Abstract

This article analyses the role of the pharmaceutical and medical device industries (‘pharma’) in the construction of scientific and medical knowledge. Pharma's activities are part of the broader dispositif of institutions, enterprises, regulations and constituencies within which medical-scientific knowledge is generated, but pharma's contributions exhibit a specific character reflecting commercial pressures. As drug development proceeds, research and marketing activities coalesce around ‘product canons’ that integrate scientific truth-claims and commercial positioning, generating knowledge with implicit commercial functionality. From this platform, pharma stamps consensus-building ‘narratives’ into medical-scientific discourse, in which ‘problems’ arise and are ‘solved’ by drugs. Concurrently, pharma modulates the structure of discourse and the social networks through which discourse proceeds. Implicit within these activities is a meta-science whose goal is to understand and technologize the operation of science to an external end. This mode of knowledge production can be viewed as a normative transformation of Kuhnian normal science, characterized by the attachment (and at times subordination) of paradigmatic tenets to extrinsic goals; exaggerated control of belief, research and consensus formation; and a capacity for infringement of traditional norms of scientific truthfulness. An International Standard of Integrity in Science would strengthen pharma's contributions to medical and scientific knowledge.

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