This paper explores a regulatory campaign to promote access to antibiotics in the United States during the 1950s, and explains it as a reaction to prewar deprivation. It tracks a decade-long attempt to prevent the drug industry from replicating a perceived pattern of big business behavior blamed for underconsumption. The Depression-era Temporary National Economic Committee (TNEC) had explained low consumption by artificially high prices associated with excess profits, excessive marketing and restrictive patents of large companies. In the post-War years a group of TNEC veterans (including Walton Hamilton, Irene Till and John Blair) campaigned to protect the drug market from these vices: through a FTC enquiry which led to a judicial investigation, and through the Kefauver hearings in Congress. This campaign culminated in the in radical increase of FDA powers in 1962, albeit triggered by the thalidomide scare. Ironically the problems of under-consumption were given institutional teeth just at the time that the novel problem of the over-consumption of antibiotics was becoming serious.
Format: Journal
‘There is worse to come’
How is the future imagined via the politics and policy of AMR? What happens when the metaphors we employ to describe AMR are overwhelmingly linked to the ‘dark ages’ and the ‘impending apocalypse’? What work do these catastrophic formulations do? Do they garner public support? Do they impel more investment in ‘new’ antibiotics? In this article, Brown and Nettleton offer a compelling history and political economy for the emergence of this kind of rhetoric, arguing that what these metaphors really do is nurture the prevailing notion of the individual body at war with a dangerous and dirty bacterial world. What other kinds of futures are possible though? What would a more cooperative – rather than combative – juncture between the human and the microbial look like?
Hygiene and Biosecurity
Infectious diseases, such as methicillin‐resistant Staphylococcus aureus and avian influenza, have recently been high on the agenda of policy makers and the public. Although hygiene and biosecurity are preferred options for disease management, policy makers have become increasingly aware of the critical role that communication assumes in protecting people during outbreaks and epidemics. This article makes the case for a language‐based approach to understanding the public perception of disease. Health language research carried out by the authors, based on metaphor analysis and corpus linguistics, has shown that concepts of journeys, pathways, thresholds, boundaries and barriers have emerged as principal framing devices used by stakeholders to advocate a hygiene based risk and disease management. These framings provide a common ground for debate, but lead to quite different perceptions and practices. This in turn might be a barrier to global disease management in a modern world.
Post antibiotic apocalypse
In this paper we will consider the question of mutation as it is manifested in press coverage of MRSA in UK hospitals. This represents a fertile field of discourse which brings into focus issues relating to microbes, people and working practices as well as the concepts of risk and vulnerability. A regular feature of reporting has been the presence of explanations for drug resistance involving repeated random mutations of the microbe to achieve progressively greater resistance and versatility, largely through a Darwinian process which is ‘clever’ at overcoming human attempts at elimination. More recently a discourse has emerged which foregrounds also the vulnerability of patients who are very young, old or otherwise immunocompromised, or whose own genetic makeup might put them at risk from the microbe. The hospital is decentred as a source of infection, and attention is turned instead to nursing homes and gymnasia as sources of infection in the community. This latter development mitigates the responsibilities of hospitals and statutory healthcare providers and turns the risk back towards the individual as a responsible actor in an ecology of mutation.
Antibiotic optimisation in ‘the bush’
The growing global concern around antimicrobial mis-use and proliferating resistance has resulted in increasing interest in optimising antibiotics, particularly in hospitals. While the agenda to tighten antibiotic use has been critically explored in metropolitan settings, the dynamics of rural and remote settings have remained largely unexplored. Drawing on 30 interviews with doctors, nurses, and pharmacists in a remote Australian hospital, we focus on the pertinence of setting, and its importance for contextualising and potentially achieving antibiotic optimisation. Building on previous work on the dynamics of locale and core-periphery relations, here we consider how antimicrobial practice is deeply embedded in experiences of being on the geographical periphery, and crucially, at the periphery of (established) knowledge.
Rethinking the ‘global’ in global health: a dialectic approach
Background
Current definitions of ‘global health’ lack specificity about the term ‘global’. This debate presents and discusses existing definitions of ‘global health’ and a common problem inherent therein. It aims to provide a way forward towards an understanding of ‘global health’ while avoiding redundancy. The attention is concentrated on the dialectics of different concepts of ‘global’ in their application to malnutrition; HIV, tuberculosis & malaria; and maternal mortality. Further attention is payed to normative objectives attached to ‘global health’ definitions and to paradoxes involved in attempts to define the field.
Discussion
The manuscript identifies denotations of ‘global’ as ‘worldwide’, as ‘transcending national boundaries’ and as ‘holistic’. A fourth concept of ‘global’ as ‘supraterritorial’ is presented and defined as ‘links between the social determinants of health anywhere in the world’. The rhetorical power of the denotations impacts considerably on the object of ‘global health’, exemplified in the context of malnutrition; HIV, tuberculosis & malaria; and maternal mortality. The ‘global’ as ‘worldwide’, as ‘transcending national boundaries’ and as ‘holistic’ house contradictions which can be overcome by the fourth concept of ‘global’ as ‘supraterritorial’. The ‘global-local-relationship’ inherent in the proposed concept coheres with influential anthropological and sociological views despite the use of different terminology. At the same time, it may be assembled with other views on ‘global’ or amend apparently conflicting ones. The author argues for detaching normative objectives from ‘global health’ definitions to avoid so called ‘entanglement-problems’. Instead, it is argued that the proposed concept constitutes an un-euphemistical approach to describe the inherently politicised field of ‘global health’.
