Two of these three texts are edited collections and the other a co-authored, published policy report. In total, there are 35 contributions (and over 50 contributors) contained in these texts because the Cohen et al. collection has 25 chapters and the Petryna et al. anthology offers nine. All three publications make a welcome addition to the growing field of study that might be called, ‘Pharmaceuticals and Society’. I have already incorporated all three of them into various reading lists and courses for which I am responsible. They are all ambitious in their geographical scope – pitching their analysis literally at the global level. The wide-ranging nature of these texts means that few readers will not find some intellectual, practical, and/or policy-guiding riches among their pages. Cohen et al. and Leach et al., in particular, are excellent mines of information.

Cohen et al. correctly locate their anthology in the field of pharmaceutical policy, and rightly observe that the field requires an interdisciplinary approach. Their aim is to provide such an interdisciplinary approach, thereby developing more comprehensive thinking about pharmaceuticals and society. The book is largely successful in this goal. It is an important goal because, as Cohen et al. point out, present organization of pharmaceutical research and development is sub-optimal for global health. Leach et al. underline this point when they say that ‘there is a mismatch between pharmaceutical needs in developing countries and the current nature of the pharmaceutical market’. Two issues are at the core of The Power of Pills and Prescription for Healthy Development: that the drugs developed by the pharmaceutical industry do not correspond to the ones needed to treat major diseases in our world; and that many of the important drugs that have been developed are priced too high for those who need them.

The Cohen et al. collection emphasizes that developing countries bear the main burden of disease globally, especially infectious diseases. From the contribution by Resnik, one learns that 60% of all deaths in developing countries are due to infectious diseases, but only 10% in developed nations. In the developing world, each year, diarrhea kills 2 million, malaria 2 million and HIV/AIDS 2.3 million. Yet, as Ford’s chapter notes, until very recently, drug development for tropical diseases, such as tuberculosis, malaria, trypanosomiasis, Chagas, dengue fever, leprosy, and shistosomiasis, had ground to a virtual standstill – accounting for less than 1% of research and development (R&D) expenditure by the global pharmaceutical industry. The problem is confirmed in the piece by Orbinski and Burcuil, who observe that, between 1975 and 1999, only 13 drugs out of 1,393 approved were specifically indicated for tropical diseases – and Selgelid and Sepers add that only four of those (0.3% of the total) may be considered to be a direct result of pharmaceutical industry R&D. Lexchin, whose chapter stands out as one of the most powerfully argued in this anthology, is in no doubt that the primary reason for this neglect is the transnational pharmaceutical industry’s pursuit of profit. He reports that, in a survey of 20 of the world’s largest pharmaceutical companies, from 13 responses, only two companies spent anything on malaria research and seven spent less than 1% of their R&D budgets on tuberculosis, malaria, trypanosomiasis, Chagas, or leishmaniasis. Moreover, Lexchin presents evidence that only about a third of the new drugs that the industry does produce offer any therapeutic advance over existing products.

Given that the pharmaceutical industry will not develop unprofitable drugs, various mechanisms aimed at overcoming this obstacle with incentives for firms to develop medicines for neglected diseases are discussed. As Hollis explains in his chapter, these can be divided into ‘push’ and ‘pull’ mechanisms. The former includes R&D grants, tax write-offs, and access to public resources, perhaps involving public–private partnerships (PPPs) and philanthropic donations. The latter involves patent extensions, market exclusivity arrangements, and government commitments to advance bulk purchases. Although in the chapter by Freeman, it is asserted that companies’ reluctance to develop drugs for diseases in developing countries is because of the poor infrastructures in those countries – lack of transportation, clinics, and health personnel. The book does not resolve the validity or otherwise of this claim, even though the ‘push/pull’ mechanisms discussed do not seem to address it directly.

