Limits...
Trust and the regulation of pharmaceuticals: South Asia in a globalised world.

Brhlikova P, Harper I, Jeffery R, Rawal N, Subedi M, Santhosh M - Global Health (2011)

Bottom Line: We argue that issues of trust are crucial in reducing the likelihood of appropriate use of medicines.We conclude that the building of trust is a necessary but always vulnerable and contingent process.While it might be desirable to outline steps that can be taken to build trust, the range of conflicting interests in the pharmaceutical field make feasible solutions hard to implement.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Social and Political Science, University of Edinburgh, Edinburgh, UK. rjeffery@staffmail.ed.ac.uk.

ABSTRACT

Background: Building appropriate levels of trust in pharmaceuticals is a painstaking and challenging task, involving participants from different spheres of life, including producers, distributors, retailers, prescribers, patients and the mass media. Increasingly, however, trust is not just a national matter, but involves cross-border flows of knowledge, threats and promises.

Methods: Data for this paper comes from the project 'Tracing Pharmaceuticals in South Asia', which used ethnographic fieldwork and qualitative interviews to compared the trajectories of three pharmaceuticals (Rifampicin, Oxytocin and Fluoxetine) from producer to patient in three sites (north India, West Bengal and Nepal) between 2005-08.

Results: We argue that issues of trust are crucial in reducing the likelihood of appropriate use of medicines. Unlike earlier discussions of trust, we suggest that trust contexts beyond the patient-practitioner relationship are important. We illustrate these arguments through three case studies: (i) a conflict over ethics in Nepal, involving a suggested revised ethical code for retailers, medical representatives, producers and prescribers; (ii) disputes over counterfeit, fake, substandard and spurious medicines, and quality standards in Indian generic companies, looking particularly at the role played by the US FDA; and (iii) the implications of lack of trust in the DOTS programmes in India and Nepal for the relationships among patients, government and the private sector.

Conclusions: We conclude that the building of trust is a necessary but always vulnerable and contingent process. While it might be desirable to outline steps that can be taken to build trust, the range of conflicting interests in the pharmaceutical field make feasible solutions hard to implement.

No MeSH data available.


Key relationships affecting trust in pharmaceutical products in India
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3104379&req=5

Figure 1: Key relationships affecting trust in pharmaceutical products in India

Mentions: Trust can be built when others - not directly involved in a relationship or situation - attest to the trustworthiness of actors or groups of actors, as well as when actors themselves behave in ways that appear to be disinterested. But Mechanic lists several reasons for a declining trend of trust in medical institutions in the US and also in the UK: the influence of television and other media on public opinion, the fragmentation of community, the widespread dissemination of information on political and other violations of public trust, the restructuring of the economy, and the increase in health care provision by for-profit institutions, which present medicine as a marketplace and view patients as consumers [13]. Many of these processes are also visible in India and Nepal, but they impinge upon a system that started with less public confidence and greater reasons for mistrust. But there is a lacuna in this literature, relating to the need to consider the fact that, increasingly, disembedded systems cross national boundaries and resemble global assemblages 'through which global forms of techno-science, economic rationalism, and other expert systems gain significance' [[14]: 3]. How these global processes impact on local trust relationships is one key element of this paper (see Figure 1 for a graphical representation of these relationships).


Trust and the regulation of pharmaceuticals: South Asia in a globalised world.

Brhlikova P, Harper I, Jeffery R, Rawal N, Subedi M, Santhosh M - Global Health (2011)

Key relationships affecting trust in pharmaceutical products in India
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104379&req=5

Figure 1: Key relationships affecting trust in pharmaceutical products in India
Mentions: Trust can be built when others - not directly involved in a relationship or situation - attest to the trustworthiness of actors or groups of actors, as well as when actors themselves behave in ways that appear to be disinterested. But Mechanic lists several reasons for a declining trend of trust in medical institutions in the US and also in the UK: the influence of television and other media on public opinion, the fragmentation of community, the widespread dissemination of information on political and other violations of public trust, the restructuring of the economy, and the increase in health care provision by for-profit institutions, which present medicine as a marketplace and view patients as consumers [13]. Many of these processes are also visible in India and Nepal, but they impinge upon a system that started with less public confidence and greater reasons for mistrust. But there is a lacuna in this literature, relating to the need to consider the fact that, increasingly, disembedded systems cross national boundaries and resemble global assemblages 'through which global forms of techno-science, economic rationalism, and other expert systems gain significance' [[14]: 3]. How these global processes impact on local trust relationships is one key element of this paper (see Figure 1 for a graphical representation of these relationships).

Bottom Line: We argue that issues of trust are crucial in reducing the likelihood of appropriate use of medicines.We conclude that the building of trust is a necessary but always vulnerable and contingent process.While it might be desirable to outline steps that can be taken to build trust, the range of conflicting interests in the pharmaceutical field make feasible solutions hard to implement.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Social and Political Science, University of Edinburgh, Edinburgh, UK. rjeffery@staffmail.ed.ac.uk.

ABSTRACT

Background: Building appropriate levels of trust in pharmaceuticals is a painstaking and challenging task, involving participants from different spheres of life, including producers, distributors, retailers, prescribers, patients and the mass media. Increasingly, however, trust is not just a national matter, but involves cross-border flows of knowledge, threats and promises.

Methods: Data for this paper comes from the project 'Tracing Pharmaceuticals in South Asia', which used ethnographic fieldwork and qualitative interviews to compared the trajectories of three pharmaceuticals (Rifampicin, Oxytocin and Fluoxetine) from producer to patient in three sites (north India, West Bengal and Nepal) between 2005-08.

Results: We argue that issues of trust are crucial in reducing the likelihood of appropriate use of medicines. Unlike earlier discussions of trust, we suggest that trust contexts beyond the patient-practitioner relationship are important. We illustrate these arguments through three case studies: (i) a conflict over ethics in Nepal, involving a suggested revised ethical code for retailers, medical representatives, producers and prescribers; (ii) disputes over counterfeit, fake, substandard and spurious medicines, and quality standards in Indian generic companies, looking particularly at the role played by the US FDA; and (iii) the implications of lack of trust in the DOTS programmes in India and Nepal for the relationships among patients, government and the private sector.

Conclusions: We conclude that the building of trust is a necessary but always vulnerable and contingent process. While it might be desirable to outline steps that can be taken to build trust, the range of conflicting interests in the pharmaceutical field make feasible solutions hard to implement.

No MeSH data available.