“The Same Thing in a Different Box”: Similarity and Difference in Pharmaceutical Sex Hormone Consumption and Marketing

Abstract

The contraceptive pill has given way to a multitude of products, kinds of packaging, and modes of administration. This article draws on work on the pharmaceutical copy, extending the analysis to differentiating between forms of administration for contraceptive medicines as well as between brand-name drugs, generics, and similares, as they are known in Brazil. It explores how Brazilian prescribers and users—within the divergent structural constraints afforded by private and public health—apprehend and negotiate distinctions between the drugs available to them. This ethnographic account of hormone use reveals new fault lines through which the pharmakon exerts its influence. The attention that industry places on pharmacodynamics as it produces new products from similar compounds suggests that pharmaceutical effects are at once symbolic and real. The article concludes with a reflection on the future of the generic form in a field increasingly crowded by branded copies.

Author biography
Emilia Sanabria is a lecturer in Social Anthropology at the École normale supérieure de Lyon and Senior Research Fellow at the Amsterdam Institute for Social Science Research (AISSR). She conducted long-term fieldwork in Bahia, Brazil, on embodiment, menstruation, and sexual and reproductive health practices. Her current research builds on her sustained interest in anthropological theories of the body and materiality to examine how the relationship between substances (alimentary, chemical, or pharmaceutical) and bodies are conceptualized across a range of contexts.

Additional publications by the author
Sanabria, E., and Edmonds, A. (2014). Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil. Anthropology & Medicine, 21(2), 202-216.
Sanabria, E. (2013). Hormones et reconfiguration des identités sexuelles au Brésil. Clio. Femmes, Genre, Histoire, doi:10.4000/clio.11009
Sanabria, E. (2011). From Sub- to Super-Citizenship: Sex Hormones and the Body Politic in Brazil. Ethnos, 75(4), 377-401.
Sanabria, E. (2011). The Body Inside Out Menstruation and gynecological practice, Social Analysis: The International Journal of Social and Cultural Practice, 55(1), 94-112.
Sanabria, E. (2010). Le médicament, un objet évanescent: essai sur la fabrication et la consommation des substances pharmaceutiques. Techniques & culture, 52-53, 168-189.

Interview with the author

1. How did you come to do research on pharmaceuticals in Brazil?
My interest in pharmaceuticals arose in the context of fieldwork I carried out in Brazil on local understandings of menstruation and sex hormones. I was interested in how pharmaceutical sex hormone use was reconfiguring understandings and experiences of menstruation. In Bahia, the oral contraceptive pill is widely available over the counter and women have long being experimenting with different regimens, to skip a menstrual period. Long-acting hormonal methods such as the contraceptive injection Depo-Provera and its local generic (and non-generic) copies, subcutaneous hormonal implants or the hormonal intra-uterine device Mirena are also widely available. These methods interfere in the regular bleeding intervals experienced by users, often suppressing menstruation altogether. As my fieldwork progressed, I discovered a baffling array of pharmaceutical hormones and became attentive to the dynamics of differentiation at work at different levels, from the clinic, to the pharmacy, to the marketing strategies of national and transnational laboratories. As new methods appeared in the local pharmaceutical landscape, their copies began multiplying, as “similar” copies gave way to generics and non-generic bioequivalent copies. My forthcoming book, Plastic Bodies: Sex hormones and menstrual suppression in Bahia, Brazil by Duke University Press, examines how sex hormones are mobilized to intervene into the lived materiality of bodies, focusing on how hormones are understood as a kind of substance, not unlike blood. In this article, my focus is more specifically on pharmaceutical things and on how marketing innovations respond to and shape local uses.

2. How did you get in touch with the national marketing directors of the major pharmaceutical corporations in São Paulo for interviews, and how did they respond to your questions and your discipline?
I first began meeting pharmaceutical representatives in the waiting room of the doctors that I was interviewing. We would often wait together for hours on end until they had attended their patients and conversations struck up spontaneously. I would explain my research and several were very enthusiastic and kind, inviting me to events and giving me their perspective on the question. One senior regional representative even invited me to observe him training a new rep and we spent a week visiting doctors together. From there I was introduced to more senior regional managers and when I travelled to São Paulo I had the contacts of national marketing directors and was able to meet and interview them. They were very interested in what an anthropological perspective could bring, particularly as a key issue was making methods more adapted and acceptable to women, a process which they understood anthropology had much to contribute to.

3. Can you tell us a little about your current research? Does your next project relate to the work you present in this article or does it take things in a different direction?
I’m currently wrapping up the research I undertook after Brazil, on food and eating in France where I am now based. My thinking about food, eating and bodies was initially informed by the work I did in Brazil on how pharmaceuticals, as material things, are consumed (as in absorbed) and how they are understood to transform bodies. I wanted to extend this by exploring the way other ingested materialities are understood to sustain and transform bodies, and examining the normativities at work in this process. In the context of growing concerns with obesity, I became interested in practices that seek to address the agency of foodstuffs and shift the registers of blame and responsibility away from the informed rational individual of economic thinking. I carried out ethnographic work on sensorial pedagogies and taste education practices as they reveal how encultured the biology of appetite regulation and pleasure is. I became interested in questions of evidence-making and policy in the field of public health nutrition and sought to examine how the focus on knowledge (in both preventative measures and debates on what evidence we have to support specific interventions) obscures the contested nature of what is known.
Last year I joined the ERC ChemicalYouth program headed by Anita Hardon at the University of Amsterdam. ChemicalYouth is a 5-year project that examines alongside each other the experimental practices of youth and clinicians or pharmacologists in view of providing an ethnographically-informed understanding of how drug efficacies are forged in practice. Within the program I am developing new research on the renewed interest in the therapeutic potential of psychedelic or entheogenic substances such as LSD, MDMA and ayahuasca. The common thread might then be how the pleasures of sex, food and drugs are both understood and regulated across a range of locales.