Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto ON, Canada.
Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto ON, Canada.
Int J Drug Policy. 2024 Nov;133:104604. doi: 10.1016/j.drugpo.2024.104604. Epub 2024 Oct 19.
The global pharmaceutical industry has a long history of prioritizing profits over public health through widespread practices such as price gouging, deceptive marketing, and fraud. A prominent example of this issue is the mislabeling and mass-marketing of OxyContin by Purdue Pharmaceuticals (Purdue) that catalyzed the opioid crises in and beyond the United States.
Guided by Actor-Network Theory, this case study employs Visual Network Analysis to map the actors-networks involved in responding to the harms caused by Purdue. Data was generated from peer-reviewed and grey literature published between 2007 and 2022 (n = 40) and imported into Gephi visualization software where centrality metrics were applied.
A total of 39 actors and 99 relationships were visualized based on the relational thinking that actors who are heavily interconnected with others are rendered important. Centrality measures identified the socio-technical centrality of Purdue in influencing the response to the harms it caused. Purdue exerted influence through various avenues, most prominently through the creation and cooptation of pain advocacy groups, their close ties with United States elected officials, and through embedding pro-opioid messaging in international guidance documents. In doing so, Purdue was able to extend the reach and impact of their opioid promotion, while simultaneously limiting the capacity of regulatory bodies to pursue accountability and implement policies to mitigate opioid-related harms.
This study advances understandings of the complex interplay between transnational pharmaceutical companies, global health systems, regulatory bodies, and public health. In doing so, we underscore the need for stronger regulation and increased transparency surrounding the interactions between pharma, patient groups, governments, and international organizations to better address and prevent future harms.
全球制药行业通过广泛的做法，如哄抬价格、欺骗性营销和欺诈，将利润置于公共卫生之上，有着悠久的历史。这个问题的一个突出例子是普渡制药公司（Purdue）对羟考酮的错误标签和大规模营销，这催化了美国及其他地区的阿片类药物危机。
本案例研究以行动者网络理论为指导，采用可视化网络分析方法绘制了应对普渡制药公司造成的危害的行动者网络。数据来自 2007 年至 2022 年期间发表的同行评议和灰色文献（n=40），并导入 Gephi 可视化软件，应用中心度指标。
根据行动者之间相互关联程度决定其重要性的关系思维，共可视化了 39 个行动者和 99 个关系。中心度测量确定了普渡制药公司在影响其造成的危害的应对措施方面的社会技术中心地位。普渡制药公司通过多种途径施加影响，最突出的是通过创建和利用疼痛倡导团体、与美国当选官员的密切关系，以及将亲阿片类药物的信息嵌入国际指导文件。通过这种方式，普渡制药公司能够扩大其阿片类药物推广的范围和影响力，同时限制监管机构追究责任和实施减轻阿片类药物相关危害的政策的能力。
本研究增进了对跨国制药公司、全球卫生系统、监管机构和公共卫生之间复杂相互作用的理解。通过这样做，我们强调需要加强监管，提高制药公司、患者团体、政府和国际组织之间相互作用的透明度，以更好地应对和预防未来的危害。
