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Insurance companies The many insurance companies with a stake in the ICD wanted a breakdown of the ICD statistics in such a way as would be useful for them: "For example, there should be groups corresponding to the age at which direct compulsory sickness insurance begins, and the age at which compulsory old-age insurance starts" (CH/experts stat/80, 3). Since this rule was different for different countries (and nonexistent in many), this would have been impossible to apply. |
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Industrial firms Some of the first groups to produce lists of causes of death were from the vast German chemical companies of the late nineteenth century. For them, relevant variables included whether the deceased had touched or not touched certain compounds, had worked inside or outside, and so forth. Again, we have here a different set of variables from those of interest to other groups. |
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Pharmaceutical companies The claims that can be made for different drugs are in part a function of the list of diseases. For example, a classic case occurs in the Spanish pharmacopoeia (Bijker and Law 1992). Due to Catholoic religious restrictions against contraception, this handbook redefines what are commonly described as birth control pills. These pills may have a (typically undesirable) side effect of high blood pressure. In some cases, the pills may be prescribed as a treatment for hypotension. In a figure-ground switch, the technical side effect becomes the inhibition of birth. (Note what is likely to happen to the statistical records of incidence of hypotension in Catholic countries in such cases.) |
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This process may work inversely in some cases. One of us formerly had a student who was a national representative for a large drug company. A major part of her job was interviewing doctors about whether any of their patients had gotten better from one disease while taking one of the company's medications for another. If yes, that disease might potentially be added to the list of indications for the illness. The representative said that she was constantly pressured by her superiors to "broaden her indications" in this fashion. Here again, there is a trade-off between market pressures, frames of meaning, and regulation that require conflicting levels of restriction (see also Gerson and Star 1986). |
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No attempt will be made here to continue to list all the various actors who have been involved in compiling and implementing the ICD, but |
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