Behavior, Conrad, P. (2007) The Medicalisation of Society. Baltimore: Johns Hopkins University PressConrad, P. and Leiter, V. (2004) Medicalization, markets and consumers, Journal of Health and Social Behavior, 45, 158–76.
Conrad, P. and Leiter, V. (2009) From Lydia Pinkham to Queen Levitra: direct-to-consumer advertising and medicalization. In Williams, S.J., Gabe, J. and Davis, P. (eds) Pharmaceuticalsand Society: Critical Discourses and Debates. Oxford: Blackwell.
 2011 The Authors Sociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd Simon J. Williams, Paul Martin and Jonathan Gabe Conrad, P., Mackie, T. and Mehrota, A. (2010) The costs of medicalization, Social Science and Medicine, 70, 1943–47.
Daemmrich, A. (2004) Pharmacopolitics. Chapel Hill: University of North Carolina.
Department of Health (2003) Our Inheritance, Our Future: Realising the Potential of Genetics in the NHS. UK Government White Paper. London: Department of Health.
Elliot, C. (2003) Better Than Well: American Medicine Meets the American Dream. New York: W.W. Norton.
Fox, N.J. and Ward, K.J. (2009) Pharma in the bedroom … and the kitchen. The pharmaceuticalisation of daily life. In Williams, S.J., Gabe, J. and Davis, P. (eds)Pharmaceuticals and Society: Critical Discourses and Debates. Oxford: Blackwell.
Fox, N.J., Ward, K.J. and O'Rourke, A.J. (2005a) The ‘expert patient': empowerment or medical dominance? The case of weight loss, pharmaceutical drugs and the internet, Social Science andMedicine, 60, 1299–309.
Fox, N.J., Ward, K.J. and O'Rourke, A.J. (2005b) Pro-anorexia, weight-loss drugs and the internet: an ‘anti-recovery' explanatory model of anorexia, Sociology of Health and Illness, 27, 7, 944–71.
Fox, N.J., Ward, K.J. and O'Rourke, A.J. (2007) A sociology of technology governance for the information age: the case of pharmaceuticals, consumer advertising and the internet, Sociology,40, 315–34.
Gabe, J. and Bury, M. (1996a) Halcyon nights: a sociological account of a medical controversy, Sociology, 30, 447–69.
Gabe, J. and Bury, M. (1996b) Risking tranquilliser use: cultural and lay dimensions. In Williams, S. and Calnan, M. (eds) Modern Medicine. London: University College London Press.
Gabe, J. and Lipshitz-Phillips, S. (1984) Tranquillisers as social control? Sociological Review, 32, Garattini, S. and Bertele, V. (2001) Adjusting Europe's drug regulation to public health needs, The Lancet, 358, 66.
Gibbon, S. and Novas, C. (eds) Biosocialities, Genetics and the Social Sciences. London: Goodman, J. and Walsh, V. (1993) Little and Big Heuristics: medicine, chemistry and pharmaceutical production in nineteenth-century Europe. Paper given at Society for the Historyof Technology (SHOT), Conference on Technological Change, Oxford, 8-11 September 1993.
Greely, H., Sahakian, B., Harris, J., Kessler, R.C., et al. (2008) Towards responsible use of cognitive-enhancing drugs by the healthy, Nature, 456, 702–5.
Hedgecoe, A. (2004) The Politics of Personalised Medicine. Cambridge: Cambridge University Hedgecoe, A. and Martin, P. (2003) The drugs don't work: expectations and the shaping of pharmacogenetics, Social Studies of Science, 33, 327–64.
Hopkins, M.H., Martin, P.A., Nightingale, P., Kraft, A., et al. (2007) The myth of the biotech revolution: an assessment of technological, clinical and organisational change, Research Policy,36, 566–89.
House of Commons Health Committee (2005) The Influence of the Pharmaceutical Industry (Fourth Report for Session 2004–5). London: Stationery Office.
IMS Heath (2010) Press releases: IMS health forecasts. Available at http://www.imshealth.com/ portal/site/imshealth (last accessed 6 December 2010).
Jones, K. (2009) In whose interest? Relationships between health consumer groups and the pharmaceutical industry in the UK. In Williams, S.J., Gabe, J. and Davis, P. (eds)Pharmaceuticals and Society: Critical Discourses and Debates. Oxford: Blackwell.
