As I became acquainted with social studies of science and technology, particularly through anthropological research, I realized it opened new doors for me, offering fresh perspectives and new possibilities for conducting scientific research. During my graduate studies, I sought to bring together two fields that had always intrigued me: the anthropology of health and the social studies of science and technology.
In recent years, I have focused specifically on the regulation of cannabis derivatives for therapeutic use in Brazil. This topic, which naturally sparks heated debates and strong opinions, is fraught with controversies (Latour, 2012), especially regarding cannabis’s historical role, nationally and internationally, as both a recreational drug and a medicine. To delve deeper into these controversies, I decided to conduct research that would focus on public health discourses and scientific practice around cannabis, incorporating the Brazilian debate on public safety. The discussion of health and public safety is deeply tied to the unique position cannabis holds in Brazil. When legislators or civil society engage in debates about cannabis, distinctions between recreational and therapeutic uses often blur. One form of use tends to receive greater moral acceptance, while the other is frequently disqualified. Thus, any conversation about regulating cannabis as a health technology must consider its social and political classifications and the perceptions surrounding it.
Because cannabis can be viewed as both a drug and a medicine—depending on who is speaking or the context—it struck me as an excellent case to explore significant issues, such as the role of experts in the political debate and the health regulation of substances in Brazil. One of these issues is challenging the notion of “capital-S Science,” that is, a supposedly neutral science that exists outside of society, unaffected by social and political events. Another related question is examining how scientific products have been used to support political decisions in the ongoing debate about the regulation of cannabis for therapeutic use in Brazil.
One of my research approaches involved analyzing scientific articles written by Brazilian doctors, published from 2014 onward, focusing on cannabis or one of its components. The year 2014 was a significant milestone in the debate around therapeutic use of cannabis, as it was when the first cases involving cannabidiol—a non-psychoactive cannabis derivative—began to appear on television and social media, especially on Facebook. Additionally, in 2014, Brazil’s National Health Surveillance Agency (Anvisa) granted its first approval for the importation of a cannabis-derived therapeutic product. My initial goal was to determine if the number of studies—or the interest among biomedical researchers—increased following the media exposure and Anvisa’s approval. While the numbers themselves weren’t crucial, they provided clues about scientists’ interest in the topic and the narratives being (re)produced in the published articles.
Looking at the historical context of marijuana prohibition in Brazil, we can see how biomedicine has been intertwined with the issue. Professionals in this field, historically recognized as the authoritative voice of Science, were the ones who removed cannabis from medical manuals (Carlini, 2010) and started linking it to risks, diseases, and moral or mental disturbances. Thus, the history of prohibition in Brazil positions biomedical professionals as key players in the debate, as this process was supported by scientific publications of the time and public statements from researchers on the issue (Saad, 2010). Later, I would realize that history was repeating itself.
My approach aimed to create a “controversy map” (Venturini, 2012; Venturini et al., 2015), defined as a set of techniques for investigating disputes that become public around techno-scientific issues. In this sense, Latour (2000), by following scientists and engineers, proposed that analyzing controversies up close can reveal the underlying motivations and beliefs behind what is presented. Therefore, understanding the production of biomedical/scientific knowledge around the therapeutic use of cannabis derivatives became important, especially given the public debate over regulating these substances. This regulation went beyond defining what would be classified as a drug versus a medicine; it was fundamentally about citizens’ access to healthcare. In Brazil, access to healthcare is guaranteed by the 1988 Federal Constitution, which states that health is a right for all and a duty of the state. Since cannabis and its derivatives are not regulated as medicines, the Unified Health System (SUS) cannot provide them free of charge to the population. This forces patients to spend large amounts or “go to court” to gain access to cannabis derived substances. In some cases, patients end up accessing the substance illegally, with some even facing arrest as a result. Currently, a few Brazilian states offer some cannabis-based pharmaceutical products through the SUS, but there is no federal regulation on the matter.
