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Phase I clinical trials test the safety and tolerability of new pharmaceuticals and typically pay healthy people to enroll as research participants. In addition to being exposed to the risks of taking investigational drugs, healthy volunteers are confined to residential research facilities for some portion of the clinical trial. Most healthy volunteers are African American and Hispanic men in their late twenties to early forties. Motivated by pervasive economic insecurity and racial discrimination, these individuals often enroll serially in Phase I trials to stay afloat or to get ahead. This book reveals not only the social inequalities on which Phase I trials rest, but also depicts the important validity concerns inherent in this mode of testing new pharmaceuticals. Healthy volunteers are enrolled in highly controlled studies that bear little resemblance to real-world conditions. Moreover, in these studies everyone—from the pharmaceutical companies sponsoring the studies, to the clinics conducting them, and the healthy volunteers paid to participate—is incentivized to game the system, with the effect that new drugs appear safer than they really are. Providing an unprecedented view of the intersection of US racial inequalities with pharmaceutical testing, Adverse Events calls attention to the dangers of this research enterprise to social justice and public health.

The production of pharmaceuticals is among the most profitable industries on the planet. Drug companies produce chemical substances that can save, extend, or substantially improve the quality of human life. However, even as the companies present themselves publicly as health and environmental stewards, their factories are a significant source of air and water pollution—toxic to people and the environment. In Puerto Rico, the pharmaceutical industry is the backbone of the island's economy: in one small town alone, there are over a dozen drug factories representing five multinationals, the highest concentration per capita of such factories in the world. It is a place where the enforcement of environmental regulations and the public trust they ensure are often violated in the name of economic development. This book unites the concerns of critical medical anthropology with those of political ecology, investigating the multi-faceted role of pharmaceutical corporations as polluters, economic providers, and social actors. Rather than simply demonizing the drug companies, the book explores the dynamics involved in their interactions with the local community and discusses the strategies used by both individuals and community groups to deal with the consequences of pollution. It puts a human face on a growing set of problems for communities around the world, and encourages readers to think critically about the role of corporations in everyday life, health, and culture.

A Hindu monk in Calcutta refuses to take his psychotropic medications. His psychiatrist explains that just as his body needs food, the drugs are nutrition for his starved mind. Does it matter how—or whether—patients understand their prescribed drugs. Millions of people in India are routinely prescribed mood medications. Pharmaceutical companies give doctors strong incentives to write as many prescriptions as possible, with as little awkward questioning from patients as possible. Without a sustained public debate on psychopharmaceuticals in India, patients remain puzzled by the notion that drugs can cure disturbances of the mind. While biomedical psychopharmaceuticals are perceived with great suspicion, many non-biomedical treatments are embraced. This book illuminates how biomedical, Ayurvedic, and homeopathic treatments are used in India, and argues that pharmaceutical pluralism changes popular ideas of what drugs do. Based on several years of research on pharmaceutical markets, the book shows how doctors employ a wide range of strategies to make patients take the remedies prescribed. Yet while metaphors such as “mind food” may succeed in getting patients to accept the prescriptions, they also obscure a critical awareness of drug effects.

Millions of North Americans are priced out of North America’s expensive reproductive medicine industry. Ultimately, women learn about the possibility of doing IVF abroad, and this book reveals the layers of desire that motivate them to travel halfway across the world in their quest for parenthood. A global marketing chain has brilliantly packaged “fertility holidays”: a European vacation alongside a healthcare system where doctors really care and want you to have your beautiful white baby. Brokers promise couples that they will experience a more relaxing IVF cycle while also assuring them Czech doctors offer better care along with the highest standards of technology. Ultimately, my book reveals the alienation of poor patients in the U.S., their active response as they assume the role of global consumers of health care. Fertility clinics around the globe have begun to develop marketing schemes that cater to this North American desire for care, since it is an obvious deficiency in our healthcare system.

Autism is a deeply contested condition. To some, it is a devastating invader, robbing families of their children and sufferers of their personhood. To others, it is a form of neurodiversity, a fundamental and often valued aspect of identity that is more similar to race or gender than to disease states. How do young people coming of age with an autism spectrum diagnosis make sense of this conflict in the context of their own developing identity? The book addresses this question through sustained ethnographic engagement, informed by both clinical psychology and anthropology, within communities where people on the autism spectrum come together to live, learn, work, love, and play. Using an approach known as clinical ethnography, the book tracks neuroscientific discourses as they are adopted, circulated, and transformed among those affected by Asperger’s syndrome and related autism spectrum conditions. Dominant ways of talking about autism, whether as invasive disease or as hardwired neurogenetic identity, share a fundamental presupposition: that the healthy self is sharply bounded and destroyed if it is altered. However, the subjective experiences of youth on the spectrum exceed the limitations of these medical models. Reaching beyond medicine for their narratives of difference and disorder, these youth draw instead on shared mythologies from popular culture and speculative fiction to conceptualize their experiences of discontinuous and permeable personhood. In doing so, they also pioneer more inclusive understandings of what makes us who we are.

