In The Social Lives of Medicines, my co-authors and I argued that the efficacy of pharmaceuticals is multifaceted, consisting of material as well as social/meaning efficacies. While material efficacy is located in a drug’s pharmaceutical content, its meaning effects are related to culturally specific expectations of the drug’s effects. The latter—acknowledged by medical researchers and practitioners as “placebo effects”—are not attributed to a drug’s material content. Social efficacy, we argued, involves the relational context in which medicines are used, for example by a mother treating a child with cough syrup. The cough syrup not only suppresses the cough; it also calms the child and projects to neighbors and family members the provision of good care. In emphasizing the sociality of medicines, we sought to understand how efficacy is shaped by “common social experiences in the context of social relations” (Whyte, van der Geest and Hardon 2002: 169).
Emilia Sanabria, in her earlier work (2009) as well as in this monograph, has criticized this conceptualization of efficacy, arguing that it leaves the materiality of pharmaceuticals under-theorized. She states that her book critically engages with our approach “from the perspective of its tendency to take the object for granted, and to not attend to the absorption, dissolution, or enmeshment of the things into bodies in which they become efficacious” (Sanabria 2016: 40). Inspired by Tim Ingold’s call (2012) for social scientists to study the properties of things and how they change as they move, not only through space and time but also through the body, “sustained thanks to the continual taking in of materials from its surroundings, and in turn, the discharge into them, in the processes of respiration and metabolism” (Ingold 2012: 438)—Sanabria approaches bodies as porous and plastic, in the sense that they both “receive and give form” (Sanabria 2016: 40), and shows how the properties of drugs are tinkered with by users, doctors and pharmacists, producing multiple efficacies.
Sex hormones are good things to think with. In Brazil as well as elsewhere, they are widely used and prescribed to regulate fertility. Anthropologists have shown how the properties of sex hormones are tinkered with by consumers around the world for all kinds of off-label purposes, including delaying menstruation, inducing abortion, enhancing skin and growing breasts. Consumers adjust dosages and administration forms, while situated notions of efficacy travel by word of mouth. For example, in Indonesia, Nurul Ilmi Idrus and I observed how male-to-female transgenders use contraceptive pills and injectable hormones to “feminize” their bodies using large quantities of contraceptive pills alongside hormonal injections. Each of our informants balanced side-effects (headaches, nausea and lack of libido) with desirable efficacies (Hardon and Idrus 2014). Science and technology scholar Nelly Oudshoorn (1996) has shown how these user practices have influenced reproductive research, which aims to develop a “cafeteria” of hormonal methods involving multiple routes of entering the body (through vaginas, as implants, and as injections in addition to the oral route).
Sanabria’s ethnography suggests that Brazil is the epicenter of innovation in the field of hormonal drugs. Here, leading gynecologists and reproductive scientists have been at the forefront of experimentation, attentive to a wide range of user desires. Different mixes of hormones are prescribed by gynecologists and produced by so-called “manipulation pharmacists” to achieve specific kinds of sexual and reproductive selves, while pharmaceutical companies are producing contraceptives with a wide range of properties including suppressing menstruation and relief from acne. Sanabria shows how doctors emphasize the benefits of sex hormones—enabling women to stay young and sexually active—while discounting side-effects such as headaches and weight gain.
While medical anthropologists have widely studied the use of sex hormones and STS scholars have investigated their making, I have yet to come across a single monograph that combines the two, showing how the efficacies of sex hormones are continuously articulated and re-articulated through intertwined and situated processes of consumption, manufacturing, selling and prescribing. I am fortunate to have recently elaborated this approach with Emilia Sanabria in a forthcoming review, in which we call on anthropologists to examine pharmaceuticals as things that enter bodies, disintegrate and flow back into environments, while being reflexive about how we mobilize biomedical models and ecological understandings and for what ends (see Hardon and Sanabria, forthcoming 2017).
Anita Hardon is a Professor of Anthropology at the University of Amsterdam, where she also serves as the Co-Director for the Institute for Advanced Studies. She has published widely on the anthropology of pharmaceuticals; immunization; new sexual and reproductive technologies; and AIDS therapeutics. Since 2012, she has directed “Chemical Youth,” a multi-sited comparative ethnography which aims to understand what chemical and pharmaceutical substances, and not only illicit narcotics, ‘do’ for youths.
Hardon A., and N.I. Idrus (2014). “On Coba and Cocok: Youth-led Drug Experimentation in Eastern Indonesia.” Anthropology of Medicines 21(2): 217-29.
Hardon, A., and E. Sanabria (2017). “Fluid Drugs: Revisiting the Anthropology of Pharmaceuticals.” Annual Review of Anthropology.
Ingold, T. (2012). “Toward an Ecology of Materials.” Annual Review of Anthropology 41: 427-42
Oudshoorn, N. (1996). “The Decline of the One-Size-Fits-All Paradigm, or, How Reproductive Scientists Try to Cope with Postmodernity.” In N. Lykke and R. Bradotti, eds. Monsters, Goddesses and Cyborgs: Feminist Confrontations with Science, Medicine and Cyberspace, pp. 153-172. London: Zed Books.
Sanabria, E. (2009). “Le medicament, un object evanescent: essai sur la fabrication el la consummation des substances pharamceutique.” Techniques et Culture 52-53: 168-89.
Whyte, S.R., S. van der Geest, and A. Hardon (2002). Social Lives of Medicines. Cambridge: Cambridge University Press.