Compound Solutions: Pharmaceutical Alternatives for Global Health by Susan Craddock (review)

Susan Craddock's Compound Solutions is a compelling and important book about what she calls "humanitarian pharmaceutical production." Anyone interested in the challenges of getting TB drugs where they are needed most should read it. In recent years, in an effort to make drugs for tuberculosis more effective and accessible to the communities that need them most, a series of product development partnerships (PDPs) have formed. Made up of alliances of biotech firms, government and university researchers, global health agencies, philanthropies, and pharmaceutical companies—in short, anyone and everyone involved in the development of TB drugs—PDPs aim to change fundamentally the ways in which drugs are developed and delivered. As Craddock notes, PDPs are following in the footsteps of AIDS activists who in the late 1990s and early 2000s compelled pharmaceutical companies to reduce the costs of antiretroviral drugs. But PDPs want to do more than just lower costs, as critical as that is. Their aims are nothing less than a total overhaul of drug development and delivery. As Craddock puts it: "The main argument animating . . . this book is that PDPs extend well beyond the products they are developing. The humanitarian mooring of their endeavors means both an expansion and an alteration of the social, political, logistical, and scientific fields pharmaceutical developers typically occupy or that pharmaceuticals occupy. . . . PDPs in other words are forcing a shift in the ontological mooring of today's market-driven neoliberal pharmaceutical industry" (p. 5). To explore whether this has worked or not, Craddock focuses on the TB Alliance and Aeras, two PDPs at the forefront of the efforts to upend business as usual. It should be no surprise, least of all to Craddock, that they have had a record of mixed success. It turns out, after all, that market forces are powerful. But it's more than that. Among other things, TB, despite being a scourge for centuries, can be extraordinarily difficult to treat; the communities where the drugs are needed the most are often the least able to access them; and research on TB has not been a priority of biomedicine for decades. PDPs hope to change all of this by fostering new and critical research, reducing the time needed to complete successful treatment, and making communities more integral to the processes of research and delivery.

Compound Solutions begins with a tour de force of an introduction—which takes up nearly a quarter of this short book—that addresses a variety of issues. Craddock explores why and how some diseases became neglected; she offers a compelling explanation of why developing drugs for TB is so costly; she analyzes the influence of the Bill and Melinda Gates Foundation, the principal funder of both Aeras and the TB Alliance; and she interrogates what might be motivating pharmaceutical corporations to ally with groups like Aeras and TB Alliance—it seems to be a combination of "corporate social responsibility" and the hope of breaking into new markets in places like Brazil and China. The introduction also narrates with exceptional clarity the history of drug patents and intellectual property law that is critical to understanding the challenges PDPs face.

All of this is then further elaborated on in three tightly focused, jam-packed, chapters. Chapter 1 explores what PDPs can and cannot accomplish in a market-based economy. Chapter 2 analyzes the process of scientific collaboration and "innovation" at a time when drug development seems geared toward making money and not saving lives. And chapter 3 is concerned with the ethics of TB drug trials. For instance, Craddock takes on the "hard to resolve" "tension between strict requirements of international clinical trials, and more nuanced practices attuned to local understandings and politics" (p. 112).

Craddock is writing a history of the present. The landscape she describes is in a constant state of flux. For instance, companies come and go as their commitment waxes and wanes; the funding priorities of major donors change. And [End...