the fetishization of regulation, and the secret thereof

Of the colorful characters who populate open-air markets and equally crowded public buses in rural Guatemala, one quickly identifies the ersatz physician by his charismatic, albeit illogical, sales pitch and his mound of medicines: "This little tablet, ladies and gentlemen," and a quick chortle for effect, "this tiny little tablet, will provide the 100 % cure for pain -- headaches, liver pain, kidney pain..."

Once, curious, I asked to look at the miraculous plastic blister pack that would cure multi-system organ failure: tetraciclina. "Holy shit," a responsible and self-respecting healthcare professional might say, and he'd be right, but not because he seems to have discovered the cause of novel antimicrobial resistance profiles in Central America, which he has not. Rather, his expression of dismay--"holy shit"--contains a metaphorical truth, insomuch as it recapitulates the fallacy of misrecognizing as transcendent and powerful something that is anything but. The obsession with Big (Bad) Pharma, just like our reflexive condemnation of ersatz physicians handing out low-dose antibiotics willy nilly in rural Guatemala, leads us to an upside down diagnosis of the causes of these predicaments.

Shall we turn things on their heads, right side up?

Amidst vociferous calls for increased scrutiny and regulation of pharmaceutical marketing and distribution strategies to curb the corrupting effects of competition, a paradox emerges: the Central American Free Trade Agreement (CAFTA-DR) was accompanied by "TRIPs-plus" laws, which, strangely, impose unprecedented restrictions on market competition in the name of intellectual property, by severely constraining National Drug Regulatory Authorities' (NRDAs') ability to acquire non-originator, or "generic," bioequivalent formulations to important new drugs (Health Affairs 28(5):w957). For example, as a result, Guatemala's national HIV/AIDS treatment program was obligated to begin purchasing two second-line antiretroviral medications from the originator, multiplying the total cost of one of them 15-fold. Life-prolonging medicines became impossibly unaffordable from one year to the next; put another way, a year's supply of Kaletra--and Abbott's intellectual property--was deemed of higher value than the relatively expendable life of an impoverished HIV+ Guatemalan.

We should be cautious, then, as the fetishization of regulation can lead to very divergent outcomes--either the assumption or disavowal of social responsibility. The fetish of "Pharm-Free," deposits and fixes responsibility for moral failures on individual actors--physicians, CEOs, biotech companies and salespeople--thereby magnifying their sins to the point of demonization. Banal, everyday objects are transformed by the activist fetish into the creeping manifestation of something evil, nearly supernatural--like sacred excrement.

In fact, these fetishes merely distract our attention, keeping secret another more abject one--the fetishization of commodities. The regulation of markets, as a solution, assumes the ontological inescapability of those markets. Indeed, the immoral strategies identified by "Pharm-Free" fetishists are merely distal expressions of the originary immoral presumption that Capital and caregiving are fungible.