How does a drug with a limited safety and efficacy record become an international blockbuster? In June 2006 the FDA approved and recommended a new vaccine directed against 4 types of sexually transmitted human papillomavirus, associated with 70% of cervical cancer cases and 90% of genital wart cases. Branded as a "cervical cancer vaccine" Gardasil has been met with as much fanfare as controversy, and retains blockbuster status in Merck's portfolio. Sold as a cancer risk-reduction method, Gardasil carries its own risks, with startlingly low efficacy and elevated likelihood of serious adverse events (side effects). Through the lens of risk, this dissertation examines Gardasil's popularity in the face of evidence that it is neither as safe nor as effective as advertised. Through three distinct research projects, I identify (a) five sociological factors responsible for Gardasil's success on the heels of Vioxx, one of the biggest drug scandals in history; (b) how amongst healthy vaccinated girls, cervical cancer is experienced as a "risk object," yet when a young woman experiences a serious adverse event that "object of risk" and her "experience of risk" shift toward Gardasil; and (c) that Gardasil is so trusted among young women, that warnings about potential side effects from others made some girls more likely to get vaccinated and have a positive opinion on the vaccine, suggesting that Gardasil benefits from a broader cultural assumption that vaccines are inherently safe and effective. Physicians and pharmaceutical marketing also play an important role. Gardasil is a risk-reduction drug and vaccine purported to treat risk while it simultaneously creates new risk for further health problems in some consumers. This dissertation contributes to sociological literatures on pharmaceuticalization, pharmaceutical pseudoscience, the social construction of risk, research on regulatory agencies, and the sociology of medicine more broadly.

In Manitoba, as elsewhere, there is a growing trend towards the use of pharmaceuticals and medical technology (pharmaceuticalization) on children and youth in care (C/YIC). As legally mandated guardians and trained experts on children and youth, social workers in Manitoba may play pivotal roles in the decision to medicate C/YIC with psychotropics. Yet there are no studies on Manitoba social workers’ experiences with medicated children/youth or on their perceptions and attitudes towards medicating C/YIC with psychotropics. Using a multilevel Social Structure and Personality analytic, I explored what Manitoba social workers from various fields of practice have to say about this trend. Data consisted of five in-depth interviews and 29 self-completed questionnaires. Findings highlighted that social workers in Manitoba are dealing with increasingly complex cases within a system of residual social welfare. Funding and resource constraints, lack of skilled medical professionals and educators quick to refer all contribute towards medicating C/YIC.

Made available in DSpace on 2016-04-29T13:31:09Z (GMT). No. of bitstreams: 1 Morgana Moreira Moura.pdf: 5636135 bytes, checksum: fb88bdab4f2965082084e0e2c8a07735 (MD5) Previous issue date: 2014-03-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In a scenario of self-medication, drug advertising has a significant role. Thus, in this research, we seek to understand the strategies used to regulate OTC (out-the-counter) medications, focusing more specifically to the regulations of advertisements addressed to the general public. For that, it has as a case study the advertisements of aspirin, Bayer lab. By having ontological, epistemological and methodological bases strands post-constructionism, the work was developed at the confluence of psychosocial studies of constructionism orientation and techno-scientific studies of Actor-Network Theory. Backed by the concept of medicalization and pharmaceuticalization, as well as the performance of the advertising of medicines in these processes, initially sought to situate the advertising of aspirin in Brazil. Then it was aimed to understand, using analysis of the identified regulations, when and how drug advertising became the object of regulation. In this stage, the different actors who are part of this process and the different periods in the regulatory line were identified. From the description of these phases, we identified the impact of such regulation on the aspirin print advertising by selecting advertisements published after the legislation change of each phase. Finally, the controversies between CONAR and Anvisa in the regulatory process were described, as well as the articulations, the divergence points and the weaknesses of this debate. Thus, we conclude that the regulation has significant effect on advertising, but it has significant gaps that show the conflict of interests among the sanitary authority, the pharmaceutical industry and the people who consume these drugs, thus questioning the notion of self-medication and the way people relate themselves to the substances and to the information about it / No cenário da automedicação, a propaganda de medicamentos possui papel significativo. Assim, nessa pesquisa, buscamos entender as estratégias de regulamentação dos medicamentos de venda livre, voltando-se mais especificamente às regulações das propagandas endereçadas ao público em geral. Para isso, tem como estudo de caso as propagandas