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制药致癌风险评估的勇敢新世界中的科学、政治和健康:技术进步还是监管俘获的循环?

Science, politics, and health in the brave new world of pharmaceutical carcinogenic risk assessment: technical progress or cycle of regulatory capture?

机构信息

Department of Sociology, University of Sussex, Brighton, UK.

出版信息

Soc Sci Med. 2012 Oct;75(8):1433-40. doi: 10.1016/j.socscimed.2012.04.043. Epub 2012 Jun 28.

Abstract

The carcinogenicity (cancer-inducing potential) of pharmaceuticals is an important risk factor for health when considering whether thousands of patients on drug trials or millions/billions of consumers in the marketplace should be exposed to a new drug. Drawing on fieldwork involving over 50 interviews and documentary research spanning 2002-2010 in Europe and the US, and on regulatory capture theory, this article investigates how the techno-regulatory standards for carcinogenicity testing of pharmaceuticals have altered since 1998. It focuses on the replacement of long-term carcinogenicity tests in rodents (especially mice) with shorter-term tests involving genetically-engineered mice (GEM). Based on evidence regarding financial/organizational control, methodological design, and interpretation of the validation and application of these new GEM tests, it is argued that regulatory agencies permitted the drug industry to shape such validation and application in ways that prioritized commercial interests over the need to protect public health. Boundary-work enabling industry scientists to define some standards of public-health policy facilitated such capture. However, as the scientific credibility of GEM tests as tools to protect public health by screening out carcinogens became inescapably problematic, a regulatory resurgence, impelled by reputational concerns, exercised more control over industry's construction and use of the tests, The extensive problems with GEM tests as public-health protective regulatory science raises the spectre that alterations to pharmaceutical carcinogenicity-testing standards since the 1990s may have been boundary-work in which the political project of decreasing the chance that companies' products are defined as carcinogenic has masqueraded as techno-science.

摘要

当考虑是否应该让成千上万的药物试验患者或市场上数以百万计/数十亿的消费者接触新药时,药品的致癌性(致癌潜力)是健康的一个重要风险因素。本文借鉴了 2002 年至 2010 年间在欧洲和美国进行的 50 多次访谈和文献研究,并基于监管俘获理论,调查了自 1998 年以来,药品致癌性测试的技术监管标准发生了哪些变化。本文重点关注的是用涉及基因工程小鼠(GEM)的短期测试替代长期的啮齿动物(尤其是小鼠)致癌性测试。基于有关财务/组织控制、方法设计以及对这些新 GEM 测试的验证和应用的解释的证据,本文认为监管机构允许制药行业以优先考虑商业利益而非保护公共健康的必要性的方式来塑造这种验证和应用。使行业科学家能够定义一些公共卫生政策标准的边界工作促进了这种俘获。然而,随着 GEM 测试作为通过筛选致癌物来保护公共健康的工具的科学可信度变得不可避免地存在问题,声誉问题促使监管机构对行业构建和使用这些测试进行更多控制。由于 GEM 测试作为保护公共健康的监管科学存在广泛问题,因此 20 世纪 90 年代以来对药品致癌性测试标准的修改可能是一种边界工作,在这种边界工作中,降低公司产品被定义为致癌物质的机会的政治项目伪装成技术科学。

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本文引用的文献

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