Terminal Cancer and the Pharmaceutical Order

• In Event: AI, Novel Technologies, and Health Equity

Abstract

Treating terminally ill cancer patients is replete with diagnostic and prognostic uncertainty. Furthermore, as cancer spreads (metastasizes), patients, caregivers, and doctors have to navigate a plethora of interactional difficulties, all while making treatment decisions that have permanent effects. Drawing on two years of ethnographic research, I examine how pharmaceutical companies heavily influence the structure and substance of patient-doctor interactions, especially as standard treatment regimens stop working. First, I argue that pharmaceutical companies have captured the clinical research process, ensuring that standard care activities (e.g., tracking tumor growth, treating cancer, searching for alternative medicines) align with their aims. While pharmaceutical interests are not always directly present in clinical interactions, I found that the logic, benchmarks, and aims of companies developing drugs do shape much of the “talk” found in clinic visits. Second, I show how clinical visits are shaped by a kind of pharmaceutical order that is reinforced as patients’ cancer gets worse and standard treatment options become less effective, and participants search for other options. The clinic itself becomes a site of socialization, as doctors work with clinical trial specialists to orient patients to the specific logic of the pharmaceutical order. Finally, I demonstrate that while pharmaceutical companies receive the bulk of the benefit from clinical trials, patients, caregivers, and doctors can also benefit from participating in clinical research and experimental agents, both biologically and interactionally. I discuss these findings in relation to debates over the expanding jurisdiction of medicine, the consequences of (bio)medicalization, and the unexpected ways the pharmaceutical order shapes discussions about death and end-of-life issues.

Author

• Dagoberto Cortez, University of Texas-Austin