The pipeline and the porcupine: alternate metaphors of the physician–industry relationship

Industry and medicine share a complicated relationship that engenders a considerable degree of controversy. Although they share a relationship, industry and medicine have different perspectives toward their involvement with each other. Industry conceives of medicine as one aspect of the “drug pipeline”, a larger set of relationships that is necessary for producing and marketing products. In contrast, select physicians refer to medicineʹs relationship with industry as “dancing with the porcupine”, an inherently difficult and dangerous activity. This paper compares the “pipeline” and “porcupine” metaphors, and draws upon ethnographic data from fieldwork conducted among clinical neuroscientists at a Canadian medical school to further elucidate the perspectives of physicians toward industry and the nature of the physician–industry relationship. The paper argues that the physician–industry relationship is akin to a type of gift-exchange known as a total prestation, and that this form of total prestation is part of a strategy of capital reconversion.