The Pharmaceutical Industry and Student Resistance: A Political Economy Perspective on Pharmaceutical Industry Influence in Medical Education in the United States and Canada

The following is an investigation of pharmaceutical industry influence in medicine in the United States and Canada and students' responses to it. I present the results of 50 interviews with medical students who are critical of the pharmaceutical industry, from the American Medical Student Association, the Canadian Federation of Medical Students, Students for Medicare, and other organisations. I use political economy to trace relationships between the health industry and higher education in the U.S. and Canada in order to describe the political and social dimensions of how medical knowledge is created, and to understand how medical students resist industry influence. I argue that industry influence is pervasive throughout medical education, and that this is the product of an historical confluence of medicine, education and profit in the context of capitalism. The experience of this context is full of tensions, as hegemonic discourses are re-produced, negotiated and challenged. Participants in this study are critical of the profit-motive in health, and also accept it as inevitable; they recognise that commercial interests enter into the way that medical evidence is produced, and also defend the objectivity of science. I discuss the complexity of these apparent contradictions by attending to medical students' agency. The participants of this study are uncomfortable with the presence of industry in their medical education, and in turning primarily to the confines of that very education for solutions, encounter the limitations of a system that is deeply complicit with industry interests. I argue that the the forms of resistance I have investigated have the potential to reinforce hegemonic ideas about medicine and industry, namely that they are 'partners,' but it also has the potential to disrupt that dominant ideology by demonstrating how industry can have a detrimental impact on the care of patients, challenging the ability of the market to allocate resources equitably, and unmasking the problems inherent in medical research that is motivated by profit.