A Bitter Pill to Swallow: Ministers, Experts, and the Politics of Pharmaceutical Policy in France

With the spread of regulatory agencies and expert committees over the past few decades experts are said to play a more prominent role in regulatory governance across policy sectors in Europe. How do elected officials, who now share regulatory space with experts, respond to outputs by experts in the policy-making process? To better understand political dynamics in the regulatory space shared by experts and politicians, the paper examines strategies of elected officials towards experts’ advice, using the case of pharmaceutical policy in France. Drawing on regulatory assessment on clinical effectiveness of drugs since the late 1990s, it explores when politicians choose to follow experts’ advice and when they refuse to do so. Through comparative case studies across different types of drugs and process tracing, it shows how elected officials’ consideration of potential or actual losses generated by policy decisions shape policy choices, and how the political strategies, in turn, affect policy change and stability. The paper examines factors that guide such consideration by politicians, by looking at different dimensions of losses triggered by policy decisions. It also considers whether and how institutional as well as political factors, including changes in organisational arrangements around decision-making process and specific events such as drug scandals, affect political strategies. The paper contributes to the literature on blame avoidance by highlighting the role of policy losses in shaping expert-politicians interactions in regulatory policy-making process. In doing so, it sheds light on implications of changing regulatory space for policy development.