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The Making of Pharmaceutical Value: Drugs, Diseases and the Political Economies of Global Health

An international workshop organized in Paris on 16-18th of June, 2016

by Jean-Paul Gaudillière, Kristin Peterson and Kaushik Sunder Rajan

 

Historians, anthropologists and economists repeatedly point to the critical role pharmaceuticals have acquired in the dynamics of global health. Yet analysis remain often separated focusing either on the dynamics of invention, production and commercialization of drugs, and on the changing actors and targets of international health initiatives. This workshop seeks to examine the multiple entanglements that bring together pharmaceuticals and global health, by taking the processes involved in the making of pharmaceutical value as vantage point.

Ever since the brand name pharmaceutical industry expanded operations and markets into continents outside its home base, the question of pharmaceutical value has been shaped by at least two distinct historical regimes. Between 1945 and 1985, a relatively coherent political economy linked forms of clinical knowledge, medical practices and the construction of markets. This was a monopoly/proprietary regime, characterized by patents, industrial (chemical) screening, scientific marketing, and socialized costs managed via health insurance subsidies. From 1985 until the present, this regime has been fragilized by the crisis of the screening model of research whereby research results and value of many drugs decreased. "Biomolecular innovation” now drives this second regime, undergirded by speculative/finance capital and the monopoly protections enabled by intellectual property enforcement mechanisms within global trade (i.e. the TRIPs Agreement of the World Trade Organization).

This event stems from the hypothesis that global pharmaceuticals far from being reducible to frontier biotechnological goods are shaped by - at least - three discernable and overlapping political economies. The first one is the renewed brand-name industrial configuration. The second originates in alternatives, such as generic medicines and distribution networks, which countries of the global South are attempting to define, for example, through forms of invention based on copy and reformulation, limited patenting, and market construction through renewed links with global public health policies driven by WHO, World Bank, NGOs in addition to nation states). This regime is not only a product of the industrialization of emerging countries, the famous BRICS, but also of the 1970s post Alma-Ata debates and the pressure of the "Third World" on international public health. Partial shadow economies in which supposedly substandard, non-efficacious, and fake drugs circulate constitute a third political economy, born from effects of the large-scale implementation of structural adjustment programs in the 1970s and 1908s and bridging producers and consumers in middle- and low-income countries, with facilitators in higher income countries. These three political economies, of course, overlap.

Rather than separate these political economies from their medical and practical context, the workshop will approach the history of drugs in the transition from “international public health” to “global health” from the dialectics of exchange value and use value. We hypothesize that global health is forging new linkages in this relationship, centered on new actors (private-public partnership, the World Bank), targets (performance, chronic diseases) and tools (project management, vertical distribution programs focusing on patients’ compliance). Highly visible alliances between private for-profit, private not-for profit and state organizations promoting drugs as the one best solution to health issues raise questions about the making of industrial and clinical knowledge, the circulation of local and global expertise, the relationship between drug prescription and public health targets, between regimes of intervention and capital accumulation. These dynamics profoundly challenge and transform communities but their inner workings and processes remain largely unmapped or preliminarily understood.

Value is a multilayered concept, which social scientists as well as economists have used with utterly different meanings. In order to advance our understanding of how value is made and unmade within the framework of these putatively distinct political economies of drugs, the workshop will pay special attention to the following iterations and issues: a) the making of surplus value and health economies; b) the intimate linkages between exchange value and use value; c) national politics and the globalized processes of valorization; d) innovation, promises and the value of (re) producing; e) circulations, materiality and the reconfigurations of value; f) value in relation to embodiment, therapeutic interventions and felt illness.
The workshop will take place from 16th to 18th June 2016 in the vicinity of Paris. Travel and accommodation costs will be covered for all participants. Papers will be pre-circulated three weeks in advance so that during the workshop invited speakers will only give a 15 minutes summary of their argument followed by 45 minutes discussion.

This workshop is supported by the ERC project “From international to Global: Knowledge, Diseases and the Postwar Government of Health”. For more information on the project see: http://globhealth.vjf.cnrs.fr/

Programme

Thursday June 16th

14h – 15h : Maurice Cassier (Cermes3) – « Between Financial Capitalism and Humanitarian Concerns: Value, Price and Profits of Hepatitis C Antivirals and Artemisinine Combination Therapies for Malaria. »
15h – 16h : Nitsan Chorev (Brown University) – « Transnational Origins of Local Production: Making Medicines in Kenya, Tanzania, and Uganda »
16h – 16h30 - Pause
16h30 – 17h30 : Kristin Peterson (University of California Irvine) – « Other Drugs: Racial & Speculative Capital, and the Value Logics of ‘African-Routed’ Pharmaceuticals. »

 

Friday June 17th

9h – 10h : Cori Hayden (University of California Berkeley) – « Mere commodification. »
10h – 11h : Laurent Pordié (Cermes3) – « Unstable Pharmaceutical Values. Drugs’ Distribution Networks and Practices in Cambodia. »
11h – 11h30 : Pause
11h30 – 12h30 : Emilia Sanabria (Ecole Normale Supérieure Lyon) – « Vegetative value: promissory horizons of therapeutic innovation in the global circulation of ayahuasca. »
12h30 – 14h : Lunch
14h – 15h : Manjari Mahajan (New York University) – « Accounts, Accounting and Accountability: The Gates Foundation and Construction of Global Publics through Local Metrics. »
15h – 16h : Alexis Walker (Cornell University) – « Valuing Life at the World Bank: Cost-Effectiveness Analysis, Patronage Politics, and Global Health in Guyana. »
16h – 16h30 : Pause
16h30 – 17h30 : Thomas Cousins (Stellenbosch University) – «Amandla: Labour, Capacity, and Value in the KwaZulu-Natal, South Africa. »


Saturday June 18th

9h30 – 10h30 : Catherine Waldby (The Australian National University) – « 20 th Century Oöcytes: Experiment and Experience. »
10h30 – 11h30 : Jean-Paul Gaudillière (Cermes3) & Kaushik Sunder Rajan (University of Chicago) – « Innovation and its others – Pharmacy, Global Capitalism and the Dialectics of Value. » 
11h30 – 12h30 Concluding remarks and discussion

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