Duke University Press, 2014, 264 pages.
In her remarkable book, Speculative Markets: Drug Circuits and Derivative Lives in Nigeria, Kristin Peterson sets out to explore and resituate the pharmaceutical industry, and pharmaceutical markets, in Nigeria. The outcome is a highly-detailed, carefully analyzed and enlightening piece of work, illuminating much of the complexities of African drug markets (and of markets and industries beyond Africa), with insights that will appeal to a broad audience.
In media and policy discourses, Nigeria has often been offered as a prime example for the problems of its pharmaceutical industry, and the circulation of fake and substandard medication in its markets, to other localities in Africa and beyond. Kristin Peterson seeks to move beyond easy conclusions, and simplified narratives, to locate the problems faced by drugs markets in Nigeria within a tangle of historical, political and economic events. Through a rich mixture of skillful ethnography and an extensive set of historical and economic data and conceptual tools (including those drawn from STS and critical economy), she attends to various facets of the complexity of the Nigerian pharmaceutical trade.
The book starts with an analysis of how one of the largest informal markets for drugs in Nigeria, Idumota, came into existence. In the history she traces, Peterson navigates local and global events, and explores how such diverse events as the civil war, the oil boom (and bust), and global economic and monetary policies influenced and reshaped the Nigerian drug market between the 1960s and the 1980s. Specifically, she shows how these events transformed the networks of the drug market from a reliance predominantly upon Nigerian pharmacists and their links with the global pharmaceutical industry (as well as a growing local drug industry) to one based on informal traders and foreign generic industries, producing conditions in which the local industry declined. Governmental responses, including the deregulation of pharmaceuticals, in turn created the conditions for the perpetuation of the market in its current form. Peterson writes, “Deregulation was a result of panic, not just an unpleasant answer to a worsening drug supply situation” (p.51).
Throughout the 1980s, Structural Adjustment Programmes (SAPs) fueled the troubling dynamics of the market, the loss of government control over its economy, and the abandonment of the Nigerian market by multinational companies. Peterson’s analysis pays critical attention to the position of populations in this context, and through the concept of “risky populations” attends to the inherent violence of the economic processes (as well as the response to resistance). She also traces compellingly the ways in which the speculative strategies of the multinational industry became key in the progressive abandonment of the Nigerian market and population. Throughout, the rich critique of global economic strategies and corporate speculation provides significant resources for understanding the arrival of the Nigerian market in its current shape. As Peterson suggests:
Corporations’ and military governance’s management of risky populations had effects that lasted well into the future. With the market for brand-name drugs drying up after the implementation of the SAP, Nigerians had to build a new drug market and new livelihoods. The pharmaceutical market was reconfigured to meet the needs of a newly impoverished consumer base. It was also reconstructed to meet the needs of companies, which had to ascertain what could sell in Nigeria in light of the reduction in customers’ purchasing power. (p.79)
As generic producers from Asia replaced European and North American drug companies, and as traders, including those active in narcotics markets, replaced pharmacists as the key agents of the Nigerian pharmaceutical market, the drug trade became something seen as both illicit and normalized. This in turn generated new spaces where the fragility of the regulated/unregulated dichotomy, as well as the complexity of the notion of market itself, became apparent. Peterson provides striking illustrations of how terms and definitions were negotiated in formal and informal settings (including agencies and courts), showing the complexity of those debates and their relationship to spaces of medicine.
Throughout, Peterson draws attention to the “essential vitality in the market and other remade urban areas that many people depend on, a quality that evades legal definition and bypasses regulatory capacity.” (p.102) As she zooms into the day-to-day of the practices of sales within the current markets of Nigeria, she exposes these movements through her core concept of “derivative life.” The volatility and fragility of the market, and the constant negotiation of risk for its actors, are brought to the forefront of her analysis––bringing yet another problematic to these market dynamics, and challenging further easy assumptions readers may have about the motivations and rationales behind individual actions. Forms of risk that are seldom talked about are brought to the fore as key elements in daily strategies. As illustrated throughout, economic and market changes are deeply influential on populations and social dynamics: “new subjectivities came into formation and new forms of individual risk emerged with changes in the Nigerian economy. Today, people must manage their own risk.” (p.107) These, in turn, are loaded with consequences in the daily practices of sales and distributions that easily disappear from sight and Speculative Markets carefully makes visible.
