The Medication Cycle

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The Medication Cycle

• SSHRC Interdisciplinary Major Projects Team

Catherine Garnier
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The Medication Cycle
Objectives

1. To analyze the dynamics of the medication cycle
   from development through consumption by studying
   the systems of representations, social practices
   and communications that operate within it .

2. To identify consensual, conflict and risk
situations related to medications by exploring
the fields of the circulation of knowledge,
official and unofficial regulations, the
interrelations of groups of social actors, and
use.

1. To draw up and develop an interdisciplinary model
   of the medication cycle.

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Pharmaceutical industry Media Distributor Governme
nt
Researchers Clinician Financial system
Representation Communication Practice
Representation Communication Practice
Physicians Patients/Consumers Patient
groups Pharmacists Families
Representation Communication Practice
Knowledge
Regulation
Marketing
Consumption
Development
Interrelations
Use
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Knowledge
Regulation
Marketing
Consumption
Development
Interrelations
Use
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How do the systems of social representations,
practices and communication, as they relate to
each other, make use of the different types of
knowledge circulating through the medication
cycle?
Medications anticancer drugs, antibiotics,
antihypertensives General questions

• In the case of antibiotics, what effect does the
  diversity of knowledge have on issues of
  overprescription and overconsumption?

For example, in the case of antihypertensives,
there is a disconnection between knowledge and
experience of the disease, resulting in drugs
being taken irregularly.
Knowledge
Regulation
Marketing
Consumption
Development
Interrelation
Use
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What is the linkage between the explicit and
implicit rules that apply to drugs as they relate
to different points in the medication cycle and
to groups of actors, their interests, and their
place in the cycle in the three countries
selected (France, Germany, Quebec)?
Medications anticancer drugs, analgesics,
anti-inflammatories General questions

• What is the relationship between economic and
  legislative factors in the marketing of new
  drugs, such as new anti-inflammatories that are
  more expensive but no more effective than the old
  ones?

For example, Vioxx and the chaotic situation
between the various authorities responsible for
the regulations and their application.
Knowledge
Regulation
Marketing
Consumption
Development
Interrelations
Use
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How are social representations (menopause,
impotence, death) linked to the communications
practices established over the course of the
interrelations between actors with regard to
hormone therapy, Viagra and antiangiogenics?

• What is the scope of the relationship systems
  (e.g., social-support networks), and what effect
  do these systems have on professional practices?

Medications anticancer drugs, hormone therapy,
sildenafil (Viagra) General questions
For example, in the case of hormone therapy,
following recent studies, there is a tendency to
acknowledge the necessity for the various actors
(women, physicians, the pharmaceutical industry)
to become real partners.
Knowledge
Regulation
Marketing
Consumption
Development
Interrelations
Use
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Given the controversies in North America and
Europe over the use of Ritalin and the drug
escalation that currently obtains, what are the
representations of Ritalin among the stakeholders
in France and Quebec?

• How, following actor-based approaches, are
  systems of representations of the uses of
  drugsmore particularly antiangiogenics,
  psychotropics and insulintransformed from one
  point to another of the cycle?

Medications anticancer drugs, psychotropics,
insulin General questions
For example, recourse to medication for ADHD
tends to increase the prescription of Ritalin and
with it abuses such as addiction and
racketeering.
Knowledge
Regulation
Marketing
Consumption
Development
Interrelation
Use
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Model Building Integration of Results
Level 2
Knowledge
Regulation
Marketing
Consumption
Development
Interrelation
Use
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Sociology/Anthropology Cohen, David Dorval,
Michel Lévy, Joseph-Josy Maisonneuve,
Danielle Niquette, Manon Perron, Michel
Pierret, Janine van der Geest, Sjaak
Veillette, Suzanne
Biology Barthomeuf, Chantal Beaulac-Baillargeon,
Louise Béliveau, Richard Legault, Jean Lussier,
Marie-Thérèse Sidani, Souraya
Advisory Committee  Serge Moscovici Guy
Rocher Reine Larose Harold Kalant
Lists of Researchers
Psychology Bataille, Michel Dufort, Francine
Doise, Willem Jacquet-Mias, Christine Piaser,
Alain Proulx, Robert Scheibler-Meissner, Petra

Administrative Sciences Crémieux, Pierre-Yves
Ebrahimi, Mehran Merrigan, Philip Saives,
Anne-Laure Turcotte, Marie-France
Philosophy/History/Ethics Keel, Othmar Robert,
Serge A. Somerville, Margaret A
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Education
Students

• 53 masters students
• 62 doctoral students
• (including Mathieu Gagné and Claude Giroux at
  Laval University, Luc Guerreschi, Chantal
  Ouellet, Claude Richard, Christine Thoër-Fabre)
• 2 postdoctoral students.

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Education
Methods

• Integration into research projects
• Integration into educational programs
• Multimedia courses (Faculty of Social Studies,
  social and cultural representations)
• Project to create a short interdisciplinary-resear
  ch training program at the graduate level
• Summer school medications and research methods
• Integration into scientific output
• Publications with student participation (15
  articles and 3 books)
• International Conference on Pharmaceutical Drugs
  Fairmont Queen Elizabeth Hotel, August 29 to
  September 2, 2005 (information
  www.geirso.uqam.ca)

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Features of the research program

• International
• Three sites Quebec (Quebec City, Montreal,
  Chicoutimi), France (Toulouse), Germany
  (Oldenburg).
• Interdisciplinary
• 17 universities
• 19 different disciplines.
• Holistic
• Current events highlight the critical need to
  consider the complexity of medications
• The different issues and interests in the
  scientific disciplines make attaining this
  objective difficult.

Conclusion
Despite this difficulty, the Major Projects on
the Medication Cycle program seeks a break with
the opposing viewpoints of the disciplines to
foster instead the deeper development of the
integrated model of the medication cycle.