Kelleher, D. (2004) Self help groups and their relationship to medicine. In Kelleher, D., Gabe, J.
and Williams, G. (eds) (2004) Challenging Medicine. 2nd edition, London: Routledge.
Kuemmerle, W. (1999) Foreign direct investment in industrial research in the pharmaceutical and electronics industries – results from a survey of multinational firms, Research Policy, 28, 179–93.
Kroll-Smith, S. (2003) Popular media and ‘excessive sleepiness', Sociology of Health and Illness, 25, 6, 625–43.
 2011 The AuthorsSociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd The pharmaceuticalisation of society? Law, J. (2006) The Big Pharma. London: Constable and Robinson.
Lexchin, J. (2006) Bigger and better: how Pfizer redefined erectile dysfunction, Public Library of Science Medicine, 3, e132.
Martin, E. (2006) The pharmaceutical person, Biosocieties, 1, 273–88.
Moynihan, R. (2002) Disease-mongering: how doctors, drug companies, and insurers are making you feel sick, British Medical Journal, 324, 923.
Moynihan, R. and Cassels, A. (2005) Selling Sickness. New York: Nation Books.
Moynihan, R. and Henry, D. (2006) The fight against disease mongering: generating knowledge for action, Public Library of Science Medicine, 3e, 191.
Nettleton, S., Burrows, R. and O'Malley, L. (2005) The mundane realities of the everyday lay use of the internet for health, and their consequences for media convergence, Sociology of Healthand Illness, 27, 7, 972–92.
Nightingale, P. and Martin, P.A. (2004) The myth of the biotech revolution, Trends in Biotechnology, 22, 564–69.
Novas, C. (2006) The political economy of hope: patients' organizations, science and biovalue, Biosocieties, 1, 289–305.
Office of Science and Technology Department of Trade and Industry (2005) Drugs Futures 2025.
London: DTI.
Rose, N. (2007) The Politics of Life Itself. Princeton: Princeton University Press.
Scambler, G. (ed.) (2006) Habermas, Critical Theory and Health. London: Routledge.
Seale, C. (2002) Media and Health. London: Sage.
Seale, C. (2005) New directions for critical internet health studies, Sociology of Health and Illness., 27, 4, 515–40.
Stevenson, F., Britten, N., Barry, C., Bradley, C. and Barber, N. (2002) Perceptions of legitimacy: the influence on medicine taking and prescribing, Health, 6, 85–104.
Stevenson, F., Leontowitsch, M. and Duggan, C. (2009) Over-the-counter medicines: professional expertise and consumer discourses. In Williams, S.J., Gabe, J. and Davis, P. (eds)Pharmaceuticals and Society: Critical Discourses and Debates. Oxford: Blackwell.
Taylor, D. and Bury, M. (2007) Chronic illness, expert patients and care transition, Sociology of Health and Illness, 29, 1, 27–45.
Teifer, L. (2006) Female sexual dysfunction: a case study of disease mongering and activist resistance, Public Library of Science –Medicine, 3, e.178.
Van Lente, H. (1993) Promising Technology: the Dynamics of Expectations in Technological Development. Enschede: University of Twente.
Webster, A., Martin, P.A., Lewis, G. and Smart, A. (2004) Integrating pharmacogenetics into society: in search of a model? Nature Reviews Genetics., 5, 663–69.
Weiss, M.C. and Sutton, J. (2009) The changing nature of prescribing, Sociology of Health and Illness, 31, 3, 406–21.
Williams, S.J. and Calnan, M. (eds) (1966) Modern Medicine: Lay Perspectives and Experiences.
London: University College London Press.
Williams, S.J. and Martin, P.A. (2008) Risks and benefits may turn out to be finely balanced, Nature, 457, 532.
Williams, S.J., Seale, C., Boden, S., Lowe, P., et al. (2009) Waking up to sleepiness: modafinil, the media and the pharmaceuticalisation of everyday ⁄ night life. In Williams, S.J., Gabe, J. andDavis, P. (eds) Pharmaceuticals and Society: Critical Discourses and Debates. Oxford: Blackwell.
Woloshin, S. and Schwartz, L.M. (2006) Giving legs to restless legs: a case study of how the media help make people sick, Public Library of Science Medicine, 3, e170–8.
 2011 The Authors Sociology of Health & Illness  2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd

Source: http://qmplus.qmul.ac.uk/pluginfile.php/158638/mod_book/chapter/3338/Williams%20pharmaceuticalisation%20of%20society%20SHI2011.pdf