[238] conclusion
do so, I consider the articulations of value, politics, and knowledge in global
phar maceuticals in relation to questions of democracy and responsibility.
Democracy and Responsibility
It is not the case that capitalized, corporatized, financialized, monopolist
capitalism cannot be benevolent. Capitalized health in fact consistently op-
erates through idioms of value that are ethical as much as they are about the
generation of surplus. Sometimes, this ethics is programmatically enshrined
as philanthropy (corporate drug donation programs, for instance). At other
times, they take the form of public health interventions (such as path’s dem-
onstration studies to roll out hpv vaccines in a national immunization pro-
gram). More generally, the trajectories of global harmonization that facilitate
capital flows in biomedicine were underwritten from the outside by norma-
tive value systems having to do with biomedical ethics or innovation. One
cannot afford to be cynical about the normative impulses that animate these
value systems; rather, it is impor tant to look at their structural limits, not just
in terms of providing health care to those who need it but also in terms of
enabling democracy. In order to elaborate this, I wish to think further about
the question of responsibility.
I argue that the responsibility articulated by corporatized structures such
as corporate social responsibility or public- private partnerships is limited
in at least four ways. First, such forms of responsibility, through a focus on
ethics, often evacuate the po litical. Second, they render market systems and
logics in place by putting forth logics of win- win.14 Third, such acts of re-
sponsibility can be withdrawn at will (consider Novartis’s threats to with-
draw the Gleevec International Patient Assistance Program in countries that
offered generic alternatives to the drug; see chapter 4). And fourth, there is
often a notable lack of public accountability in such regimes of capitalized
and limited responsibility. In this sense, the limited responsibility of corpo-
ratized philanthropy sits comfortably with an idea of Responsibility Ltd. It is
a form of responsibility that is completely appropriable and appropriated by
the interests and instruments of global capital.
I contrast this to Jacques Derrida’s (1992) idea of responsibility without
limit. This is central to Derrida’s call for a notion of justice that includes
but goes beyond the force of law. It animates the 2013 revisions to the Indian
Drugs and Cosmetics Act, which stipulates that trial sponsors be held re-
sponsible for continuing medical care for those who suffer trial- related ad-
verse events (see chapter 2). This extends the responsibility for the trial both
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