Eliciting views of Australian pharmaceutical industry employees on collaboration and the concept of Quality Use of Medicines

Challenges to pharmaceutical policymaking: lessons from Australia’s national medicines policy

Objective National medicines policies (NMP) provide a means for governments to achieve their objectives in relation to pharmaceuticals and other medicines. This research aimed to identify challenges to implementing the objectives of the Australian NMP from the perspective of key stakeholders. Methods In 2012 and 2103, we conducted 30 semistructured interviews with stakeholders involved in the discovery, clinical testing, regulation and funding of medicines in Australia. We asked participants to describe their careers and to give their opinions on specific issues surrounding drug development, clinical research, regulation and subsidisation in Australia. Data were analysed using Morse’s outline of the cognitive basis of qualitative research and Charmaz’s outline of data analysis in grounded theory. The initial phase of ‘open coding’ revealed findings that could be mapped to three of the four objectives of the NMP. We then conducted ‘focussed coding’ for themes relevant to these objectives. Results Participants identified many issues relevant to the ongoing evolution of the NMP, relating primarily to ongoing tensions between the commercial objective of ensuring a viable medicines industry, and the non-commercial objectives of ensuring that medicines are safe, effective and affordable. There were also several other challenges identified to the achievement of both the commercial and non-commercial objectives of the NMP. These included limits to government funding, globalisation, consumer advocacy, changing scientific paradigms and new information technologies. Conclusions There are many issues that need to be addressed if policymakers are to achieve the best outcomes from the NMP. Tensions between the commercial and non-commercial objectives of the NMP suggest the need to ensure that one stakeholder group’s imperatives do not stifle those of other groups. At the same time, there are several emerging issues that are likely to concern all stakeholders equally, and these are both challenges and opportunities for new kinds of collaboration. What is known about the topic? We know that stakeholders have several concerns about medicines policy, but little is known about the specific challenges to implementing medicines policy from the perspective of those involved. What does this paper add? We demonstrate that stakeholders have many concerns that could impact the implementation of medicines policies. These relate primarily to ongoing tensions between the objective of ensuring a viable medicines industry, and the objectives of ensuring that medicines are safe, effective and affordable. There are also several issues that potentially pose a challenge to achieving both the commercial and non-commercial objectives of the NMP. These include limits to government funding, globalisation, consumer advocacy, changing scientific paradigms and new information technologies. What are the implications for practitioners? Policymakers need to systematically address the barriers to the ongoing implementation of the NMP. Policymakers should also ensure that one imperative (such as the commercial imperative) does not stifle other objectives. Other emerging issues are likely to concern all stakeholders, and these provide opportunities for new kinds of collaboration among stakeholders.

How pharmaceutical industry employees manage competing commitments in the face of public criticism

The pharmaceutical industry has been criticised for pervasive misconduct. These concerns have generally resulted in increasing regulation. While such regulation is no doubt necessary, it tends to assume that everyone working for pharmaceutical companies is equally motivated by commerce, without much understanding of the specific views and experiences of those who work in different parts of the industry. In order to gain a more nuanced picture of the work that goes on in the "medical affairs" departments of pharmaceutical companies, we conducted 15 semi-structured interviews with professionals working in medical departments of companies in Sydney, Australia. We show that this group of pharmaceutical professionals are committed to their responsibilities both to patients, research participants, and the public and to their companies. Despite the discrepancies between these commitments, our participants did not express much cognitive dissonance, and this appeared to stem from their use of two dialectically related strategies, one of which embraces commerce and the other of which resists the commercial imperative. We interpret these findings through the lens of institutional theory and consider their implications for pharmaceutical ethics and governance.