The largest example of PPPs in the pharmaceutical sector is the National Institutes of Health (NIH) in the US, which invests US$30 billion annually in basic health research with many valuable insights transferred to drug companies. Such PPPs impose significant risks on public institutions, which provide substantial funding, but receive no pay-off. Nevertheless, in his contribution, Ford reports that PPPs have recently yielded about 60 neglected disease drug development projects for: malaria (33), TB (16), tryptanosomiasis (5), and Chagas (2). Unfortunately, he notes, even the pledged mounts for these have a shortfall of 40%, just US$50 million of the US$85 million needed. As several contributors acknowledge, other important efforts on the ‘push’ side have been made by UNICEF/UNDP/World Bank/WHO Research and Training in Tropical Diseases (TDR), which was involved in developing six of the 13 drugs approved specifically for tropical diseases between 1975 and 1999, but it remains under-funded and overly dependent on UN Member States. In addition, the Drugs to treat Neglected Disease initiative (DNDi) has been an important intervention, facilitating South–South as well as North–South collaborations. Pharmaceutical companies have libraries of information about products not fully developed. DNDi seeks to access and use this information where it may foster valuable drug development for neglected diseases.

The main pull mechanism is patent protection (and associated market exclusivity). However, as Hollis notes, this has limitations regarding drugs for neglected diseases. It may produce high prices that are self-defeating because the people suffering from such diseases (and their health systems) will not be able to afford the drugs developed. Furthermore, the possibility of compulsory licensing, which breaks market exclusivity, is much more likely in the neglected disease field because such diseases can reach the status of national public health emergencies – a key condition for compulsory licensing under WTO rules. Hence, pharmaceutical firms may be sceptical about market exclusivity as a ‘pull’. Hollis proposes an alternative system in which rewards are based on therapeutic impact regarding drugs for neglected diseases. Total rewards would be fixed annually and typically higher than through the patent system. Thus, manufacturers could try to make a profit by joining this system or go the traditional route of patent monopoly. However, this alternative system would face the problem of how to estimate therapeutic impact in the early stages of drug development, which could be extremely difficult. It is also unclear who would provide these rewards to firms – rewards that would have to be guaranteed regularly and long-term to gain the confidence of pharmaceutical manufacturers.

Chapters by Pogge and Ford go some way to answering these questions. They propose a system in which the results of any successful effort to develop a new essential drug should be provided as a public good that any pharmaceutical company could use free of charge, thus bringing down prices. To avoid destroying incentives for pharmaceutical research, they suggest that manufacturers could be entitled to take out multi-year patents on essential medicines but during the life of the patent should be rewarded out of public funds in proportion to the impact of their invention on the global disease burden. Here again the sentiments and political goals seem laudable, but it not clear what is meant by public funds – perhaps the taxpayers of wealthier nations? Few governments of developing countries could fund such a scheme. More radically, Mannan and Story challenge the need for patents at all. They cite the fact that substantial amounts of pharmaceutical innovation derive from publicly funded research at NIH, and that the world’s first malaria vaccine, Salk’s polio vaccine, and penicillin mass production were all achieved without patents. They contend that without the protectionism of patents, firms would have to compete more efficiently leading to lower prices.

The discussions of PPPs and other push mechanisms are much more impressive and sophisticated than the reflections on patents. The latter tend to be high in aspiration, but a little low on detail and flexible policy options. For example, there is little consideration of how different time periods of market exclusivity could be used to influence incentives and prices. There is also a tendency to discuss essential medicines in isolation, which foregoes policy options that might regulate the industry’s patent protection rights for pharmaceuticals generally in relation to their efforts to develop drugs for neglected diseases. The chapter by Parmet emphasizes the global interdependence of pharmaceuticals especially to control infectious diseases as an appeal for a global approach to drug and vaccine development, but it does not go beyond this to construct a governance framework.

