The outsourcing and offshoring of clinical trials has expanded a global field of experimental activity. This essay addresses the competitive logic and social norms by which a field of human subjects research for drug development has taken form. The clinical trials industry and its move to low- and middle-income countries (particularly in eastern Europe) serve as a telescope into the global clinical trial and how it is crafted and made to work in different locales. Lives often depend on new medical commodities as they enter (via the trial) the value chains of transnational medicine and capital. Transparency remains a key problem. The essay explores the politics of creating centralized registries through which the scope of this experimental enterprise might be known. As the engine of pharmaceutical research molds itself to international and national regulatory norms, detection of adverse risk can be deferred or minimized. The essay also points to policy gaps with respect to how the benefits and insecurities of global experiments are distributed as well as to emergent political practices of care and accountability.


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pp. 949-974
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