Negotiating Moral Boundaries: Social Movements and the Strategic (Re)definition of the Medical in Cannabis Markets

Social Movements, Stakeholders and Non-Market Strategy

ISBN: 978-1-78754-350-8, eISBN: 978-1-78754-349-2

ISSN: 0733-558X

Publication date: 6 August 2018


How can organizations use strategic frames to develop support for illegal and stigmatized markets? Drawing on interviews, direct observation, and the analysis of 2,497 press releases, I show how pro-cannabis activists used distinct framing strategies at different stages of institutional development to negotiate the moral boundaries surrounding medical cannabis, diluting the market’s stigma in the process. Social movement organizations first established a moral (and legal) foothold for the market by framing cannabis as a palliative for the dying, respecting moral boundaries blocking widespread exchange. As market institutions emerged, activists extended this frame to include less serious conditions, making these boundaries permeable.



Dioun, C. (2018), "Negotiating Moral Boundaries: Social Movements and the Strategic (Re)definition of the Medical in Cannabis Markets", Briscoe, F., King, B. and Leitzinger, J. (Ed.) Social Movements, Stakeholders and Non-Market Strategy (Research in the Sociology of Organizations, Vol. 56), Emerald Publishing Limited, pp. 53-82.

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Over the past two decades, organizational scholars have combined theories of collective action found in social movement studies with theories of structure found in economic and organizational sociology, yielding a dynamic theory of contentious markets (Fligstein & McAdam, 2012; King & Pearce, 2010). Social movement organizations and social movement-like entrepreneurs play a central change-making role in these theories, performing cultural and institutional “work” by constructing frames, mobilizing resources, and targeting the state and society in order to build, contest, and reconfigure market institutions. While an extensive literature has developed showing how firms in industries can act like social movements by taking part in collective action (Carroll & Swaminathan, 2000; Fligstein, 1996), only recently have scholars begun to explore how social movements outside of markets influence market dynamics (King & Soule, 2007).

Social movement organizations can shape the meaning of markets by using frames strategically. Frames are “schemata of interpretation” that allow actors to “locate, perceive, identify, and label” the world around them (Goffman, 1974, p. 21; see also Benford & Snow, 2000; Snow, 2004; Snow, Rochford, Worden, & Benford, 1986). Framing is a process of theorization in which actors highlight problems and propose solutions, drawing upon culturally resonant symbols to suggest cause-and-effect relationships (Strang & Meyer, 1993; Oliver & Johnston, 2000).

Meaning making is often rooted in social norms regarding morality. Social movement organizations can act as moral entrepreneurs and support or challenge a market by making normative claims to its moral legitimacy or lack thereof (Becker, 1963). 1 Examples include the Women’s Christian Temperance Union’s mobilization to make alcohol illegal in the early 20th-century United States (Hiatt, Sine, & Tolbert, 2009) and environmentalists’ valorization of wind energy (Sine & Lee, 2009). Activists can construct moral boundaries that segregate offending products from reputable commerce, blocking exchange (Walzer, 1983), or take a commodity and elevate it on moral grounds (Weber, Heinze, & DeSoucey, 2008).

While studies describe how social movements can stigmatize and challenge the legitimacy of existing organizations and markets (Hiatt & Park, 2013; Hiatt, Grandy, & Lee, 2015; Weber, Rao, & Thomas, 2009), few studies have uncovered the processes by which movements do the opposite, namely destigmatize taboo exchange. A burgeoning literature on organizational stigma has emerged that shows how stigmatization affects both organizational performance and worker identities (e.g., Tracey & Phillips, 2016), yet few studies have examined how stigmatized organizations, markets, and practices become legitimate (Hampel & Tracey, 2017). This elision points to a gap in the literature on movements and markets, which has largely ignored how social movements co-evolve with markets over time (Sine & Lee, 2009).

This chapter illustrates how social movements can construct and deploy frames strategically to dilute a market’s stigma, incrementally negotiating the moral boundaries surrounding the market through the use of different framing strategies. During political campaigns to legalize an illegal and stigmatized market, social movements can strategically emphasize a restrictive framing of the market, highlighting a morally deserving subset of consumers. Activists use these claims to garner support among the general public and policymakers who believe such a product should be separated from market exchange. Once activists gain a legal foothold for the market, they can extend their initial frame to make moral boundaries more permeable and the market more profitable.

I test this process model using a longitudinal data set of 2,487 social movement press releases published in 49 states between 1996, the year California passed the first law legalizing medical cannabis in the United States, and 2013, the year before the first recreational cannabis markets opened in Colorado and Washington. During this 18-year period, medical cannabis transformed from a universally prohibited product into an industry that was legal in 20 states, giving rise to 12 active markets that together yielded over $1.4 billion in revenue in 2013 (ArcView Market Research, 2014). Leveraging these data, as well as interviews with movement activists and observation of social movement organization conferences and meetings, I demonstrate how activists strategically deployed different frames regarding what constituted legitimate medical use at different stages of legalization and market development.

I find that social movement organizations employed distinct strategic framing practices in response to changes in the market’s opportunity structure and institutional context. During political campaigns to legalize medical cannabis, social movement organizations restricted their definition of cannabis’s medical use to a subset of morally deserving participants, the seriously ill and dying. Following the successful legalization of medical cannabis, activists extended their framing of cannabis’s medical use to include less serious illnesses such as pain and insomnia, helping enlarge the market’s customer base.

To develop this argument, I first describe the case of medical cannabis markets in the United States, drawing upon interviews with activists and entrepreneurs to outline two distinct conceptions of cannabis’s medical use, one restrictive and one expansive. Next, I connect theories of movements and markets with theories of morals, markets, and organizational stigma to outline a number of hypotheses describing how social movements can use specific frame alignment strategies to negotiate moral boundaries blocking exchange, diluting the market’s stigma in the process. Finally, I describe my data and measures and explain my findings.

