After a decade of operations, the Global Fund is an institutional form in flux. Forced to cancel its eleventh round of funding due to a shortfall in donor pledges, the Fund is currently in firefighting mode, overhauling its leadership, governance structures, and operations. Drawing on a case study of Uganda, we look at how the original Global Fund vision to be a simple financial instrument has played out at the country level. Even prior to the cancellation of round 11, the proliferation of partners required to sustain the Global Fund to Fight AIDS, Tuberculosis and Malaria experiment led to increasing bureaucratization and an undermining of the Fund’s own intentions to award life-saving grants according to need. Understanding these effects through the ethnographic material presented here may be one way of reflecting on the Fund’s structure and practices as it struggles to reinvent itself in the face of criticism that it has impeded resource distribution.
Format: Journal
Rethinking Antibiotic Research and Development
Policy leaders and public health experts may be overlooking effective ways to stimulate innovative antibiotic research and development. I analyzed archival resources concerning the US government’s efforts to produce penicillin during World War II, which demonstrate how much science policy can differ from present approaches. By contrast to current attempts to invigorate commercial participation in antibiotic development, the effort to develop the first commercially produced antibiotic did not rely on economic enticements or the further privatization of scientific resources. Rather, this extremely successful scientific and, ultimately, commercial endeavor was rooted in government stewardship, intraindustry cooperation, and the open exchange of scientific information. For policymakers facing the problem of stimulating antibiotic research and development, the origins of the antibiotic era offer a template for effective policy solutions that concentrate primarily on scientific rather than commercial goals.
Making time for soil
The dominant drive for understanding soil has been to pace its fertility with human demand. Today, warnings about soil’s exhaustion and endangered ecology raise concerns marked by fears of gloomy environmental futures, prompting scientists and soil practitioners urgently to develop better ways of taking care of soils. Yet the pace required by ecological soil care could be at odds with the predominant temporal orientation of technoscientific intervention, which is driven by an inherently progressivist, productionist and restless mode of futurity. Through a conceptual and historical approach to the soil sciences and other domains of soil knowledge, this article looks for soil ontologies and relations to soil care that are obscured by the predominant timescape. Contemporary discussions of the future of the soil sciences expose tensions between ‘progress as usual’ – by intensifying productivity – and the need to protect the pace of soil renewal. The intimate relation of soil science with productionism is being interrogated, as ecology attempts to engage with soil as a living community rather than a receptacle for crops. In this context, and beyond science, the ‘foodweb’ model of soil ecology has become a figure of alternative human–soil relations that involve environmental practitioners in the soil community. Reading these ways of making time for soil as a form of ‘care time’ helps to reveal a diversity of more-than-human interdependent temporalities, disrupting the anthropocentric appeal of predominant timescales of technoscientific futurity and their reductive notion of innovation.
Nothing Comes Without Its World
What is the significance of caring for thinking and knowing? Thinking and knowing are essentially relational processes. Grounded on a relational conception of ontology the essay argues that ‘thinking with care’ is a vital requisite of collective thinking in interdependent worlds, but also one that necessitates a thick vision of caring. A speculative exploration of forms of thinking with care unfolds through a rereading of Donna Haraway’s work, specifically of its take on feminist discussions on the situated character of knowledge. The notion of thinking with care is articulated through a series of concrete moves: thinking-with, dissenting-within and thinking-for. While weaving Haraway’s thinking and writing practices with the trope of care offers a particular understanding of this author’s knowledge politics, the task of caring also appears in a different light.
History Teaches Us That Confronting Antibiotic Resistance Requires Stronger Global Collective Action
Antibiotic development and usage, and antibiotic resistance in particular, are today considered global concerns, simultaneously mandating local and global perspectives and actions. Yet such global considerations have not always been part of antibiotic policy formation, and those who attempt to formulate a globally coordinated response to antibiotic resistance will need to confront a history of heterogeneous, often uncoordinated, and at times conflicting reform efforts, whose legacies remain apparent today. Historical analysis permits us to highlight such entrenched trends and processes, helping to frame contemporary efforts to improve access, conservation and innovation.
