Anthropology and the Pharmaceutical Nexis

Adriana Petryna, Andrew Lakoff, and Arthur Kleinman, Global Pharmaceuticals: Ethics, Markets, Practices. Cambridge University Press, January 2006, 312 pp.

Medicines constitute a meeting point of almost any imaginable human interest: material, social, political and emotional. They are medical, of course, and symbolic (which is also medical). As chemical substances, they bring about physical changes in the body. As ritual symbols, they express concern and give comfort. They are indeed emblems of concern but also commodities in a hard and merciless market. They are political weapons in the hands of the powerful. They play their many roles at different levels of social and political organization: in international policy and funding, in national politics, in local health institutions, in consulting rooms and shops, on the street corner, in households and, ultimately, in the private lives of individual patients. They are merchandise in formal and informal, public and secret, legal and illegal transactions. Thus one may indeed speak of a "pharmaceutical nexus" as do the editors of this fascinating new book on Global Pharmaceuticals (Petryna et al. 2006).

Studying medicines in order to know how the world functions, and understand the work of medicines in the wider context of culture and society, seems an obvious choice for anthropologists, but it has taken some time to realize this. With very few exceptions, medicines were only mentioned in passing; they were always "traditional medicines," magical remedies and herbal concoctions. One such exception was Evans-Pritchard (1937:424-78) who devoted more than average attention to the typology, perception and use of Zande local medicines in order to make his point about the rationality of Azande reasoning.

The fashion and convention of early anthropology—especially the sentimental focus on exoticism—prevented researchers from looking at ubiquitous Western-produced pharmaceuticals as cultural phenomena worthy of anthropological scrutiny. One of the few exceptions was Cunningham (1970) who wrote about "injection doctors" in Thailand, a topic that was apparently exotic enough to capture his attention, even though it concerned a familiar Western practice, injection.

I became interested in pharmaceuticals during my fieldwork on sexual relationships and birth control in a Ghanaian rural town (Bleek 1976). I discovered that young people were putting their trust in a contraceptive that had a social life of its own, entirely outside the world of professional medicine and/or official Family Planning services. Tracing that "contraceptive," I made a second discovery: it was a laxative. From that moment onward my own cultural blinders were lifted and I started to see pharmaceuticals everywhere: in "provisions" shops selling daily necessities, in market stalls, in drugstores that were supposed to sell "over the counter medicines" only but were in fact selling an abundance of prescription-only medicines, including antibiotics. I was amazed both at their omnipresence in daily life and their almost total neglect by anthropologists who claimed to describe that very same daily life. At the same time, however, I realized that this negligence formed part of a general pattern. Anthropologists had turned away from phenomena that seemed too familiar to them: schools, Christian churches with their "boring" religious services, hospitals and everything related to what was assumed to be "Western medical practice," including pharmaceuticals.

My interest in the familiar (yet unfamiliar) world of pharmaceuticals coincided with (1) the gradual home-coming of anthropology, (2) the birth of medical anthropology as a distinct specialization, (3) a world-wide outcry about the practices of multinational pharmaceutical firms and (4) the launching of the WHO's Action Program on Essential Drugs. Here, I will discuss only the two last two of these phenomena.

Pharmaceutical Companies

At the end of the seventies, multinational pharmaceutical firms became the target of public criticism. They were accused of unethical marketing practices, especially in developing countries. The dumping of inferior medicines that had fallen out of favor in Western countries was one of the charges. Another one was that they adjusted the texts of inserts of medicines exported to poor countries...