From Compassion to Wellness: Framing the Medical in Cannabis Markets

Cannabis (commonly known as marijuana) is a flowering herb that has been used as a medicine, intoxicant, and spiritual aid for over five millennia (Bostwick, 2012). When a person consumes cannabis, cannabinoids (such as THC and CBD) enter the bloodstream and bind to receptors in regions of the brain that coordinate and regulate movement, learning, memory, and higher brain functions, such as pleasure and judgment (Ameri, 1999; Iversen, 2003). The National Institute on Drug Abuse describes this process:

After inhaling marijuana smoke, an individual’s heart begins beating more rapidly, the bronchial passages relax and become enlarged, and blood vessels in the eyes expand, making the eyes look red. The heart rate…may increase by 20 to 50 beats per minute… As THC enters the brain, it causes a user to feel euphoric…by acting in the brain’s reward system… A marijuana user may experience pleasant sensations, colors and sounds may seem more intense, and time appears to pass very slowly. The user’s mouth feels dry, and he or she may suddenly become very hungry and thirsty. (Volkow, 2005: p. 3)

Users can interpret the meaning of cannabis’s physiological and psychoactive effects in a number of different ways. This is because cannabis is a pleiotropic substance that can have multiple, often ambiguous effects, providing a broad canvas for the social construction of cannabis’s qualities and consequences, which may vary across time and cultures (Becker, 1953; Molina-Holgado et al., 2002; Pacher & Ungvári, 2008).

Medical professionals in the United States first recognized cannabis as a medicine in 1850 when they included it in the third edition of The Pharmacopeia of the United States, a list of sanctioned medicinal preparations. At the time, cannabis was described as a legitimate treatment for a variety of illnesses, including “neuralgia, gout, rheumatism, tetanus, hydrophobia, epidemic cholera, hysteria, mental depression, insanity, and uterine hemorrhage” (Wood & Bache, 1851, p. 311). Cannabis was sold during the late 19th and early 20th century until moral entrepreneurs crusaded for its prohibition. Prohibitionists described cannabis as a menace to youth that caused madness, violence, and licentious behavior (Anslinger & Cooper, 1937; Rowell & Rowell, 1939; Stanley, 1931). During this time, market opponents rebranded cannabis as “marijuana,” a slang term used by Mexican farmworkers who had recently immigrated to the Western United States fleeing the Mexican Civil War (Bonnie & Whitebread, 1970). By linking the flowering herb to a stigmatized minority group and playing on the public’s xenophobic fears, prohibitionists created what Goffman (1963) calls a “courtesy stigma,” that is, a stigma by association. These campaigns to stigmatize cannabis were successful. The federal government outlawed cannabis in 1937, and medical professionals removed cannabis from the Pharmacopeia in 1947.

During the half century following the prohibition of cannabis, both prohibitionists and consumers primarily conceptualized cannabis as an intoxicant used for pleasure. This framing, often described as “recreational,” depicted the act of using cannabis as “getting high” and portrayed cannabis users as “potheads” living outside the norms of traditional society (Suchman, 1968). In 1970, the US government codified the recreational intoxicant framing when it enacted the Controlled Substances Act (CSA), which classified cannabis as a Schedule 1 narcotic with “no currently accepted medical value” and “high potential for abuse” (21 USC § 812). This classification prohibited the prescription of cannabis for medical use and blocked research into its medical applications.

Cannabis prohibition remained relatively unchallenged until the AIDS epidemic created an opportunity for activists and entrepreneurs to leverage a new, morally legitimate framing of cannabis use. Prior to the emergence of effective anti-retrovirals in the mid-1990s, many AIDS patients suffered from wasting syndrome (cachexia), a complication of AIDS that caused extreme nausea, leading to rapid weight loss (Grinspoon, Bakalar, & Doblin, 1995). AIDS patients battling wasting syndrome found that the antiemetic properties of cannabis helped them eat, maintain weight, and live longer (Werner, 2001). During this period, gay rights and AIDS activists who were prominent in the black market for cannabis developed a new organizational form, the cannabis buyer’s club, where sick patients could buy cannabis even though it remained illegal under local, state, and federal law.

At the same time, activists and market pioneers developed moral legitimacy and legal support for the emerging medical cannabis market in California by framing cannabis as a compassionate palliative for the seriously ill and dying. The compassionate frame relied on moral claims, imploring the general public to have sympathy for the suffering of the terminally ill. Rather than challenge the prevailing view that cannabis was a recreational intoxicant, activists and entrepreneurs carved out a morally legitimate subset of users, the seriously ill and dying, who could righteously claim access to cannabis despite its intoxicating qualities (Dioun, 2017).

Activists who helped legalize the first medical cannabis markets in the contemporary United States confirm that they used the compassionate frame to win support for their cause. Dennis Peron – the founder of the first medical cannabis buyer’s club in San Francisco and the co-author of initiatives to legalize medical cannabis use in San Francisco and California – describes the strategic act of framing during the early years of the market:

To get the answer you want you got to ask the right questions, you got to frame it right. So I framed it in such a way, cannabis is medicine that helps people [who are] sick and dying. (Interview May 18, 2012)

Peron purposefully distanced himself and the medical cannabis market from the more common recreational intoxicant framing of cannabis. Peron explains, “I realized I had to get away from the potheads … they had so much baggage … I had to put it aside for the greater goals” (Interview May 18, 2012).

The public supported medical cannabis use if it was limited to the seriously ill and dying. The Columbia University Center for Addiction and Substance Abuse (CASA, 1996) surveyed 800 likely voters in October 1996, just before Californians voted on The Compassionate Use Act to legalize medical cannabis. The CASA survey found that a majority of respondents supported medical cannabis legalization, but only if it was limited to the seriously ill and dying. California voters passed The Compassionate Use Act by a wide margin (55.6% – 44.4%), suggesting that social movement framing of cannabis as a compassionate palliative resonated with the public.

Between 1996 and 2013, laws allowing the medical use of cannabis spread to 20 states and the District of Columbia. At the same time, the number of AIDS deaths per year decreased as public health campaigns and more effective anti-retroviral medications lessened the severity of the AIDS crisis in the United States. As AIDS became less deadly, medical cannabis markets proliferated, and the composition of these markets changed to include patients with less serious illnesses such as chronic pain and insomnia (Colorado Department of Public Health, 2012; Reinarman, Nunberg, Lanthier, & Heddleston, 2011).

