EASA, 2010: EASA2010: Crisis and imagination
Maynooth, 24/08/2010 – 27/08/2010
Location Arts Classhall C
Date and Start Time 27 Aug, 2010 at 11:30
"All the NGO work, treatment legislation, [and] struggles over drug pricing are forms of governmentality in action… engineering something else, producing a new world."*
Biological and therapeutic citizenships are increasingly familiar since the global pharamceuticalization of public health systems. While this has revolutionised treatment for serious diseases in resource-poor settings and brought access to medicines for the poor into public consciousness it is also at least partly responsible for a globalization of disease classification and diagnostic routines.
The story of pharmaceuticals is one of continuing cycles of imagination and crises - less than a decade ago the Indian government led the battle against Big Pharma by introducing generic drugs for the treatment of HIV, and has developed its own industry producing numerous generic drugs, including fluoxetine. Even as the victory of imagination over crisis is celebrated, a new crisis looms as funding to those countries where the drugs are most needed is cut. Reports are emerging of stocks of anti-retrovirals being depleted in parts of Africa whilst the infrastructures developed to deal with the HIV crisis can offer only vitamins and solace.
The imaginative use of pharmaceuticals is of concern where off-label use of medicines, not only for recreational purposes, but for inclusion in 'traditional' remedies, could signal further crises for the treatment of infectious disease. There are also symbolic logics beyond the simple calculus of scarcity.
This panel seeks to engage with the social lives of pharmaceuticals, their symbolic logics, materiality and their impact on the world
*Fernando Henrique Cardoza in conversation with Joao Biehl
This workshop is closed to new paper proposals.
The use of pharmaceuticals and plant medicines for tuberculosis among the Ju/'hoansi San of Namibia
Abstract: In this case study of tuberculosis in a small village in Tsumkwe district, Namibia, I discuss how, why and when Ju/'hoansi sufferers utilize various knowledge traditions and medicines to treat their ill health under circumstances of scarcity, as well as their lack of power. This paper shows how different notions concerning tuberculosis and TB-like complaints were distinguished and treated with medication in relation to symptomology, medical diagnostics and its absence and embodied experiences of illness. The paper scrutinises the uneasy and complex interface between various treatment practises and medication regimens and the understanding thereof in relation to tuberculosis in the experience of a Ju/'hoan (San) man and his family.
The making of an African medicine: Sutherlandia
The scientific clinical trial of the African traditional medicine, Lessertia frutescens (Sutherlandia) forms an interface between the indigenous local knowledge of people living with Aids, traditional health practitioners and that of science and global health. Up till now no cross-disciplinary studies have been done on epistemological questions concerning especially the knowledge and understanding of 'proof' of efficacy concerning an African traditional medicine. The paper draws together insights and analysis from the anthropology and sociology of health and healing in a discussion on the intersecting fields of knowledge and experience of pharmacology, phytotherapy and related fields, as well as that of biomedical and traditional health practitioners, and of research subjects involved in the making of clinical trials of Lessertia frutescens (Sutherlandia) in South Africa.
The social life of a medicine: "Artemisia annua" - the transformation of a Chinese plant to a global pharmaceutical
This paper focuses on the transformation of a recently promoted medicinal plant named Artemisia annua L. For over 2000 years, the Chinese have used A. annua as a herbal tea preparation against malaria. Pharmacological studies led to the isolation of Artemisinin as the principal Anti-malarial compound. Since 2002, WHO has recommended Artemisinin-based combined therapies ("ACTs") for the treatment of malaria - Novartis is the leading actor to extract the compound in tablet form. In the 1990s, A. annua was introduced to Tanzania. Beside the local promotion of Artemisia-tea as an efficient, inexpensive natural practice to treat malaria, Tanzania hosts influential actors to commercialize the plant. By following the biography of the Chinese medicinal plant, its global transfer, production, marketing, distribution, consumption, and its transformation to a highly demanded commodity, the paper critically reveals the dialectics and reciprocities between different actors and their relation to existing powerful reference systems (WHO, Pharmaceutical Industry).
Mending and bending antimalarial drug innovation at times of emerging multi-drug resistance in Southeast Asia
First signs of artemisinin resistance in P. falciparum malaria along the Cambodia-Thailand border threaten the vision of a malaria-free world. The international malaria community has therefore renewed calls for sustained financial investment in malaria eradication to avert a potential global health disaster. The controversially discussed question of what the world would be with, or without, the introduction of a co-buyer based drug subsidy for antimalarials, brings into perspective its underlying symbolic logic embossed in the logo to be printed on the packaging of artemisinin-based combination therapies that will be channelled through the Affordable Medicines Facility - malaria. Genealogies of health crises have their own theoretical appeal. My ethnographic analysis however, has a different take on the world's cradle of antimalarial drug resistance.
Recreational use of ARVs: imagination or crisis?
During an ongoing ethnographic study in South Africa's West Coast region, health service providers report a general off-label trade in ARVs, which is seen a barrier to adherence for many of their patients whose medication is traded to, or stolen by, drug users. While anecdotal evidence is emerging, there has been little hard evidence thus far of the existence of a recreational market for ARVs.
There is speculation that a crisis of confidence in the health system has seen HIV+ patients buy their ARVs from the black market rather than attending public clinics. In addition, there are rumours that Efivarenz is used in the manufacture of crystal methamphetamine (locally 'tik'). This paper explores the off-label trade of ARVs which is gaining currency in the social imagination of health and social care workers, which in turn could precipitate a real crisis in the Government's public rollout programme.
'Free treatment': drug shortages, total planning, and therapeutic markets in mass HIV/AIDS treatment programs in Uganda
Since 2004, Uganda provides free treatment to HIV/AIDS patients. In 2010, it is still far off the goals towards "universal access". Access to treatment varies greatly among different providers, which is determined by a complex entanglement of stable and unstable supply sources in the country. This paper focuses on the technical and scientific domain of free treatment that operates as a "total planning" of budgets, drug prices, and patient numbers. Large surveys are conducted to establish the relationship between drugs and the available budget, vice versa, how treatment regimens can be adjusted to what is affordable in the country, in order to plan how many lives can be saved at which cost. Moreover planning for a totality of elements in the supply of ART presumes that contingencies in the "social live of pharmaceuticals" can be controlled. It is against this background of a situated and experimental configuration of rigorous scientific methods, health economics, and structural instabilities in the supply side of ART, where practices in regulating mass HIV/AIDS treatment program are translated into a therapeutic market for ART.
Of docile bodies and problematic persons: providing and living with antiretroviral medicines in urban Tanzania
Few years into the roll-out of antiretroviral treatment in Tanzania thousands of HIV-positive patients are now living with antiretroviral drugs (ARVs). The production of treatment adherence constitutes the priority of medical professionals who are transferring the "biomedical truth" about the therapy to the patients. In this paper the procedures of getting access to treatment in urban Tanga and the mechanisms of controlling the patients' behavior throughout the life-long treatment are analyzed along the lines of recent debates on "therapeutic citizenship". It is argued that this concept does not entirely capture the processes taking place at health facilities and in the patients' social environments. Precarious economic situations, the dependency on kinship-based networks of support, and the adherence to traditional and religious practices of healing in some cases generate a stance of "resistance" towards the pharmaceuticalization of even the most intimate spheres of life through the biomedically defined treatment regime.
This workshop is closed to new paper proposals.