Global Pharmaceuticals
In some parts of the world spending on pharmaceuticals is astronomical. In others people do not have access to basic or life-saving drugs. Individuals struggle to afford medications; whole populations are neglected, considered too poor to constitute profitable markets for the development and distribution of necessary drugs. The ethnographies brought together in this timely collection analyze both the dynamics of the burgeoning international pharmaceutical trade and the global inequalities that emerge from and are reinforced by market-driven medicine. They demonstrate that questions about who will be treated and who will not filter through every phase of pharmaceutical production, from preclinical research to human testing, marketing, distribution, prescription, and consumption.
Whether considering how American drug companies seek to create a market for antidepressants in Japan, how Brazil has created a model HIV/AIDS prevention and treatment program, or how the urban poor in Delhi understand and access healthcare, these essays illuminate the roles of corporations, governments, NGOs, and individuals in relation to global pharmaceuticals. Some essays show how individual and communal identities are affected by the marketing and availability of medications. Among these are an exploration of how the pharmaceutical industry shapes popular and expert understandings of mental illness in North America and Great Britain. There is also an examination of the agonizing choices facing Ugandan families trying to finance AIDS treatment. Several essays explore the inner workings of the emerging international pharmaceutical regime. One looks at the expanding quest for clinical research subjects; another at the entwining of science and business interests in the Argentine market for psychotropic medications. By bringing the moral calculations involved in the production and distribution of pharmaceuticals into stark relief, this collection charts urgent new territory for social scientific research.
On the monopoly
The drug patent monopoly has been described as a key deterrent to Africans’ access to brand-name, life-saving drugs. Research in Nigeria, however, shows that another factor restricts access in that country: Brand-name pharmaceutical companies’ pricing and marketing strategies keep patented drugs off the market. In this article, I retheorize the question of monopoly in the pharmaceuticals industry. I first track the historical precedents of this particular iteration of the drug monopoly. I then situate the monopoly in the context of ethnographic research I conducted on pharmaceutical markets and drug marketing (2005–10) as well as on Nigeria’s compliance struggles with the WTO’s Trade Related Aspects of Intellectual Property (TRIPs) Agreement (1999–2003). TRIPs enforces patent holders’ rights and mandates intellectual property harmonization across nation-states. In analyzing these two ethnographic sites together, I argue that rather than its purported short-term legal existence, the current drug monopoly operates as though it has an indefinite life.
What Can Critical Medical Anthropology Contribute to Global Health?
We are now facing an unprecedented moment in the history of global health, in which infectious diseases such as HIV/AIDS, malaria, and tuberculosis are no longer peripheral concerns but primary targets of bilateral aid programs, philanthropy, and research. The Critical Anthropology of Global Health Special Interest Group of the Society for Medical Anthropology is committed to bringing a critical perspective to global health that encompasses factors that contribute to the maldistribution of disease, health care inequities, and problems in health care management, within a biopolitical environment.
Post-Pasteurian Cultures
Out of concern for public health, the U.S. government bans the sale of cheese made from unpasteurized milk if it is aged fewer than 60 days. But while the FDA views raw-milk cheese as a potential biohazard, riddled with pathogenic microbes, aficionados see it as the reverse: as a traditional food processed for safety by the action of good microbes. This article offers a theoretical frame for understanding the recent rise in American artisan raw-milk cheese production, as well as wider debates over food localism, nutrition, and safety. Drawing on ethnographic interviews with cheese makers and purveyors and on participant-labor conducted on a Vermont sheep dairy farm, I develop the concept of microbiopolitics to analyze how farmer–cheese makers, industry consultants, retailers, and consumers negotiate Pasteurian (hygienic) and post-Pasteurian (probiotic) attitudes about the microbial agents at the heart of raw-milk cheese and controversies about this nature–culture hybrid.
Thick Prescriptions
Anthropologists of medicine and science are increasingly studying all aspects of pharmaceutical industry practices–from research and development to the marketing of prescription drugs. This article ethnographically explores one particular stage in the life cycle of pharmaceuticals: sales and marketing. Drawing on a range of sources-investigative journalism, medical ethics, and autoethnography–the author examines the day-to-day activities of pharmaceutical salespersons, or drug reps, during the 1990s. He describes in detail the pharmaceutical gift cycle, a three-way exchange network between doctors, salespersons, and patients and how this process of exchange is currently in a state of involution. This gift economy exists to generate prescriptions (scripts) and can mask and/or perpetuate risks and side effects for patients. With implications of pharmaceutical industry practices impacting everything from the personal-psychological to the global political economy, medical anthropologists can play a lead role in the emerging scholarly discourse concerned with critical pharmaceutical studies.
