conclusion [233]
Terrains of Phar ma ceu ti cal Politics
My purpose in this book is neither to diagnose a desperate or hopeless state
of phar maceutical politics captured by logics of capital, nor to end with pre-
dictions for the possibility of better futures consequent to re sistance from the
South. The ways in which logics materialize and trajectories of the po litical
develop are always contingent and situated. What I wish to do instead is to
think about the terrain of politics as it is constituted through the articula-
tions of its multiple emergent and constitutive forms with value and knowl-
edge in all their multiple senses. I argue in these concluding reflections that
this raises crucial questions for a praxis toward pharmocracy, which involves
thinking about the impacts of po litical economic structures of global bio-
medicine on both health and democracy, and further involves considering
democracy in terms of forms of responsibility and the structures of account-
ability that they engender. This is not an attempt to be superficially prescrip-
tive or to suggest that socialized health is better than capitalized health in
any simple sense.8 It is rather to note that a spectrum of biomedical, social,
and po litical imaginaries emerge through par ticular spaces for and forms of
phar maceutical politics, with consequences not just for health but also for
Compare for instance the range of po litical possibilities that were imagined
in the Hathi Committee Report of 1975 (see chapter 5) with those that are
imaginable today. The Hathi Report was arguing, as a realistic princi ple of
policy, for the establishment of a strong public sector phar maceutical indus-
try even as it made a case for situating phar maceuticals within the context
of broader policy interventions into providing basic health care for citizens.
Now, the best bet for access to essential medicines is seen as the survival of
a private generic drug industry, including especially in southern countries
such as India. Even imagining a viable mechanism for drug access through
building institutional capacity in the public sector seems inconceivable. And
the long- term prospects of Indian generics companies seem tenuous at best
in a changing market landscape that makes them attractive targets for acqui-
sition by the multinational phar maceutical industry. The question therefore
is not whether public sector phar maceutical companies are better or worse
than private sector ones— that would be an overly simplistic and hy pothetical
question, meaningless unless situated in relation to par ticular conjunctures,
histories, trajectories, and locations. Rather, the question we face concerns
the consequences of living in a world where a public sector alternative to
the acutely felt prob lems of health care access is not even on the table. This
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