
































A Pill for Every Market, and a Market for Every Pill 

Review by Ellen Rubinstein

The Pharmaceutical Studies Reader

by Sergio Sismondo & Jeremy A. Greene (eds)

Wiley-Blackwell, 2015

My mother is a psychiatrist, and I grew up in a house littered with Prozac pens and paperweights. By

the  time I  reached adolescence,  I  had already attended my fair  share  of  drug company-sponsored

dinners and had met several fresh-faced, cheery pharmaceutical sales representatives who visited the

outpatient clinic where my mother worked. The sales reps were part of the clinical scenery, bearing

gifts  of  drug  samples  she  could  pass  on  to  patients  who  couldn’t  afford  their  meds.  It  seemed

straightforward enough at the time.

Of  course,  ensuing  decades  have  proven  that  the  social  and  biological  relations  between

pharmaceuticals,  physicians,  and  patients  are  anything  but  straightforward.  It  is  in  these  tangled

relations that editors Sergio Sismondo and Jeremy A. Greene find their  point of departure for  The

Pharmaceutical Studies Reader. Citing the value of a science and technology studies (STS) approach,

Sismondo and Greene argue for a critical gaze on “the scientific, organizational, and rhetorical work”

that engenders new logics and practices involving pharmaceuticals (p. 2). The seventeen previously

published articles and book chapters that comprise the reader shed light on the complexities therein.

In  their  introduction,  Sismondo  and  Greene  invoke  Derrida’s  pharmakon  to  describe  the

pharmaceutical’s potential both to cure and to poison. It is not the pill or capsule that proves the focal

point of this volume, however, but the social processes that undergird the production and marketing of

drugs. Eleven of the articles address some aspect of pharmaceutical marketing, testifying to the wealth



of strategies companies use to peddle their wares to unsuspecting customers. (Adriane Fugh-Berman

and  Shahram Ahari’s  description  of  sales  representatives’ “tactics  for  manipulating  physicians”  is

particularly troubling when I think back on those fresh-faced, cheery reps who once frequented my

mother’s  office.)  As  these  articles  make  clear,  every  interaction  we  have  with  pharmaceuticals  is

carefully framed, scripted, and finessed to ensure maximum persuasion to prescribe (for physicians) or

request (for patients) a certain drug.

Sismondo and Greene have divided the book into five parts  that represent cross-cutting themes in

pharmaceutical studies: 1) pharmaceutical lives; 2) new drugs, diseases, and identities; 3) drugs and the

circulation of medical knowledge; 4) political and moral economies of pharmaceutical research; and 5)

intellectual property in global and local markets. In what follows, I highlight some of the articles that

comprise each section. 

Part  I  (Pharmaceutical  Lives)  provides  a  general  overview  of  some  of  the  people  and  processes

involved in the pharmaceutical world. The first article (ch. 2), by Simon J. Williams, Paul Martin, and

Jonathan  Gabe,  argues  for  the  theoretical  utility  of  “pharmaceuticalization”  as  a  framework  for

understanding  both  the  therapeutic  and  non-therapeutic  roles  of  drugs  in  everyday  lives.

Pharmaceuticalization expands on the twentieth-century concept of “medicalization” by acknowledging

that biological and psychological states are now targets of enhancement and transformation, not simply

pathologization. 

Part II (New Drugs, Diseases, and Identities) addresses the market logics that contribute to the creation

of  disease  and identity  categories,  particularly  vis-à-vis  gender  and race.  Nathan Greenslit  (ch.  4)

details  the  rebranding of  Prozac  (fluoxetine  hydrochloride)  as  Sarafem,  a  chemically  identical  yet

symbolically separate substance. While the green-and-white Prozac pill was marketed as a treatment

for depression, pink-and-purple Sarafem was advertised to treat premenstrual dysphoric disorder, itself

a contested diagnosis. Greenslit demonstrates that “identity practices”—the situating of individuals and

organizations with respect to sociomedical discourses—apply to pharmaceutical objects, as well, and

are  made  manifest  through  direct-to-consumer  advertising.  Anne  Pollock  (ch.  6)  recounts  the

“contingent history” of BiDil, approved by the Food and Drug Administration in 2005 to treat heart

failure in “self-identified black patients.” Pollock unpacks the various actors and motivations that drove

the production of this highly publicized yet commercially unsuccessful drug, arguing that its potency

lies in its unresolvable “undecidabilities” as pharmakon (cure and poison) and as a material object rife



with symbolic meaning. 

Part III (Drugs and the Circulation of Medical Knowledge) offers explicit delineation of the marketing

strategies employed by pharmaceutical companies. As mentioned above, Fugh-Berman and Ahari, the

latter  a  former  Eli  Lilly  sales  rep  (ch.  8),  describe  in  chilling  detail  the  strategies  behind  sales

representatives’ social interactions with physicians, all of which are calculated to increase physicians’

prescriptions of their respective pharmaceuticals. Sergio Sismondo (ch. 10) introduces readers to a new

set of marketing specialists (although they would rankle at such a description): publication planners

who “ghost manage” the production of drug company-favorable manuscripts for publication in peer-

reviewed scientific journals. He argues that publication planning represents a “new, corporatized, mode

of scientific research” (p. 151)—research that is still scientifically defensible but is produced for the

sake  of  the  corporation.  Scientific  knowledge  itself  becomes  a  commodity  to  be  bought  and sold

through knowledge brokers such as publication planners, medical science writers, and journal editors.

