Kokeilullisuus. Maailmanlaajuiset kliiniset kokeet ja lääketieteen tulevaisuus
Experimentality. The Global Clinical Trials and the Future of Medicine
The outsourcing and offshoring of clinical trials has generated an unprecedented global field of experimental activity. The geography of drug development and clinical trial participation is changing, but estimates of trials being carried out worldwide remain tentative at best. This essay illuminates the scientific and regulatory mechanisms by which a field of experimentality takes form. It charts the mobility of a clinical trials industry and its move into low- and middle-income countries, focusing on how subcontracted scientists and entrepreneurs who make up this industry interact with regulatory bodies in the United States and abroad, particularly in eastern Europe, where I carried out ethnographic research. In showing how this experimental enterprise molds itself to international norms and national politics, the essay elucidates how the recognition of adverse risks can be deferred or engineered out of the system. It also raises broader questions about how the boundaries between research and practice are negotiated in various settings. There is a public policy vacuum with regard to how benefits and risks are being assessed in this new enterprise.