As medical cannabis markets grew larger and more widespread, a new, more expansive framing of cannabis’s legitimate medical use, the wellness frame, emerged. This frame was congruent with the shifting demographics of the patient population, expanding cannabis’s medical use to include less serious illnesses. Steve DeAngelo, the Executive Director of Harborside Health Center, the nation’s largest medical cannabis provider, describes the wellness frame:

Now I define wellness very broadly, right? I mean, I think that people are using it to manage their cancer tumors or their pain or their nausea or their MS [multiple sclerosis]. They’re using it for wellness purposes. So are people who are using it for anxiety or insomnia or depression. So are people who are using it for libido, or just to enjoy a meal a little bit more, or to get creative inspiration … not to get recreation, but to make the transition from the work day to the leisure day and thereby be able to do recreational activities more easily … Those for me are all wellness issues. (Interview May 31, 2012)

DeAngelo’s definition of wellness does not abandon the compassionate framing, which described cannabis as a palliative for the seriously ill and dying; he maintains that cannabis helps patients suffering from terminal and debilitating illnesses such as cancer and multiple sclerosis. At the same time, DeAngelo adds less serious conditions such as anxiety, pain, and lack of libido as reasons for cannabis’s medical use and even includes non-medical uses such as creativity and enjoyment in the wellness frame, normalizing a broad definition of medical cannabis without calling it “recreational.”

How did compassion give way to wellness? Did social movements strategically restrict or expand their definition of cannabis’s medical use at different stages of legalization and market development? In the following section, I draw upon theories of movements and markets, moral boundaries, and organizational stigma to propose a process by which social movements (and firms acting like social movements) can use frames strategically to dilute market stigma and develop support for morally and legally contested markets.

Theoretical Development

Morally and Legally Contested Markets

Firms in morally and legally contested markets are more likely to fail than firms in legal and reputable markets, because taboo and illegal markets lack sociopolitical legitimacy and state support (Aldrich & Fiol, 1994; Sine, Haveman, & Tolbert, 2005). When the state prohibits a market, it blocks the development of institutions such as property rights, governance structures, and rules of exchange, limiting the size and stability of the market (Campbell & Lindberg, 1990). It also increases the cost of exchange by actively prosecuting market participants (Beckert & Wehinger, 2012). Even if a market is legal, social stigma can prevent sellers from operating openly, restricting their ability to market “unmentionable” products and making it harder to find buyers and connect with capital (Wilson & West, 1981, 1992).

While social stigma and legal obstruction are powerful normative and regulatory forces that can inhibit market growth, these social and legal classifications are not immutable, but rather contingent on the market’s political and cultural context. Different categories of exchange ranging from the sale of humans (slavery) to the sale of political favors (corruption) are “blocked” because they lack moral legitimacy (Walzer, 1983). At the heart of blocked exchange is the Durkheimian concept of segregating the sacred from the profane such that the sacred cannot be commensurate with the profane via normal market exchange (Durkheim, 1912). The sacred does not necessarily refer to something that is religious or spiritual. Rather, the sacred describes “something ‘set apart,’ regardless of whether it is distinct because it is exalted or because it is fouled” (Rossman, 2014, p. 44; see also Douglas, 1966). Moral boundaries separating the sacred from profane are ubiquitous. However, what is considered taboo varies across societies and over time, inviting scholars to investigate when and how moral boundaries are created, contested, and negotiated (Fourcade & Healy, 2007).

Organizational theorists have joined economic sociologists and focused their attention on how morals shape markets by studying organizational and categorical stigma (Vergne, 2012). Organizational stigma is “a collective stakeholder group-specific perception that an organization possesses a fundamental, deep-seated flaw that deindividuates and discredits the organization” (Devers, Dewett, Mishina, & Belsito, 2009, p. 155). There are two primary types of stigma that affect organizations: event stigma and core stigma (Hudson, 2008). An organization is marked with event stigma when it transgresses a social norm once, gaining the stigma for a specific violation, for example, when Arthur Anderson committed accounting fraud during the Enron scandal. In these cases, organizations can attempt to distance themselves from the stigmatizing event through symbolic decoupling or by separating from the organizational unit or employee that caused the infraction (Boeker, 1992; Elsbach & Sutton, 1992). In contrast, core stigma refers to organizations that are stigmatized for their essential qualities: who they are and what they do. For example, cigarette companies, abortion providers, nuclear power plants (Piazza and Perretti 2015), and gay bathhouses (Hudson & Okhuysen 2009) are stigmatized for selling products or services that are viewed as immoral or damaging. In these cases, organizations do not acquire stigma from a single act, but rather are marked as immoral because the organization’s core attributes are connected to a stigmatized category.

Scholars have shown how organizations can prevent stigma through the defensive adoption of certain rhetoric and practices (Carberry & King, 2012). Organizations can also manage the consequences of stigma through impression management techniques such as hiding their business’s purpose (Hudson & Okhuysen, 2009) and straddling multiple categories (Vergne, 2012). Yet there is little evidence of the process by which organizations rid themselves of core stigma and normalize exchange. This may be because organizational accounts of destigmatization rarely draw on theories of framing that are prominent in social movement studies.

Framing the Morality of Markets

Most studies of the relationship between social movements and markets conceptualize the relationship as antagonistic – value-rational social movement organizations oppose the negative impact and externalities of instrumentally rational economic actors (e.g., Gamson & Modigliani, 1989). In these cases, social movement organizations construct and deploy morally charged frames in order to stigmatize specific organizations or industries for their negative effects on society (Galvin, Ventresca, & Hudson, 2004; Weber et al., 2009). Recently, scholars have shown how market proponents can use strategic frames and moral suasion to develop legitimacy for markets by valorizing normal “amoral” markets and destigmatizing morally contested markets (Hampel & Tracey, 2017; Lounsbury, Ventresca, & Hirsch, 2003). Such framing can transform a commodity into a morally elevated cause by imbuing it with meaning. For example, environmental activists framed grass-fed beef, an unpopular and discounted product, in terms of authenticity and sustainability, transforming it into a highly valued symbol of environmental care (Weber et al., 2008). In doing so, activists united consumers and producers with a shared understanding of a product that was evaluated based on moral taste.

Organizations hoping to win support for an illegal or stigmatized market often stress how the market solves a social problem, benefits society, or helps a deserving group that has the sympathy of the public (Hampel & Tracey, 2017). For example, sellers of life insurance transformed a practice that was originally viewed as a violation of the sanctity of life into a death ritual that provided security for the deceased’s loved ones (Zelizer, 1978). Similarly, the “ghoulish” secondary market for life insurance, where the insured party can monetize their life insurance policy to be traded as a financial instrument, gained moral legitimacy because market participants framed it as a product that provided terminally ill consumers consolation and a dignified death (Quinn, 2008).

