Document Type : Research Article
Author
MD, PhD in Sociology, Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
10.22059/jisr.2025.389820.1581
Abstract
Introduction
Pharmaceuticalisation denotes the translation or transformation of human conditions, capabilities, and capacities into opportunities for pharmaceutical intervention. However, Pharmaceuticalisation is not an entirely new sociological concept, its application has increased in recent years. In Iran, although Pharmaceuticalisation is a concept that has not yet entered the research field of medical sociology, by referring to Persian literature, a clear example can be found that helps in understanding it; where in the Shahnameh, Rostam seeks a potion hidden in the treasure of Kikavus to make up for the mistake of son-killing. Kikavus refuses to give him the potion and Sohrab dies, but the idea that potions can cure life's problems is a metaphor that has persisted throughout Persian literature and found its way into the works of others. The importance of medicine has also been maintained in contemporary life, as per capita drug consumption in Iran is higher than developed countries, and news about medicine, from shortages and high prices to new medications and their properties and harms, is woven into everyday life. drug has become increasingly significant not only within the domains of health and medicine, but also across the political, economic, and social spheres. As a result, an expanding range of aspects of everyday life appears to be undergoing Pharmaceuticalisation. However, this influence of drug in various areas of life has not been examined from a sociological perspective so far, and the aim of this study is to explore Pharmaceuticalisation of Iranian society and its dimensions.
Methodology
This qualitative study employed content analysis using an analogical approach. The analysis was guided by six key sociological dimensions identified by Williams, Martin, and Gabe (2011) considered as the basis for the analogy. Then, texts related to the Pharmaceuticalisation were selected and analyzed including documents, articles, news, and reports.
Findings
Eight key sociological dimensions of Pharmaceuticalisation were identified in Iran, six of which are consistent with those introduced by Williams et al., and the other two are new and emerge from the conditions of Iranian society.The first dimension, “the redefinition or reconfiguration of health problems as having a pharmaceutical solution” has two components: Expanding the drug market, corporate construction of disease. The second dimension, "Changing form of governance," consists of four components: the neoliberal turn in health care, Weakening the Generic Drug System, Weak oversight and corruption in the pharmaceutical industry, Supporting pharmaceutical innovation. The third dimension is the reframing of health problems in the media as having a pharmaceutical solution, and has four components: Drug shortage propaganda, Redefining health problems as problems to be treated with medication, Direct-to-consumer advertising, Online drug sales. The fourth dimension, Patients, consumers and the life world include two components: Consumption, self-medication and over-the-counter drug provision, the mobilization of patient groups around drug shortage. The fifth dimension is the use of drugs for non-medical (enhancement) purposes. The utilization of medication not for the purpose of treatment but to enhance and improve the lives of healthy individuals has become increasingly popular, creating a large market for vitamins, supplements, and herbal medicines.The sixth dimension involves drug innovation and the colonization of health futures. Although personalized medicine, and specifically pharmacogenetics, is in the early stages of development in Iran, it can be expected to enter health policymaking in the future.
the seventh dimension, comprises the emergence of alternative medicine as a new competitor in the Pharmaceuticalisation of society. Alternative medicine does two things: de-Pharmaceuticalisation in opposition to and competition with modern medicine. Pharmaceuticalisation with traditional and herbal medicines.The eighth dimension, physician agency, encompasses the contradictory role of physicians in Pharmaceuticalisation. Both when the physician's gatekeeper role is weakened and when the scientific authority of physicians is placed at the service of the pharmaceutical industry, Pharmaceuticalisation is facilitated.
Conclusion
The Pharmaceuticalisation process in Iran is accelerating, and its drivers are available at both the macro and micro levels. Changing form of governance and the change in approach to health, which has paved the way for the privatization of medicine and health care services, is the most essential structural transformation facilitating the process of Pharmaceuticalisation. The expansion of the pharmaceutical market, which is characterized by increased turnover, an upsurge in the number of companies, and a rise in the production, import, and sale of drugs, is the product of government support for privatization, deregulation, lax licensing, weakening of government control and supervision, treatment-orientation, and the commodification of drugs. On the other hand, the media plays a mediating role in advertising, promoting, and selling medicines.
At the micro level, patients and consumers are now buyers who tend to various medicines and supplements as commodities from pharmacies or online platforms, not only to get rid of health problems and life issues, but also for enhancement purposes; and they engage in collective protests for access to medicines. the physician's gatekeeper role has often been reduced to an intermediary between the patient and the insurance organizations, and their medical credibility is used to promote specific drug brands for the benefit of pharmaceutical companies. The entry into the field of personalized medicine and new efforts in pharmacogenetics indicate that the Pharmaceuticalisation of the future has just begun in Iran.
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