Tag: Pharmaceuticals

Between Pain and Relief: Morphine’s Ambiguities in India

The root of the word morphine is Morpheus, the Greek god of dreams. Neil Gaiman’s contemporary reimagining of the character in his magnum opus Sandman likewise thrusts upon us a gothic titular figure, constantly morose, deeply troubled, and yet a benevolent god of dreams that embodies everything human. Perhaps it should be no surprise then that in the modern world this character’s namesake, morphine, the gold standard of medically prescribed painkillers (Ruiz-Garcia and Lopez-Briz 2008), offers a similarly troubling medical story, evoking in equal measure the contingent histories of pleasure and war, relief and addiction, commerce and regulation. In few places is this more apparent than in India. Legal opium is grown throughout certain regions of the country for the sole purpose of pharmaceutical production, yet irrespective of this robust industrial production, very little morphine is used within the country’s own hospitals (Rajagopal and Joranson 2007). This is a story that involves both the everyday impacts of restrictive regulation, and a local palliative care movement intent on widening access to the drug. (read more...)

PrEP on Trial: the Future of HIV in Indonesian Policy Worlds

In 2012, the first pre-exposure prophylaxis (PrEP) drugs, billed as a pill a day to prevent HIV, were authorized for use in the United States. Heralded as a transformative prevention technology for gay men and trans women in particular, one that encouraged new forms of self-management and risk mitigation practices alongside condoms, testing, and treatment, PrEP has since been incorporated into the global HIV prevention toolkit. In reports, policy documents, and community organizations, PrEP is uniformly described as necessary to accelerate the HIV control response and meet the global target of the “end of AIDS” by 2030. In line with this dominant policy narrative, governments reliant on international donor funding for HIV programs are now encouraged to incorporate PrEP into HIV programs for MSM, transgender women and other “key populations” assessed as meeting a specific risk profile. This is the case for Indonesia, which formally approved PrEP for a trial in 2021 (United States Agency for International Development (USAID) 2021). Although initially announced in 2019 with a considerable degree of community support, Indonesia’s PrEP trial was postponed both due to the COVID-19 pandemic and subsequent bureaucratic delays. Nevertheless, with significant pressure from international donors and support from the Global Fund, USAID, and Australia’s Department of Foreign Affairs and Trade, a PrEP trial commenced in April 2022 across seven provinces in Indonesia. Key populations who agreed to undertake an array of tests and routine clinical monitoring, would obtain access to a 30-day supply of a single pill combining tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) – generic Truvada – from one of 34 primary health clinics at no cost. As it circulates in policy, clinical, and community spaces, PrEP is transforming the temporal horizon for HIV in Indonesia and other postcolonial settings where access to healthcare remains thwarted by entrenched global inequalities. (read more...)

Fugitive Science: Beer Brewing & Experiments with Pharmaceuticals in Tanzania

When I originally arrived to start fieldwork in the Southern Highlands of Tanzania, I set out to observe the scientific practices through which counterfeit drugs were identified at the regional hospital. I knew, from previous fieldwork, that the hospital had a mini-lab for conducting a Thin-Layer Chromatographic Test. Two years passed before I was finally able to observe this test; one of the reasons was that the hospital was out of the iodine detection reagent needed to carry it out. During the ensuing years, I came to learn that science was happening elsewhere; not always in the laboratory or hospital, but—perhaps even more frequently—in the home, marketplace, and workshop. (read more...)