By analyzing both biomedical articles and Anvisa’s public hearings, I realized that the debate was not solely about whether cannabidiol, and later cannabis and its derivatives, could be used as medicines. It was also about regulating specific substances that were being named, discovered, and characterized. Cannabidiol seemed to belong to the “good science” category. Since it wasn’t considered psychoactive, it held a privileged position and wasn’t seen as a threat to public health or safety. THC, another cannabis derivative, appeared to come from the “bad science,” which shouldn’t be celebrated—it was psychoactive, and therefore harmful. It’s important to note that, besides Anvisa’s directors, the agency’s technical staff is responsible for gathering scientific evidence to help the directors make informed decisions. For instance, during the first vote on the issue, the technical staff supported the regulation of cannabidiol, while the directors opposed it. During that meeting, much was said about the lack or insufficiency of scientific evidence, despite there already being substantial research on the topic. But how do we measure this? How do we know when we have enough scientific evidence?
The debate over the therapeutic use of cannabis derivatives offers a valuable lens for examining health and scientific processes in Brazil. This is because all discussions on the topic eventually involve Science, whether during Anvisa hearings or debates on legislation in Congress (both the Federal Senate and the House of Representatives). In these discussions, Science is called upon to speak through experts on the subject—most of whom come from the biomedical field. Scientific articles are often cited to justify proposed legislation, lending credibility and support to the proposals. In other words, at every stage of the public debate about access to healthcare, scientific production plays a crucial role.
One fascinating aspect of this debate is the recurring appearance of two opposing sides, each presenting its own arguments about whether there is enough scientific evidence to support the therapeutic use of cannabis derivatives. On one side, we have specialists and lay experts (Epstein, 1995) who support the regulation of cannabis derivatives for therapeutic use in Brazil. According to them, there is already sufficient scientific evidence for the medicinal use of cannabis components, leaving no room for prohibition. On the other side, we have specialists and lay experts who oppose regulation. Some in the latter group are not entirely against medicinal use, while others believe that certain exceptions can be considered for therapeutic purposes. However, they all agree that there is not yet enough scientific evidence to justify the regulation of cannabis for therapeutic use in Brazil.
Thus, depending on your position in the debate, scientific evidence may or may not be considered sufficient. This demonstrates how Science and its products are manipulated by social actors. Since there is no consensus on what constitutes “sufficient scientific evidence,” participants in the debate use scientific findings to support their arguments. Currently, especially when legislation is debated in Congress, biomedical experts are the main voices. They are invited to speak by deputies and senators in the name of Science. Whether in official requests or when introducing a researcher at a hearing, these politicians emphasize that the experts were brought in to present Science’s perspective on the issue, so they can make an informed decision based on scientific evidence. The idea is that these experts, through their public statements, will affirm whether therapeutic use is viable and whether a regulatory process should occur in Brazil. These specialists rely on technical and scientific arguments to justify their stance, either for or against regulation.
What’s particularly interesting is that scientific evidence is contested at every turn. Scientific articles, or scientific products, are tossed back and forth to validate different viewpoints. This highlights how scientific production and experts play an active role in politics and health debates in the country. It’s crucial that anthropology remains attentive to scientific production and its role in public life. We already know that no science is neutral or produced in isolation from social reality, but it’s important to closely examine these scientific processes, which are key to shaping health and science policies in Brazil. When considering the daily construction of laws, regulations, and the knowledge practices that shape them, we can understand the processes, trajectories, and meanings being contested. Examining the relationships between experts, scientific products, and politics allows us to reframe this interaction, understanding it as part of a larger universe made up of conflicts, negotiations, and disputes among subjects who are, above all, political.
In the case of cannabis in Brazil, it is in the name of Science that access to healthcare is being questioned. To ensure we have healthcare and medicine worthy of our trust (Benjamin, 2023), we must understand that scientific production should always be under scrutiny, as it plays an active and central role in political decisions around the world. Anthropology, as the study of difference and as a field tied to important social causes, must remain vigilant, fulfilling its role of researching and questioning political and scientific processes. The participation of scientists in these spaces should be seen as a deeply political endeavor (Jasanoff, 1996a). When dealing with health, it’s important to recognize that science is embedded in politics, and politics is embedded in science (Jasanoff, 1996b).
References
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LATOUR, Bruno. Ciência em ação: como seguir cientistas e engenheiros sociedade afora. São Paulo: Unesp, 2000.
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