These movements, in turn, are deeply entangled within both global connections, and within drugs themselves. The fragility and negotiations that surround medicines, flowing from much of the above, and as cheaper generic drugs entered a volatile market, is carefully explored through the notion of chemical arbitrage (one of the many strengths of Speculative Markets is that it leaves none of the complex dimensions of the fragility and negotiation of the market unexplored). This notion of chemical arbitrage opens an analysis of how pricing is the outcome of constant strategic decisions, how drugs and human biologies may become disconnected in those processes – turning for example to inadequacies of drugs and resistance – and how more generally market fragility moves from economic questions to the making of drugs. The chemistry of drugs––shaped, modified, and often fragilised by those decisions––in turn becomes a constant source of anxiety and attention by the population. “These dynamics of drug resistance and market structure are not separate articulations or discrete events but rather a dynamic continuum, or a social life of bioequivalence.” (p.129)
However, as Peterson demonstrates, this is not the product of any single or straightforward process that can be isolated within Nigeria itself, but a much more convoluted set of happenings that find their roots in multiple sites and political and corporate decisions. One of the key strengths of the critical exploration of drugs through the notion of arbitrage is to complexify narratives of fakeness in conversation about drugs:
So, perhaps in rejecting the discourse of evil fake drug traders and concomitantly India and China as paradigmatic sites of drug faking, perhaps we can look to the ways that poverty drives fakes in the face of limited price arbitrage that gives way to chemical arbitrage. Perhaps we can see how arbitrage shapes the contours of the West African drug market – a market that is necessarily intertwined with activities driven by downward pricing pressures such as offshoring. Perhaps we can see just how fake drugs are the outcome of the speculative nature of the drug industry. (p.154)
Finally, Peterson turns to the question of monopolies, marketing strategies, and intellectual property (IP) to wrap-up an important remaining angle of the analysis of the pharmaceutical industry in Nigeria. She powerfully demonstrates the inherent links between the market of Nigeria and the strategies of drug companies on European markets, showing how strategic decisions that affect Africa are often taken with other markets in mind. The use of legal and regulatory tools, including patents, are linked to these strategies and the final chapter of the book highlights how these legal tools become used for purposes that are neither those they have officially been designed for, nor those that may be expected by focusing in any particular market in isolation of global movements. Here one of the contributions of the book is to lend back to conversations on intellectual property and drug markets in Africa some of the complexity that was missed in early legal commentaries which associated IP regulation too tightly with the constraints of jurisdiction.
Overall, the book makes an impressive contribution to the analysis of drug markets in Africa and demonstrates why any commentary that attempts to isolate their problematic from further temporal or geographical considerations inevitably misses essential elements. One of the most fascinating aspects of the book is its effort to move away from any of the classic dichotomies and causalities found in much of the discussion of drug markets in Africa, to replace them with a well-demonstrated set of fragile boundaries and entangled events. As she makes clear in her conclusion, Peterson stays away from the languages of corruption and criminality that have become common in studies that explore counterfeit medicines and drug markets in Africa. This is both illustrative of and conducive to the fresh eye that she turns toward the notions of legality and illegality in her analysis. The implications are important here not only for those interested in drug markets, or those interested in African markets, but to readers wanting to open-up the question of regulation in its practice, and to explore new sites where the fragility of the boundaries that law often seeks to establish (and that commentators often take for granted) is made visible. Her analysis beautifully demonstrates the entanglement of practices, histories, economics (official and non-official, regulated and unregulated, legal and illegal), to a point where drawing lines becomes impossible.
I thoroughly enjoyed reading this book and would most strongly recommend it not only to those with an interest in drug markets, in health in Africa or in global health, but also to those seeking to explore the complex dynamics of sites commonly described as “unofficial,” “unregulated,” or that in any way operate at the borders of law.
Emilie Cloatre is Senior Lecturer in law at the University of Kent, working on law and STS. She is the author of Pills for the Poorest: an exploration of TRIPS and access to medication in sub-Saharan Africa (Palgrave McMillan 2013) and co-editor of Knowledge, Technology and Law (with Martyn Pickersgill, Routledge 2014)’