Pharmaceutical crises and questions of value: Terrains and logics of global therapeutic politics

South Atlantic Quarterly

Volumn 111, Issue 2, 2012, Pages 321-346

  Rajan, Kaushik Sunder ^a  

^a UNIVERSITY OF CHICAGO   (United States)

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[No Author keywords available]

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EID: 84860785844     PISSN: 00382876     EISSN: 15278026     Source Type: Journal    
DOI: 10.1215/00382876-1548239     Document Type: Review

References (27)

1. Joseph A. di Masi, R. W. Hansen, H. G. Grabowski, H. G. Lasagna, and L. Lasagna, "Cost of Innovation in the Pharmaceutical Industry", Journal of Health Economics 10(1991):107-42.
2. For instance, a study in December 2003 by the consulting firm Bain and Company put the figure at $1.7 billion. Ashish Singh and Preston Henske, "Has the Pharmaceutical Blockbuster Model Gone Bust?", Bain and Company, December 8, 2003, www.bain.com/about/press/press-releases/has-the- pharmaceutical-blockbuster-model-gonebust.aspx.
3. Adriana Petryna, "Drug Development and the Ethics of the Globalized Clinical Trial", Occasional Papers of the School of Social Science, no. 22 (2005).
4. These figures are from Ronald Norton, "Clinical Pharmacogenomics: Applications in Pharmaceutical R & D", Drug Discovery Today 6, no. 4(2001):180-85.
5. Mark Edwards and Christian Dokomajilar, "Acquisitions versus Product Development: An Emerging Trend in Life Sciences", Deloitte, 2009, www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/MA/ us-ma-LS%20Industry%20Advantage-Acquisitions%20versus%20product%20development- 091609.pdf.
6. Ed Silverman, "One More Reason that Lilly Must Do a Deal, Fast", Pharmalot, October 20, 2010, www.pharmalot.com/2010/10/one-more- reason-that-lilly-must-do-a-deal-fast/.
7. Life Sciences and Health Care Industry Group, "The Future of the Life Sciences Industries: Transformation amid Rising Risk", Deloitte, 2008, www.deloitte.com/assets/Dcom-Global/Local%20Assets/Documents/FutureLS- TransformationRisk-FINAL%282%29.pdf (accessed July 21, 2011).
8. Joseph Dumit, Drugs for Life: Growing Health through Facts and Pharmaceuticals (Durham, NC: Duke University Press, forthcoming).
9. A particularly explicit example of this is seen in the writing of pharmaco-epidemiologist John Urquhart, who frames the choices between healthy living and therapeutic consumption in terms of "risk-swapping." See John Urquhart, "Some Key Points Emerging from the COX-2 Controversy", Pharmacoepidemiology and Drug Safety 14, no. 3(2005):145-47. For a critique of Urquhart's position and its consequences for understanding the redefinition of health
10. see Dumit, Drugs for Life.
11. Nikolas Rose, The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century (Princeton, NJ: Princeton University Press, 2006).
12. Karl Marx, Capital: A Critique of Political Economy, vol. 1, trans. Ben Fowkes (1867; London: Penguin, 1976).
13. These analogies are not merely conceptual but can be read through Marx. To this end, Dumit has performed an experiment, which he calls BioMarx, where he has taken key categories in Marx's labor theory of value and substituted them with analogous categories that might be relevant to a health theory of value. Through such keyword substitution, Marx's analysis, ported into contemporary pharmaceutical economies, works remarkably well. See BioMarx Experiment (blog), https://sites.google.com/site/biomarxexperiment/home (accessed July 16, 2011).
14. See, for instance, Michael Montoya, Making the Mexican Diabetic: Race, Science, and the Genetics of Inequality (Berkeley: University of California Press, 2011). Montoya studies how Latino/a populations in the United States become idealized subjects in genetic testing and clinical trials for diabetes research. What Montoya calls bioethnic conscription suggests the structures of prior marginalization, mapping onto histories and geographies of poverty and racial inequality, which pharmaceutical economies appropriate to their own value-creating ends.
15. Kaushik Sunder Rajan, "Subjects of Speculation: Emergent Life Sciences and Market Logics in the U. S. and India", American Anthropologist 107, no. 1(2005):19-30;
