When Experiments Travel: Clinical Trials and the Global Search for Human Subjects

When Experiments Travel: Clinical Trials and the Global Search for Human Subjects

by 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

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Overview

"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

"This superb book provides the best overview of the pharmaceutical industry's rush to move clinical trials to developing countries, and the intensely troubling moral, political, economic, and cultural issues this effort raises. Petryna's argument is balanced and compelling, and her case studies are riveting."—Arthur Kleinman, M.D., Harvard University

"This is a very important book, notable for its novel subject, innovative approach, and seriousness. A singular contribution to the anthropology of science and medicine."—Veena Das, Johns Hopkins University

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Product Details

ISBN-13:
9780691126579
Publisher:
Princeton University Press
Publication date:
04/27/2009
Edition description:
New Edition
Pages:
270
Sales rank:
687,394
Product dimensions:
6.10(w) x 9.20(h) x 0.80(d)

Table of Contents

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

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