While some studies show how collective action can develop moral legitimacy for markets, there have been few processual accounts explicating when and how strategic framing can be used to diminish stigma over time. In the following section, I outline a number of frame alignment processes and describe how social movement organizations can use distinct framing strategies at different stages of legalization and market development to destigmatize a morally and legally contested market.

Stage 1: Amplifying Frames, Respecting Moral Boundaries

Social movements do not construct frames in a vacuum, but rather in a cultural context that renders some ideas more legitimate, recognizable, and sensible than others (Koopmans & Statham, 1999; McCammon, Sanders Muse, Newman, & Terrell, 2007). Savvy social movement organizations craft frames that resonate by taking part in frame alignment processes that make their message congruent with the values of potential supporters. Frame alignment consists of “strategic efforts by social movement organizations to link their interests and interpretive frames with those of prospective constituents and actual or prospective resource providers” (Benford & Snow, 2000, p. 624).Frame amplification is a frame alignment process that involves highlighting elements of a frame that are more likely to be salient to the target audience. Activists may foreground one part of the frame, particularly if it resonates with the political and cultural environment, while de-emphasizing other parts that are less salient. Frame amplification is a conservative strategy that stigmatized groups often use because it does not “require potential supporters to depart from traditional and widely shared values” (Klandermans, 1992, p. 189; see also Berbrier, 1998). Rather, stigmatized groups construct frames to meet prevailing pockets of sentiment where they are and highlight areas of agreement between public opinion and their goals.

I posit that social movement organizations will be more likely to take part in frame amplification during political campaigns to legalize a morally and legally contested market. Since these markets lack both legality and legitimacy, social movement organizations must win the support of the general public to approve a ballot initiative or lobby lawmakers to pass legislation that legalizes the market. During these periods of heightened political opportunity, I expect that social movement organizations will highlight elements of their frames that resonate with prevailing public attitudes that support moral boundaries separating the taboo market from reputable commerce. Thus, activists will attempt to make their frames congruent with these attitudes by putting forth a more restrictive framing of the market. In the context of medical cannabis markets, I hypothesize that during political campaigns to legalize the market, social movement organizations will be more likely to use the compassionate frame, which focuses on cannabis’s medical use by those who are terminally ill or have a debilitating illness, than they will during non-campaign periods.

Stage 2: Extending the Frame to Expand the Market’s Customer Base

Once a market becomes legal through ballot initiative or legislation, there is an implementation period that takes place between the passage of the law or ballot initiative and the emergence of state-sanctioned providers. During this period, state authorities draft rules that will shape the market, specifically its size, by designating who may participate in the market. Social movement organizations can remain politically active during implementation, lobbying the state and the public regarding the specifics of the regulatory regime. At this time, market proponents must balance political and economic goals, continuing to develop political support for the market by aligning their frames with public sentiment, while at the same time pushing for a large and profitable market by defining its potential customer broadly.

To enlarge the size of the market, while at the same time maintaining the coherence of the original frame, activists can take part in frame extension, a frame alignment process by which a social movement organization attempts to enlarge “the boundaries of its primary framework” in order to recruit new supporters (Snow et al., 1986, p. 472). In the case of a newly legal market, organizations may attempt to grow the market’s potential customer base by strategically extending the initial frame, showing how the product can be useful to a variety of consumers, not just the restricted use amplified in the initial framing of the market. Note that frame extension does not eliminate the original meaning highlighted in the frame amplification process, but rather adds additional, more expansive cases of how consumers can legitimately use the product. Thus, activists will continue to invoke the needs of morally deserving consumers, while at the same time extending the frame to consumers who have weaker moral claims to the stigmatized product. In the context of medical cannabis markets, I hypothesize that during the implementation period between legalization and the emergence of market institutions, social movement organizations will continue to describe cannabis as a compassionate palliative for the seriously ill and dying, but will also introduce the more expansive wellness frame that includes less serious conditions such as insomnia, headaches, and chronic pain.

Stage 3: Market Emergence and Frame Transformation

Thus far I have described the first two stages of legalizing a prohibited product: the political push for legalization, and if successful, the political, yet economically consequential battle for implementation. The final stage in this process is the emergence of a legal market. While firms often operate in illegal markets before legalization and during implementation, the emergence of a market with state-sanctioned institutions marks a distinct phase because the market no longer has an existential need for support from the social movement. If social movement organizations continue to use strategic frames in support of the market even after the market has developed legal and institutional support, then this suggests that social movement organizations are continuing to attempt to shape the meaning of the market.

Once the need to justify the market to the public and relevant authorities becomes less intense, I suspect that social movement organizations will attempt to remove the moral boundaries surrounding the market and develop support for a larger market. Social movement organizations will continue their use of a more expansive frame and discontinue their use of a restrictive frame that reifies the moral boundaries surrounding the market. Thus, frame extension will give way to frame transformation, the wholesale reconfiguration of an extant frame, as a new, more expansive meaning fully displaces the old, restrictive meaning. In the context of medical cannabis markets, I hypothesize that following the emergence of a legal market, social movement organizations will be less likely to deploy press releases that solely emphasize the seriously ill and dying and will instead focus on cannabis’s efficacy for less serious illnesses.

Data and Measures

The dataset consists of press releases created and distributed between 1996 and 2013 by two of the largest and most influential pro-cannabis social movement organizations in the United States, the National Organization for the Reform of Marijuana Laws (NORML) and Americans for Safe Access (ASA). Founded in 1970, NORML’s (2013) mission is:

To move public opinion sufficiently to legalize the responsible use of cannabis by adults, and to serve as an advocate for consumers to assure they have access to high quality cannabis that is safe, convenient and affordable.

NORML defines responsible use to include both medical and recreational use. In 2013, NORML had 150 local chapters, 6 million website visits, 123,000 email subscribers, over 482,000 Facebook likes, and 2,000 media interviews (St. Pierre, 2013). ASA was founded in 2002 in response to ongoing federal raids of medical cannabis providers. ASA describes itself as “the country’s leading medical cannabis advocacy group” with a mission to bring “the patient’s voice to the table” and “to ensure safe and legal access to cannabis for therapeutic uses and research” (Americans for Safe Access (ASA), 2013a; Duncan, 2012). In 2013, ASA had over 50,000 members.

