69entwined with the market value these companies see in the drugs thateventually get developed, and the market risk that attends the drug devel-opment process. According to the Healthcare Financial ManagementAssociation’s newsletter, ‘twenty years ago, 80 per cent of clinicalresearch trials were conducted through academic medical centres. In1998, estimates indicated the number of [these] centres as investigatorsites had dropped to less than half.’
Health research and production isthus progressively captured by capital, and now needs to be seen as asemi-autonomous branch of it.
The organizational complexity of clini-cal trials does however mean that it has been hard for pharmaceuticalcompanies to manage them, leading to the emergence of an entirely newsector devoted to the management and administration of clinical trials.These companies, known as clinical research organizations (
s), arenow an integral part of the overall biomedical economy.
A plurality of actors
The movement of clinical trials to international—non-
—locationsstarted in earnest in the mid-1990s. Adriana Petryna cites ﬁgures thatpoint to a dramatic growth in the number of human subjects recruitedinto these trials, from 4,000 in 1995 to 400,000 in 1999.
A recentstudy by the consulting ﬁrm A. T. Kearney shows that roughly half of the 1,200
clinical trials in 2005 made use of an international site.
Inthe 1990s, as Petryna notes, most of this growth occurred in countriesthat had agreed to harmonize standards in commercial drug testing withthe guidelines set by the International Conference on Harmonization of
Indeed, law and policy scholars Tracy Lewis, Jerome Reichman and Anthony Sohave argued for public funding of clinical trials as a crucial mechanism to makeessential therapeutics more accessible—and therefore to move health away frombeing an abstract market value towards being about healthiness. See Tracy Lewis,Jerome Reichman and Anthony So, ‘The Case for Public Funding and PublicOversight of Clinical Trials’,
The Economists’ Voice
, vol. 4, no. 1 (2007). For theHealthcare Financial Management Association’s ﬁgures, see Jennifer Jones andAlan Zuckerman, ‘Clinical Research Trials: Creating Competitive and FinancialAdvantages’,
Managing the Margin Newsletter
, available at www.hfma.org.
This is an example of what Etienne Balibar has described as the continual expan-sion of the value form and the inﬁnite process of accumulation. Etienne Balibarand Immanuel Wallerstein,
Race, Nation, Class: Ambiguous Identities
, London andNew York 1992, p. 180.
Petryna, ‘Drug Development’.
A. T. Kearney Report, ‘Make Your Move: Taking Clinical Trials to the BestLocation’, 2006; available at www.atkearney.com.