Wednesday, December 16, 2015

Brief comment: Efficacy in the hands of clinical trial participants

by Gideon Lasco, MD, MSc

"...it is not only medical professionals who are determining the efficacy of these pharmaceuticals. So too are the individuals enrolled in the trial. Any pharmaceutical or medical product will most likely only be used if people consider it to be effective and appropriate." - Gelling medical knowledge: innovative pharmaceuticals, experience, and perceptions of efficacy (Saethre and Stadler, 2009) 

In their paper, Saethre and Stadler (2009) give voice to participants in a clinical trial of a vaginal microbicidal gel in South Africa, saying that these participants and their partners ascribe various parameters to the gel independently of and prior to the establishment of the gel’s effects by the scientists, and regardless of what they were actually getting – the gel itself or a placebo. These parameters, they suggest, draw on local notions of gynecology and physiology, as well as their own ‘felt’ experiences of using the gel.

Theoretically, there is nothing new in this concept of efficacy that has been conceptualized and applied in various settings (Etkin, 1988; Tan, 1999; Nicther, 1995 to name a few examples). As Whyte, van der Geest, and Hardon note: "In real life, efficacies are assessed not by pharmacologists but by social actors." However, the innovativeness of this paper lies in its application of notions of efficacy to clinical trials, which are interesting because they are the site of first contact between novel products and lay individuals. In a more applied and collaborative research, Pool (2011) looks at clinical trials as ‘cultural trials’, asserting the importance not just of controlled measurements but also what the patients feel about the drug in evaluating new pharmaceuticals. Montgomery and Pool (2011) echo the same rationale, essentially calling for ‘representation’ in the process of developing drugs for prevention.

The benefits of this ethnographic voice in making drugs ‘better’ make me reflect on the role of anthropologists in the pharmaceutical industry in general, mindful of the underlying political economy. What guideposts do anthropologists have in this kind of work? How do we draw the line between the anthropology of pharmaceuticals and anthropology for pharmaceuticals?

Amsterdam
October 2013

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