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  • BERGERON Henri (14)
  • CASTEL Patrick (12)
  • PILMIS Olivier (4)
  • DUBUISSON-QUELLIER Sophie (4)
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The stakes around the global and national medicines markets have been rising steadily for the last twenty years. How can one think of a market in which operate companies ranking among the most capital-intensive and profitable, states that want to provide their populations with access to essential and innovative treatments without jeopardizing their national health insurance systems, and health professionals who play a central role as market intermediaries? How can one analyse a market in which there are both innovative medicines (most often but not always) resulting from long R&D processes, protected by patents and costing up to several hundred thousand euros per patient, and generic medicines, produced on a large scale to treat "common" diseases and costing just a few euros? The purpose of this article is to present this research agenda which is both individual and collective. The first line of research is to examine the organisation and regulation of health product markets. A second line of research consists in analyzing the processes through which medicines contribution to Health and Economy is valued.

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Le coronavirus a mis la France face à la défaillance de son système de santé publique. Centré sur l’hôpital, il tend à négliger certains facteurs sociaux et environnementaux, en amont et en aval d’une prise en charge médicalisée. En vue des crises sanitaires à venir, faut-il développer des surcapacités hospitalières ou réformer en profondeur nos politiques de santé publique ?

The popularity of labels as tools of government is growing in many policy areas. This chapter focuses on the creation and implementation of one specific kind of label, which we have defined as a “rewarding label”. These labels are granted by governments or public authorities and reward organizations for their contribution to public welfare. Governance by rewarding labels relies on the mechanisms of competition and social distinction at play within a given field, in order to orient actors towards options that governments consider to be in the public interest. Taking eco-labels and nutritional charters as case studies, this chapter shows the difficulties involved in governing through this tool. Rewarding labels are designed to satisfy a range of conflicting objectives and interests and their application has become a site of conflict among public authorities and private actors. Four limitations to this approach are highlighted: management of labels’ reputations, consumer enrolment, competition between companies, and competition between government labels and other market devices or actors.

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The popularity of labels as tools of government is growing in many policy areas. This working paper focuses on the creation and the implementation of three different public labels in the public health field. Granted by the States or other public authorities, those labels reward distinctively organizations for their contribution to a public cause. Governance by labels relies on the mechanisms of market competition and of social distinction at play within a field, to orient actors towards opinions that governments consider to be in the public interest. This working paper nevertheless shows the difficulties to implement effectively that kind of soft policy tools: for them to affect firms and consumers' behaviours, they have to integrate many conflicting objectives and interests at the same time, which is rarely the case. We actually show, in our three case studies, that governing the market through labels implies governing the labels themselves, by carefully selecting their grantee, promoting them to both consumers and companies, and struggling against other challenger labels or market intermediaries. It is not an uncommon paradox that these labels that are entrusted with such a high power of "changing the world", have been finally stripped of any power.

Les faux médicaments se comptent par centaines de millions et font des ravages dans les populations. Comment comprendre que des ONG, des gouvernements ou des mouvements activistes s’opposent à la lutte contre ce fléau ?

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Functional foods have swept across France and Europe since the late 1980s. Margarines enriched with omega 3 or phytosterols, yoghurts enriched with bifidus or vitamin-rich food supplements... these foods with health claims have reopened the boundary erected over the course of the twentieth century between the markets for medicines, whose primary function is to treat the sick, and those for foods, whose primary function is to meet the nutritional needs of healthy people. They thus raise many issues for regulators, producers, distributors and consumers. Are they health products that can usefully contribute to the prevention of chronic diseases or marketing manipulations that are not of any health interest? Should they be regulated and marketed as drugs, as food or as a separate category? Drawing on significant contributions in economic history and sociology, this article analyzes the consequences of the classification of these products as medicines, foods or dietary supplements on their valuation and the structure of their markets. It also focuses on the boundary work in which industry and regulatory actors engage in order to “(re)classify” these products, and thereby “(re)structure” the markets in which they circulate. The first part of the article describes the process that led France to establish a boundary between the previously intertwined markets for medicines and foods over the course of the twentieth century, which has been blurred by the appearance of functional foods since the beginning of the 1980s. The second part deals with the efforts of French and European regulatory authorities and industry actors to renegociate these boundaries between the markets for medicines and foods bearing nutritional and health claims. We conclude this second part with a discussion of the consequences of this reframing for the reorganization of markets and the reevaluation of the health benefits and commercial advantages of these products.