Part IV (Political and Moral Economies of Pharmaceutical Research) departs from previous sections in

its  attention  to  the  material  and  symbolic  construction  of  pharmaceuticals  before  they  become

marketable to the general public. This construction happens in part through clinical trials, and the need

for participants for such trials gives rise to new populations of human subjects, whose rights are often

protected in name only. Jill Fisher (ch. 13), Adriana Petryna (ch. 14), and Kaushik Sunder Rajan (ch.

15)  all  interrogate  the  slippery  ethical  standards  of  the  American  contract  research  organizations

(CROs) responsible for conducting trials both domestically and abroad. Sunder Rajan describes the

creation of a new infrastructure in India to support the mass migration of clinical trials, arguing that

these trials have the potential to create two types of subjects: ethical subjects (i.e., researchers) and

local experimental subjects who become exploitable human capital. 

Part V (Intellectual Property in Global and Local Markets) returns to the idea of markets, this time

linking  patents,  the  generics  industry,  and  public  and  private  health  organizations  to  explore  the

pharmaceutical landscapes of Brazil, India, and Mexico. Maurice Cassier and Marilena Correa (ch. 16)

detail the “technological learning process” that occurred in Brazilian generics laboratories following

the implementation of the Health Ministry’s 1996 policy to provide its citizens with universal access to

HIV/AIDS drugs. Stefan Ecks (ch. 17) reveals how Novartis’s Glivec International Patient Assistance

Program (GIPAP), which gave Indian patients the cancer drug Glivec free of charge, was driven not by

corporate responsibility and the moral obligation to be a good corporate citizen, but rather by a strategy



to protect Glivec’s high price point in American and European markets. Cori Hayden’s article (ch. 18)

on the shifting semiotic terrain of “similars, generics, and interchangeable generics” (p. 262) in Mexico

raises the question “of what, precisely, does a pharmaceutical consist?” (p. 264)—a fitting question to

which each article in the reader offers its own unique answer. 

The Pharmaceutical Studies Reader is the first volume to come out from the Blackwell Readers in

Anthropology series in which neither of the two editors is an anthropologist. Sismondo is a philosopher

by training, and Greene is a physician and medical historian. As the title of the book suggests, and as

the authors make clear in their introduction, this is a volume situated within the interdisciplinary space

of STS rather than in sociocultural anthropology proper. Articles focus on processes rather than people

and  engage  with  abstract  concepts  like  regimes  (“pharmaceutical,”  “global  scientific,”  and

“experimental,” to name a few) rather than lived experiences. The result is a portrayal of a Big Pharma

behemoth that is well-nigh unstoppable in today’s neoliberal, global economy. 

I do not intend to rehash the stale anthropological debate about structure versus agency, but agency is

something we see little of when the unit of analysis remains at the level of regimes (pharmaceutical or

otherwise) and multinational corporations. Sociologist Jill Fisher observes in her chapter that the failure

of  current  models  of  informed consent  to  protect  patients’ rights  hinges  on a  crucial  oversight  in

“focusing on how subjects participate but ignoring  why” (p. 205). Her observation may as well have

been about  this  reader;  there  is  a  lot  of  how here,  but  not  a  lot  of  why.  Or  rather,  the  uncritical

assumption is that the why is always the profit motive—and while that may indeed be (and probably is)

the case for the corporation, I think the editors missed something by not including literature that delves

into the lived experiences of the scientists, physicians, patients, and other actors who constitute the

heterogeneous pharmaceutical landscape. As Sismondo and Greene write in their introduction, “Drugs

take  on  value  because  they  simultaneously  alter  the  chemistry  and  biology  of  our  bodies,  the

expectations and categorizations of our experiences, and the potentialities and networks of our social

relations”  (p.  1).  None  of  the  articles  explore  these  intimate  processes,  however,  and  I  think  the

collection would have benefited from more engagement with the micro-social in addition to the macro-

social. 

Even the most comprehensive of anthologies cannot cover everything, and such critiques are not meant

to detract from the strength of the conceptual and theoretical work included in  The Pharmaceutical

Studies Reader. In the brief foreword to Part II, Sismondo and Greene paraphrase Claude Lévi-Strauss



by identifying pharmaceuticals as good to think with. So, too, are the articles in this volume. Taken

together,  they  provide  an  in-depth  look at  the  machinery  that  enables  the  continued expansion of

pharmaceutical products, markets, and subjects. 

Ellen Rubinstein is an anthropologist and Postdoctoral Fellow in the Department of Family Medicine

and  Community  Health  at  Rutgers  Robert  Wood  Johnson  Medical  School.  Her  research  explores

caregivers’ conceptualizations of mental illness in the U.S. and Japan.

© 2016 Ellen Rubinstein


