A Different Perspective?

My thesis revolves around an experience that I had when I worked as a nurse. A certain medication delivery device with which I worked presented difficulties that constituted a safety problem for nurses, and potential dosing issues for patients. A related issue was the fact that this went on for years, and around the world, without acknowledgement from the producer. Some nurses even perceived bad faith on behalf of the producer, believing that their concerns where not being listened to. Because the device was only used in psychiatric settings, there were allegations that more would have been done if the client base had been more affluent and socially audible.

As I come to grapple with what kind of background such a project might need, and how best to frame my question for a review of that background, I find myself wondering what is truly salient here? So far, I have found hundreds of articles related to various faulty, or reportedly faulty clinical implements. They tend to focus on what the issues were, and how they were mechanically fixed. Studies looking at how healthcare settings reacted to these situations are harder to find, and critical examinations of the power relationships between the pharmaceutical industry, nurses, psychiatric patients and other players don’t seem to be presented with these types of practical contexts. Am I exploring a perspective on our pharmaceutical system that hasn’t been explored before? Surely not – but even when I find something that seems promising, it generally seems that the approach is very different.

Aside from individual articles, this seems to happen more broadly in the way we look at pharmaceutical products. Take, for example, the Therapeutics Initiative (TI) at the University of British Columbia. It had, on several occasions, been suggested to me as a possible partner for my research. During the actual struggle with the device, a possible ally in teasing out the best evidence around the situation. On its website the TI (2010) purports that “To reduce bias as much as possible the TI is an independent organization, separate from government, pharmaceutical industry and other vested interest groups.” It goes on to say that practical, unbiased information about medication is a critical part of its role. Looking through its reviews, however, there is somewhat little in the way of critical analysis. Rather than exploring effectiveness, the studies explore pharmacological efficacy. And instead of searching for a broader understanding of effects, most available studies on the TI website are meta-analyses of efficacy studies, most of which would have been conducted by the pharmaceutical companies themselves.

I look forward to exploring this issue in more depth. I’m concerned that instead of an informative review of the subject, I will be writing a patchwork of understanding originating from no central theoretical framework.


Therapeutics Initiative, (2020). Therapeutics Initiative Home. Retrieved From : http://www.ti.ubc.ca



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