Another ‘pull mechanism’ examined by several contributors to this anthology is advanced market/purchase commitments (AMC/APCs). This works by a donor offering a minimum price to any firm that could develop, say, a vaccine meeting particular technical characteristics. The donor is committed to pay the price for only a number of units representing a suitable profitable reward – thereafter the purchase price is very low. One logistical difficulty with this arrangement is that the technical specifications must be made in advance, which could be very difficult. Moreover, in an excellent chapter offering refreshing insight and independence of thought, Light demonstrates that there is a much more fundamental problem with AMC/APCs, at least for vaccines. He points out that, if the utilitarian goal is to relieve poor countries of the greatest amount of disease, suffering, medical costs and death, then committing the same amount of money to possibly achieving the same outcome 10-15 years from now is indefensible because use of those resources to eradicate diseases that already have effective vaccines is twice as cost-effective. In other words, he exposes the irrationality of the fashionable obsession with novel technologies and innovation over concrete health objectives and gains. Light further argues that current APC/AMC models draw uncritically on the estimates of costs and profits that the large TNCs claim they need in order to obtain terms acceptable for their participation. Light’s contribution is one of those special chapters that makes the reader think about the train of policy proposals in a new and more expansive way.

Regarding access to needed drugs at affordable prices, the first thing to realize is that pharmaceutical prices vary from one country to the next, according to what firms think the market and national health-care systems can or will bear. As Lexchin notes, drug prices in the US are 30-40% higher than in Canada or Europe. The need for the industry to invest so much in R&D is its justification for high prices. However, according to Lexchin, pharmaceutical companies are among the most profitable in the world and their estimates of over $800 million R&D investment per new drug are too high. The contributions by Lybecker, Kaplan, and Freeman speak to some of the factors motivating pharmaceutical firms to charge high prices. Lybecker argues that it is because of ‘squeezes’ on the duration of product market exclusivity, which derive from lengthening of R&D time, increased demands from government regulatory authorities and legislation allowing more nimble entry into the market by generic products. However, there is slippage in her argument. For example, when she says that, ‘since 1980 the average number of clinical trials required filing a new drug application [to the FDA] has more than doubled’, this is not a regulatory imposition. Rather, she means that companies have found themselves having to do twice as many trials in order to be successful. This tells us more about the quality of industry trials and perhaps the types of conditions for which efficacy evidence is sought, than it does about changes in regulations. Lybecker also refers to increasing approval times, but these have been falling for the last 15-20 years in the EU and US (Abraham and Davis, 2007). The evidence she presents relates to increases in total drug development times from the 1960s to 1990s, but again this results largely from industry activity. She may be right about generic competition, but it is good for consumers and health-care systems. While it threatens industry profitability, if Lexchin’s chapter is correct, then the industry can withstand such threats.

Kaplan and Freeman elaborate by focusing on the relationship between eroding market exclusivity and the blockbuster model of pharmaceutical development. This model depended on the discovery and launch of products with global sales of over US$1 billion. However, as Freeman observes, this model requires high levels of sales and marketing activity to sustain it as many of the drugs are ‘me-too’s, rather than significant therapeutic advances. Furthermore, as Kaplan explains, current blockbusters are the result of research done decades ago. Firms are finding it more difficult and more costly to develop new blockbusters. This puts companies under intense pressure to replace lost revenues quickly when the patents of blockbusters expire – hence the drive for high prices, acquisition of small biotechnology companies to enhance R&D efforts, horizontal mergers to increase economies of scale, and the proliferation of PPPs.

In their contributions, Freeman and Parmet partly attribute high prices to the costs of regulation with the implication that lower prices could be achieved in exchange for more lax regulation. In so doing they assume that regulation of drug product safety and efficacy is currently stringent. I would question the validity of that assumption. There is plenty of evidence that for decades regulation of drug safety and efficacy in Europe and North America has not been stringent enough, let alone regulation in developing countries (Abraham, Reference Abraham1995; Abraham and Davis, Reference Abraham and Davis2005; Abraham and Sheppard, Reference Abraham and Sheppard1999; Healy, Reference Healy2004; House of Commons Health Committee, 2005; Medawar, Reference Medawar1992; Medawar and Hardon, Reference Medawar and Hardon2004). Perhaps the questionable assumption by these authors that regulation is stringent leads them to think only in terms of how regulation might be shaped to meet industry goals. Unfortunately, they do not explore how the regulatory state could shape industry priorities, especially in terms of drug efficacy.

