When Experiments Travel

Adriana Petryna

"This thoughtful and reflective book offers us a sobering account of the spread of clinical research in a world without borders and often without norms. Based on careful comparative anthropological research, it both casts light on a gray zone where research, medicine, and capitalism merge, and provides a first-rate example of how an anthropology for the twenty-first century can contribute to our understanding and to the public good."--Paul Rabinow, author of Marking Time

Abbreviations ix INTRODUCTION: EXPERIMENTAL FIELDS 1 The Search for Human Subjects 1 Anthropology and the Global Clinical Trial 5 CHAPTER ONE: ETHICAL VARIABILITY 10 Why Are Clinical Trials Globalizing? 10 Treatment Saturation 19 Experimentality 26 Ethics as "Workable Document" 33 Floater Sites and Hidden Harms 41 The Aftermath of Clinical Trials 44 CHAPTER TWO: ARTS OF DRUG DEVELOPMENT 47 Study Mills 47 Drug-Development Services 53 From Vulnerable to Professional Subjects 61 The Pharmaceutical Boom and Everyday Research 68 Engineering Out Harm 77 The Scientific Plateau and the New Safety Paradigm 85 CHAPTER THREE: THE GLOBAL CLINICAL TRIAL 89 How Many Clinical Trials Are Being Carried Out Worldwide? 89 The Polish Market and the "Nonexistent" Patient 98 Clinical Research Frontiers 106 Collaborations in Global Science 109 Akademia Kliniczna 116 The Work of Slack 119 Patient-Consumers 124 "Our society was not competitive" 127 Pivotal Countries 130 Insurance and Legal Protection 132 CHAPTER FOUR: PHARMACEUTICALS AND THE RIGHT TO HEALTH 139 Reclaiming Patients and the Evidence Base of Drugs 139 "Pharmaceuticals are the new gold" 142 Health Technology Assessment in Brazil 146 The Judicialization of Health 150 Alternative Treatment Guidelines 153 The Clinical Research Unit 156 When a Country Is a Pharmacy 160 A Public Health Experiment 165 What Happens When Clinical Trials End 167 The Values Patients Bring 173 Information Asymmetry and Agency 179 CONCLUSION: THE FUTURE OF GLOBAL MEDICINE 186 Scientific Evidence and Value 186 Drugs as Public Goods 190 Global Health Markets 192 Innovation 195 Acknowledgments 201 Notes 205 References 225 Index 249