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  • Acknowledgments vii

    The Pharmaceutical Nexus / Adriana Petryna and Arthur Kleinman 1

    Globalizing Human Subjects Research / Adriana Petryna 33

    The New Medical Oikumene / David Healy 61

    Educating for Global Mental Health: The Adoption of SSRIs in Japan / Kalman Applbaum 85

    High Contact: Gifts and Surveillance in Argentina / Andrew Lakoff 111

    Addiction Markets: The Case of High-Dose Buprenorphine in France / Anne M. Lovell 136

    Pharmaceuticals in Urban Ecologies: The Register of the Local / Veena Das and Ranendra K. Das 171

    Pharmaceutical Governance / João Biehl 206

    Treating AIDS: Dilemmas of Unequal Access in Uganda / Susan Reynolds Whyte, Michael A. Whyte, Lotte Meinert, and Betty Kyaddondo 240

    References 263

    Contributors 289

    Index 291
  • Adriana Petryna

    David Healy

    Kalman Applbaum

    Andrew Lakoff

    Anne M. Lovell

    Veena Das

    João Biehl

    Susan Reynolds Whyte

    Arthur Kleinman

    Ranendra Das

    Michael A. Whyte

    Lotte Meinert

    Betty Kyaddondo

  • “[A] welcome addition to the growing field of study that might be called ‘Pharmaceuticals and Society.’ . . . Global Pharmaceuticals provides some valuable discussions on the recruitment of patients into drug trials, the access/availability of needed medications, and the marketing strategies of pharmaceutical companies, including the suppression of adverse drug reaction data.” — John Abraham, American Journal of Sociology

    “[A]s a collection of ethnographic case studies trying to disentangle the Gordian knots in the increasingly interconnected and complex world of global pharmaceuticals, especially in the marketing of lifestyle drugs, this book is important.” — Dinesh Sharma, Health Affairs

    “[F]ascinating. . . .” — Sjaak van der Geest, Anthropological Quarterly

    “Although the book is billed as an ethnographic approach, the authors are by no means all academic anthropologists but come from a variety of disciplines and have wide-ranging country experience. Although the editors are all from US universities, the discussion is not United States–centric or Eurocentric but also ranges across developing countries and Asia. The breadth of experience, views, and approaches is refreshing and makes for a collection that should appeal to and stimulate both a development and health-system audience." — Tim Ensor, Journal of the American Medical Association

    “The book's laudable political purpose is to induce a rethinking of the system of pharmaceutical production and distribution and promote a more equitable global pattern of availability and access. . . . [T]he collection is to be recommended. There is sufficient colour in each of the individual essays to hold attention, and collectively the essays provide a range of viewpoints that highlight the complexity of the global expansion of pharmaceutical trade, the logics, stakes and interests that impel it and the political, economic and ethical challenges it represents.” — Evan Doran and David Henry, Australian and New Zealand Journal of Public Health

    “This is a must read for anyone who wants to understand the complex local nuances involved as neo-liberal globalisation increasingly redefines the location of human rights, justice and equity away from the social sphere and towards the individual body of the biotechnical citizen.” — Sami Timimi, British Journal of Psychiatry

    “When successfully applied, the anthropological approach, as presented in the book, has the capacity to dissolve our everyday reality into a puddle of assumed beliefs. . . . [T]his anthropological approach offers an ‘Aha!’ experience, making us aware of what we knew but could not articulate.” — Daniel Luchins, American Journal of Psychiatry

    Reviews

  • “[A] welcome addition to the growing field of study that might be called ‘Pharmaceuticals and Society.’ . . . Global Pharmaceuticals provides some valuable discussions on the recruitment of patients into drug trials, the access/availability of needed medications, and the marketing strategies of pharmaceutical companies, including the suppression of adverse drug reaction data.” — John Abraham, American Journal of Sociology

    “[A]s a collection of ethnographic case studies trying to disentangle the Gordian knots in the increasingly interconnected and complex world of global pharmaceuticals, especially in the marketing of lifestyle drugs, this book is important.” — Dinesh Sharma, Health Affairs

    “[F]ascinating. . . .” — Sjaak van der Geest, Anthropological Quarterly

    “Although the book is billed as an ethnographic approach, the authors are by no means all academic anthropologists but come from a variety of disciplines and have wide-ranging country experience. Although the editors are all from US universities, the discussion is not United States–centric or Eurocentric but also ranges across developing countries and Asia. The breadth of experience, views, and approaches is refreshing and makes for a collection that should appeal to and stimulate both a development and health-system audience." — Tim Ensor, Journal of the American Medical Association

