Adriana Petryna

On April 26, 1986, Unit Four of the Chernobyl nuclear reactor exploded in then Soviet Ukraine. More than 3.5 million people in Ukraine alone are still suffering the effects. This text examines the political, scientific and social circumstances that followed the disaster.

Biological Citizens After Chernobyl

Life Exposed

Joao Biehl

"Rapid social change is the one constant in this ambitious volume. These pages come to life and are wrenching because they never seek to elide the messiness of experience. With ethnographic evidence from some of the most important theaters of global health, the authors give us a sound understanding of the collision of a crushing burden of disease, emerging audit cultures, and new therapeutic regimes. As case studies rooted in long familiarity but alive to overwhelming transformation, they will stand the test of time."--Paul Farmer, Harvard Medical School and Partners in Health "Award-winning medical anthropologists Joao Biehl and Adriana Petryna have produced a stunning and original collection. In an era of market-driven global health interventions, this volume demonstrates anthropology's unique contribution as a critically evaluative and humanizing discipline."--Marcia C. Inhorn, Yale University "Global health as a field is being redefined, from one based on narrow interventions to a more holistic focus on delivering value to patients. This requires a deep understanding of how to connect care delivery to patients, their families, and the local country context. "When People Come First" is an indispensable resource in creating the global health delivery systems of the future. Its rich case studies are essential for practitioners and scholars in designing and implementing care processes that really work."--Michael E. Porter, Harvard Business School "Global health is a big business: the World Bank, the World Health Organization, the United Nations, the Gates Foundation, academia, pharmaceutical companies, and thousands of NGOs are working to improve health around the world. Lost among these powerful groups, the supposed beneficiaries have little to say. "When People Come First" tells us why and how to make global health better. It is an eye-opener, especially for those of us locked into our comfortable disciplinary silos."--Angus Deaton, Princeton University ""When People Come First" is a truly pioneering volume that will change the kind of work that is done in the anthropology of global health in the future."--Richard G. Parker, Columbia University ""When People Come First" sets an ambitious agenda that emphasizes ethnography as an important methodological tool for better understanding health services at all levels of analysis, including at the stages of service provision, medicine marketing, and policymaking. There is no doubt that this book will be read and widely cited by scholars of global health."--Nitsan Chorev, Brown University

Critical Studies in Global Health

When People Come First

João Biehl

A people-centered approach to global health When People Come First critically assesses the expanding field of global health. It brings together an international and interdisciplinary group of scholars to address the medical, social, political, and economic dimensions of the global health enterprise through vivid case studies and bold conceptual work. The book demonstrates the crucial role of ethnography as an empirical lantern in global health, arguing for a more comprehensive, people-centered approach. Topics include the limits of technological quick fixes in disease control, the moral economy of global health science, the unexpected effects of massive treatment rollouts in resource-poor contexts, and how right-to-health activism coalesces with the increased influence of the pharmaceutical industry on health care. The contributors explore the altered landscapes left behind after programs scale up, break down, or move on. We learn that disease is really never just one thing, technology delivery does not equate with care, and biology and technology interact in ways we cannot always predict. The most effective solutions may well be found in people themselves, who consistently exceed the projections of experts and the medical-scientific, political, and humanitarian frameworks in which they are cast. When People Come First sets a new research agenda in global health and social theory and challenges us to rethink the relationships between care, rights, health, and economic futures.

When People Come First critically assesses the expanding field of global health. It brings together an international and interdisciplinary group of scholars to address the medical, social, political, and economic dimensions of the global health enterprise through vivid case studies and bold conceptual work. The book demonstrates the crucial role of ethnography as an empirical lantern in global health, arguing for a more comprehensive, people-centered approach. Topics include the limits of technological quick fixes in disease control, the moral economy of global health science, the unexpected effects of massive treatment rollouts in resource-poor contexts, and how right-to-health activism coalesces with the increased influence of the pharmaceutical industry on health care. The contributors explore the altered landscapes left behind after programs scale up, break down, or move on. We learn that disease is really never just one thing, technology delivery does not equate with care, and biology and technology interact in ways we cannot always predict. The most effective solutions may well be found in people themselves, who consistently exceed the projections of experts and the medical-scientific, political, and humanitarian frameworks in which they are cast. When People Come First sets a new research agenda in global health and social theory and challenges us to rethink the relationships between care, rights, health, and economic futures.

Arthur Kleinman

Andrew Lakoff

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. Contributors. Kalman Applbaum, João Biehl, Ranendra K. Das, Veena Das, David Healy, Arthur Kleinman, Betty Kyaddondo, Andrew Lakoff, Anne Lovell, Lotte Meinert, Adriana Petryna, Michael A. Whyte, Susan Reynolds Whyte

Global Pharmaceuticals

The phenomenal growth of global pharmaceutical sales and the quest for innovation are driving an unprecedented search for human test subjects, particularly in middle- and low-income countries. Our hope for medical progress increasingly depends on the willingness of the world's poor to participate in clinical drug trials. While these experiments often provide those in need with vital and previously unattainable medical resources, the outsourcing and offshoring of trials also create new problems. In this groundbreaking book, anthropologist Adriana Petryna takes us deep into the clinical trials industry as it brings together players separated by vast economic and cultural differences. Moving between corporate and scientific offices in the United States and research and public health sites in Poland and Brazil, When Experiments Travel documents the complex ways that commercial medical science, with all its benefits and risks, is being integrated into local health systems and emerging drug markets. Providing a unique perspective on globalized clinical trials, When Experiments Travel raises central questions: Are such trials exploitative or are they social goods? How are experiments controlled and how is drug safety ensured? And do these experiments help or harm public health in the countries where they are conducted? Empirically rich and theoretically innovative, the book shows that neither the language of coercion nor that of rational choice fully captures the range of situations and value systems at work in medical experiments today. When Experiments Travel challenges conventional understandings of the ethics and politics of transnational science and changes the way we think about global medicine and the new infrastructures of our lives.

Adriana Petryna

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