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  • Standards, Populations, and Difference
  • Mariam Fraser (bio)

The global reach of biomedicine (which should be distinguished from the reach of its "benefits") is a striking feature of contemporary life. It is pursued by international corporations that produce drugs that are taken by people all over the world, and is embodied in scientific research projects that carry ambitious titles such as The Human Genome Project, The Visible Human Project, and The International HapMap Project. This extensive reaching out across the globe draws attention, once again, to the question of human bodies, and of whether the human bodies that are the targets, objects, and consumers of biomedical research and its products are the same the world over—or not. In this paper, I want to consider two very different occasions in which the problem of sameness and difference was raised.

The first of these is Fentress et al. vs. Shea Communications et al. (Fentress 1994), the first suit against Prozac to reach a jury.1 This case is better known as the Wesbecker trial, after Joseph Wesbecker, who returned to his former place of work (a printer called Standard Gravure) on September 14, 1989, and shot eight people dead. Twelve people were also injured, and Wesbecker himself committed suicide in front of the pressroom supervisor's office. In 1994, the plaintiffs' lawyers attempted to establish that Eli Lilly, the makers of Prozac, "had knowingly manufactured and marketed a drug that causes agitation in certain individuals, and had failed to provide appropriate package warnings in the United States" (Cornwell 1997, ix). They argued that Joseph Wesbecker had been one such certain individual. As I will be illustrating below, the plaintiffs' lawyers' case rested on the assumption that nearly all differences in the field of science and medicine—whether they concern human bodies and their responses to drugs, or the standards, regulations, and procedures that are designed to facilitate the movement of prescription drugs around the globe—can [End Page 47] at least potentially be eradicated. Or to put that differently: in the Wesbecker trial, the issue of standardization provoked debates about sameness and difference that were apparently as relevant to how adverse effects were being coded by Eli Lilly (are the same terms being used in different geographical locations? are those terms being understood in the same way or not?) as they were to the efficacy of Prozac in living bodies in different parts of the world (are the effects of Prozac "the same," to all intents and purposes, in Germany as they are in America?).

Both the lawyers for the plaintiffs and the defendant, Eli Lilly, assumed that biological bodies are the same the world over. Just one year before the Wesbecker trial, however, the National Institutes of Health (NIH) Revitalization Act (1993) stipulated that the NIH, the world's largest funder of medical research, would, from 1995 onwards, require "women and 'members of racial and ethnic minority groups' [to] be included as research subjects in NIH–funded studies" (Epstein 2007, 82). The belief that "one size fits all," that is, that there is a "standard human" on which clinical trials could be based and their conclusions generalized, had begun to lose scientific and political credibility in the United States. Measuring differences was not only encouraged but, in some instances, required. As Steven Epstein explains:

advocates of the inclusion-and-difference paradigm repudiated the notion that humanity could be standardized at the level of the species—that is, they rejected the presumption that biomedical knowledge could be derived from the study of, or be broadly applicable to, the "standard human." At the same time, these skeptics of universalism did not veer fully to the opposite extreme of embracing total particularity. Though they frequently involved the rhetoric of "individualized therapy," their response in fact was not to insist on the medical uniqueness of each individual. Rather, advocates proposed that the working units of biomedical knowledge-making could be groups: women, children, the elderly, Asian Americans, and so on. The inclusion-and-difference paradigm therefore enshrines what might be termed niche standardization.


Health in Western democracies, Monica Greco writes, has acquired the status both of a metavalue and a metaright (Greco 2004, 1...


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pp. 47-80
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