16. and Kaushik Sunder Rajan, "Experimental Values: Indian Clinical Trials and Surplus Health", New Left Review, no. 45(2007):67-88.
17. For an account of how I conceptualize the relationship of biocapital to systems and regimes of capital writ large, see Kaushik Sunder Rajan, Biocapital: The Constitution of Postgenomic Life (Durham, NC: Duke University Press, 2006).
18. For ethnographic studies of CROs and the economies they create and inhabit, see Jill Fisher, Medical Research for Hire: The Political Economy of Pharmaceutical Clinical Trials (New Brunswick, NJ: Rutgers University Press, 2009);
19. and Adriana Petryna, When Experiments Travel: Clinical Trials and the Global Search for Human Subjects (Princeton, NJ: Princeton University Press, 2009).
20. Carlos Novas and Nikolas Rose, "Biological Citizenship", in Global Assemblages: Technology, Politics, and Ethics as Anthropological Problems, ed. Aihwa Ong and Stephen Collier (Oxford: Blackwell, 2004), 439-63. For the operation of obligation, commitment, and indebtedness in biomedical economies in relation to organ trade in India
21. see Lawrence Cohen, "Where It Hurts: Indian Material for an Ethics of Organ Transplantation", Daedalus 128, no. 4(1999):135-65;
22. and Lawrence Cohen, "Operability, Bioavailability, and Exception", in Global Assemblages, 79-106. For an analysis of the place of love in biomedical economies
23. see Chloe Silverman's account of parent advocacy groups of children affected with autism: Chloe Silverman, Understanding au tism: Parents, Doctors, and the History of a Disorder (Princeton, NJ: Princeton University Press, 2011). Both Cohen and Silverman provide moving accounts of emergent kinds of labor in biomedical economies. In Cohen's case, obligation, commitment, and indebtedness can never be simple liberal constructs, because they are founded on differential forms and relations of bioavailability. In Silverman's case, the love of a parent for his or her autism-afflicted child often goes hand-in-hand with having to make painful decisions about subjecting the child to experimental therapeutic interventions. The affective entanglements of capital and biocapital are never innocent.
24. This is a simplified account of the debate that Marx engaged with at the start of the "Chapter on Money", in Grundrisse: Foundations of a Critique of Political Economy, trans. Martin Nicolaus (1857; London: Penguin, 1993), 117-28. Marx's specific critique is of the response of the socialist Alfred Darimon to the Banque de France's making credit more difficult to obtain consequent to the progressive dilution of its reserves in 1855. Darimon cited the problem as being the importance attributed to the role of precious metals in circulation and exchange. Marx showed that there was in fact no relationship between metal assets and the bank's portfolio. Darimon lamented that the bank withdrew its services from the public precisely when they were most needed. This was the point at which Marx explained that the bank did so because it was a bank ("And the bank should be made an exception to... general economic laws?"; ibid., 120). This meant they were subject to laws of supply and demand, but also that they engaged in financially speculative ventures, which he pointed out were as much responsible for their problems as anything else. These speculations were inherent to their institutional character and role, and would have led to crisis regardless of whether the medium of monetary exchange consisted of precious metals. The reason why banks made credit more difficult for people when they most needed it, Marx argued, was because of the structural logics inherent to credit itself, and these are tied into institutional rationalities of speculation. This argument would be as relevant in its basic logic for the 2008 financial crisis as it was in the mid-1850s.
25. see Jeremy Greene, Prescribing by Numbers: Drugs and the Definition of Disease (Baltimore, MD: Johns Hopkins University Press, 2007).
26. Slavoj Žižek, "The Ongoing 'Soft Revolution'", Critical Inquiry 30, no. 2(2004):294.
27. Marx, Capital, 255; emphasis mine. This passage appears almost immediately after Marx introduces the concept of surplus value in volume 1 of Capital.