Biocapital is a major theoretical contribution to science studies and political economy. Grounding his analysis in a multi-sited ethnography of genomic research and drug development marketplaces in the United States and India, Kaushik Sunder Rajan argues that contemporary biotechnologies such as genomics can only be understood in relation to the economic markets within which they emerge. Sunder Rajan conducted fieldwork in biotechnology labs and in small start-up companies in the United States (mostly in the San Francisco Bay area) and India (mainly in New Delhi, Hyderabad, and Bombay) over a five-year period spanning 1999 to 2004. He draws on his research with scientists, entrepreneurs, venture capitalists, and policymakers to compare drug development in the two countries, examining the practices and goals of research, the financing mechanisms, the relevant government regulations, and the hype and marketing surrounding promising new technologies. In the process, he illuminates the global flow of ideas, information, capital, and people connected to biotech initiatives.

Sunder Rajan’s ethnography informs his theoretically sophisticated inquiry into how the contemporary world is shaped by the marriage of biotechnology and market forces, by what he calls technoscientific capitalism. Bringing Marxian theories of value into conversation with Foucaultian notions of biopolitics, he traces how the life sciences came to be significant producers of both economic and epistemic value in the late twentieth century and early twenty-first.

While the creation of Dolly the sheep, the world's most famous clone, triggered an enormous amount of discussion about human cloning, in Dolly Mixtures the anthropologist Sarah Franklin looks beyond that much-rehearsed controversy to some of the other reasons why the iconic animal's birth and death were significant. Building on the work of historians and anthropologists, Franklin reveals Dolly as the embodiment of agricultural, scientific, social, and commercial histories which are, in turn, bound up with national and imperial aspirations. Dolly was the offspring of a long tradition of animal domestication, as well as the more recent histories of capital accumulation through selective breeding, and enhanced national competitiveness through the control of biocapital. Franklin traces Dolly's connections to Britain's centuries-old sheep and wool markets (which were vital to the nation's industrial revolution) and to Britain's export of animals to its colonies—particularly Australia—to expand markets and produce wealth. Moving forward in time, she explains the celebrity sheep's links to the embryonic cell lines and global bioscientific innovation of the late twentieth century and early twenty-first.

Franklin combines wide-ranging sources—from historical accounts of sheep-breeding, to scientific representations of cloning by nuclear transfer, to popular media reports of Dolly's creation and birth—as she draws on gender and kinship theory as well as postcolonial and science studies. She argues that there is an urgent need for more nuanced responses to the complex intersections between the social and the biological, intersections which are literally reshaping reproduction and genealogy. In Dolly Mixtures, Franklin uses the renowned sheep as an opportunity to begin developing a critical language to identify and evaluate the reproductive possibilities that post-Dolly biology now faces, and to look back at some of the important historical formations that enabled and prefigured Dollys creation.

In some parts of the world spending on pharmaceuticals is astronomical. In others people do not have access to basic or life-saving drugs. Individuals struggle to afford medications; whole populations are neglected, considered too poor to constitute profitable markets for the development and distribution of necessary drugs. The ethnographies brought together in this timely collection analyze both the dynamics of the burgeoning international pharmaceutical trade and the global inequalities that emerge from and are reinforced by market-driven medicine. They demonstrate that questions about who will be treated and who will not filter through every phase of pharmaceutical production, from preclinical research to human testing, marketing, distribution, prescription, and consumption.

Whether considering how American drug companies seek to create a market for antidepressants in Japan, how Brazil has created a model HIV/AIDS prevention and treatment program, or how the urban poor in Delhi understand and access healthcare, these essays illuminate the roles of corporations, governments, NGOs, and individuals in relation to global pharmaceuticals. Some essays show how individual and communal identities are affected by the marketing and availability of medications. Among these are an exploration of how the pharmaceutical industry shapes popular and expert understandings of mental illness in North America and Great Britain. There is also an examination of the agonizing choices facing Ugandan families trying to finance AIDS treatment. Several essays explore the inner workings of the emerging international pharmaceutical regime. One looks at the expanding quest for clinical research subjects; another at the entwining of science and business interests in the Argentine market for psychotropic medications. By bringing the moral calculations involved in the production and distribution of pharmaceuticals into stark relief, this collection charts urgent new territory for social scientific research.

Contributors. Kalman Applbaum, João Biehl, Ranendra K. Das, Veena Das, David Healy, Arthur Kleinman, Betty Kyaddondo, Andrew Lakoff, Anne Lovell, Lotte Meinert, Adriana Petryna, Michael A. Whyte, Susan Reynolds Whyte

A recent study of productivity in the workplace revealed that workers spend on average eight percent of their workday doing nothing. This statistic takes on greater significance when we find that health problems impact employee productivity loss by an even greater percentage. In light of this discovery, a group of leading experts from the emerging field of health and productivity research argues that the expansion of health care benefits represents a substantial investment opportunity for employers.
 
Health and Work Productivity presents state-of-the-art health and productivity research that suggests interventions aimed at prevention, early detection, and best-practice treatment of workers along with an informed allocation strategy can produce significant cost-benefits for employers. Contributors cover all the major aspects of this new area of research: approaches to studying the effects of health on productivity, ways for employers to estimate the costs of productivity loss, concrete suggestions for future research developments in the area, and the implications of this research for public policy.

