Brazil is among the approximately 100 countries that recognize a constitutional right to health that includes access to medicines. All over Brazil, patients are turning to courts to access prescribed medicines. Although lawsuits secure access for thousands of people, at least temporarily, this judicialization of the right to health generates intensely complex sociomedical realities and significant administrative and fiscal challenges that, officials argue, have the potential to widen inequalities in health-care delivery. In this article, we explore how right-to-health litigation became (...) an alternative pathway for Brazilians to access health care, now understood as access to medicines that are either on government lists for pharmaceutical distribution or are only available through the market. Is the judicial system an effective venue to implement socioeconomic rights? Which practices of citizenship and governance are crystallized in these struggles over drug access and administrative accountability? (shrink)

The outsourcing and offshoring of clinical trials has expanded a global field of experimental activity. This essay addresses the competitive logic and social norms by which a field of human subjects research for drug development has taken form. The clinical trials industry and its move to low- and middle-income countries serve as a telescope into the global clinical trial and how it is crafted and made to work in different locales. Lives often depend on new medical commodities as they enter (...) the value chains of transnational medicine and capital. Transparency remains a key problem. The essay explores the politics of creating centralized registries through which the scope of this experimental enterprise might be known. As the engine of pharmaceutical research molds itself to international and national regulatory norms, detection of adverse risk can be deferred or minimized. The essay also points to policy gaps with respect to how the benefits and insecurities of global experiments are distributed as well as to emergent political practices of care and accountability. (shrink)