Intended for healthcare professionals

Education And Debate

Global consumption and the challenge to pharmaceutical governance in the United Kingdom

BMJ 2005; 331 doi: (Published 30 June 2005) Cite this as: BMJ 2005;331:40
  1. Nick Fox (, reader in the sociology of health and the body1,
  2. Katie Ward, research associate1
  1. 1 School of Health and Related Research, University of Sheffield, Sheffield S1 4DA
  1. Correspondence to: N Fox

    Analysis of governance, based on research into the views of stakeholders, can show the ways in which systems for regulation of technology evolve in the face of changes such as globalisation


    The globalisation of production and consumption challenges the ways in which potentially harmful yet essential technologies such as pharmaceuticals are governed. In modern liberal democracies, governance (a term whose Greek root implies control) depends not only on law and regulation but also on successfully engaging a wide range of interests within society—industry, professionals, and the public—as responsible and accountable. With the emergence of the internet, consumers' access to information and opportunities to purchase goods online may destabilise the established processes regulating prescription drugs.

    Technology, governance, and globalisation

    For democratic societies, the challenge of governance is to balance and reconcile the differing interests of the state and of individuals in an effort to sustain the continuity, security, and cultural integrity of the state and the liberty and rights of individuals.1 Governance systems can be established in the absence of legal or political authority and often depend on voluntary and consensual processes. A good example is the governance of professions, such as the medical profession, which have applied self regulation and codes of conduct alongside legal frameworks.

    Embedded Image

    A hundred years ago, local pharmacies had no competition from the internet, and governance was more straightforward

    Credit: MEPL

    Scientific and technological developments such as nuclear power, genetic engineering, food safety, and pharmaceutical innovation all demand regulation for reasons of public health, safety, and security.24 These developments require policy makers and professionals to balance a paternalistic responsibility for others against individual freedoms and rights and the commercial interests of industry. New technologies gradually acquire regulatory frameworks as policy makers assess and weigh different interests among innovators, professionals, consumers, and ethicists. For drugs, national governments …

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