Inert facts and the illusion of knowledge: strategic uses of ignorance in HIV clinics

Heimer, Carol A.

doi:10.1080/03085147.2011.637332

Cited by 65 publications

(48 citation statements)

References 20 publications

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“…Agents may strategically remain ignorant, not in an effort to commit themselves to an action, but to avoid repercussions for what they must know is a likely effect of their action (Dana 2005). Heimer (2012) suggests that organizations may deliberately divide tasks and establish bureaucratic barriers to foster such "distributed ignorance." This is particularly problematic, as little blame appears to be assigned to those who did not, but should have, known about wrongdoing.…”

Section: Ethical Transgressionsmentioning

confidence: 99%

Information Avoidance

Golman

Hagmann

Loewenstein

2017

Journal of Economic Literature

588

198

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Section: Ethical Transgressionsmentioning

confidence: 99%

Information Avoidance

Golman

Hagmann

Loewenstein

2017

Journal of Economic Literature

588

198

View full text Add to dashboard Cite

“…Examining who participates in industry clinical trials allows for engagement not only with their experience of participating in clinical trials but also with how the decision to enrol in research is shaped by broader patterns of social and economic inequalities (Fisher, 2013; Heimer, 2012; Joseph & Dohan, 2012; Kingori, 2013). For example, patients in the United States with inadequate access to health care might enrol in a clinical trial in order to have the opportunity to interact with health care providers and try an investigational drug that might ameliorate their medical condition (Fisher, 2007, 2009).…”

Section: Clinical Trials As Workmentioning

confidence: 99%

‘I'm still a hustler’: entrepreneurial responses to precarity by participants in phase I clinical trials

Monahan¹,

Fisher

2015

Economy and Society

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This paper questions the implications of entrepreneurial responses to conditions of employment precarity by ‘healthy volunteers’ in phase I clinical trials in the United States. Such individuals are typically serial participants who often identify as professional volunteers and seek out drug studies as their primary source of income. Drawing on extensive qualitative research, this paper illustrates how healthy volunteers selectively import the identity of ‘hustler’ from the street environment and reposition it as connoting a set of valuable creative skills that give them a competitive edge over other participants. An entrepreneurial ethos allows them to view personal sacrifice and exposure to potentially dangerous drugs as smart investments leading to financially stable futures. These discursive moves normalize extractive, and at times dehumanizing, labour relations that offload expenses and risks to workers.

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“…We address the question of how an understanding of standards and rules sheds light on the conceptualization and processes of global pharmaceuticalization and the pharmaceuticalization of public health, and we use work on the expansion of pharmaceutical clinical trials in India by Sunder Rajan to illustrate our argument (Sunder Rajan 2005, 2012). …”

Section: Disruptions To Standardization?mentioning

confidence: 99%

“…Thus, in a study of clinical trials in countries at varying levels of development -the US, South Africa, Thailand and Uganda - Petty andHeimer (2011) andHeimer (2012) show that global HIV research can be more beneficial to countries in the Global South than to the US. Clinics reconfigure their local practices of care and treatment to bring them in line with ICH standards: to produce accurate, complete, and verifiable study data and to ensure "that the rights and well-being of human subjects are protected" (Petty and Heimer 2011: 350).…”

Section: New Configurationsmentioning

confidence: 99%

“…Much work remains to be done in exploring how pharmaceuticalization works globally, and we must recalibrate the balance between studies of the global North and global South (e.g., Brazil [Biehl 2006[Biehl , 2007, Barbados [Whitmarsh 2008], India [Sunder Rajan 2007, 2012, Thailand, Uganda and South Africa [Petty and Heimer 2011], and (Dumit 2012a:18). Since the 1990s, the number of international subjects involved in clinical trials -including pharmaceutical trials -has grown substantially, from 4000 in 1995 to 400,000 in 1999 (Petryna 2006:189).…”

Section: Conceptual Framing: Medicalization Biomedicalization and Phmentioning

confidence: 99%

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Big Pharma and Big Medicine in the Global Environment

Figert¹,

Bell²

Routledge Handbook of Science, Technology, and Society

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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.

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Inert facts and the illusion of knowledge: strategic uses of ignorance in HIV clinics

Cited by 65 publications

References 20 publications

Information Avoidance

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‘I'm still a hustler’: entrepreneurial responses to precarity by participants in phase I clinical trials

Big Pharma and Big Medicine in the Global Environment

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