From Drug Safety to Drug Security: A Contemporary Shift in the Policing of Health

Abstract

The counterfeiting of medication is increasingly seen as a major threat to health, especially in the light of both the everyday reliance on and a broadening of world-wide access to pharmaceuticals. Exaggerated or real, this threat has inaugurated, this article argues, a shift from a drug safety regime to a drug security regime that governs the flow of pharmaceuticals and brings together markets, police, and health actors in new ways. This entails a shift from soft disciplinary means aimed at incremental and continued inclusion of defaulters, to one of drastically sovereign measures of exclusion and banishment aimed at fake goods and the people associated with them, in the name of health. Through a multi-sited ethnographic study, this article shows how such new drug security efforts play themselves out especially in (South) Africa, highlighting a modus operandi of spectacular performativity and of working through suspicion and association rather than factuality, producing value less so for those in need of health than for a petty security industry itself.

The ghost in the data: Evidence gaps and the problem of fake drugs in global health research

“…Whilst signalling the urgency of the problem of fakes, in terms of the threat fakes pose to life-threatening conditions that can only be treated with life-saving medicines, for instance, many papers drew on documented cases of ill health caused by bad drugs that were not life-saving drugs. Instead they were products such as skin lighteners (see Hornberger, 2018 for a discussion of this). In other papers, fakes of both medical and non-medical products were presented and their problem defined in terms of their availability on the market.…”

“…For example, one paper paints a picture of how fakes – both medicines and non-medical products – were presented to inquisitive passers-by and presumably potential consumers: Such exposure presents a major health challenge as the market is likely to be proliferated with SF [substandard & falsified] pharmaceutical products for major diseases such as antiretroviral therapy (ART) anti-tuberculosis (anti-TB), anti-malarial therapy and other essential medicines. (Gwatidzo et al, 2017 , p. 82) Here, the possibilities of the market extend claims about fakes’ threat to health by using the extent of their reach (Hornberger, 2018 ) as indicative of ‘evidence gaps’. Similar claims were made about the absence of regulation in online markets (Interpol, 2014 ; see also discussion by Clark, 2015 ).…”

“…Within broader medical humanities enquiry, questions of what is at stake in claims of pharmaceuticals' fakeness, however, have only just begun to attract substantial attention (Cloatre, 2016;Gryseels et al, 2019;Hodges, 2019;Hornberger, 2018Hornberger, , 2019Meek, 2018;Quet, 2018). Julia Hornberger's ethnographic analyses of the material and discursive careers of fake drugs is particularly important (2018, 2019).…”

“…Within broader medical humanities enquiry, questions of what is at stake in claims of pharmaceuticals’ fakeness, however, have only just begun to attract substantial attention (Cloatre, 2016 ; Gryseels et al, 2019 ; Hodges, 2019 ; Hornberger, 2018 , 2019 ; Meek, 2018 ; Quet, 2018 ). Julia Hornberger's ethnographic analyses of the material and discursive careers of fake drugs is particularly important ( 2018 , 2019 ). Hornberger explores how everyday practices of anti-counterfeit policing are rooted in the belief that large criminal conspiracies are to blame for the circulation of bad pharmaceuticals.…”

The case of the ‘Spurious Drugs Kingpin’: shifting pills in Chennai, India

“…Anxiety about fake drugs produces a particular form of public health scandal, and rehearses a set of spectacular forms: the perp walk, the drug bust, the worried chat. These accounts of Indian pharma's twenty-first century history are saturated with stories from the coterminous rise of the global anticounterfeiting movement (Hornberger, 2018). They are coupled with expressions of worry manifest in the quotes and headlines above, repeated over and over again by both expert and popular outlets.…”