Clinical trials used to be conducted overwhelmingly in the US and Europe but for a range of economic, technical and ethical reasons, the number of multicentre studies recruiting subjects in different regions of the World has grown exponentially. New medicines are tested in vast research networks involving several countries, hospitals and other medical institutions, and hundreds of individual subjects. In Pharmaceutical Research, Democracy and Conspiracy, Edison Bicudo examines the connections between global and local scales, exploring how it is possible for social actors as different as global companies and patients of local hospitals to come together and establish social relationships that may last many years. He also identifies the implications of these global-local relationships for the financial, technical and cultural structures of the participating hospitals. His study draws on fieldwork conducted in five countries: the UK, Spain, France, Brazil and South Africa. Shining a light on the social mediations that enable the encounter between these rationalities, the author concludes that this has the practical effect of subjecting countries hosting trials to institutional engineering. Hospitals and research agencies create new, sometimes surprising, institutional arrangements to cope with international research projects, which change relations between physicians and patients, as they acquire new roles as clinical investigators and research subjects. Frequently, such shifts deviate the institutional structures of medical institutions away from democratic, and towards conspiratorial, schemes. The book reviews the concept of mediation in sociological thought, proposes further developments in Habermas’ theory of communicative action, and offers some political reflection about the role of institutions in contemporary democracies.
As a researcher, Edison Bicudo developed several studies in Brazilian institutions, exploring the fields of sociology, geography, politics and cultural studies. In his personal projects, he has been interested in health technologies and their impacts on the organization of society and geographical space. His previous studies focused on the production of medicines (Master’s Degree at the University of SÃ£o Paulo, Brazil) and the biotechnological activities conducted in the European Union (Master’s Degree at the University Paris 1, France). In his PhD study, ethics committees and the international clinical trials sponsored by pharmaceutical companies are focused on. Drawing attention to the situations of South Africa and Brazil, Edison looks at ethics committees as institutions promoting several ideological blends. The author’s main theoretical framework is the theory of communicative action proposed by German sociologist JÃ¼rgen Habermas, as well as the geographical theory formulated by Brazilian geographer Milton Santos.
’...a richly detailed description of the contributions made on the local end of global clinical trials ... making the case for asserting democratic control over the incursions of corporations into local medical institutions. ... there is plenty to engage the interest of anyone who enjoys thinking about the ethics of global clinical trials.’ Developing World Bioethics, vol. 15, no. 1, 2015 ’Based on dozens of interviews with pharmaceutical company representatives, CRO managers, clinical trial recruiters, physicians conducting trials, as well as staff and administrators for drug trial sites... Bicudo draws attention to what he calls mediational actions, which he argues are instrumental to the success of the clinical trials enterprise because they enable the pharmaceutical industry to navigate the translation from the global to the local contexts. ... Perhaps the most interesting section is focused on the privatization of clinical trials that are conducted in state or publicly funded institutions.’ Roberto Abadie, Medical Anthropology Quarterly