Jean-Paul Gaudillière
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Volker Hess
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The industry of clinical trials and the rise of medico-economic accounting
The case of antidepressants, 1970–90
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Three processes – pharmaceutical revolution, drug regulation, and new methodologies – radically changed clinical research after the Second World War. The existing historiography highlights the first two. This chapter addresses the shift in research methodology with special emphasis on accounting. Accounting – understood as tools of knowledge – is thus neither restricted to financial transactions nor to any kind of administrative transactions within enterprises, hospitals, and other health organisations.

This chapter argues for an extended meaning of accounting as the activity of preparing and comparing lists, used in a second step to define different forms of value and construct markets. An invisible bookkeeper has therefore emerged in the world of clinical research who holds together the fields of knowledge and economy. To explore such accounting, the chapter presents the two forms of accounting involved in the research and marketing of Ciba-Geigy’s antidepressants since the 1970s. The first focuses on the accounting technologies that balanced clinical features with the effects of drugs in order to document efficacy and build a hierarchy of uses and putative prescription motives; the second focuses on the market-based accounting involved in scientific marketing that integrates data on sales, prescriptions, and market-shares in order to build a hierarchy of targets and promotional investments.

We therefore propose to understand the blending of clinical research and marketing as the rise of a medico-economic mode of accounting which is bringing together ‘the counter’ and ‘the bedside’ for managing what are massively private, for profit, investments in research and marketing.

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Accounting for health

Calculation, paperwork, and medicine, 1500–2000

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