This brings me to the main overall weakness of the Cohen et al. collection. With the exception of the contribution by Lexchin, and Lybecker’s discussion of counterfeit drugs (which in a sense are not really drugs at all), the entire thrust of the book is on the development, availability and accessibility of drugs. This is, of course, very important, but there is another side to a coin bearing the title, ‘The Power of Pills’, that is the prevention and regulation of injury and waste caused by the marketing and use of unsafe and/or ineffective pharmaceuticals. For example, Lazarou, Pomeranz and Corey (Reference Lazarou, Pomeranz and Corey1998) estimate that 106,000 hospital patients died from an adverse drug reaction (ADR) in the US in 1994, making ADRs the fourth leading cause of death among hospitalized patients in the country after heart disease, cancer, and stroke. It seems reasonable to assume that the incidence of serious and fatal ADRs is likely to be even higher in many developing countries. While there is plenty of valuable information about drug development, availability, and accessibility, there is inevitably some repetition in a 25-chapter book so focused on these aspects. Instead of so many chapters on these issues, the book would have benefited greatly from the incorporation of some contributions about how the regulatory state performs in preventing the exposure of populations to unsafe and ineffective drugs. Nowhere is this problematic bias in coverage more starkly illustrated than in Hollis’s proposal that pharmaceutical companies should be awarded fast-track vouchers for new drugs by government regulatory agencies (thus reducing safety and efficacy checks on standard drugs) in exchange for developing a drug for neglected diseases. In this extreme case, the inattention to pharmaceutical/regulatory policy as protection against (unsafe or ineffective) drugs permits one contributor to ‘sacrifice’ it on the altar of drug development and availability.

No such criticism can be levelled at Leach et al. It is what it says on the ‘label’ – a much narrower focus on ‘access to essential medicines’, which pays off for the reader. It is an impressive report. Well-researched and clearly written, its key audience is policy-makers, NGOs, and others active in pharmaceutical policy. However, anyone who is serious about global pharmaceutical policy should read this publication. The authors progress skillfully from setting out the nature of the problem to concrete policy proposals at national and international levels. One learns that, in Africa and South-east Asia, prompt diagnosis and treatment with appropriate medicines could save approximately 4 million lives annually. In the Alma Ata Declaration, The World Health Organization (WHO) called for ‘Health for All by 2000’. There has been progress over the last 30 years, but not enough. In 1975, less than half of the world’s population had regular access to essential medicines, but now the figure is two-thirds. However, given population growth, the absolute number of people without such access has remained roughly constant at about 1.7 billion. Global inequality is stark: only 0.3% of those lacking access to essential medicines live in high-income countries, whereas 38% live in India and 15% in Africa.

Leach et al. show an excellent grasp of the issues that need to be tackled. Much more than Cohen et al. or Petryna et al., the authors of this publication get to grips with the substantive content of the relevant policy issues and engage with the subtleties of government policy and regulatory intervention. Only a few examples can be mentioned here. Regarding improving availability, they appreciate the need to go beyond fashionable (though very important) discussions of HIV/AIDS to point to the critical need for new medicines to supplement/replace those to which micro-organisms have become resistant, such as malaria and tuberculosis. The role of the regulatory state as part of the solution is re-discovered with proposals that developing countries could devise fast-track systems for priority medicines, based on national health priorities, in conjunction with support for local production, compulsory licensing, and parallel importation when these help to meet demand for access to essential medicines. Realizing the pivotal role of the state, Leach et al. recommend that national regulatory bodies urgently need to be strengthened in developing countries with a judicial system of sufficient resources to enforce regulations and eliminate waste/corruption, including counterfeit drugs. Inspection processes should be tightened up, consumers encouraged to be vigilant, and national monitoring systems addressing pharmaceutical risk–benefit assessments need to be established and improved.