Comme l’indique son titre, cet ouvrage est le fruit d’une ethnographie réalisée au sein d’un des plus importants laboratoires pharmaceutiques mondiaux, le groupe franco-allemand Sanofi-Aventis. Si l’on considère le peu de recherches académiques ayant abordé le fonctionnement interne des laboratoires pharmaceutiques et les nombreux scandales affectant régulièrement cette industrie, ce livre (et la thèse dont il est issu) était porteur de nombreuses attentes de la part des chercheurs comme de l’opinion publique. Prenant à rebours la littérature journalistique centrée sur les scandales affectant cette industrie, Quentin Ravelli entend s’intéresser à la Pyostacine, un antibiotique a priori « sans histoire », commercialisé depuis les années 1970, afin de décrire le fonctionnement ordinaire de l’industrie pharmaceutique. S’appuyant sur différentes enquêtes in situ, l’auteur a ainsi suivi ce médicament tout au long de son parcours au sein de l’entreprise, de sa fabrication et son conditionnement dans des usines françaises et espagnoles à sa promotion dans les cabinets médicaux par des « visiteurs », en passant par sa (re)qualification dans les services du marketing et les congrès médicaux et son évaluation par les experts dans les essais cliniques et au sein de l’Agence du médicament. De fait, ce livre s’inscrit explicitement dans les recherches qui, de Bronislaw Malinowski à Arjun Appadurai, entendent retracer la biographie sociale des marchandises afin de mieux saisir la façon dont elles se transforment au fur et à mesure de leur circulation dans les espaces productifs, marchands ou consuméristes. L’auteur entend plus précisément montrer en quoi cette biographie sociale de la Pyostacine met en lumière une dialectique entre valeur(s) d’usage et valeur(s) d’échange qui serait constitutive du capitalisme contemporain. [premier paragraphe]

in La Vie des Idées Publié en 2019
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Since the beginning of the 2000s, the fight against counterfeit and illegal medicines has become an international cause, mobilizing the World Health Organization and the World Customs Organization. Numbers and harrowing facts are regularly cited in justification of the international agenda: one in 10 drugs in circulation in developing countries is apparently illegal, and customs intercepted 550 million doses of counterfeit medicines in 2013; these medicines have also caused many deaths, the most striking example being the 2500 deaths in Niger in 1995 after a fake vaccine was administered (pp. 7-10). In this context, the international fight that was organized from the 2000s to counter this scourge of “pharmaceutical fraud” appears not only perfectly justified, but even somewhat belated. How, then, can one explain the fact that NGOs, governments and activist movements have protested against this fight? Based on two ethnographic field works conducted in Kenya and India, and on an analysis of the press and of reports published by the World Health Organization, Mathieu Quet’s book highlights the controversies surrounding this “pharmaceutical fraud”, which involve public health, economic interests, the securing of quality medicines and the monitoring of their global circulation. (first paragraph)

L’économie comportementale, nouvelle obsession de nos décideurs, réduit tout à des « biais cognitifs ». Ce faisant, elle focalise les politiques publiques sur les conduites individuelles, et elle recherche les traits communs à ces conduites au lieu d’en explorer les différences. Contre cette raison comportementaliste, une analyse sociologique des structures et des inégalités s’impose.

L’article étudie les évolutions de la fixation du prix des médicaments par l’État en France depuis 1948. Si les objectifs de cette politique sont restés les mêmes depuis 70 ans (assurer l’accès des patients à des traitements de qualité, sans grever les comptes de l’Assurance maladie ni compromettre le développement de l’industrie), ses modalités concrètes ont de leur côté fortement évolué, passant d’une administration unilatérale des prix par l’État à une co-régulation du marché des médicaments. Cette transformation a amené les représentants de l’État et de l’Assurance maladie (le Comité économique des produits de santé) à composer avec un nombre croissant d’acteurs (industriels, experts indépendants, professionnels de santé mais aussi politiques pratiquées dans d’autres pays). Pour autant, elle n’a pas conduit à un retrait de l’État : au contraire, la portée de la régulation s’est étendue à l’ensemble des acteurs et des dispositifs déterminant les dépenses de médicaments remboursés.

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