Using a Python script, I collected the text of all press releases relevant to the United States included in NORML’s news release archive and ASA’s press release archive in March and April of 2014 (ASA, 2014; NORML, 2014). Tables 1 and 2 present the distribution of press releases by state, organization, and year. These tables show that the NORML corpus included 2,105 press releases published over 18 years (1996–2013), and the ASA corpus included 382 press releases published over 12 years (2002–2013). Press releases were published in 49 states and the District of Columbia.

Table 1.

Distribution of Press Releases by State.

State Frequency State Frequency
AK 16 MO 17
AL 3 MS 1
AR 8 MT 25
AZ 28 NC 17
CA 587 ND 6
CO 58 NE 1
CT 19 NH 26
DC 23 NJ 45
DE 4 NM 20
FL 41 NV 21
Federal (National) 794 NY 85
GA 10 OH 23
HI 34 OK 16
IA 6 OR 42
ID 5 PA 21
IL 30 RI 25
IN 8 SC 4
Il 1 SD 12
KS 2 TN 4
KY 21 TX 17
LA 11 UT 2
MA 62 VA 16
MD 73 VT 21
ME 20 WA 66
MI 61 WI 12
MN 15 WV 2
Total 2,487
Table 2.

Distribution of Press Releases by Organization and Year.

Year ASA NORML Total
1996 0 178 178
1997 0 111 111
1998 0 105 105
1999 0 116 116
2000 0 147 147
2001 0 108 108
2002 14 103 117
2003 30 110 140
2004 34 111 145
2005 20 97 117
2006 25 110 135
2007 22 118 140
2008 21 88 109
2009 40 112 152
2010 45 131 176
2011 35 127 162
2012 40 108 148
2013 56 125 181
Total 382 2,105 2,487

I have focused on press releases to study framing processes because they are strategic acts of communication that organizations carefully craft to influence public opinion and policymakers. If NORML and ASA are strategically framing the medical use of cannabis, distinct frames should appear in their press releases. To contextualize press releases, I interviewed 17 pro-cannabis social movement activists and entrepreneurs, including members of both NORML and ASA. I also observed 15 hours of pro-cannabis social movement organization conferences and chapter meetings between 2013 and 2014. These interviews and observations helped me construct the criteria and keywords for the compassionate and wellness frames that I operationalize below.

Dependent Variables

To capture how social movement organizations framed medical cannabis, I used computational methods for text analysis to measure how narrowly or broadly social movement organizations described what constituted legitimate medical use. I developed a dictionary of keywords associated with the more restrictive compassionate frame and the more expansive wellness frame in the following manner. 2 First, I used a Python script to create a frequency table of every unigram (single word) and bigram (two consecutive words) in the corpus. I then marked every word in the table that referred to a specific medical condition (e.g., AIDS, depression, and anxiety) or a more general description of an illness (e.g., terminal illness, seriously ill, and dying). Next, I located every medical keyword in the corpus, reading each press release to understand the context in which NORML or ASA mentioned the medical condition. 3

I constructed a framing variable with three mutually exclusive outcomes: no medical frame, compassionate frame, and wellness frame. To measure the use of the compassionate frame, I constructed the dummy variable compassionate, coded 1 if the press release mentioned a terminal illness or debilitating disease but did not mention a less serious medical condition and 0 otherwise. To measure the use of the wellness frame, I constructed the dummy variable wellness, coded 1 if the press release included a less serious medical condition, such as chronic pain, anxiety, gastrointestinal problems, or eating disorders or specified how cannabis could be used to prevent disease and 0 otherwise. Since the wellness frame is an extension of the compassionate frame, social movement press releases that included both serious illnesses and less serious illnesses were coded 1 for the wellness dummy and 0 for the compassionate dummy. Table 3 shows a frequency table of medical conditions associated with the compassionate or wellness frames in the corpus of 2,487 press releases. Note that references to the terminally ill and dying (9.53%) were the most common keywords associated with the compassionate frame and that chronic pain (7.08%) was the most common keyword associated with the wellness frame.

Table 3.

Medical Condition Frequency in Press Corpus.

Medical Condition # of Press Releases % of Corpus Frame
Terminally ill/seriously ill/dying 237 9.53 Compassionate
Chronic pain 195 7.84 Wellness
HIV/AIDS 190 7.64 Compassionate
Cancer/lymphoma 176 7.08 Compassionate
Multiple sclerosis 121 4.87 Compassionate
Spasms/spasticity 76 3.06 Compassionate
Epilepsy/seizures 44 1.77 Compassionate
Nausea 42 1.69 Wellness
Insomnia/sleep disorder 33 1.33 Wellness
Prevents cancer 24 0.97 Wellness
Nerve damage 23 0.92 Compassionate
Anxiety 23 0.92 Wellness
Crohn’s disease 23 0.92 Wellness
Depression 21 0.84 Wellness
Alzheimer’s 19 0.76 Compassionate
Diabetes 18 0.72 Wellness
Hepatitis 17 0.68 Wellness
Neuroprotectant 17 0.68 Wellness
ALS/Lou Gehrig’s 16 0.64 Compassionate
Inflammation 16 0.64 Wellness
Stroke 15 0.60 Compassionate
Migraines/headaches 13 0.52 Wellness
PTSD 12 0.48 Wellness
Parkinson’s 11 0.44 Compassionate
Inflammatory bowel/irritable bowel 10 0.40 Wellness
Hypertension 9 0.36 Wellness
Schizophrenia 8 0.32 Compassionate
Spinal cord injury 8 0.32 Compassionate
Quadraplegic/paraplegic 7 0.28 Compassionate
Obesity 5 0.20 Wellness
Eating disorders/anorexia 4 0.16 Wellness
Tourrette’s/movement disorder 3 0.12 Compassionate
Prevents Alzheimers 2 0.08 Wellness
Sickle cell anemia 2 0.08 Wellness

Predictor Variables

To assess whether different phases of institutional development were associated with specific framing strategies, I created three mutually exclusive dummy variables, which each represent a distinct stage of legalization and institutional development at the state level. To measure the relationship between political campaigns to legalize medical cannabis and activist framing strategies, I created the dummy variable medical campaign period, coded 1 if the press release was published during the 180 days preceding a vote on a ballot initiative to legalize medical cannabis and 0 otherwise. 4 Similarly, to measure the association between implementation and framing, I created the dummy variable implementation period, coded 1 if a press release was published following the passage of a ballot initiative or state law authorizing medical cannabis but before a legal market emerged and 0 otherwise. Finally, to see how providers framed medical cannabis once a state-sanctioned market opened, I created the dummy variable market period, coded 1 if state-legal providers were operating and 0 otherwise. All three of these dummy variables use the reference period, when medical cannabis was neither legal nor at the center of a political campaign, as their baseline.

