The Spectacular Generic: Pharmaceuticals and the Simipolitical in Mexico by Cori Hayden (review)

Abstract

Reviewed by:

• The Spectacular Generic: Pharmaceuticals and the Simipolitical in Mexicoby Cori Hayden
• David Herzberg

Cori Hayden. The Spectacular Generic: Pharmaceuticals and the Simipolitical in Mexico. Critical Global Health: Evidence, Efficacy, and Ethnography. Durham, N.C.: Duke University Press, 2023. xii + 244 pp. Ill. $26.95 (978-1-4780-1904-6).

What is a "generic" medicine? The term wants to signal an absence: no marketing, no branding, just a simple, bare, undifferentiated chemical. Yet as Cori Hayden explains in her brilliant book The Spectacular Generic, claims to genericness are themselves a sort of brand—and a sort of science, and a sort of politics. What sort? Well, actually, lots of different sorts. "Generic" can mean an extraordinary number of things and accomplish many different kinds of work, depending who claims it, for what purposes, and in what historical context. In twenty-first-century Mexico, where The Spectacular Genericis (mostly) set, claims of genericness have predominantly been made in the name of making health care more affordable, more accessible, fairer. As Hayden argues, this plan to fix capitalism's injustices with more capitalism extracts its own unpredictable, yet also all-too-predictable, costs. [End Page 654]

Hayden begins by exploding the most compelling claim of genericness: that it names the single, undifferentiated Platonic essence of a medicine lying beneath distinctions generated by marketing hype and other cultural enchantments. In turn-of-the-twenty-first-century Mexico, she points out, there were many types of generic medicines, each legitimated by a distinctive commercial and informational infrastructure. The Mexican government formally recognized two of them: chemically equivalent ("generic") medicines and bioequivalent ("generic interchangeable") medicines. Transnational pharmaceutical companies favored bioequivalence, Hayden explains, but not necessarily because it was a truer marker of sameness. Like chemical equivalence, bioequivalence is a human-designed validation system with its own arbitrary and often circular choices. How close do blood levels have to be to count as "the same," for example? What do such comparisons even mean when original (branded) products themselves vary from batch to batch? Under international pressure, the Mexican government officially began to switch to bioequivalent generics and built up a drug testing infrastructure focused on measuring blood levels. At the same time, however, it also passively resisted the new regime by continuing to accept cheaper, chemically equivalent generics. Medicines, in other words, became "generic" only through contested processes that imbued them with (rather than stripping them of) distinctive commercial, scientific, and political significance.

Hayden next delves into genericness as a form of politics. Before the twenty-first century, she explains, pharmaceutical markets in Mexico were divided in two: private pharmacies selling only relatively expensive, brand-name medicines, and Seguro, the state program, providing certified "generic" or "generic interchangeable" medicines to the formally employed. This setup excluded over fifty million Mexicans without official employment, and in 2003 the government launched a new program, the Seguro Popular, to provide for them. The huge new program was not accompanied by an investment in new health infrastructure, however, so beneficiaries received substandard care if they received any at all. This created an opening for elite businessman González Torres, or "Dr. Simi," who sold uncertified, less expensive similares ("the same but cheaper!") in a network of inexpensive pharmacies often attached to equally inexpensive clinics. This wildly successful private-sector alternative to a seemingly bungling state enterprise was classically neoliberal, undoing political collectivities and remaking citizens into individual, atomized consumers. The Seguro Popular even began to offer beneficiaries vouchers to buy Simi's similares, redirecting state resources to the private sector. Yet, Hayden points out, even as the state leaned on the private sector, entrepreneur González Torres was building a traditional political base by acting like a state: "gathering" constituents by loudly, even spectacularly providing them with a crucial social service. Here again, genericness was not the absence of something—politics—but rather a vehicle for a distinctive brand of politics and for building new political collectivities.

Hayden completes her case for the commercial, scientific, and political distinctiveness of supposedly interchangeable "generic" goods with a chapter on the fate of "Dr. Simi's" generic enterprise in Argentina. Simi's Mexican success, she [End Page 655]argues, emerged...