On the issue of increasing affordability of essential medicines, Leach et al. identify some crucial principles and policy proposals worthy of attention. They understand that low-income countries need bases for long-term planning that the market does not provide. Consequently, they argue that donor support for such countries should be designed with 20-year horizons at levels needed to meet national health goals. Unlike, the other two publications, Leach et al. spell out clearly the political implications of their analysis of drug affordability. Specifically, they assert that essential medicines should be provided at no cost to end users in developing countries, and that financing for this in the poorest countries must come from grants from wealthy countries, which have committed to, but frequently fallen short of, 0.7% of their GDP on official development assistance. At the national level, high prices should be countered by mandatory generic substitution. TNCs should be required to provide essential medicines to developing countries at production cost by either regulation or support for generic competition. At the international level, a key concern is the impact of TRIPS compliance by India (Cipla), a major source of low-cost generic medicines for developing countries. Leach et al. make a compelling case that regional and bilateral trade agreements (TRIPS-plus) should not be permitted to compromise the abilities of developing countries to invoke flexibilities in TRIPS in order to access low-cost essential medicines (e.g. via compulsory licensing).

The Petryna et al. collection is derived from a workshop that assembled leading anthropologists working in the field of science and medicine and historians of medicine concerned about pharmaceuticals. The book identifies itself as an anthropological work with ambitions to extend the boundaries of anthropology. This orientation is a mistake because, as Cohen et al. appreciate, the field demands interdisciplinary engagement. For a book entitled, ‘Global Pharmaceuticals’, there is for example, very little engagement with the social science literature on globalization, including work on the globalization of pharmaceuticals (Alaszewski, Reference Alaszewski2001; Lofgren, Reference Lofgren2004; Sklair, Reference Sklair2001). According to the editors, the Petryna et al. anthology aims to examine the cultural, scientific and economic practices that contribute to the growth of the drug industry using ‘the anthropological technique’ extended to government, corporate and professional agencies. The book achieves only limited success in these objectives partly because, despite passing reference to literature about ‘de-statized’ regulatory operations, analysis of the state and government regulatory agencies is sparse.

The editors define the political, economic, and ethical dimensions of drugs as constituting the ‘pharmaceutical nexus’. They then propose to understand the nexus as an empirical object, a problem, and a method of inquiry. Apparently, this nexus may appear different and pose different kinds of problems for different kinds of people and interests. I thought that this conceptualization was, at best, a statement of the obvious, at worst, a dead end. The vague concept of ‘pharmaceutical nexus’ offers nothing of value to social scientific or policy analysis.

The editors correctly identify some important issues addressed in the book, such as the growing division between populations who can access life-saving drugs and those who cannot, controversies about the secrecy and reliability of industry data, conflicts between privatizing interests and professional obligations in pharmaceutical science, and control of bias in the pharmaceutical industry. The level at which these are addressed is usually fairly elementary. One gets the impression that this stems from the misconception that because many of these pharmaceutical issues are new to anthropology, they are being discovered. In fact, other social scientists and policy analysts have been writing about these issues for about 20 years. Take for example, the claim that differential pricing needs to be understood anthropologically because policy analysts have hardly challenged it. This is clearly not true given the citations in the Cohen et al. collection and other publications, such as Mossialos, Mrazek, and Walley (Reference Mossialos, Mrazek and Walley2004). Unfortunately, the chapters by Applbaum and Petryna also miss out on several existing publications about international harmonization of regulatory standards (ICH) that would have enriched their analyses, especially Applbaum’s analysis of the introduction of SSRI antidepressants into Japan (e.g. Abraham and Reed, Reference Abraham and Reed2001). Medical sociologists have been writing about the role and growth of contract research organizations – the topic of Petryna’s chapter – for over a decade.