    “The book's laudable political purpose is to induce a rethinking of the system of pharmaceutical production and distribution and promote a more equitable global pattern of availability and access. . . . [T]he collection is to be recommended. There is sufficient colour in each of the individual essays to hold attention, and collectively the essays provide a range of viewpoints that highlight the complexity of the global expansion of pharmaceutical trade, the logics, stakes and interests that impel it and the political, economic and ethical challenges it represents.” — Evan Doran and David Henry, Australian and New Zealand Journal of Public Health

    “This is a must read for anyone who wants to understand the complex local nuances involved as neo-liberal globalisation increasingly redefines the location of human rights, justice and equity away from the social sphere and towards the individual body of the biotechnical citizen.” — Sami Timimi, British Journal of Psychiatry

    “When successfully applied, the anthropological approach, as presented in the book, has the capacity to dissolve our everyday reality into a puddle of assumed beliefs. . . . [T]his anthropological approach offers an ‘Aha!’ experience, making us aware of what we knew but could not articulate.” — Daniel Luchins, American Journal of Psychiatry

  • “Covering an extremely timely topic, Global Pharmaceuticals is a strong and innovative volume with substantial field-based insider knowledge of how pharmaceuticals actually attach themselves to and transform local social relations.” — Rayna Rapp, author of Testing Women, Testing the Fetus

    “Hundreds of millions of people around the world are denied access to desperately needed medications. Eliminating the inequalities of the current system of drug production and distribution requires a deep and nuanced understanding of that system. By offering ethnographically grounded investigations of the dynamics of the global pharmaceutical industry, this volume advances significantly an urgent research agenda.” — Dr. Jim Yong Kim, Director, Department of HIV/AIDS, World Health Organization

    “This collection of brilliantly incisive essays gives us the necessary standpoint from which to view the increasing global circulation of pharmaceuticals, the spreading influence of ‘Big Pharma,’ and the growing use of medication to shape identities in a neoliberal world order. It is a work of superior, innovative scholarship, addressing issues of major contemporary significance. — Warwick Anderson, author of The Cultivation of Whiteness: Science, Health, and Racial Destiny in Australia

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  • Description

    In some parts of the world spending on pharmaceuticals is astronomical. In others people do not have access to basic or life-saving drugs. Individuals struggle to afford medications; whole populations are neglected, considered too poor to constitute profitable markets for the development and distribution of necessary drugs. The ethnographies brought together in this timely collection analyze both the dynamics of the burgeoning international pharmaceutical trade and the global inequalities that emerge from and are reinforced by market-driven medicine. They demonstrate that questions about who will be treated and who will not filter through every phase of pharmaceutical production, from preclinical research to human testing, marketing, distribution, prescription, and consumption.

    Whether considering how American drug companies seek to create a market for antidepressants in Japan, how Brazil has created a model HIV/AIDS prevention and treatment program, or how the urban poor in Delhi understand and access healthcare, these essays illuminate the roles of corporations, governments, NGOs, and individuals in relation to global pharmaceuticals. Some essays show how individual and communal identities are affected by the marketing and availability of medications. Among these are an exploration of how the pharmaceutical industry shapes popular and expert understandings of mental illness in North America and Great Britain. There is also an examination of the agonizing choices facing Ugandan families trying to finance AIDS treatment. Several essays explore the inner workings of the emerging international pharmaceutical regime. One looks at the expanding quest for clinical research subjects; another at the entwining of science and business interests in the Argentine market for psychotropic medications. By bringing the moral calculations involved in the production and distribution of pharmaceuticals into stark relief, this collection charts urgent new territory for social scientific research.

    Contributors. Kalman Applbaum, João Biehl, Ranendra K. Das, Veena Das, David Healy, Arthur Kleinman, Betty Kyaddondo, Andrew Lakoff, Anne Lovell, Lotte Meinert, Adriana Petryna, Michael A. Whyte, Susan Reynolds Whyte

    About The Author(s)

    Adriana Petryna is Associate Professor of Anthropology and Associate Fellow, Center for Bioethics, University of Pennsylvania. She is the author of Life Exposed: Biological Citizens after Chernobyl.

    Andrew Lakoff is Assistant Professor of Sociology and Science Studies at the University of California, San Diego. He is the author of Pharmaceutical Reason: Knowledge and Value in Global Psychiatry.

    Arthur Kleinman is the Esther and Sidney Rabb Professor and Chair of Anthropology, Professor of Medical Anthropology, and Professor of Psychiatry at Harvard University. Among his books are Writing at the Margin: Discourse between Anthropology and Medicine and The Illness Narratives: Suffering, Healing, and the Human Condition.

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