de aspirina, do laboratório Bayer. Tendo por bases ontológicas, epistemológicas e metodológicas as vertentes pós-construcionistas, o trabalho foi desenvolvida na confluência dos estudos psicossociais de orientação construcionista e dos estudos tecnocientíficos da Teoria ator-rede. Respaldados pelo conceito de medicalização e farmaceuticalização, bem como a atuação da publicidade de medicamentos nesses processos, buscamos inicialmente situar a propaganda de aspirina no Brasil. Em seguida, objetivou-se entender, por meio de análise da regulamentação identificada, quando e como a propaganda de medicamentos tornou-se objeto de regulação. Nessa etapa, identificamos os diferentes atores que fazem parte desse processo e os diferentes períodos na linha de regulamentação. A partir da descrição dessas fases, pudemos identificar o impacto dessa regulamentação na propaganda impressa de aspirina, escolhendo propagandas publicadas após a legislação referente a ruptura de cada fase. Por fim, descrevemos as controvérsias entre CONAR e Anvisa nesse processo de regulamentação, bem como as articulações, os pontos de divergência e as fragilidades desse debate. Com isso, podemos concluir que a regulamentação tem efeitos significativos na propaganda, mas possui expressivas lacunas, que evidenciam o conflito de interesses entre a autoridade sanitária, a indústria farmacêutica e as pessoas que consomem o medicamento, problematizando assim a noção de automedicação e a forma como as pessoas se relacionam com as substâncias e como as informações sobre essas

Submitted by Maike Costa (maiksebas@gmail.com) on 2017-09-04T12:21:18Z No. of bitstreams: 1 arquivototal.pdf: 3262909 bytes, checksum: bd1abc4d0e814c526f39e071a22ba562 (MD5) / Approved for entry into archive by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2017-09-04T15:54:10Z (GMT) No. of bitstreams: 1 arquivototal.pdf: 3262909 bytes, checksum: bd1abc4d0e814c526f39e071a22ba562 (MD5) / Made available in DSpace on 2017-09-04T15:56:02Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 3262909 bytes, checksum: bd1abc4d0e814c526f39e071a22ba562 (MD5) Previous issue date: 2017-01-25 / The purpose of this thesis is to analyze how the health marketing system is unbalanced by the influence of the medicalization and pharmaceuticalization phenomena, seeking an alternative to restore the the equilibrium of the system especially in favor of the consumer. Inicially, we conceptualized the medicalizaition and pharmaceuticalization phenomena to understand how they are configured and how they influence the exchange processes in the health marketing system. Sequentially, the health marketing system was Characterized in main agents, actions and flows and outcomes. For this, we aplied the equilibrium concept and we analysed how the processes of medicalization and pharmaceuticalization can be potencial factors of desequilibrium of this system. We observe that imbalances directly and indirectly fall mainly on the consumer, even if this is considered an active agent in the processes of medicalization and pharmaceuticalization. In this sense, we argue that the performance of a social organization can be understood as an alternative of equilibrium for the health marketing system, insofar as this type of organization can aim to defend the interests of the less beneficiaries of a marketing system. To empirically illustrate this proposition, we characterize the performance of ‘Despatologiza: the despatologization of life movement’, through a qualitative and exploratory study of case. The Despatologiza operates seeking to sensitize professionals, particularly health and education, and empower society about the phenomena of medicalization and pharmaceuticalization. In addition, we interviewed nine medical professionals to analyze their vision about the functioning of social organizations in the health sector, as well as possible actions that Despatologiza can implement to consolidate its performance in the marketing system of health. As results, we highlight that the training of professionals and consumer education were the main actions considered with possible means of organizations such as Despatologiza to promote changes in the health marketing system under the influence of the sociocultural phenomena of medicalization and pharmaceuticalization. Thus, this study contributes in a theoretical and practical way to the discussion about the phenomena of medicalization and pharmaceuticalization through the bias of macromarketing, presenting an alternative of acting in favor of the balance of the marketing system, in the actions of social organizations, especially when well structured, towards social improvement goal / O propósito desta tese é analisar como o sistema de marketing de saúde é desequilibrado pela influência dos fenômenos da medicalização e da farmaceuticalização, buscando uma alternativa para restaurar o equilíbrio do sistema em prol, especialmente, do consumidor. Inicialmente conceituamos os fenômenos da medicalização e da farmaceuticalização com vistas a entender como se configuram e influenciam os processos de troca no sistema de marketing de saúde. Sequencialmente, o sistema de marketing de saúde foi caracterizado em principais agentes, ações e fluxos, e saídas. Para tanto, aplicamos o conceito de equilíbrio e analisamos de que maneira os processos de medicalização e farmaceuticalização se colocam como potenciais fatores de