Technoscientific Musings at WUSTL

Petryna documents a growing trend starting in the 90s of American pharmaceutical companies using vulnerable patients in countries outside the US as experimental subjects for drugs. Prior to the 90s prison inmates were used as experimental subjects. I had heard about this before, but I didn’t realize the extent to which prison inmates functioned as the bedrock of clinical trials. This necessarily global system of western drug production is just another example of the mythical nature of American “rugged individualism” and the territorially inscribed social/political/economic infrastructure for “boundless opportunity.” It is not just the development of new drugs but also the putative absence of abject poverty, human rights violations, and legally disenfranchised citizens that are are touted as nationalist evidence of the “progress” and “innovation” that uniquely define America. But both these material and moral claims rely on a systemic outsourcing of all that is un-American to countries outside our borders. Drug companies don’t just recruit experimental subjects overseas because it is cheaper, which would be morally uncomfortable but logically coherent for free-market loving Americans. To procure maximally positive results companies need access to the sickest and most impoverished patients with the least stringent demand for ethical oversight. Petryna introduces the concept of biological citizenship to discuss the power structures in which these experimental subjects are embedded. For the continued improvement in pharmaceutical drugs and corresponding continued improvement in national health—a phenomenon Americans take for granted as a teleological property of capitalism—countries that we rationalize as further behind but still developing” need to stay “undeveloped” so as to remain an available source of pure bodies that can be turned into usable data.

I’m still struggling with the idea of ethics as a “working document” and teasing out the differences and maybe overlapping dimensions of ethical imperialism vs. relativism. In multiple cases of pharmaceutical companies defending behavior that had come under international scrutiny, these companies would push back by alleging that the imposition of American ethical norms to judge the behavior in question was “paternalistic.” This is a clever and effective pivot. Multiple layers of mutable systems of ethical oversight decentralize, diffuse, and dilute the priority of ethics in this privatized industry of ensuring the integrity of data produced by vulnerable bodies. Integrity, here, refers to the usefulness of the content of the data and the portability of that data into U.S. regulatory settings of drug approval. In this system of recruiting and using the bodies of experimental subjects, ethics is codified as instrumental and to be understood in relation to efficiency. This is antithetical, of course, to the idea of ethics itself that is invoked in erecting these multilayered systems of oversight.