Residents of a small Louisiana town were sure that the oil refinery next door was making them sick. As part of a campaign demanding relocation away from the refinery, they collected scientific data to prove it. Their campaign ended with a settlement agreement that addressed many of their grievances—but not concerns about their health. Instead of continuing to collect data, residents began to let refinery scientists' assertions stand without challenge. What makes a community move so suddenly from actively challenging to apparently accepting experts' authority? This book argues that the answer lies in the way that refinery scientists and engineers defined themselves as experts. Rather than claiming to be infallible, they began to portray themselves as responsible—committed to operating safely and to contributing to the well-being of the community. The book shows that by grounding their claims to responsibility in influential ideas from the larger culture about what makes good citizens, nice communities, and moral companies, refinery scientists made it much harder for residents to challenge their expertise and thus re-established their authority over scientific questions. The book shows how industrial facilities' current approaches to dealing with concerned communities leave much room for negotiation while shielding industry's environmental and health claims from critique—effectively undermining individual grassroots campaigns, as well as environmental justice activism and efforts to democratize science. The book drives home the need for both activists and politically engaged scholars to reconfigure their own activities in response, in order to advance community health and robust scientific knowledge about it.

The premature birth rate in the United States has been persistently high among Black women for many decades. While most research on the topic of premature birth involves poor and low-income women, this book focuses on the experiences of more affluent women to show that race is as much a common denominator as class in adverse birth outcomes. Using the afterlife of slavery framework, the book argues that racism shapes professional and college-educated Black women’s prenatal and birthing medical encounters, which have precedents that emanate from slavery. The book weaves in historic examples of medical racism, offering analytical context for understanding contemporary Black women’s interpretations of medical encounters of prenatal care, labor, birthing, and the admission of their premature child to the neonatal intensive care unit. Based on ethnographic observations, archival research, and nearly fifty interviews with parents, medical professionals, public health administrators, and birth workers, including midwives, doulas and reproductive justice advocates, the book is divided into two parts. Part I offers definitions of prematurity, outlines some of its causes, and describes what it is like to have a premature child. This part also explores the everyday forms of racism, such as diagnostic lapses or being dismissed by medical personnel, and links those experiences to past ideologies and practices of medical racism. Part II uses a critical racial lens to explore three strategies to address prematurity: technological intervention, public health intervention, and the preventionist approach taken up by birth workers. The conclusion gestures toward ideas to address medical racism.

In 1924, IBM built its first plant in Endicott, New York. Now, Endicott is a contested toxic waste site. With its landscape thoroughly contaminated by carcinogens, Endicott is the subject of one of the nation's largest corporate-state mitigation efforts. Yet despite the efforts of IBM and the U.S. government, Endicott residents remain skeptical that the mitigation systems employed were designed with their best interests at heart. This book tracks and critically diagnoses the experiences of Endicott residents as they learn to live with high-tech pollution, community transformation, scientific expertise, corporate-state power, and risk mitigation technologies. By weaving together the insights of anthropology, political ecology, disaster studies, and science and technology studies, the book explores questions of theoretical and practical importance for understanding the politics of risk and the ironies of technological disaster response in a time when IBM's stated mission is to build a “Smarter Planet.” The book critically reflects on IBM's new corporate tagline, arguing for a political ecology of corporate social and environmental responsibility and accountability that places the social and environmental politics of risk mitigation front and center. Ultimately, the book argues that we will need much more than hollow corporate taglines, claims of corporate responsibility, and attempts to mitigate high-tech disasters to truly build a smarter planet.

