One of the formative books in my personal and intellectual
development is Nikolas Rose’s Politics of
Life Itself. Rose describes these as “the growing capacities to control,
manage, engineer, reshape, and modulate the very vital capacities of human
beings as living creatures.” Through advances in medicine, we’ve disrupted a “natural
vital order” by imagining life at the molecular level, life as a set of
mechanisms that can be identified, isolated, and manipulated in brand new ways.
We now conceptualize individuals in new ways through a molecular, medical gaze:
susceptible to illness, vulnerable to stress, immunocompromised.
Petryna’s ideas of experimentality and the growth of global
pharmaceutical trials represent one of the ways these capacities manifest. This
work fits quite neatly as a prologue to Biehl’s notion of pharmaceuticalization.
(And no wonder; the two are married). Biehl, focusing on AIDS and ART in particular,
writes about the ways that public health infrastructures are being transformed
as a result of increasing numbers of pharmaceuticals. Petryna details how those
get to market. A few scattered thoughts:
1. The subtitle of Rose’s book is “Biomedicine,
Power, and Subjectivity in the Twenty-First Century.” If I have one critique of
Petryna, it’s that she could explore more nuanced notions of power. She gained
access to so many people, and yet the majority of voices in the text are those
who hold (ostensibly) greater power. More patient voices would have, I think,
helped to blur the dichotomy that the book predominantly treads in, especially
in Poland.
2. I don't’ know if it’s because I’m in a school of
public health and spend parts of the week on the medical campus, but I am
constantly amazed, in reflection on these authors, how normalized this “biological
citizenship” (Petryna’s earlier work) has become. Healthcare spending in the US
is roughly 18% of our GDP.
And what does that get us? I find this map amazing when considering
the difference between, for example, Costa Rica ($811 per person/per year in
healthcare costs) and the US (8360). I’m not sure what figures correspond to pharmaceutical
spending, but it’s clear that either way we and many other Western countries devote
high levels of resources and attention to health.
Rose writes about the ways that psychological
pharmaceuticals have changed the way we think about the self. “Individuals are
prescribed them, and utilize them, in the hope of restoring themselves to a
state they feel they have lost.” But what about the patients who enroll for
Gaucher disease in Brazil? What about the untried CVD drugs in Poland? What are
their rights to such drugs? I’m sure we’re going to be talking a lot about the
profit motives behind pharmaceutical expansion (especially “me-too” drugs and
drugs which treat rare conditions), but I think it’s also important to keep in
mind that supply is meeting demand. How that demand is created I think Petryna
only began to explore.
3. Finally, there’s plenty of overlap here with the
idea of evidence-based medicine (and its limitations), which some have
discussed in class. I think Petryna does a particularly good job of the explaining
the development of regulatory requirements for pharmaceuticals and how statistics
play a large role in getting drugs cleared – to patients’ detriment, I think
Petryna would argue. Yet these are also the same requirements that help to keep
patients safe.
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