Global Public Health, 2015 http://dx.doi.org/10.1080/17441692.2015.1039559
BOOK REVIEW (Download)
Speculative markets: Drug circuits and derivative life in Nigeria, by Kristin Peterson, Durham, NC, Duke University Press, 2014, 256 pp., US$23.95 (paperback), ISBN 9780822357025
The streets and alleyways in one of Nigeria’s largest informal markets for drugs are abuzz. Drugs are sold at busy intersections, in tight passageways, from all variety of entrepreneurs. Some who work in this market came here after the war. Others saw little choice after the oil bust. All are businessmen of one sort or another, and they are trying to move their latest product.
This is Idumota. Drugs come here from all over the world, and in many forms – some are brand name, many more are generic, and potentially, even more, are fake. Conservative estimates suggest thirty per cent of drugs sold in Nigerian markets are fake drugs. Further estimates claim fake drugs could constitute as much as sixty per cent of all drugs sold in the country.
Kristin Peterson has taken on the responsibility of understanding this market, how it came to be, and how it operates today. To do so, she engages robust bodies of literature in the humanities and social sciences that describe pharmaceutical production and distribution. This literature displays the political and economic relationships of clinical research, critiques monetary policies, and highlights the role of trade policies that, in large part, determine the production and distribution of pharmaceuticals, and contribute to inequities of health on a global scale. Some scholars have suggested markets such as this one can be traced to corruption and criminality, or claim origins of these markets rest on the shoulders of unfair trade and monetary policies.
Kristin Peterson’s work finds root here and adds fresh perspective to well-worn con‐ versation of drug markets and their machinations. Her inquiry builds through historical detail and ethnographic exploration as she moves beyond commonplace critiques, and closely follows the exigencies of diverse factors and actors that influence market structures as they have built upon one another over time. The author traces pharmaceut- ical distribution through histories of economic change in Nigeria and around the globe. For Peterson, the Nigerian civil war, oil exportation, and structural adjustment pro‐ grammes can be seen influencing the distribution and regulation of drugs throughout the latter half of the twentieth century and into the present-day. These are not flat-footed factors – they are active and varied. And Peterson’s analysis keeps pace.
Working from a science studies perspective, Peterson shows us how the Nigerian drug market is teeming with dynamic political, economic, and social elements that build on one another, and open opportunities for mutual growth or disproportionate destruction. Some industries represent profit while others are rendered too risky for investment, and each layers on the next, defining local economic life and what it means to buy and sell drugs in Nigeria.
Through ethnography, Peterson goes beyond concerns of corruption and cri‐ minality. She leads us to ask how we might better think about the implications of OPEC (Organization of the Petroleum Exporting Countries) membership after structural adjustment, and how these conditions affect drug distribution networks today. Her assertions find strength not through bold claims of wrongdoing, but through nuanced attention to possibility and its opposite. How could a nation that has been repeatedly recreated – politically and economically – for the better part of the last century be expected to regulate a global industry? Is regulating Nigeria’s drug market even possible?
Through the turmoil of national and international politics, local and global economies, formal and informal markets, drugs will circulate. Peterson tracks the circulation of drugs and parses apart ideas of formal and informal, official and unofficial, brand name and fake to show the reader just how complex this market truly is, such as in the case of producing and distributing a drug, or determining the recognised status of Idumota as a market. However, Peterson is clear that contestation over what counts as official or unofficial and fake or generic matters less to regulators than to consumers and entre‐ preneurs. With an active cash economy and wealth of informal markets, entrepreneurs, like consumers, take risks for their lives and livelihoods. And in this market, Peterson reminds us, ‘people must manage their own risk’ (107).
Here Peterson makes an important theoretical intervention around this concept of ‘risk’, especially in relation to health and financial markets. While topically, this use of risk reflects recent inquiries by Joe Dumit and Kaushik Sunder-Rajan, Peterson works to invert an important claim about the way risk functions in medical markets today. Dumit and Sunder-Rajan have offered accounts of what it means to be a patient and consumer, and how people strive to prevent disease. These inquiries are based in the USA, where financial capital and biosciences have established close relationships, and the cate‐ gories that determine who is at ‘risk’ and what is ‘risky’ are expanding, while ‘health’ is increasingly seen as malleable, improvable, and indeed, capable of accruing surplus value.1
While health may gather surplus in US markets, Peterson asserts life in Nigeria is derivative. Following early political machinations of OPEC, structural adjustment fed the coals of a smouldering economy and the Nigerian Government lost control. Multina‐ tional companies moved out, and drug industries turned speculative, leaving popula‐ tions within the country to manage their own risks. Entire populations have been rendered risky, and life, on the heels of speculation, cannot be seen as surplus, but only derivative.
This is an important contribution, and it comes during a vital moment in global health. As diverse fields of research and industry continue to work toward equity of health for all, and attention is increasingly oriented forward, it is my hope that Peterson’s attention to historical detail can be a tool for thinking about how to proceed. Obstacles not only lie ahead of us, on streets and in markets, but also deep, beneath, in the thick mantle of history. Peterson pushes us, like I push all potential readers, to unearth this history, or be left none the wiser for the future, speculating about what could or should happen, instead of engaging with what has and will. And Peterson’s pointed prose makes this book a delight to read, an inviting entry into an invaluable perspective.
1. Dumit, J. (2012). Drugs for life: How pharmaceutical companies define our health. Durham, N.C.: Duke University Press; Sunder Rajan, K. (Ed.) (2012). Lively capital: Biotechnologies, ethics, and governance in global markets. Durham, N.C.: Duke University Press.
This material is based upon work supported by the National Science Foundation Graduate Research Fellowship [grant number 2012140097]. Any opinion, findings, and conclusions or recommenda- tions expressed in this material are those of the authors(s) and do not necessarily reflect the views of the National Science Foundation.
Department of Anthropology, History, and Social Medicine
University of California San Francisco & Berkeley, USA
2015, Ryan Whitacre