Big Pharma and Big Medicine in the Global Environment

Abstract

IntroductionIn previous work we argued that sociologists need to expand our thinking about pharmaceuticalization, the process of understanding and/or treating social, behavioral, or bodily conditions with pharmaceuticals. The majority of sociological scholarship has investigated pharmaceuticalization as a primarily Western process and conceptualized it in modern terms (Bell and Figert 2010, 2012a, 2012b. In our view, the work of anthropologists and science and technology studies (STS) scholars who decenter the West as the starting point for research opens up new avenues for understanding the global dynamics of pharmaceuticalization. We have also argued in favor of adopting a postmodern theoretical lens which allows us to understand pharmaceuticalization both as a strategy of enhancement by individuals in resource-rich societies and as an exercise of power in resource-poor societies and to bring to light its multiple, multidirectional and at times apparently contradictory effects.In this chapter we expand upon our previous work and focus on one essential part of the pharmaceuticalization process: global clinical trials and related ethical and research standards. We also consider the role of global clinical trials in reducing public health strategies from a broad array of disease prevention efforts to one seeking to improve the health of populations with pharmaceuticals. The issues we explore center upon the key research and ethical standards for global pharmaceutical development. We define, review and problematize the concept of ethical variability and show how it simultaneously upholds and disrupts Western ethical guidelines for human subjects research. In doing so, we show how global clinical trials contribute to the further pharmaceuticalization of public health worldwide with major implications for people's lives globally. The degree 3 and scope of how people interact with pharmaceuticals throughout the world is uneven, because pharmaceuticalization and global clinical trials map onto global patterns of inequality. Some human bodies serve as research subjects whereas some bodies are pharmaceutical sales targets. Whereas some people in some areas of the world are (over)pharmaceuticalized, other people are (under)pharmaceuticalized. We conclude the chapter with a discussion of how and why STS perspectives on harmonization and variability in ethical and research standards shed light on the study of pharmaceuticalization and more broadly on the global dynamics of health inequality.