Control Variables

Secular trends, discursive opportunities, and coercive threat could each explain why social movement organizations used more restrictive or expansive frames in their press releases. I have included the variable time, operationalized as the number of days since the beginning of the study period (January 1, 1996), to control for secular changes in the environment that might have affected the frames used by social movement organizations. If secular trends over time were associated with greater acceptance of cannabis, then I would expect to find that time was positively associated with the use of the wellness frame and negatively associated with the use of the compassionate frame. Time was scaled (divided by 365) to make the interpretation of coefficients more intuitive (change per year). Interactions between implementation period and time (implementation × time) and market period and time (market × time) measured whether the effects of implementation period and market period increased or decreased over time.

The AIDS epidemic made the public more sympathetic to the plight of medical cannabis users and receptive to the compassionate frame (CASA, 1996). To control for the discursive opportunity provided by the AIDS epidemic, I created the variable AIDS deaths, the number of AIDS deaths per year per capita in the United States between 1995 and 2012, using the Center for Disease Control’s (CDC) Annual Surveillance Reports (CDC, 2002, 2003, 2005, 2009, 2014). This variable reflects the number of AIDS deaths per 100,000 US residents. I lagged this variable one year because it is an annual measure. To control for the political opportunity provided by campaigns to legalize cannabis for recreational use, I created the dummy variable recreational campaign, coded 1 if the press release was published during the 180 days preceding a vote on a ballot initiative legalizing cannabis for recreational purposes and 0 otherwise.

Coercive threat from the federal government may have affected organizational framing strategies. During periods of increased enforcement actions, activists might have attempted to shield the market through impression management techniques, framing medical cannabis in morally acceptable ways. To control for coercive threat, I constructed the variable federal raids, a count of the number of federal raids of medical cannabis providers each year nationwide. This information was collected by ASA and published in the report What’s The Cost? The Federal War on Patients (ASA, 2013b). I lagged this variable one year because these numbers were collected annually. Conversely, organizations may have been less likely to shield the market during periods of decreased threat. For most of the study period, federal policy prohibited medical cannabis, rejecting state laws supporting medical cannabis markets. But during a 20-month period between October 19, 2009, and June 29, 2011 (Cole, 2011; Ogden, 2009), the federal government changed its policy so that it would no longer devote federal resources to prosecute medical cannabis providers operating in accordance with state law. To control for the effect of easing state-federal tensions, I constructed the dummy variable federal deference, coded 1 during this period and 0 otherwise.

I also controlled for organizational differences in framing strategies with the dummy variable Americans for Safe Access, coded 1 if ASA published the press release and coded 0 if NORML published the press release. Longer press releases were more likely to cover a broader range of topics, including the medical uses of cannabis, so I created the variable word count to control for press release length.

Plan of Analysis

I used a multinomial logistic regression model to predict the occurrence of the compassionate frame or wellness frame in a press release as compared to the baseline (no medical frame). As a robustness check, I modeled the average marginal effects of explanatory and control variables on the probability of social movement organizations using each medical frame in their press release, meaning the effect of a one-unit change of each regressor on the conditional mean of the outcome variable. This allowed for the comparison of effects between groups, samples, and periods of time, rendering the interpretation of interaction effects more meaningful (Cameron & Trivedi, 2009; Mood, 2010). I also conducted a robustness check excluding press releases that were not associated with any specific state (national) or the District of Columbia.


Table 4 presents descriptive statistics and a correlation table for all observations. Twenty-six percent of press releases included either the compassionate (14.2%) or wellness (11.8%) frame. Most variables were weakly or moderately correlated except time, which had a strong positive correlation with federal raids (+0.84) and a strong negative correlation with AIDS deaths (–0.70). The variance inflation factor was 6.85, below the cut-off of 10 commonly used in social science research, indicating that collinearity was not a major concern (Belsley, Kuh, & Welsch, 1980).

Table 4.

Descriptive Statistics and Correlation Table.

1 2 3 4 5 6 7 8 9 10 11 12 13 14
N 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487 2,487
Mean 7.181 0.014 29.040 0.117 0.154 316.578 9.415 0.013 0.192 1.922 0.169 2.275 0.142 0.118
SD 3.899 0.116 30.299 0.321 0.361 159.301 5.374 0.114 0.394 4.546 0.375 5.174 0.349 0.323
Min 4.825 0 0 0 0 21 0.008 0 0 0 0 0 0 0
Max 19.400 1 92 1 1 1,071 17.997 1 1 17.978 1 17.959 1 1
 1 AIDS deaths 1.000
 2 Recreational campaign −0.062 1.000
 3 Federal raids −0.457 0.013 1.000
 4 Federal deference −0.190 0.270 0.077 1.000
 5 ASA −0.191 0.075 0.225 0.099 1.000
 6 Word count −0.133 0.047 0.201 0.026 0.578 1.000
 7 Time −0.709 0.111 0.842 0.355 0.281 0.215 1.000
 8 Medical campaign 0.177 −0.014 −0.047 −0.031 −0.049 −0.030 −0.107 1.000
 9 Implementation −0.122 −0.031 0.012 0.081 −0.029 −0.107 0.055 −0.048 1.000
10 Implement × time −0.179 −0.024 0.197 0.174 0.000 −0.077 0.256 −0.036 0.868 1.000
11 Market −0.209 0.233 0.297 0.133 0.403 0.226 0.338 −0.052 −0.220 −0.191 1.000
12 Market × time −0.212 0.255 0.344 0.156 0.375 0.228 0.378 −0.051 −0.214 −0.186 0.974 1.000
13 Compassionate 0.119 −0.028 −0.131 −0.076 0.063 0.139 −0.161 0.074 0.018 −0.040 −0.039 −0.048 1.000
14 Wellness −0.048 −0.032 0.023 −0.017 0.117 0.161 0.035 −0.010 0.040 0.029 0.021 0.003 −0.149 1.000

Tables 5 and 6 present the results of a multinomial logistic regression model for predictors of the compassionate frame (Table 5) and the wellness frame (Table 6). These tables compare each specific outcome (compassionate or wellness) to the reference group (no medical frame). All results were exponentiated to show the relative risk ratio of each medical frame vis-a-vis the baseline of no medical frame. Relative risk is the ratio of the cumulative incidence rate among those exposed to the treatment compared to the rate among those not exposed.