Summary
While global-as-worldwide and global-as-transcending-national-boundaries are misleading and produce redundancy with public and international health, global-as-supraterritorial provides ‘new’ objects for research, education and practice while avoiding redundancy. Linked with ‘health’ as a human right, this concept preserves the rhetorical power of the term ‘global health’ for more innovative forms of study, research and practice. The dialectic approach reveals that the contradictions involved in the different notions of the term ‘global’ are only of apparent nature and not exclusive, but have to be seen as complementary to each other if expected to be useful in the final step.
Witchcraft, Bureaucraft, and the Social Life of (US) Aid in Haiti
In this article I discuss the unintended consequences of humanitarian and development assistance provided to “victims of human rights abuses” in Haiti in the years following the restoration of democracy in 1994. Such targeted aid was a component of international political and economic development aid intended to facilitate the nation’s postconflict transition. I argue that in much the same manner that witchcraft discourses signify moral struggles over the distribution of resources in small-scale societies, the cultures and moral economies of humanitarian and development aid—well-intentioned activities that nonetheless include opaque bureaucratic practices and competition over knowledge, scarce resources, and institutional territory—can produce similar phenomena as has been described regarding contemporary witchcraft. I draw on the literature on witchcraft, bureaucracy, and secrecy to analyze accusations of malfeasance, scapegoating, and violence directed toward both providers and recipients of humanitarian and development assistance. I characterize such processes occurring in relation to compassion economies by the term bureaucraft. [witchcraft; bureaucracy; bureaucraft; humanitarianism; democracy; insecurity; human rights; Haiti]
Tangles of Care
If calls to care for other species multiply in a time of global and local environmental crisis, this article demonstrates that caring practices are not always as benevolent or irenic as imagined. To save endemic tortoises from the menace of extinction, Proyecto Isabela killed more than two hundred thousand goats on the Galápagos Islands in the largest mammal eradication campaign in the world. While anthropologists have looked at human engagements with unwanted species as habitual and even pleasurable, I discuss an exceptional intervention that was ethically inflected toward saving an endemic species, yet also controversial and distressing. Exploring eradication’s biological, ecological, and political implications and discussing opposing practices of care for goats among residents, I move past the recognition that humans live in a multispecies world and point to the contentious nature of living with nonhuman others. I go on to argue that realizing competing forms of care may help conservation measures—and, indeed, life in the Anthropocene—to move beyond the logic of success and failure toward an open-ended commitment to the more-than-human.
Pharmaceuticalization
This article examines the political economy of pharmaceuticals that lies behind global AIDS treatment initiatives, revealing the possibilities and inequalities that come with a magic bullet approach to health care. It tells how Brazil, against all odds, became the first developing country to universalize access to antiretroviral drugs—a breakthrough made possible by an unexpected alliance of activists, government reformers, development agencies, and the pharmaceutical industry. The article moves between a social analysis of the institutional practices shaping the Brazilian response to AIDS and the stories and lives of people affected by it. It draws from interviews with activists, policy makers, and corporate actors and from longitudinal ethnographic work among grassroots AIDS care services.
Pharmaceutical innovations allow unlikely coalitions that both expose the inadequacies of reigning public health paradigms and act to reform, if to a limited extent, global values and mechanisms (of drug pricing and of types of medical and philanthropic interventions, for example). Treatment rollouts are matters of intense negotiation; their local realizations are shaped by contingency and uncertainty. Such realizations encode diverse economic and political interests, as well as the needs and desires of citizens. These therapeutic coalitions also expose the deficiencies of national and local infrastructures and consolidate novel state-civil society relations.
A pharmaceutically-centered model of public health has emerged as a byproduct of AIDS treatment scale-up and the sustainability of the Brazilian AIDS policy has to be constantly renegotiated in light of global drug markets. A multitude of networks and variations in AIDS care have emerged on-the-ground, and the article explores why AIDS treatment has been so difficult to put into practice among poor Brazilians, who are often stigmatized as noncompliant or untreatable, becoming invisible to the public. Poor AIDS patients live in a state of flux, simultaneously acknowledging and disguising their condition while they participate in local economies of salvation. At both the macro and micro levels, we see a state of triage and a politics of survival crystallizing.
The complexities of simple technologies
BACKGROUND:
Malaria rapid diagnostic tests (RDTs) are assumed to be simple-to-use and mobile technologies that have the capacity to standardize parasitological diagnosis for malaria across a variety of clinical settings. In order to evaluate these tests, it is important to consider how such assumptions play out in practice, in everyday settings of clinics, health centres, drug stores and for community health volunteers.
METHODS:
This paper draws on qualitative research on RDTs conducted over the last nine years. In particular the study reports on four qualitative case studies on the use of RDTs from Uganda, Tanzania and Sierra Leone, including qualitative interviews, focus group discussions and participant observation.
RESULTS:
Results suggest that while RDTs may be simple to use as stand-alone technological tools, it is not trivial to make them work effectively in a variety of economically pressured health care settings. The studies show that to perform RDTs effectively might very well need exactly the infrastructure they were designed to substitute: the medical expertise, organizational capacity and diagnostic and treatment options of well-funded and functioning health systems.
CONCLUSIONS:
These results underline that successful malaria diagnosis and treatment requires as much investment in general health infrastructure as it does in new technologies.