Despite these drawbacks, there are some excellent chapters in the Petryna et al. collection. Biehl’s contribution provides fascinating insights into the ‘pharmaceutical governance’ of HIV/AIDS in Brazil. It vindicates the value of well-focused, policy-relevant, empirical anthropological research without pretentious terminological constructions. Biehl illuminates how Brazilian AIDS policy represented a shift from a crumbling welfare state to an activist state, and from public health understood as prevention and clinical care to access to medication. In response to grassroots health-care campaigns, in November 1996 Brazil became the first developing country to adopt an official policy of universalizing access to life-extending drugs. This law obliged the public health system to freely dispense anti-retroviral (ARVs) to all registered cases of HIV/AIDS. Around the same time, Brazil signed up to TRIPS so pharmaceutical imports to Brazil increased substantially – even at low prices, the new Brazilian market was a bonus for drug companies that had already recouped their R&D investment by selling AIDS drugs in US and Europe. Thus, we learn from Biehl that Brazil’s political will to treat AIDS could be seen as part of the country’s partnership with both international financial institutions and the pharmaceutical industry.

Biehl’s analysis also demonstrates the importance of distinguishing between patient groups, on the one hand, and public health advocacy groups or public health interests, on the other. He states that, ‘an increasing number of patients groups – many funded by the pharmaceutical industry – are legally forcing the government to keep importing their extremely expensive medication’. However, he also explains that, empowered by the National AIDS programme, activists forced the Brazilian government to allow compulsory licensing of patented drugs in a public health crisis, thereby creating state activism against the pharmaceutical industry. The high prices charged by the transnational pharmaceutical companies (TNCs) for their ARVs caused the Brazilian health system to shift purchases to Brazilian pharmaceutical laboratories, which were producing cheap generic AIDS drugs. In 1999, 81% of government money spent on ARVs went to TNCs and 19% to Brazilian firms; in 2000, 41% went to Brazilian labs both public and private. Biehl makes the important point that Brazilian AIDS policy not only created a market for generic drug components locally, it also raised international competition that led to an overall decrease in ARV drug prices. For example, in 1999, 2.2 pounds of 3TC (an HIV drug) cost $10,000; in 2001, the same 2.2 pounds sold for $700. The Brazilian Ministry of Health has used the threat of compulsory licensing to negotiate better prices with TNCs. In 2002, the government obtained 40–60% cost reductions on purchases from Merck and Roche of patented components essential to the production of the AIDS cocktail. Despite these successes, unfortunately, some other AIDS victims, who are outside, what Biehl calls, this ‘patient citizenship’ (of registered cases) die in abandonment.

In Uganda, even though the price of ARV therapy fell from US$500 to US$28 per month, thanks to use of generic drugs produced by the Indian firm Cipla, this is still beyond the means of most Ugandans. In this context, complementing Biehl’s chapter nicely, Whyte et al. describe how families have to decide that some members will be treated but not others. In particular, the long-term commitment to purchase ARV drugs is difficult. The medical consequences of these family dilemmas are non-adherence to treatment regimes and the possibility of ‘anti-retroviral anarchy’, with dangers of developing resistance. People who are ‘in the system as professionals’ of receiving treatment help relatives and friends to obtain the drugs, but this creates bitterness in communities about public funds being channelled secretly to relatives by those in power. The inclusion or exclusion of people with HIV in trials that receive ARVs can generate similar tensions.

In two rather descriptive and uninspiring chapters, by Lovell, and Das and Das, medication selection and use, including self-medication, are discussed in France (buprenorphine for opiate addiction) and Delhi (mainly analgesics and antibiotics), respectively. These have interesting moments, but a clearer statement of their purposes, and an analytical/theoretical framework to which they relate, would have been helpful. There are three chapters on antidepressants (those of Healy, Lakoff, and Applbaum), which seems rather excessive for a single therapeutic class. It would have been interesting to have the odd contributor working on different types of drugs.