Transnational Reproduction explores the global surrogacy industry in India, focusing on the ways in which surrogate mothers, parents, egg providers, and doctors navigate their relationships formed through gestational surrogacy. In the early 2010s India was one of the top providers of surrogacy services in the world. Drawing on in-depth ethnographic research in India, Transnational Reproduction argues that while the surrogacy industry in India offers a clear example of “stratified reproduction”—the ways in which political, economic, and social forces structure the conditions under which women carry out reproductive labor—it also complicates that concept as the various actors work to understand their relationships to one another. The book pays special attention to the racial dimensions within transnational surrogacy, investigating how race is constructed among the various actors involved. The book outlines how particular notions of race and difference intersect with notions of kinship and relatedness. Ultimately, the book shows how practices of racialization shape kinship and family making, arguing that racial reproductive imaginaries underpin the unequal relations at the heart of transnational surrogacy. This book illustrates how actors constitute racial reproductive imaginaries through various transnational reproductive practices: through practices that Other, through articulation of difference, and through the production and reproduction of power and stratification.

Unequal Coverage documents the everyday experiences of individuals across the United States as they attempted to access coverage and care in the five years following the passage of the Affordable Care Act (ACA). The contributors to this edited volume employ research methods rooted in ethnography and focused on how reform was actually experienced on the ground by frontline health care workers, the newly insured, and those who remained uninsured. The book argues that while the ACA did extend social protections to some groups previously excluded from health insurance, its design- and controversy-plagued implementation also created new forms of exclusion. Access to affordable coverage options were highly segmented by state of residence, income, and citizenship status. To explain and contextualize the stratified experiences of health reform that the book’s authors documented across nine states, Unequal Coverage explores interrelated themes from medical anthropology: stratified citizenship, risk, and responsibility. In the years since its enactment, some 20 million uninsured Americans gained access to insurance coverage. And yet, the law remained unpopular and politically vulnerable. This book illustrates lessons learned from the contentious implementation of the ACA and reveals how the law became a flashpoint for battles over inequality, fairness, and the role of government.

Set at a health insurance company dubbed Acme, this book chronicles how the privatization of the health care system in Puerto Rico transformed the experience of accessing and providing care on the island. Through interviews and participant observation, the book explores the everyday contexts in which market reforms were enacted. It follows privatization into the compliance department of a managed care organization, through the visits of federal auditors to a health plan, and into the homes of health plan members who recount their experiences navigating the new managed care system. In the 1990s and early 2000s, policymakers in Puerto Rico sold off most of the island's public health facilities and enrolled the poor, elderly and disabled into for-profit managed care plans. These reforms were supposed to promote efficiency, cost-effectiveness, and high-quality care. Despite the optimistic promises of market-based reforms, the system became more expensive, not more efficient; patients rarely behaved as the expected health-maximizing information processing consumers; and care became more chaotic and difficult to access. Citizens continued to look to the state to provide health services for the poor, disabled, and elderly. This book argues that pro-market reforms failed to deliver on many of their promises. The health care system in Puerto Rico was dramatically transformed, just not according to plan.

Every year in the United States, thousands of women and hundreds of men participate in sexual assault forensic examinations. Drawing on four years of participatory research in a Baltimore emergency room, this book reveals the realities of sexual assault response in the forensic age. It analyzes the ways in which forensic nurses work to collect and preserve evidence while addressing the needs of sexual assault victims as patients. The book considers how blending the work of care and forensic investigation into a single intervention shapes the ways that victims of violence understand their own suffering, recovery, and access to justice. As nurses race the clock to preserve biological evidence, institutional practices, technologies, and even state requirements for documentation undermine the way in which they are able to offer psychological and physical care. Yet most of the evidence they collect never reaches the courtroom and does little to increase the number of guilty verdicts. The book illustrates the violence of care with painstaking detail, illuminating why victims continue to experience what many call “secondary rape” during forensic interventions, even as forensic nursing is increasingly professionalized. Revictimization can occur even at the hands of conscientious nurses, simply because they are governed by institutional requirements that shape their practices. This book challenges the uncritical adoption of forensic practice in sexual assault intervention and post-rape care, showing how forensic intervention profoundly impacts the experiences of violence, justice, healing and recovery for victims of rape and sexual assault.

War affects human lives and public health far beyond the battlefield, long after combat ceases. Based on ethnographic research by anthropologists, healthcare workers, social workers, and activists, these chapters cover a range of subjects from maternal health in Afghanistan, to the public health effects of US drone strikes in Pakistan, to Iraq’s deteriorating cancer care system, to the struggles of US military families to recover from combat-related trauma, among other topics. With a spotlight on the US-led wars in Afghanistan, Iraq, and Pakistan, started ostensibly to root out terrorism, the book argues that the terror and wounds of war have no clear resolution for the people who experience it, and for the communities where battles are fought.