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Drawing on various disciplinary perspectives, this book re-focuses the debate on what makes a good health system, with a view to clarifying the uses of social science research in thinking about health care issues in Africa. The explosion of the HIV/AIDS pandemic, the persistence of malaria as a major killer, and the resurgence of diseases like tuberculosis which were previously under control, have brought about changes in the health system, with implications for its governance, especially in view of the diminished capacity of the public health facilities to cope with a complex range of expande

▪ Abstract  Anthropological approaches broaden and deepen our understanding of the finding that high levels of socioeconomic inequality correlate with worsened health outcomes across an entire society. Social scientists have debated whether such societies are unhealthy because of diminished social cohesion, psychobiological pathways, or the material environment. Anthropologists have questioned these mechanisms, emphasizing that fine-grained ethnographic studies reveal that social cohesion is locally and historically produced; psychobiological pathways involve complex, longitudinal biosocial dynamics suggesting causation cannot be viewed in purely biological terms; and material factors in health care need to be firmly situated within a broad geopolitical analysis. As a result, anthropological scholarship argues that this finding should be understood within a theoretical framework that avoids the pitfalls of methodological individualism, assumed universalism, and unidirectional causation. Rather, affliction must be understood as the embodiment of social hierarchy, a form of violence that for modern bodies is increasingly sublimated into differential disease rates and can be measured in terms of variances in morbidity and mortality between social groups. Ethnographies on the terrain of this neoliberal global health economy suggest that the violence of this inequality will continue to spiral as the exclusion of poorer societies from the global economy worsens their health—an illness poverty trap that, with few exceptions, has been greeted by a culture of indifference that is the hallmark of situations of extreme violence and terror. Studies of biocommodities and biomarkets index the processes by which those who are less well off trade in their long-term health for short-term gain, to the benefit of the long-term health of better-off individuals. Paradoxically, new biomedical technologies have served to heighten the commodification of the body, driving this trade in biological futures as well as organs and body parts.

AbstractThe need for novel antibiotics to combat emerging multi-drug resistant bacterial strains is widely acknowledged. The development of new therapeutic agents relies on small and medium-sized biotechnology enterprises (SMEs), representing 75% of the late-stage pipeline. However, most SME sponsors of an antibacterial approved by the FDA since 2010 have gone bankrupt, or exited at a loss, below investment cost. Uncovering financial flows related to the development and commercialisation of a single drug is complex and typically untransparent. There is therefore a lack of empirical research on the financial vulnerabilities of these critical SMEs. The development of plazomicin by Achaogen (2004–2019) entailed financial disclosures as a public company enabling application of financial analysis methods to: determine quantum and timing of public and private investments; quantify development costs; and provide a deeper understanding of the role of capital market dependency in exacerbating pipeline fragility. Achaogen's widely cited bankruptcy, and plazomicin's commercialisation failure, created a perception that novel antibiotics have zero market value, causing investors to question the SME developer business model. Our analysis of Achaogen's inability to fund commercialisation suggests three key implications for the antibiotic investment ecosystem: (1) novel antibiotics with narrow approval for small patient populations affected by severe resistant infections cannot be successfully commercialised in the current US antibiotic market; (2) SMEs need incentive payments structured to enable them to survive the commercialisation cashflow drought, and (3) these changes are necessary to restore industry and financial investor confidence in the antibiotic SME development model. Achaogen's demise demonstrates that proposals to incentivise innovation, e.g. by providing one-off payments at registration, may be insufficient to ensure access to novel antibiotics developed by SMEs. In plazomicin's case, moreover, US government biosecurity investments have not resulted in access, as the Indian and Chinese companies which bought post-bankruptcy rights have not widely commercialised the drug. This study is timely as new market-based incentives are currently being proposed by the US, EU, Canada and Japan. In order to make further government funding effective, ensuring access, not only innovation, these must support sustainable financial models for the SMEs critical to novel antibiotic development.

Frontmatter -- CONTENTS -- Acknowledgments -- stacy leigh pigg and vincanne adams Introduction: The Moral Object of Sex -- stacy leigh pigg Globalizing the Facts of Life -- Part 1 The Production of New Subjectivities -- Moral Science and the Management of ''Sexual Revolution'' in Russia -- Family Planning, Human Nature, and the Ethical Subject of Sex in Urban Greece -- From Auntie to Disco: The Bifurcation of Risk and Pleasure in Sex Education in Uganda -- Part 2 The Creation of Normativities as a Biopolitical Project -- Sexuality, the State, and the Runaway Wives of Highlands Papua, Indonesia -- ''Ordinary'' Sex, Prostitutes, and Middle-Class Wives: Liberalization and National Identity -- Moral Orgasm and Productive Sex: Tantrism Faces Fertility Control in Lhasa, Tibet (China -- Part 3 Contestations of Liberal Humanism Forged in Sexual Identity Politics -- Uses and Pleasures: Sexual Modernity, hiv/aids, and Confessional Technologies in a West African Metropolis -- The Kothi Wars: aids Cosmopolitanism and the Morality of Classification -- References -- Contributors -- Index