Healy’s chapter is interesting if you have not already read it elsewhere (e.g. Social Studies of Science in 2004). He argues that pharmaceutical companies use articles in medical journals as marketing devices by employing ghostwriters. Interestingly, he shows that this is not confined to peripheral medical journals, but occurs in the most prestigious ones too. He claims that pharmaceuticals companies have made selective (biased?) use of data regarding the suicidal risks for patients taking SSRI antidepressants. In order to make his claims, Healy adopts an evidence-based analysis, yet he seems to want to deconstruct evidence-based medicine ‘that sees itself as building a value-free, timeless, ahistorical science’. These ideas are too underdeveloped in Healy’s contribution to ascertain exactly what is intended and whether his theory of science is consistent with his practice of exposing bias in science apparently by appeals to objective evidence.

Lakoff’s chapter also suffers from an underdevelopment of theory so that the broader implications of his arguments are unclear. Nevertheless, his contribution is highly original in its approach and content. It is about drug company gifts to doctors and surveillance of prescribing by sales representatives and audit firms in Argentina in the psychopharmaceutical sector. His argument is that the mutual interaction of science, regulation, and business in the circulation of pharmaceuticals is best seen not as a contamination of pure science but rather as a regime for authorizing knowledge-claims and expert action. Company gifts to doctors have been construed as compromising doctors’ integrity, creating a conflict of interest, but Lakoff rejects this because it assumes a clear distinction between ‘rational pharmacology’ and marketing. I was not convinced by his analytical framework. It may be true that it is not always possible to distinguish between marketing claims and rational pharmacology, but often it is – indeed Healy’s analysis of suicide risks from SSRIs depends on such a possibility. Hence, concerns about conflicts of interest are entirely valid. However, sloppy theory/philosophy of science aside, I thoroughly enjoyed his chapter because the empirical content is fascinating. Lakoff explains how audit and database firms collect data on prescribing and prescription leaders (doctors) in various localities mapping out sales territories and selling the data on to pharmaceutical companies. After the economic crisis in Argentina in 2002, there was a 13% increase in antidepressants' sales. Media pundits, sales directors, and database firm directors agreed that insecurity from the economic crisis was driving up psycho-pharmaceutical sales. However, Lakoff cleverly shows that the quantity of patients treated with antidepressants had not increased much, and that what had changed was their price, including the switch from cheaper benzodiazepines to more expensive SSRIs – a switch made by doctors in response to sales reps and opinion leader actions.

Overall, the Petryna et al. collection provides some valuable discussions on the recruitment of patients into trials, access/availability of needed medications, and marketing strategies of pharmaceutical companies, including suppression of ADR data. A major weakness is that the anthology has no contributions that take pharmaceutical regulation, drug regulatory agencies, or the regulatory state more generally as the objects of study. The book simply does not ask: what are regulatory agencies doing or how does/could pharmaceutical regulation operate and impact on other actors, with respect to various health objectives? This is a serious omission because the role of government is crucial. Perhaps the editors are unaware of work already done in these areas (e.g. Abraham, Reference Abraham1995; Daemmrich, Reference Daemmrich2004; Hilts, Reference Hilts2003; Mossialos et al., Reference Mossialos, Mrazek and Walley2004). Another disappointing aspect of this book is that no clear evaluative framework is developed to relate the practices described to the interests of public health (though Healy and Biehl do this implicitly). Regarding these anthropological descriptions of practices, one might ask: so what?

The Cohen et al. anthology will be extremely useful to students and specialists alike. I suspect that non-advanced students would find the publication by Leach et al. fairly hard going, but it is indispensable for specialists working in pharmaceutical policy. By contrast, the Petryna et al. collection (the weakest of the three publications) will be valuable to students first entering the field of ‘pharmaceuticals and society’, but will be frustrating for specialists who, too often, are likely to feel that the book makes new inroads into anthropology without appreciating the opportunities to build on established work by other social scientists working on pharmaceuticals, who have already travelled those roads.