Dr. Donna M. Goldstein, along with a health economist and two in-country collaborators, will undertake research that seeks to develop appropriate multi-level, interdisciplinary models for studying globalization. Their specific focus will be the case of pharmaceutical health care. They will study the provisioning of HIV/AIDS medication to infected local populations. Governments of developing countries that support inclusive health care policies are caught between the demands of intellectual property law, the strength of global and national pharmaceutical lobbies, and the growing demands of well-organized AIDS activists. Through the collection and analysis of comparative economic and ethnographic evidence, the current project seeks to evaluate how forces acting on different levels -- global, natational, and local -- play out in pharmaceutical negotiation processes as they materialize within two metropolitan areas: Buenos Aires and Mexico City.
This pilot phase of the project will focus on four kinds of stakeholders: (1)transnational pharmaceutical corporations producing HIV/AIDS drugs, (2) generic producers of HIV/AIDS drugs, (3) HIV/AIDS activists who lobby the federal government, and (4)HIV/AIDS activists who mainly provide services and do not lobby the federal government, plus two ethnographic case studies of ongoing pharmaceutical negotiations. The data collected will be used to answer the central questions regarding pharmaceutical policies in Latin America: What forces play into pharmaceutical negotiations in developing countries such as Argentina and Mexico? What role do pharmaceutical companies and HIV/AIDS activists play in national contexts with regard to the consideration of international regulatory bodies and intellectual patent law?
The research is important because while globalization is frequently cited as a major force affecting people's lives all over the world, how it comes to bear through the many intervening levels is not well understood. This research will make those links clear and help to develop models that can be used by other researchers in other contexts. The research also will contribute to understanding the consequences of recent legal changes for HIV/AIDS care in developing countries, and will foster international research cooperation.
This investigation explores how pharmaceutical products, particularly life-saving drugs, have come to occupy an imperial position in the lives of citizens in the Latin American region. Focused primarily on Argentina, the research explores how national level health and social policy intersects with the goals of regional and global institutions such as the Global Fund to Fight AIDS, the World Health Organization, the World Intellectual Property Organization, and the U.S. Food and Drug Administration. The research asks how decades of neoliberal social policy has impacted the accessibility and safety of pharmaceutical products, particularly those used to treat HIV/AIDS. The project investigates how the public health-care needs of HIV/AIDS patients are framed in the context of global, national, and local institutions that can often reflect competing agendas. Major findings and arguments will appear in my book (in process) provisionally titled, Pharmaceutical Politics in Neoliberal Latin America: The Traffic of Drugs, Lives, and Profits. The book draws from ethnographic research I have been conducting in Argentina since 2003, as well as related field work in Mexico, Switzerland, Brazil, and the U.S. since 2007. The book's six anticipated chapters examine both local and global articulations of potent life-saving drugs in various sites: the patient's body, the hospital, the doctor's clinic, world class research institutes, pharmaceutical corporate offices and laboratories, governmental and non-governmental agencies, regulatory institutions, criminal drug trafficking circuits, and at the borders of nation-states. The book addresses the "politics of survival" among citizens in need of specific drug treatments and examines the institutions that articulate health policy directed at them. Pharmaceutical Politics maps the ethical dilemmas associated with pharmaceutical access issues. In Chapter 1, entitled "Life or Profit?" (adapted from Goldstein 2007), I situate neoliberalism as both a forum and logic of market-oriented governance that intensifies the global pharmaceutical industry's drive for intellectual property protection and profit while stifling diverse forms of popular dissent. During the last two decades, Argentina became a textbook case through which to examine neoliberal development. The economic collapse of 2001 (known as the corralito) sent the country into an economic crisis that had enduring effects. The chapter outlines the rise and fall of neoliberal health policy over the last several decades in Argentina, the effects on government and public health institutions, and the strategies of citizens seeking HIV/AIDS treatment in this reconfigured pharmaceutical and public health landscape. Chapter 2, "How Corruption Kills: Pharmaceutical Crime, Mediated Representations, and Middle-Class Anxiety in Neoliberal Argentina" (adapted from Goldstein 2012), interrogates the complicated ways in which the legal, nationally based pharmaceutical industry and the illegal drug trade have become deeply intertwined. Specifically, I examine how differential regulattory policies structured by regional free trade agreements have encouraged the migration of criminal narcotics trafficking gangs from Mexico into Argentina. Of central interest is ephedrine, a drug found in expensive cancer and HIV/AIDS treatments and in common decongestants. Ephedrine was strongly regulated in Mexico beginning in 2007, but not in Argentina. Criminal drug trafficking gangs from Mexico entered the legal Argentine pharmaceutical marketplace seeking access to this product, and after extraction from other products, uses it to process methamphetamine, or crystal meth. In 2008, the triple homicide of three middle-class pharmaceutical entrepreneurs involved in ephedrine sales led investigators to uncover a trail of corruption, money laundering, and the falsification of medicines across Argetntine business and government sectors. Prominent and high profile middle-class individuals from labor unions, social welfare agencies, and health care institutions were found to be involved in serious crimes, which has led to new forms of pharmaceutical regulation. Pharmaceutical Politics historicizes the rising use of particular populations in the global South as "ideal" populations for human disease and clinical trials research by the global pharmaceutical industry. Chapter 3, entitled "HIV/AIDS Pharmaceutical Trials in Neoliberal Context" (adapted from Goldstein 2012a), addresses the ways in which pharmaceutical trials are concerned with methodological issues related to the proper structuring of experimental and control populations. The chapter addresses the formation of partnerships between non-governmental organizations, the medical community, and pharmaceutical corporations working on clinical trials of HIV/AIDS treatments. Chapter 4, "Pharmaceutical Governance: Transnational, National, and Local," identifies how transnational intellectual property regimes and national level government policy works with the profitable generic drug industry in Argentina. Chapter 5, provisionally entitled "Personal Virtues and Scientists: The Practice of Science Under Pharmaceutical Capitalism" explores some of the new ways that public and private collaborations are taking place within the pharmaceutical and public health care context in Argentina, revealing several possible alternative futures from these partnerships. The concluding chapter of Pharmaceutical Politics, "Patient Rights and Citizenship Rights," explores the regulatory landscape of pharmaceutical access in Argentina and examines the process through which patient citizens seek relief not only through pharmaceutical treatment but also through legal action.
