Reviewed Book
Synthesizing Hope: Matter, Knowledge and Place in South African Drug Discovery. Anne Pollock, Chicago: University of Chicago Press, 2019, 191 pp.
Readers of Medical Anthropology Quarterly who, like me, were impressed by the originality and scholarly rigor of Anne Pollock’’ previous monograph Medicating Race will be pleased to learn that she has written a new book, Synthesizing Hope: Matter, Knowledge and Place in South African Drug Discovery. Like Medicating Race, it fills a gap in the anthropology of pharmaceuticals, which to date has largely focused on patients’ use of pharmaceuticals, distribution, and doctors’ prescribing practices. Such studies tend to focus on the design and production of medicines in U.S. or European laboratories, glossing over their making as material things. It is rare for science and technology studies scholars to conduct research in laboratories in the Global South; it is also rare for them to do long-term fieldwork. Pollock shows what can be gained from following the life and death of a research company over time, situating it both locally and in the webs of global and local research connections.
Synthesizing Hope presents fascinating insights on how a company called iThemba Pharmaceuticals was set up on the outskirts of Johannesburg. Drawing on the Zulu word for “hope,” iThemba has a mission to discover new drugs for tuberculosis, HIV, and malaria. The book details the global connections and collaborations that led to the founding of the company, and the work of company scientists in laboratories set up to generate “African solutions for African problems” (p. 10). Although the company ultimately fails to achieve this aim, Pollock argues that “imagined possibilities” matter because they illuminate not only what technologies could be, but also what South Africa as a nation can achieve. Indeed, as Pollock stresses, iThemba’s cofounders’ visions for “building science in South Africa were informed by their visions for the future of South Africa itself” (p. 63).
Pollock argues that in trying to bring black South Africans into research and development, iThemba’s founding should be understood as part of the postcolonial movement to Africanize science. The company broke with the past by serving not only the white population, but the South African majority. It also broke with postcolonial science by not seeking to uncover subjugated knowledge (e.g., the efficacy of traditional medicines), and not just presenting global collaborators with a site to test the safety and efficacy of new molecules in clinical trials. Rather, iThemba focused on investing in drug discovery in a chemistry laboratory. The company received support from the South African government to make new molecules, which the government hoped could eventually be patented.
The African bench scientists at iThemba passionately identify with the mission of their laboratory to discover new treatments for HIV, malaria, and TB. Their day-to-day work involves searching online for information on chemical reactions in the mornings, when their peers in the United States are still asleep and the databases that they consult have not yet slowed down. Then, in the afternoon, they turn to the bench to try out chemical reactions and analyze molecules. The making of new drugs at iThemba, Pollock suggests, reflects Andrew Barry’s argument that molecules “should not be viewed as discrete objects, but as constituted in their relations to complex informational and material environments” (Barry 2005, 52). At iThemba, the material and informational qualities of chemicals are inseparable (p. 95).
It is important to note that Pollock entered the laboratory through an American professor of chemistry, Dennis Liotta, who had worked on discovering key antiretroviral drugs through which being infected with HIV is no longer lethal. Struck by the paucity of drug discovery in the country, Liotta became a co-founder of iThemba. Liotta’s participation raises several questions: How instrumental was Liotta is setting up the laboratory and guiding the work? And was he primarily motivated by South African needs? Was he not also seeking strategic alliances with an institution in the Global South to generate funds for collaborative research from global donors (which, some would argue, is a good thing to do)? If this is the case, it changes the story about a South African lab meeting the needs of South African people.
Pollock further describes how in iThemba’s business model, the scientists are simultaneously expected to synthesize particular molecules for global research initiatives, which also does not necessarily meet the needs of South Africans. They are expected to do so to generate income for the laboratory, but it constrains the work of discovery. This section of the book offers valuable insights into how a synthetic chemistry start-up operates in the context of South Africa. Over time, the core funding that iThemba receives from the South African government threatens to dry up, forcing its scientists to redefine their mission of developing new treatments for HIV, TB, and malaria.
She describes how the company tries to reinvent itself—again with support from U.S. scientists—by adopting a new technique in synthetic chemistry (flow chemistry) that produces fewer waste products, thereby greening pharmaceuticals. But this strategy fails, and the company closes. Writing this review on a sabbatical in Silicon Valley, I am aware that part of the continued global inequity lies in the lack of access of iThemba scientists to venture capitalists, who may have been interested in funding the new green flow chemistry line of research if the scientists had happened to work at Stanford.
South Africa is a relatively rich country in the Global South, with a science and technology landscape comparable to that of Thailand or Brazil. In the field of HIV/AIDS, these countries have put their synthetic chemists to work to reverse engineer medicines in order to circumvent patent laws and make the drugs accessible to the majority of their HIV patients. But these countries also have strong universities where basic science is pursued, which can lead to innovations that benefit their populations. How does iThemba’s research compare with start-ups and university labs in Thailand and Brazil? For new treatments to be discovered, clinical trials are needed, and laboratories without the capacity or connections to pursue such trials are bound to fail. Postcolonial science may be served better by calling on funding for basic chemistry research in universities, where scientists can connect across disciplines to meet the needs of the South African people. Pollock describes how some of iThemba’s scientists migrate to university settings where they work on projects funded by the Gates foundation—funding that was not available for a laboratory that was set up as a for-profit start-up.
Synthesizing Hope could be read alongside studies of postcolonial science in Asia (Pordié and Hardon 2015; Rajan 2017) and provides excellent material for courses on global health, medical anthropology, and science and technology studies at both the undergraduate and graduate levels. The post-apartheid context, the vivid descriptions of laboratory life, and the incisive analysis of the context in which the laboratory emerges makes Synthesizing Hope a compelling case study of postcolonial science.
References Cited
Barry, A. 2005. Pharmaceutical Matters: The Invention of Informed Materials. Theory, Culture and Society 22: 51–69.
Pordié, L., and A. Hardon. 2015 Drugs’ Stories and Itineraries. On the Making of Asian Industrial Medicines. Anthropology & Medicine 22: 1–6.
Rajan, K. S. 2017. Pharmocracy: Value, Politics, and Knowledge in Global Biomedicine. Durham: Duke University Press.