Bowra Andrea, Perez-Brumer Amaya, Forman Lisa, Kohler Jillian Clare
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
Global Health. 2025 Aug 12;21(1):45. doi: 10.1186/s12992-025-01140-5.
Beginning in 1996, Purdue Pharmaceuticals (Purdue) knowingly mislabeled and mass marketed OxyContin (oxycodone), an opioid painkiller, catalyzing the opioid crisis which has been responsible for more than 600 000 deaths in and beyond North America. This case is an extreme example of how transnational pharmaceutical companies prioritize shareholder profits over public wellbeing. As such, the field of global health faces the critical challenge of better understanding how transnational pharmaceutical companies, like Purdue, can be held to account for the harms they cause. Within the framework of Actor-Network Theory, a sociomaterial approach to analyzing complex networks, this case study uses key informant interviews (n = 18) to examine how accountability is taken up in and by global health systems in response to the harms caused by Purdue. Findings highlight the multiple co-existing versions of accountability enacted within global health systems organized as three separate but interrelated networks: social accountability, political accountability, and legal accountability. Though often interconnected, these diverse networks mobilized distinct tools, resources, and strategies, such as news articles, scholarly literature, and policy guidelines, to construct and stabilize enactments of accountability. Through this in-depth examination of the complex interactions involved in global health and pharmaceutical systems, this study offers a nuanced understanding of the diverse actors mobilized and the unique strengths leveraged within and by accountability networks. Further, in examining these networks' differences, interconnectedness, and peculiarities, we broaden the scope of how accountability is defined, conceptualized, and operationalized in global health systems.
从1996年开始，普渡制药公司（Purdue）故意对阿片类止痛药奥施康定（羟考酮）进行错误标注并大规模营销，引发了阿片类药物危机，这场危机已导致北美及其他地区超过60万人死亡。该案例是跨国制药公司将股东利润置于公众福祉之上的极端例子。因此，全球卫生领域面临着一项关键挑战，即更好地理解像普渡这样的跨国制药公司如何为其造成的危害承担责任。在行动者网络理论（一种分析复杂网络的社会物质方法）的框架内，本案例研究通过关键信息人访谈（n = 18）来考察全球卫生系统如何以及由谁来追究普渡造成的危害的责任。研究结果凸显了在全球卫生系统中作为三个独立但相互关联的网络而制定的多种并存的问责版本：社会问责、政治问责和法律问责。尽管这些网络通常相互关联，但它们动员了不同的工具、资源和策略，如新闻文章、学术文献和政策指南，来构建和稳定问责的实施。通过对全球卫生和制药系统中复杂相互作用的深入研究，本研究对动员的不同行为者以及问责网络内部和所利用的独特优势提供了细致入微的理解。此外，在研究这些网络的差异、相互联系和特殊性时，我们拓宽了全球卫生系统中问责如何定义、概念化和实施的范围。