Table 5.

Multinomial Logistic Models Predicting the Compassionate Frame.

Variables 1 2 3 4
AIDS deaths 0.983 0.976 0.993 0.997
Recreational campaign 0.512 0.512 0.513 0.616
Federal raids 0.998 0.998 0.997 0.998
Federal deference 0.744 0.742 0.716 0.730
Americans for safe access 1.562* 1.574* 1.513* 1.584*
Word count 1.004*** 1.004*** 1.004*** 1.004***
Time 0.884*** 0.884*** 0.903** 0.909*
Explanatory variables
Medical campaign period 2.911** 3.113** 3.076**
Implementation period 2.381** 2.540**
Implementation × time 0.951 0.940
Market period 1.948
Market × time 0.935
N 2,487 2,487 2,487 2,487

Notes: * p < 0.05; ** p < 0.01; and *** p < 0.001; two-tailed t-tests.

Results exponentiated.

Table 6.

Multinomial Logistic Models Predicting the Wellness Frame.

Variables 1 2 3 4
AIDS deaths 0.959 0.958 0.973 0.989
Recreational campaign 0.169 0.169 0.178 0.248
Federal raids 0.996 0.996 0.995 0.997
Federal deference 0.773 0.772 0.734 0.800
Americans for safe access 1.313 1.317 1.277 1.178
Word count 1.003*** 1.003*** 1.003*** 1.004***
Time 0.983 0.983 0.998 1.014
Explanatory variables
Medical campaign period 1.453 1.560 1.532
Implementation period 2.223* 2.816**
Implementation × time 0.972 0.948
Market period 14.660***
Market × time 0.805***
N 2,487 2,487 2,487 2,487

Notes: * p < 0.05; ** p < 0.01; and *** p < 0.001; two-tailed t-tests.

Results exponentiated.

Table 5 shows that ASA and NORML were more likely to use the compassionate frame during political campaigns to legalize medical cannabis (medical campaign period) and during the implementation phase following legalization (implementation period). The effects of medical campaign period and implementation period were large, positive, and statistically significant. Press releases published during political campaigns to legalize medical cannabis were 3.1 times as likely to include the compassionate frame as press releases published during the reference period. Press releases published during implementation were 2.5 times as likely to include the compassionate frame as press releases published during the reference period. However, once a state-sanctioned market emerged (market period), ASA and NORML were neither more nor less likely to use the compassionate frame as during the reference period. Together, these findings suggest that social movement organizations began to amplify parts of the medical frame that were morally acceptable to the public during campaigns to legalize medical cannabis and maintained this framing during the implementation phase. However, they discontinued their increased use of the compassionate frame once a state-legal market emerged.

A review of the variables that controlled for alternate explanations shows that neither discursive opportunities nor coercive threats were significantly associated with the use of the compassionate frame, but that ASA was more likely to use this frame than NORML. This is not surprising, as ASA is dedicated to defending the medical use of cannabis, while NORML supports both medical and recreational use. As expected, press release length (word count) was associated with an increase in the relative risk that a social movement press release included the compassionate frame. Finally, the use of the compassionate frame decreased over time. Each additional year in the study period was associated with a 9.1% decrease in the relative risk of including the compassionate frame in a press release, suggesting a secular decrease in the use of the more restrictive frame over time.

Table 6 shows that social movement organizations were neither more nor less likely to use the wellness frame in press releases published during campaigns to legalize medical cannabis (medical campaign period) than during the reference period, but were more likely to use the wellness frame during implementation (implementation period) and following the emergence of a legal market (market period). The effects of implementation and market emergence were large, positive, and statistically significant. Press releases published during the implementation period were 2.8 times as likely to include the wellness frame as press releases published during the reference period. Press releases published during the market period were 14.6 times as likely to include the wellness frame as press releases published during the reference period. However, the effect of market period decreased with time. Following market emergence, each additional year was associated with a 19.5% decrease in the relative risk of including the wellness frame in a press release, suggesting that while social movement organizations escalated their use of the wellness frame following the emergence of a legal market, they used the wellness frame with decreasing frequency as the market matured.

Table 6 shows little support for alternate arguments that secular trends, discursive opportunities, or variation in levels of federal threat were associated with the wellness frame. None of the controls except document length (word count) were associated with this more expansive frame, suggesting that social movement organizations did not respond to opportunities or threats with the wellness frame and that neither ASA nor NORML were more likely to use the more expansive frame. While Table 5 shows that time was associated with a decrease in the compassionate frame, Table 6 does not show that time was associated with an increase in the wellness frame, indicating that there was not a secular trend toward a more expansive framing over time.

In summary, Tables 5 and 6 suggest social movement organizations first used frame amplification to develop public support for legalizing medical cannabis by highlighting aspects of cannabis’s medical use that were congruent with the socially constructed moral boundaries surrounding the market. Once activists helped develop legal support for the market, social movement organizations shifted to a strategy of frame extension, interspersing their use of the restrictive compassionate frame and the expansive wellness frame to make these moral boundaries more permeable. Finally, once a state-legal market emerged, social movement organizations continued to support the market through strategic framing, dramatically increasing their use of the wellness frame while discarding the compassionate frame, resulting in a frame transformation. However, as state-authorized markets grew older, social movements decreased their use of the wellness frame, indicating that while social movements may continue to support a market through strategic framing after the market opens, this support may decrease over time. Robustness checks estimating average marginal effects show similar results, as do robustness checks estimating these models for the subset of data excluding national press releases.


This study shows how social movement organizations used distinct framing strategies at different stages of institutional development to destigmatize medical cannabis markets. NORML and ASA performed cultural and institutional work redefining the legitimate medical use of cannabis by strategically deploying different medical frames to negotiate the moral boundaries surrounding cannabis. By showing how social movement organizations sequenced their framing strategies to develop support for the market – first respecting moral boundaries through frame amplification and then making boundaries permeable through frame extension and frame transformation – this study demonstrates how organizations can incrementally dilute stigma and develop support for the normalization of a taboo market. But do organizations always follow this strategic process when attempting to legalize and legitimate an illegal and taboo market?

