Pharmaceuticalization: AIDS treatment and global health politics

Anthropological Quarterly

Volumn 80, Issue 4, 2007, Pages 1083-1126

  Biehl, João ^a  

^a PRINCETON UNIVERSITY   (United States)

Author keywords

AIDS treatment; Contemporary Brazil; Global health; Market based biopolitics; Pharmaceuticalization; Political subjectivity

Indexed keywords

EID: 38049136683     PISSN: 00035491     EISSN: None     Source Type: Journal    
DOI: 10.1353/anq.2007.0056     Document Type: Note

References (80)

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3. See Biehl, João. Will to Live: AIDS Therapies and the Politics of Survival. Princeton: Princeton University Press, forthcoming 2007.
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12. For more epidemiological information on HIV/AIDS in Brazil see: http://www.cdc.gov/nchstp/od/gap/countries/brazil.htm http://www.usaid.gov/ our_work/global_health/aids/Countries/lac/brazil.html
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23. See Biehl, João. 2005. "Technologies of Invisibility: The Politics of Life and Social Inequality." Anthropologies of Modernity: Foucault, Governmentality, and Life Politics, edited by Jonathan Xavier Inda. London: Blackwell, pp. 248-271.
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25. See Biehl, João (with Torben Eskerod). 2006. "Will To Live: AIDS Drugs and Local Economies of Salvation." Public Culture 18(3):457-472.
26. Several studies in Brazil uncovered a variety of factors associated with poor adherence to ARVs, and these findings have bearing on how we understand particular hardships and the possibilities for positive treatment outcomes in a place like Caasah.
27. See Nemes M, Carvalho H, Souza M. 2004. "Antiretroviral therapy adherence rates in Brazil." AIDS 18 Suppl 3:S15-20.
28. Garcia, R, Schooley R, Badaro R. 2003. "An adherence trilogy is essential for long-term HAART success." The Brazilian Journal of Infectious Diseases 7(5):307-314.
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31. See Abadia-Barrero CE, Castro A. 2006. "Experiences of Stigma and Access to HAART in Children and Adolescents Living with HIV/AIDS in Brazil." Social Science and Medicine 62(5): 1219-1228.
32. Nguyen, Vinh-kim. 2005. "Antiretroviral Globalism, Biopolitics, and Therapeutic Citizenship." Global Assemblages: Technology, Politics, and Ethics as Anthropological Problems edited by Aihwa Ong and Stephen J. Collier. Malden, MA: Blackwell Publishing, p.126.
33. For a discussion of AIDS treatment activism and citizenship in South Africa see Robins, Steven. 2006. "From Rights to 'Ritual': AIDS Activism and Treatment Testimonies in South Africa." American Anthropologist 108(2):312-323.
34. For an anthropological discussion of contemporary statecraft and sovereignty see: Geertz, Cliford. 2004. "What Is a State If It Is Not a Sovereign?" Current Anthropology 45: 577-591.
35. Das, Veena and Deborah Poole. 2004. Anthropology in the Margins of the State. Santa Fe: School of American Research Press.
36. Greenhouse, Carol, Elizabeth Mertz, Kay B. Warren (eds). 2002. Ethnography in Unstable Places: Everyday Lives in Contexts of Dramatic Political Change. Durham: Duke University Press.
37. Ong, Aihwa. 2006. Neoliberalism as Exception: Mutations in Citizenship and Sovereignty. Durham, NC: Duke University Press.
38. Hansen, Thomas Blom and Finn Stepputat. 2006. "Sovereignty Revisited." Annual Review of Anthropology 35:295-315.
39. See Cardoso, Fernando Henrique. 1998. "Notas sobre a Reforma do Estado." Novos Estudos do CEBRAP 50:1-12.
40. Cardoso, Fernando Henrique. 2005. A Arte da Político: A História Que Vivi. Rio de Janeiro: Record.
41. As I interviewed Cardoso and other policy makers, I was struck by the ethos of power and innovation they conveyed and by their extensive use of social scientific idioms to describe their work and vision. While speaking of political alternatives under the constraints of global trade rules, they frequently mentioned terms such as networks, assemblages, governmentality, contingency, and flexibility - terms by now familiar to many social scientists studying contemporary politics.
42. See Riles, Annelise. 2004. The Network Inside Out. Ann Harbor: Michigan University Press.
43. Ong, Aihwa and Stephen J. Collier (eds). 2004. Global Assemblages: Technology, Politics, and Ethics as Anthropological Problems. London: Blackwell Publishing.
44. Biehl, João, Byron Good, and Arthur Kleinman (eds.). 2007. Subjectivity: Ethnographic Investigations. Berkeley: University of California Press.
45. See Sell S. 2003. Private Power, Public Law: The Globalization of Intellectual Property Rights. Cambridge: Cambridge University Press.
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51. See Comaroff, John L., and Jean Comaroff. 2006. "Law and Disorder in the Postcolony: An Introduction." Law and Disorder in the Postcolony (edited by Jean Comaroff and John L. Comaroff). Chicago: Chicago University Press, pp.1-56.
52. The Comaroffs elaborate on the contemporary "judicialization of politics." Class struggles, they argue, "seem to have metamorphosed into class actions. Citizens, subjects, governments, and corporations litigate against one another, often at the intersections of tort law, human rights law, and the criminal law, in an ever mutating kaleidoscope of coalitions and cleavage" (p. 26).
