AN UNHEALTHY ALLIANCE:

 

A DISCOURSE ANALYTIC STUDY OF

GENERAL PRACTITIONERS

AND

PHARMACEUTICAL REPRESENTATIVES,

GIFTS AND SAMPLES

 

 

 

 

 

 

Lynda Caudle B Sc

 

 

 

 

 

This thesis is submitted in partial fulfilment of the requirements for the

Bachelor of Science, Honours Psychology

 

 

Department of Psychology

University of Adelaide

 

October 2001

 

 

Word Count 11,879

 

 

 

 

 

 

 

 

AN UNHEALTHY ALLIANCE:

 

A DISCOURSE ANALYTIC STUDY OF

GENERAL PRACTITIONERS

AND

PHARMACEUTICAL REPRESENTATIVES,

GIFTS AND SAMPLES

 

 

 

 

 

 

Lynda Caudle B Sc

 

 

 

 

 

This thesis is submitted in partial fulfilment of the requirements for the

Bachelor of Science, Honours Psychology

 

 

Department of Psychology

University of Adelaide

 

October 2001

 

 

 

 

 

 

TABLE OF CONTENTS

 

 

ABSTRACT                                                                                                               iv

DECLARATION                                                                                                      vi

ACKNOWLEDGEMENTS                                                                                     vii

 

 

CHAPTER ONE:    INTRODUCTION                                                                    1          1.1            Pharmaceutical Promotion

1.1.1.      General Overview

1.1.2.      The Influence of Pharmaceutical Promotion on Prescribing

1.2            Medical Ethics

1.3              Ethical Dilemmas

 

CHAPTER TWO:    METHODOLOGY                                                                  22

            2.1            Discourse Analysis

2.2              Collection of Data

2.3              Analysis Procedure

2.4              Methodological Issues

2.5              Analysis Outline

 

CHAPTER THREE:           ANALYSIS AND DISCUSSION                                               30

            3.1            The ‘Business’ Repertoire

            3.2            The ‘Information/Knowledge’ Repertoire

            3.3            Discussion

 

REFERENCES                                                                                                            59

 

APPENDICES:                                                                                                           67

A:            Information Letter                                                                                

B:            Consent Form                                                                                     

C:            Focus Group Information Sheet                                                   

D:            Focus Group Questions and Issue Statements                               

E:            Transcript Notation                                                                             

F:            MaLAM                                                                                            

G:            AMA Position Statement: Code of Ethics                                     

H:            ‘Business’ Repertoire Extracts                                                              76

I:            ‘Information/Knowledge’ Repertoire Extracts                                      81

Pharmaceutical promotion has become increasingly sophisticated and influential in changing the prescribing practices of doctors.  The largesse of pharmaceutical companies in their efforts to influence doctors’ prescribing behaviour is wide ranging, from the ubiquitous pens and post-it notes, to ‘knick-knacks’, thermoses, free lunches, exclusive restaurant dinners and other entertainment.  Medical equipment, textbooks, adjunctive medical services, sponsored continuing medical education, symposia travel and accommodation expenses, honoraria and research funding are some of the professional incentives offered.  Pharmaceutical representative visits, together with pharmaceutical company gifts and samples, are primary in influencing doctors’ prescribing habits, especially in preference for new and expensive drugs.  The development of interpersonal and interactive relationships of pharmaceutical representatives with doctors enhances the promotional influence of pharmaceutical companies.  Despite a myriad of empirical studies demonstrating inappropriate and less-rational prescribing, and as well increased costs of prescribing, doctors commonly deny any influence on their prescribing behaviour.  Irrespective of these adverse influences on prescribing, many doctors accept pharmaceutical promotion as commonplace and uncontroverted.  Some doctors however, consider this relationship to be extremely controversial and adverse to the ethical practice of medicine.  In this study, the ways in which general practitioners understand and manage the ethical implications of their involvement with pharmaceutical promotion are examined through the analysis of focus group discussions on pharmaceutical representatives, gifts and samples.  Discursive analysis is made of the common sense ideologies informing and justifying the doctors’ rhetorical constructions of pharmaceutical promotion and medical practice, supplemented by fine-grained analysis of the linguistic and rhetorical devices utilised in their constructions.  The discursive repertoires of ‘Business’ and ‘Information/Knowledge’ emerged from the analysis, and each repertoire is discussed with reference to the supporting extracts of doctors’ talk.  A discursive approach to the countering of each of these repertoires is presented, together with other possible alternative interventions.

 

 

 

 

 

 

 

 

DECLARATION

 

 

 

This thesis contains no material that has been accepted for the award of any other degree or diploma in any university and that, to the best of my knowledge and belief, this thesis contains no material previously published or written by any other person, except where due reference has been made in the text.

 

 

I give consent for this thesis to be made available for photocopying and loan.

 

 

 

 

 

 

 

Lynda Caudle

October 2001

 

 

 

 

 

 

 

 

ACKNOWLEDGEMENTS

 

 

I would like to express my gratitude to my internal supervisor, Martha Augoustinos for her support, comments and revisions.

 

I would also like to thank my external supervisors, Dr Peter Mansfield and Melissa Raven, of Health Skepticism (formerly MaLAM), for their assistance throughout this project.

 

Thank you also to my friends and family for their support throughout this year.