desequilíbrio desse sistema. Observamos que os desequilíbrios recaem diretamente e indiretamente sobretudo no consumidor, mesmo que esse seja considerado um agente ativo nos processos de medicalização e farmaceuticalização. Nesse sentido, argumentamos que a atuação de uma organização social pode ser compreendida como alternativa de equilíbrio para o sistema de marketing de saúde, na medida em que esse tipo de organização pode ter como objetivo defender os interesses dos stakeholders menos beneficiados de um sistema de marketing. Para ilustrar empiricamente essa proposição, caracterizamos a atuação do “Despatologiza: movimento de despatologização da vida”, por meio de um estudo de caso qualitativo e do tipo descritivo. Complementarmente, entrevistamos nove profissionais médicos com vistas a analisar a sua visão acerca do funcionamento de organizações sociais no setor da saúde, bem como sobre possíveis ações que o Despatologiza pode implementar para consolidar sua atuação no sistema de marketing de saúde. Como resultados, destacamos que a formação de profissionais e a educação do consumidor foram as principais ações consideradas com possíveis meios de organizações como o Despatologiza promoverem mudanças no sistema de marketing de saúde sob a influência dos fenômenos socioculturais da medicalização e da farmaceuticalização. Desse modo, este estudo contribui de maneira teórica e prática para a discussão sobre os fenômenos de medicalização e farmaceuticalização pelo viés do macromarketing, apresentando uma alternativa de atuação em prol do equilíbrio do sistema de marketing, nas ações de organizações sociais quando bem estruturadas em direção a objetivos de melhoria social.

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Ce mémoire de maitrise constitue une proposition théorique dans le cadre de laquelle je propose une conceptualisation de la construction sociale du trouble déficitaire de l’attention (TDAH) et son traitement par médication psychostimulante, en s’intéressant au processus diagnostique et aux interactions qu’il implique entre les membres de l’écologie scolaire (enseignants, professionnels, élèves, parents, gestionnaires, formateurs), mais aussi entre ces derniers et ceux du domaine médical (médecin généraliste, pédopsychiatre ou psychiatre, pédiatre, psychologue, neurologue). En brossant un portrait exhaustif des connaissances sociales et scientifiques sur ce qu’on nomme communément le TDAH, je présente comment il y a eu redéfinition sociale d’un trouble scolaire en trouble médical, c’est-à-dire comment il y a eu une médicalisation des difficultés scolaires. Cette médicalisation ayant socialement cheminé vers une pharmaceuticalisation de cette non-conformité aux normes scolaires, alors que le traitement par médication psychostimulante est devenu une solution de plus en plus légitime pour plusieurs élèves d’ordre primaire au cours des dernières décennies. Cependant, même si mémoire ne vise pas à nier l’existence d’un tel trouble neurologique, de nombreux facteurs permettent d’observer que des processus sociaux peuvent influencer les taux diagnostiques et les taux de traitement par médication, alors qu’il y a raisons de croire que le Québec est en situation de surdiagnostics et de surprescriptions, principalement chez la population des élèves d’ordre primaire. Suivant cette perspective, ce mémoire propose une conceptualisation sociologique inédite qui pourrait permettre de mieux comprendre comment ces deux phénomènes sont le résultat d’une construction sociale par des processus sociaux. Une conceptualisation qui propose autant d’aborder et d’analyser le TDAH d’un point de vue macrosocial que d’un point de vue microsocial. / This master's thesis constitutes a theoretical proposal in which I propose a conceptualization to understand the social construction of ADHD and its treatment with psychostimulant medication, focusing on the diagnostic process and the interactions it involves between members of the school ecology (teachers, professionals, students, parents, managers, trainers), but also between those and those of the medical field (general practitioner, child psychiatrist or psychiatrist, pediatrician, psychologist, neurologist). By providing a comprehensive picture of social and scientific knowledge of what is commonly referred to as ADHD, I present how a school disorder has been socially redefined in a medical disorder, i.e. how academic difficulties have been medicalized. This medicalization has made a social path to pharmaceuticalizing this non-compliance with school standards, while psychostimulant medication treatment has become an increasingly legitimate solution for many primary students in recent decades. However, while memory is not intended to deny the existence of such a neurological disorder, there are many factors that can be observed by social processes that can influence diagnostic rates and rates of medication treatment, while there is reason to believe that Quebec is in a situation of overdiagnosis and overprescription, mainly among the primary student population. From this perspective, this dissertation proposes a new sociological conceptualization that could allow us to better understand how these two phenomena are the result of social construction from social processes. A conceptualization that proposes as much to address and analyze ADHD from a macrosocial point of view as from a microsocial point of view.