In some parts of the world spending on pharmaceuticals is astronomical. In others people do not have access to basic or life-saving drugs. Individuals struggle to afford medications; whole populations are neglected, considered too poor to constitute profitable markets for the development and distribution of necessary drugs. The ethnographies brought together in this timely collection analyze both the dynamics of the burgeoning international pharmaceutical trade and the global inequalities that emerge from and are reinforced by market-driven medicine. They demonstrate that questions about who will be treated and who will not filter through every phase of pharmaceutical production, from preclinical research to human testing, marketing, distribution, prescription, and consumption.

Whether considering how American drug companies seek to create a market for antidepressants in Japan, how Brazil has created a model HIV/AIDS prevention and treatment program, or how the urban poor in Delhi understand and access healthcare, these essays illuminate the roles of corporations, governments, NGOs, and individuals in relation to global pharmaceuticals. Some essays show how individual and communal identities are affected by the marketing and availability of medications. Among these are an exploration of how the pharmaceutical industry shapes popular and expert understandings of mental illness in North America and Great Britain. There is also an examination of the agonizing choices facing Ugandan families trying to finance AIDS treatment. Several essays explore the inner workings of the emerging international pharmaceutical regime. One looks at the expanding quest for clinical research subjects; another at the entwining of science and business interests in the Argentine market for psychotropic medications. By bringing the moral calculations involved in the production and distribution of pharmaceuticals into stark relief, this collection charts urgent new territory for social scientific research.

Contributors. Kalman Applbaum, João Biehl, Ranendra K. Das, Veena Das, David Healy, Arthur Kleinman, Betty Kyaddondo, Andrew Lakoff, Anne Lovell, Lotte Meinert, Adriana Petryna, Michael A. Whyte, Susan Reynolds Whyte

In 1998, health expenditures in the United States accounted for 12.9% of national income-the highest share of income devoted to health in the developed world. The United States also spends more on medical research than any other country-in 2000, the federal government dedicated $18.4 billion to it, compared with only $3.7 billion for the entire European Union. In this book, leading health economists ask whether we are getting our money's worth.

From an economic perspective, they find, the answer is a resounding "yes": in fact, considering the extraordinary value of improvements to health, we may even be spending too little on medical research. The evidence these papers present and the conclusions they reach are both surprising and convincing: that growth in longevity since 1950 has been as valuable as growth in all other forms of consumption combined; that medical advances producing 10% reductions in mortality from cancer and heart disease alone would add roughly $10 trillion-a year's GDP-to the national wealth; or that the average new drug approved by the FDA yields benefits worth many times its cost of development.

The papers in this book are packed with these and many other surprising revelations, their sophisticated analysis persuasively demonstrating the massive economic benefits we can gain from investments in medical research. For anyone concerned about the cost and the value of such research-from policy makers to health care professionals and economists-this will be a landmark book.

Part cultural history, part sociological critique, and part literary performance, Panic Diaries explores the technological and social construction of individual and collective panic. Jackie Orr looks at instances of panic and its “cures” in the twentieth-century United States: from the mass hysteria following the 1938 radio broadcast of H. G. Wells’s War of the Worlds to an individual woman swallowing a pill to control the “panic disorder” officially recognized by the American Psychiatric Association in 1980. Against a backdrop of Cold War anxieties over atomic attack, Orr highlights the entanglements of knowledge and power in efforts to reconceive panic and its prevention as problems in communication and information feedback. Throughout, she reveals the shifting techniques of power and social engineering underlying the ways that scientific and social scientific discourses—including crowd psychology, Cold War cybernetics, and contemporary psychiatry—have rendered panic an object of technoscientific management.

Orr, who has experienced panic attacks herself, kept a diary of her participation as a research subject in clinical trials for the Upjohn Company’s anti-anxiety drug Xanax. This “panic diary” grounds her study and suggests the complexity of her desire to track the diffusion and regulation of panic in U.S. society. Orr’s historical research, theoretical reflections, and biographical narrative combine in this remarkable and compelling genealogy, which documents the manipulation of panic by the media, the social sciences and psychiatry, the U.S. military and government, and transnational drug companies.