Anecdotal evidence from a number of different campaigns to destigmatize morally and legally contested markets suggests that organizations often attempt to win support for a contested product or practice by emphasizing how the market will benefit a subset of sympathetic and worthy individuals. For example, advocates of euthanasia restrict their framing of the right to die to those who are terminally ill or have illnesses that cause constant suffering. Lotteries, a form of gambling, are often justified because the proceeds go toward schools or other public services. Proponents of legalized prostitution point to how regulation will protect sex workers from exploitation and trafficking. These examples suggest that this study’s findings are generalizable to other morally and legally contested markets. Organizations will attempt to develop support for morally repugnant products and practices by amplifying frames that highlight how the market is restricted to a set of worthy individuals who are unlikely to be perceived as transgressing the moral boundaries that separate the offending market from reputable commerce.

However, not all organizations will extend and transform frames following legalization because in some cases, unrestrained commerce may undermine the values that helped give rise to the market (Lee, Hiatt, & Lounsbury, 2017; McInerney, 2014). In these cases, organizations may fight market expansion and maintain more restrictive frames as bulwarks against full normalization. The generalizability of these findings should be conditioned on whether expansion of the market is aligned with social movement values.

Alternately, social movement organizations may move on to other battles or cease to exist once they develop support for a morally and legally contested market. In these cases, social movement organizations would no longer take part in strategic framing in support for the market. As medical cannabis remains illegal at the federal level, it may be that social movements continue to play a role in state-legal medical cannabis markets because of the ongoing threat of federal prohibition.

While movements may support or oppose market expansion, depending on their values, it is safe to assume that most market participants will desire a larger and more profitable market once it has gained legitimacy and legal support. Industry actors and trade associations are likely to extend and transform frames following legalization and market emergence. Therefore, these findings may be more generalizable to the universe of market participants that engage in collective action than the universe of social movement organizations.

I could not rule out a number of alternate explanations due to data limitations. Social movement scholars often describe the discursive battles taking place between movements and countermovements. Social movement organizations’ framing strategies are often contingent on the frames used by their opponents. It has been challenging to obtain reliable strategic messaging data from opponents to medical cannabis over the 18-year study period. This is in part because much of the opposition to medical cannabis legalization has come from the state and collective bodies, such as state-level and local unions that represent law enforcement and correctional guards. 5 It has been difficult to develop a corpus to show how the countermovement has framed cannabis across all 50 states. Including movement–countermovement dynamics may shed light on how social movements strategically negotiate moral boundaries surrounding a market. Future research should explore how movement–countermovement dynamics co-evolve with legalization and the development of market institutions.

Finally, this study has practical implications for social movement organizations, firms in contested industries, and policymakers attempting to persuade the public with regard to a controversial issue. In order to transform perception of a maligned category, product, or practice, actors must first understand the moral environment in which they are operating and frame their message so as to gain a foothold for their institution-building project. Once actors gain a degree of moral legitimacy for a contested product or practice, they can use this foothold as a foundation for transformative change.



Moral legitimacy refers to “a positive normative evaluation…about whether the activity is ‘the right thing to do’…as defined by the audience’s socially constructed value system” (Suchman, 1995, p. 579; see also Aldrich & Fiol, 1994).


This approach “assumes that frames manifest themselves by the presence or absence of certain keywords and concepts” (Fiss & Hirsch, 2005, p. 35).


NORML and ASA included medical conditions in their press releases in one of the three ways: They (1) described cannabis’s efficacy for treating a medical condition; (2) explained how a law or ballot initiative would allow for (or unfairly prohibit) certain medical uses; or (3) highlighted the plight of a patient with a specific illness.


Most efforts to legalize cannabis have gone through the public ballot initiative process, where voters decide whether or not to allow for legal medical cannabis use. During the study duration, 16 states voted on legalizing medical cannabis with 12 ballot initiatives passing and four failing. I chose the 180-day cutoff because in most states, relevant state authorities must approve a ballot initiative four to six months before the election for it to be placed on the ballot (e.g., California’s cutoff is 131 days, while Oregon’s cutoff is 165 days).


The federal government appears to have accepted the compassionate framing of cannabis’s medical use. In the 2011 Cole Memo, the Department of Justice stated that its hands-off approach to medical cannabis markets was restricted to “individuals with cancer or other serious illnesses” (Cole, 2011, emphasis added).


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Special thanks to Heather Haveman, Laura Stoker, Neil Fligstein, Mike Hout, Jens Beckert, Dave Harding, Cristina Mora, Kim Voss, Cybelle Fox, Sarah Brothers, and Gillian Gualtieri, as well as participants in the Berkeley-Stanford Organization Behavior Conference and Berkeley’s CCOP workshop and the anonymous reviewers/editors at Research in the Sociology of Organizations for their helpful comments. Also, thanks to Amazon Web Services and Github, as well as the Berkeley URAP program for their generous grants and support. All mistakes and omissions are my own.

Introduction: Integrating Research Perspectives on Business and Society
Section I Social Movements and Organizational Theory
Chapter 1 Plug Power. Social Movements and Electric Vehicle Charging Stations in California, 1995–2012
Chapter 2 Negotiating Moral Boundaries: Social Movements and the Strategic (Re)Definition of the Medical in Cannabis Markets
Chapter 3 Movement-Led Institutional Change: Uncertainty, Networks, and the Diffusion of Contentious Practices in Organizational Fields
Chapter 4 Social Movement Theory’s Contribution to Understanding Activism Around Corporations and Markets
Section II Social Movements and Stakeholders
Chapter 5 The Negative Relationship Between Event-Specific Corporate Social Responsibility and Shareholder Value
Chapter 6 Bridging Social Movement and Industrial Relations Theory: An Analysis of Worker Organizing Campaigns in the United States and China
Chapter 7 Not a Drop to Drink? Drinking Water Quality, System Ownership, and Stakeholder Attention
Chapter 8 Influence Stakeholders, Influence the World
Section III Social Movements and Non-Market Strategy
Chapter 9 On Two Sides of the Smoke Screen: How Activist Organizations and Corporations use Protests, Campaign Contributions, and Lobbyists to Influence Institutional Change
Chapter 10 Failure or Success? Defensive Strategies and Piecemeal Change Among Racial Inequalities in the Brazilian Banking Sector
Chapter 11 Non-Market Strategy and Social Movements Research: What are the Gains from Trade?
Afterword Broadening Business And Society Research: A Postscript on the Limits of Strategic Action