When People Come First by Biehl João Petryna Adriana

Author:Biehl, João, Petryna, Adriana
Language: eng
Format: epub
Publisher: Princeton University Press
Published: 2013-04-10T04:00:00+00:00

III

MARKETS

Overview

Various movements are afoot in the field of global health: from the collective control of epidemics to the personalization of disease; from trial and error to the standardization of evidence and policy; from health as a public good to the pharmaceuticalization of health care; from governmental detachment to the industrialization of the nongovernmental sector and a privatized politics of survival. Alongside them, critical questions abound: Has the biopolitical morphed into a multilevel turf war of private versus public stakeholders battling over the utility of government? Where does this leave the majority and the “surplus” poor and diseased subjects who are not targets of specific interventions? Is their biomedical rehabilitation “futile” in a world where health policies are increasingly oriented by market principles? How does this underside of global health speak to the decline of civil society as a viable “transactional locus” for the guarantee of social justice?

The chapters by Ecks and Harper, Han, Whitmarsh, and Biehl and Petryna provide valuable examples of the ways in which the movement of global health toward ever-greater scientization and private-sector involvement can be creatively studied by anthropologists. Strategically located at the sites where pharmaceutical industries, public health care providers, and patient-citizen-consumers intersect, these case studies provide a fertile ground from which to rethink the role of science, the state, and the market in global health and to evaluate alternative configurations, protagonists, dynamics, and possibilities.

How are the interpenetrating domains of ill health, therapeutic markets, and the law emerging as implicit and explicit sites for claiming political rights and confronting political failures? Are the subjects of rights and economic subjects—once understood as distinct entities—now included or excluded through shared mechanisms shaped by the market of global medicine? Is the market, then, what is ultimately produced by government and by the people?

Case studies in this section show how health policy debates about risk and compliance, as well as patient struggles for access to pharmaceuticals, are part of a changed health care landscape that the concept of the medicalization of social problems cannot fully address (Conrad 2007; Lock 2003; Scheper-Hughes 1992). While the culture of biomedicine is undeniably powerful, it is also speculative and improvised, and patients do not simply become the diagnostic categories and treatments that are applied to them. People may inhabit them to greater or lesser degrees, but they are also able to refuse them, or to redefine and deploy them to unanticipated ends. Understanding today’s capacious pharmaceuticalization of health care requires analytical tools and methods that can account for the entanglement of multiple social forces and markets in defining the politics of health, the unregulated circulation of pharmaceuticals and their chemical effects, and the role of patients in creating demand.

In their contribution, Stefan Ecks and Ian Harper offer a way to see how the landscape of tuberculosis treatment in India emerges at the intersection of global business and political schemes and the local constraints of providing care. They follow the pharmaceutical industry’s efforts to shape the diagnosis and treatment of TB, homing in on

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