53. See the press release by IMS Health (March 21, 2006): "IMS Health Reports Global Pharmaceutical Market Grew 7 Percent in 2005, to $602 Billion" http://www.imshealth.com/ims/portal/front/articleC/0,2777, 6599_3665_77491316,00.html
54. See Bermudez, Jorge. 1992. Remédies: Saúde ou Indústria. Rio de Janeiro: Relume Dumará.
55. See "Pharmaceutical Growth Opportunities in Brazil, Russia, India and China: Healthcare Reform, Market Dynamics and Key Players." Business Insights, Aug 1, 2006.
56. URL: http://www.marketresearch.com/product/display.asp?productid=1331044
57. Note that Mexico has recently displaced Brazil, becoming the largest pharmaceutical market in Latin America. Argentine and Venezuela rank third and fourth respectively.
58. Personal communication, August 2000.
59. Personal communication, May 2003.
60. For a discussion of how pharmaceutical companies inform public health practices see Applbaum, Kaiman. 2006. "American Pharmaceutical Companies and the Adoption of SSRI's in Japan." Global Pharmaceuticals: Markets, Practices, Ethics, edited by Adriana Petryna, Andrew Lakoff, and Arthur Kleinman. Durham, NC: Duke University Press.
61. See Farmer Farmer, Paul. 2003. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press.
62. Pogge, Thomas W. 2005. "Human Rights and Global Health: A Research Program." Metaphilosophy 36(1/2):182-209.
63. Sterckx, Sigrid. 2004. "Patents and Access to Drugs in Developing Countries: An Ethical Analysis." Developing World Bioethies 4(1):58-75.
64. Personal communication, June 2003.
65. As part of a policy of rationalization and decentralization of assistance, in the mid-1990s the Brazilian government began to recast the costly and inefficient basic pharmacy program whereby municipalities distributed state-funded medicines to the general population (this program preexisted the ARV rollout). Provinces and municipalities were urged to develop their own epidemiologically specific treatment strategies and to administer federal and regional funds in the acquisition and dispensation of medicines.
66. Brazil's trajectory towards specifically targeted medical interventions, especially those comprised of a particular biological technology or drug, mirrors the development of international health care methods throughout the late twentieth and into the twenty first century.
67. See Yunes J. 1999. "Promoting Essential Drugs, Rational Drug Use and Generics: Brazil's National Drug Policy Leads the Way." Essential Drugs Monitor 27: 22,23.
68. See Cosendey, Marly Aparecida, Bermudez JAZ, Reis ALA, Silva HF, Oliveira MA, Luiza VL. 2000. "Assistência Farmacêutica na Atenção Básica de Saúde: A Experiência de Três Estados Brasileiros." Cadernos de Saúde Pública 16(1): 171-182.
69. See Petryna, Adriana. 2007. "Clinical Trials Offshored: On Private Sector Science and Public Health." BioSocieties 2:21-40
70. Bermudez, J.A.Z, R. Epsztein, M.A. Oliveira, and L. Hasenclever. 2000. "O Acordo TRIPS da OMC e a Proteção Patentária no Brasil: Mudanças Recentes e Implicações para a Produção Local e o Acesso da População aos Medicamentos." Escola Nacional de Saúde Pública, FIOCRUZ/OMS.
71. See Langevin, South Asian Research Institute for Policy and Development at http://www.sarid.net/health/healthdocs/050701-hiv.htm).
72. The Global Fund is meant to be an "innovative approach to international health financing" between governments, civil societies, afflicted populations, and the private sector (see http://www.theglobalfund.org/ en/).
73. See Wogart J.P. and G. Calcagnotto. 2006. "Brazil's Fight Against AIDS and Its Implications for Global Health Governance." World Health & Population January, pp.1-16.
74. Announced in December 2003, this initiative began with a good deal of momentum, and the Indian generic triple fixed dose capsule (FDC) provided its pharmaceutical backbone. Supporters of the initiative hailed "3 by 5" as opening up "a new era in international public health," while critics claimed that it was irresponsibly unrealistic, with "little vision, no credible framework, and insufficient technical assistance."
75. See http://www.healthgap.org/press_releases/03/051903_HGAP_BP_WHO_TA_TX. html
76. Jim Kim cited in Madeleine Morris's report "OMS admite fracasso em meta de combate ao HIV," Folha Online, 11/28/2005 (my translation).
77. World Health Organization. 2006. "Progress Towards Universal Access: 3 by 5 and beyond." Geneva: WHO.
78. By February 2006, more than 30 countries had convened national consultations on universal ARV access, and nearly 100 other countries had initiated the planning process. Over the past year, the number of people receiving treatment increased by about 300,000 every six months. Scale-up in sub-Saharan Africa has been particularly dramatic, from 100,000 at the end of 2003 to 310,000 at the end of 2004 and 810,000 at the end of 2005.
79. See Farmer, Paul. 2003. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press.
80. Fassin, Didier. 2007. When Bodies Remember: Experiences and Politics of AIDS in South Africa. Berkeley: University of California Press.