Collin Johanne, Otero Marcelo
Sociology and History of Health Sciences, Faculty of Pharmacy, Research Group on Medications as Social Objects (MEOS), University of Montreal, Canada.
Department of Sociology, University of Quebec at Montreal (UQAM), Canada.
Soc Sci Med. 2015 Apr;131:228-38. doi: 10.1016/j.socscimed.2014.12.008. Epub 2014 Dec 3.
Pharmaceuticalisation is a complex phenomenon, co-constitutive of what scholars identify as a pharmaceutical regime, comprised of networks of actors, institutions and artefacts as well as cognitive structures that underlie the production, promotion and use of medications. The aim of this paper is to explore the linkages between different components of this pharmaceutical regime through the analysis of psychotropic drug advertising in Canadian medical journals between 1950 and 1990. Advertisements stand at the nexus of macro-level processes related to the development, regulation and marketing of new drug treatments and of micro-level processes related to the use of these drug treatments, both by clinicians and lay persons. We thus examine advertisements from the angle of the mental and classificatory universes to which doctors were exposed through direct-to-prescriber advertisement strategies implemented during this period. Furthermore, we explore to what extent the rationale behind advertisements was permeated by both scientific/professional and popular narratives of mind-body connections. This paper demonstrates that, although this period was marked by paradigm shifts in the classification of mental diseases, the development of modern psychopharmacology, and the questioning of the scientific legitimacy of psychiatry, advertisements unveil a remarkable continuity: that of the mass management of anxiety-depressive disorders by primary care physicians through psychotropic drugs. Also, despite the effective resistance to specificity as shown by the constant redefinitions of diagnostic categories and therapeutic indications, our analysis suggests that the language of specificity used in the promotion of new drugs and in the various narratives of mind-body connection may have been appealing to general practitioners. Finally, our study of the classes of psychoactive medications that have been in use for over half a century reveals a complex, non-linear dynamic of pharmaceuticalisation and de-pharmaceuticalisation.
药物化是一种复杂的现象，与学者们所认定的药物体系共同构成，该体系由行为者、机构和人工制品网络以及构成药物生产、推广和使用基础的认知结构组成。本文旨在通过分析1950年至1990年间加拿大医学期刊上的精神药物广告，探讨这一药物体系不同组成部分之间的联系。广告处于与新药治疗的开发、监管和营销相关的宏观层面过程以及与临床医生和普通民众使用这些药物治疗相关的微观层面过程的交汇点。因此，我们从医生通过这一时期实施的直接面向开处方者的广告策略所接触到的精神和分类领域的角度来审视广告。此外，我们还探讨了广告背后的基本原理在多大程度上渗透了身心联系的科学/专业和大众叙事。本文表明，尽管这一时期以精神疾病分类的范式转变、现代精神药理学的发展以及对精神病学科学合法性的质疑为特征，但广告揭示了一个显著的连续性：即初级保健医生通过精神药物对焦虑抑郁障碍进行大规模管理的连续性。同样，尽管诊断类别和治疗适应症的不断重新定义显示出对特异性的有效抵制，但我们的分析表明，新药推广中使用的特异性语言以及各种身心联系叙事可能对全科医生具有吸引力。最后，我们对已使用半个多世纪的精神活性药物类别的研究揭示了药物化和去药物化的复杂非线性动态。
