The Medication Cycle

1. The Medication Cycle SSHRC Interdisciplinary Major Projects Team Catherine Garnier

2. The Medication Cycle Objectives • 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. • To draw up and develop an interdisciplinary model of the medication cycle.

3. Pharmaceutical industry Media Distributor Government 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

4. Knowledge Regulation Marketing Consumption Development Interrelations Use

5. How do the systems of social representations, practices and communication, as they relate to each other, make use of the different typesof 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

6. 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

7. 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

8. 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 drugs—more particularly antiangiogenics, psychotropics and insulin—transformed 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 Ritalinand with it abuses such as addiction and racketeering. Knowledge Regulation Marketing Consumption Development Interrelation Use

9. Model Building & Integration of Results Level 2 Knowledge Regulation Marketing Consumption Development Interrelation Use

10. 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

11. 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.

12. 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-research 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)

13. 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.