The Power of Pills: Social, Ethical and Legal Issues in Drug Development, Marketing and Pricing – By Jillian Clare Cohen, Patricia Illingworth, and Udo Schuklenk

The Power of Pills: Social, Ethical and Legal Issues in Drug Development, Marketing and Pricing . London : Pluto Press . xx + 300 pages. ISBN 9780745324036 , $95.00 cloth. ISBN 9780745324029 , $35.00 paper . Jillian Clare Cohen, Patricia Illingworth, and Udo Schuklenk . 2006 . Today, AIDS is both a preventable and treatable illness, and yet globally less than 8% of HIV-positive people who need treatment are receiving it. In Sub-Saharan Africa, home to over 65% of all people infected with HIV, less than 4% of those in need of anti-retroviral (ARV) treatment are receiving it.1 The epochal nature of the AIDS pandemic that has already claimed over 20 million lives worldwide has2 brought the issue of access to essential medicines to the fore of the international community's agenda. Yet there are many more preventable and treatable neglected diseases, including tuberculosis and malaria, that disproportionately affect the world's poor and for which the issue of access to medicines has become pivotal. The global threat posed by the spread of infectious diseases is a major part of the recent pharmaceutical debate, but not the only one. Skyrocketing drug prices in the United States spurred largely by rising research and development costs; Medicare reform and gaps in the prescription drug plans; and the reimportation of less expensive drugs from Canada and elsewhere highlight the importance of this issue for domestic and international politics and policy. The Power of Pills: Social, Ethical & Legal Issues in Drug Development, Marketing and Pricing—a collection of short essays—is a timely book that covers a range of issues that relate to pharmaceutical policy with a particular focus on the pharmaceutical industry. In the debate over access to essential medicines that has often pitted the pharmaceutical industry against activists and campaigners, this book clearly comes down on the side of the activists. The contributors are an eclectic mix of academics, activists, health care professionals, lawyers, ethicists, economists, and philosophers, as well as one countervailing voice from the pharmaceutical industry. Together, they promote a particular discursive framework that promotes health as a human right and medicines as global public goods. But the essays will appeal to policy makers and researchers, as well as to activists in that many of the essays are prescriptive, offering alternative frameworks and policy options for those wishing to reconcile the profit-driven imperatives of the pharmaceutical industry with global public health needs. The contributors provide critical analyses on a range of topics including: the nature and implications of intellectual property rights-based incentives for drug research and development; drug research undertaken in developing countries and the inequitable spread of benefits; hybrid organizational forms and public–private partnerships in the global health arena; building pharmaceutical research capacity in the Global South; global health inequities and international justice; and treatment activism and access to essential medicines and the human rights agenda. The most interesting chapters are those where the author offers his or her own constructive response to the problems plaguing health policy globally. Of note, Thomas Pogge's chapter critiques the present patent system designed to reward research and development by granting the patent holder exclusive rights to market the product usually for a period of twenty years. He proposes a system that would reward pharmaceutical research in proportion to its impact on the global disease burden. Such an approach would stimulate research for historically neglected diseases, drop drug prices through greater competition and distribution, and increase their accessibility in the Global South. Michael Selgelid and Eline Sepers provide a further critique of patents on the grounds that they offer little incentive to develop medical technologies specifically needed by the poor, and in this regard are an obstacle to global public health. They then review alternative incentive schemes and conclude that political will, particularly on the part of developed nations, will be a key factor in addressing challenges in global healthcare, especially that of developing countries. While health and health policy issues have generally been absent from the mainstream political science scholarly agenda, the chapters in this book confirm their highly political nature and will appeal to scholars and political scientists interested in understanding how science and technology intersect with politics and international affairs. The Power of Pills, however, offers more of a practical rather than a theoretical perspective on the constraints of science, and the political implications of technology, patents, and intellectual property regimes. As the chapters were kept intentionally short, they offer little generalized ideas or theoretical frameworks on these issues. There are several issues that make the book somewhat tedious to read at times. The quality of writing varies greatly across the chapters, and they include a lot of repetitive information. It is unclear why this group of scholars and chapter topics were included, and perhaps it would have been more fruitful to take up additional, timely issues such as U.S. healthcare policy, Medicare reform, and prescription drug plans that are proving to be increasingly political issues at home. There are some very interesting and worthwhile chapters, but the book as a whole is not particularly coherent or well integrated. In addition, a list of abbreviations is provided at the beginning of the book which you will need to memorize before you start as the chapters are full of acronyms that are never spelled out. (Since when is the President's Emergency Plan for AIDS Relief referred to as PEDFAR?) That said, The Power of Pills is conceptually an important and timely book on a topic likely to have broad ramifications at local, national, and international levels.

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