Pharmaceutical Citizenship
Sarah Whitaker
Definition / Background
In his article “Pharmaceutical Citizenship: Antidepressant Marketing and the Promise of Demarginalization in India,” Dr. Stefan Ecks coins the term “pharmaceutical citizenship” in order to explore how marketing strategies of Indian pharmaceutical companies reflect Western culture (Persson, et al. 2016). The term pharmaceutical citizenship has two main concerns. First, how does a patient’s legal citizenship status affect their access to pharmaceuticals? Second, can receiving pharmaceuticals in turn grant one citizenship? Here, Ecks is not referring to a legal citizenship, but rather social inclusion and the demarginalization of those who previously felt isolated by society (Ecks 2005).
Historical / Topical Context
Focussing specifically on antidepressants, Ecks references four Indian pharmaceutical ads, all of which focus not on the actual properties of the drugs which the ads are presenting (Paxidep CR, Arpizol, Firsito, and Aripra), but rather on various images of people fulling included in society. Typically, these images portray happy couples or families (all of whom are light-skinned, South Asian, wearing Western clothes, and seemingly middle-class) engaging in some sort of recreational activity. Through these advertisements, Indian pharmaceutical companies are promising that their antidepressant will remove all traces of isolation and marginalization and assure full reintegration into society (Ecks 2005).
Similarly, Ecks discusses a “Depression Self Test” leaflet that was distributed by a Mumbai-based pharmaceutical company. The Self Test contained a list of common symptoms of depression, including reduced appetite / sleep, restlessness, lost of interest in activities, etc. The leaflet advised anyone who checked off 5 or more of the ten listed symptoms to seek medical help, presumably in the form of an antidepressant or another type of pharmaceutical. The leaflet, targeted towards those individuals who feel marginalized by society, and promises a future free of social isolation, but only if that individual seeks pharmaceutical intervention. In short, only those who suffer from depression who are also not medicated remain isolated from society (Ecks 2005).
In another article, Ecks discusses the role that evidence-based medicine has in pharmaceutical citizenship. Ecks mentions an anti-cancer dug, Herceptin, which NHS officials had not previously offered to early-stage breast cancer patients, as the drug’s effectiveness lacked sufficient evidence. However, after a lawsuit by one such patient, the use of Herceptin is now wide-spread, as is the evidence of its effectiveness. This lawsuit, and other factors in the rise of evidence-based medicine, allow both non-medical and medical professionals to analyze sources of evidence and how they’re used, which, Ecks argues, makes the connection between citizens and pharmaceutics more public (Ecks 2008).
Controversies / Other Perspectives
Ecks mentions several perspectives that contrast the idea that pharmaceutical citizenship is a necessarily positive idea. Many of these critics, such as Leon Kass, argue that pharmaceutical citizenship implies that one can fully reintegrate into society merely by taking a drug. Critics like Kass argue that replacing attempting to curb one’s depression through medicine creates only an artificial sense of happiness, rather than rebuilding authentic happiness, which is constructed through social, human interactions. However, Ecks points out a possible flaw in Kass’s argument: the only world wherein Kass’s definition of authentic happiness can exist is a world completely void of any sort of pharmaceutical, which does not suit India well (Ecks 2005).
Asha Persson uses Ecks’s term to examine a far different realm of medicine: HIV treatment in Australia. Persson conducted several interviews with serodiscordant relationships (relationships wherein one partner is HIV-positive) to determine how a treatment-as-prevention method of controlling the spread of HIV can affect both public health and the marginalization many HIV-postive patients and their partners often feel. Through her interviews, Persson found that the use of pharmaceuticals to treat HIV can actually reduce feelings of isolation and marginalization. By seeking medical treatment rather than completely changing (or getting rid of altogether) one’s sexual behavior, partners in serodiscordant relationships feel far less sexually and socially isolated. Therefore, Persson actually believes that pharmaceutical citizenship can have a positive role in the public sphere, because by seeking medical treatment (and thereby becoming a pharmaceutical citizen), patients eventually will feel demarginalized (Persson 2015).
In another article, which Persson contributed to, the flip-side of that idea is considered: while the notion pharmaceutical citizenship may improve the quality of life of those individuals and couples who believe in pharmaceutical intervention, what are the implications for an HIV-positive patient who decides not to seek treatment for it? This idea became a topic for debate after Australia attempted for seek universal HIV treatment. Persson, et al. argue that, although medical treatment for HIV often leads to reduced feelings of isolation, such forceful suggestions that all HIV-positive patients should seek medical treatment could actually label them as a threat to public health, thereby marginalizing the patients in a different way. And, patients who do not believe in or do not care to take pharmaceuticals would be even further marginalized (Persson, et al. 2016).
Connection to Politics of Health
The idea of pharmaceutical citizenship relates to the politics of health because many of the controversies surrounding the notion center around policies which either force or limit certain individuals and their pharmaceutical treatment. For example, when the Australian government pushed for universal HIV treatment, much pushback was received because many thought it could place a dangerous label on HIV patients which would further their isolation from society (Persson, et al. 2016). Further, many basic American health care plans do not cover the cost of drugs such as antidepressants. Therefore, the policies behind American health care could actually limit certain individuals from receiving the treatment which, according to pharmaceutical citizenship, has the potential to reduce their feelings of societal marginalization. Because health policy plays such a significant role in the normalization of certain diseases and their respective treatments, and because the idea of pharmaceutical treatment has so much to do with normalizing and destigmatizing diseases such as HIV or depression, the politics of health have much potential to alter the role pharmaceutical citizenship plays in society.
Bibliography
Ecks, Stefan. “Pharmaceutical Citizenship: Antidepressant Marketing and the Promise of Demarginalization in India.” Anthropology and Medicine 12, no. 3 (2005). http://www.tandfonline.com/doi/full/10.1080/13648470500291360.
———. “Three Propositions for an Evidence-Based Medical Anthropology.” The Journal of the Royal Anthropological Institute 14 (2008). http://www.jstor.org.proxy.library.vanderbilt.edu/.
Persson, Asha. “‘The World Has Changed’: Pharmaceutical Citizenship and the Reimagining of Serodiscordant Sexuality among Couples with Mixed HIV Status in Australia.” Sociology of Health and Illness, 2015. http://onlinelibrary.wiley.com/doi/10.1111/1467-9566.12347/abstract.
Persson, Asha, Christy E. Newman, Limin Mao, and John de Wit. “On the Margins of Pharmaceutical Citizenship: Not Taking HIV Medication in the “Treatment Revolution” Era.” Medical Anthropology Quarterly, 2016. http://onlinelibrary.wiley.com/doi/10.1111/maq.12274/full.
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