Organizer and Chair: Gail E. Henderson, University of North Carolina
Discussant: Jim Yong Kim
This interdisciplinary panel (from history, anthropology, sociology, public health, and medicine) gathers together scholars who ask a series of questions about the nature of the market in China, and in particular, the market for pharmaceutical products. Its significance lies at the heart of understanding the post-command economy, reform era: Is there a mass market? If so, how is it functioning? Has it been produced in the current era by the machinations of foreign and/or domestic companies? Or, is it a re-creation of earlier pre-49 patterns? Faced with multiple pressures from pharmaceutical companies seeking favorable market conditions, and from government health officials seeking rational resource allocation, how has the state responded? Do its regulatory activities reflect integration in the world economic community or local protectionism?
On a more micro level, investigations of the market for pharmaceutical products offers a rich example of the marketing of modernity. Detailed case studies illustrate the "social life" of pharmaceuticals, where issues of commodification of health, medical practice, state policies, and market forces meet. The panel discussant, Jim Yong Kim, is a physician and anthropologist who has conducted research on the pharmaceutical industry in Korea, Latin America and the Caribbean, as well as sponsored health promotion activities through the organization, Partners In Health. His commentary will contextualize the discussion of China’s pharmaceutical market with examples drawn from this work.
Mass Marketing Medicine in China before 1949
Sherman G. Cochran, Cornell University
In contemporary China, are pharmaceutical companies creating or recreating mass markets for their goods? My fellow panelists (all of whom are specialists on contemporary China) are likely to give the former answer, and as a historian, I propose to challenge them to accept the latter possibility. It is true that up to now little research has been done on the history of the pharmaceutical business in China. And it is also true that specialists on China’s mass culture before the founding of the People’s Republic in 1949 have maintained that it lacked effective mass media which have been crucial for the creation of mass markets everywhere in the world. In the words of Leo Lee and Andrew Nathan, "It was not until after 1949 that a truly mass audience was created."
Fortunately, I have had the opportunity to reconsider Lee’s and Nathan’s thesis on the basis of research in previously inaccessible business archives, and I have come to the conclusion that pharmaceutical companies did use mass media to help create "a truly mass audience" in China before 1949. In this paper I plan to support my conclusion by citing both documentary and visual evidence (in slides) to show how the biggest Chinese-owned pharmaceutical companies created mass markets for medicine, and I hope to persuade my fellow panelists and our audience that there are institutional parallels and continuities between the past and the present.
Regulating Drugs in China in the 1990s: The Struggle for Authority Over the Medical Market
Gail E. Henderson, University of North Carolina
Pharmaceuticals are among the most highly regulated products in the world, including oversight of safety and efficacy, protection of intellectual property rights, and cost containment programs. In the U.S., public sector regulation evolved gradually over most of this century. In China, this process has been compressed, by pressure from multiple sources during the 1980s and 1990s: the state-run pharmaceutical industry has been challenged by powerful multinational firms that initially have dominated many therapeutic markets. The government has been pressured by those firms to provide favorable market conditions, including protection against intellectual property infringement. At the same time, the cost of expensive, new drugs has added to already alarming spending increases in urban hospitals and state-sponsored insurance programs.
This paper describes two phases in the evolution of Chinese regulatory responses to this rapidly changing pharmaceutical market: The 1980s, when dreams of "a billion peasants popping state-subsidized pills" created a gold-rush mentality among multinational companies, yet with no close regulation of drug approvals, intellectual property, or hospital purchasing behaviors; and The 1990s, when the state reacted to the disorder and loss of authority with regulations that addressed out-of-control spending, and balanced concerns of the multinationals against the need for rational resource allocation and protection of local industry. Regulation thus has as least two faces—one pulling China into the international economic community, and another protecting local interests.
Marketing Prozac in China and Other Tales of Consumption
Nancy N. Chen, University of California, Santa Cruz
The recent changes in state subsidized medicine in China signals a moment in which practices of socialized medicine are significantly revised. Despite the withdrawal of funding for a number of prescription medicines, the consumption of new drugs and medicines remains one of the most significant expenses of most households. State development of the official drug market has been accompanied by the presence of transnational pharmaceutical corporations and joint venture firms devoted to new modes of consumption. Local pharmacies have burgeoned with vast shelves devoted to over the counter medicines that include biomedical drugs, traditional Chinese medicine, and other types of home health aids. Strategies of engaging "the masses" as clientele instead reveals a significant transformation of socialized bodies to individual bodies and subjectivities in the 1990s.
The lucrative market in drugs relies significantly upon Chinese cultural notions of medicine as integral to everyday life and contemporary advertisements that promote such commodities as integral to the good life. Beginning with a case study of Prozac and how it was promoted in China, the paper will address the "social life" of pharmaceuticals and renewed visions of modernity that accompany these modes of consumption. Ethnographic analysis will include discussion of recent trends in health and bodily practices, especially popular medical fads that challenge the market and state regulatory missions.
Old Formula in New Bottles: Marketing Nutritional Drinks and Infant Formula in a Beijing Hospital
Suzanne K. Gottschang, Clark University
With sales of baby food expected to increase more than ten-fold by 2000, multinational infant formula companies such as Nestlé’s and Borden have not been bypassed in China’s remarkable economic transformation. At the same time, however, China has enthusiastically adopted the United Nations and World Health Organization’s initiative to improve rates of breastfeeding and child health. These organizations’ policies also seek to curb the influence of infant formula companies in developing countries by prohibiting the marketing of their breastmilk substitutes in hospitals. To this end, China has established a law prohibiting the promotion and sale of infant formula products in hospitals as a means to encourage breastfeeding and discourage the use of infant formula by new mothers. This law has blocked a lucrative advertising venue for multinational formula companies.
In this paper, I examine how these companies are using new tactics to circumvent the prohibition of advertising infant formula by promoting nutritional drinks for pregnant and nursing mothers in an obstetrics clinic in Beijing. I focus on the ways that marketing strategies used by these companies converge with the medical institution’s interests in promoting maternal health during pregnancy through good nutrition. This case represents an instance where issues of the commodification of health, medical practice, state policies and market forces meet, and signals a shift in the structure of relations between consumers and markets.