Biotechnology is the new capital. The stakeholders in this revolution are many: the scientists who generate the knowledge in fields where the pace is maddeningly fast; the technologists who make ideas a reality; the managers who struggle to deal with an industry where the old rules of thinking do not always apply; the venture capitalists who provide funds based on market moods rather than science; the health care, agricultural, chemical, and pharmaceutical industries whose once cozy enclaves have been revolutionized and are now barely recognizable; the law professionals and ethicists who have to grapple with issues unimaginable just a few years ago; the public policy makers who struggle with the complex issues and have to make decisions quickly, or risk being left behind; and, finally, the society and individuals who are in the midst of all that is taking place. This book addresses this diverse constituency and offers an integrated view of exciting new biotechnologies, both from a science and business perspective.

The book walks the reader through the "what"--what are some of the newest biotechnologies that will revolutionize the way we think about health?; the "how"--how to transform those technologies into profitable products and companies; and the "who"--who will benefit from these technologies?

Kellogg on Biotech is the outgrowth of a collaborative student-faculty effort called TechVentures at the Kellogg School of Management. Their research forms the raw material for Kellogg on Biotech.

In 1998, health expenditures in the United States accounted for 12.9% of national income-the highest share of income devoted to health in the developed world. The United States also spends more on medical research than any other country-in 2000, the federal government dedicated $18.4 billion to it, compared with only $3.7 billion for the entire European Union. In this book, leading health economists ask whether we are getting our money's worth.

From an economic perspective, they find, the answer is a resounding "yes": in fact, considering the extraordinary value of improvements to health, we may even be spending too little on medical research. The evidence these papers present and the conclusions they reach are both surprising and convincing: that growth in longevity since 1950 has been as valuable as growth in all other forms of consumption combined; that medical advances producing 10% reductions in mortality from cancer and heart disease alone would add roughly $10 trillion-a year's GDP-to the national wealth; or that the average new drug approved by the FDA yields benefits worth many times its cost of development.

The papers in this book are packed with these and many other surprising revelations, their sophisticated analysis persuasively demonstrating the massive economic benefits we can gain from investments in medical research. For anyone concerned about the cost and the value of such research-from policy makers to health care professionals and economists-this will be a landmark book.

American health care is in crisis because of exploding medical malpractice litigation. Insurance premiums for doctors and malpractice lawsuits are skyrocketing, rendering doctors both afraid and unable to afford to continue to practice medicine. Undeserving victims sue at the drop of a hat, egged on by greedy lawyers, and receive eye-popping awards that insurance companies, hospitals, and doctors themselves struggle to pay. The plaintiffs and lawyers always win; doctors, and the nonlitigious, always lose; and affordable health care is the real victim.

This, according to Tom Baker, is the myth of medical malpractice, and as a reality check he offers The Medical Malpractice Myth, a stunning dismantling of this familiar, but inaccurate, picture of the health care industry. Are there too many medical malpractice suits? No, according to Baker; there is actually a great deal more medical malpractice, with only a fraction of the cases ever seeing the inside of a courtroom. Is too much litigation to blame for the malpractice insurance crisis? No, for that we can look to financial trends and competitive behavior in the insurance industry. Are these lawsuits frivolous? Very rarely. Point by point, Baker—a leading authority on insurance and law—pulls together the research that demolishes the myths that have taken hold about medical malpractice and suggests a series of legal reforms that would help doctors manage malpractice insurance while also improving patient safety and medical accountability.

President Bush has made medical malpractice reform a priority in his last term in office, but if history is any indication, legislative reform would only worsen the situation and perpetuate the gross misunderstanding of it. The debate surely will be transformed by The Medical Malpractice Myth, a book aimed squarely at general readers but with radical conclusions that speak to the highest level of domestic policymaking.

Medical malpractice suits today can result in multi-million-dollar settlements, and a practicing physician can pay $100,000 or more annually for malpractice insurance. Some complain that lawyers and plaintiffs are overcompensated by exorbitant judgments that add to the rising cost of health care. But there has been very little evidence to show whether these arguments are true. In this timely work, six experts in health policy, law, and medicine study nearly 200 malpractice claims to show that, contrary to popular perceptions, victims of malpractice are not overcompensated and our legal system for dealing with malpractice claims is not defective.

The authors survey claims filed in Florida between 1986 and 1989 by people who suffered permanent injury or death during birth or during treatment in an emergency room. How often did illegitimate claims result in financial awards? What was the relation between the injury and the amount the patient lost economically? How much did the plaintiffs actually recover? How did the claimants choose their lawyers and what kind of relationship did they have?

Contrary to common perceptions, in the majority of cases the claims were merited, and the authors found that claimants were on average substantially undercompensated—only about one-fifth of plaintiffs recovered more than their economic loss caused by injury or death. The evidence in this book suggests that placing dollar limits on malpractice cases is unjustified and that our tort system is not so faulty after all.

Evidence from the United States suggests that technological change is a key factor in understanding both medical expenditure growth and recent dramatic improvements in the health of people with serious illnesses. Yet little international research has examined how the causes and consequences of technological change in health care differ worldwide. Seeking to illuminate these issues, this volume documents how use of high-technology treatments for heart attack changed in fifteen developed countries over the 1980s and 1990s. Drawn from the collaborative effort of seventeen research teams in fifteen countries, it provides a cross-country analysis of microdata that illuminates the relationships between public policies toward health care, technology, costs, and health outcomes.
The comparisons presented here confirm that the use of medical technology in treatment for heart attack is strongly related to incentives, and that technological change is an important cause of medical expenditure growth in all developed countries. Each participating research team reviewed the economic and regulatory incentives provided by their country's health system, and major changes in those incentives over the 1980s and 1990s, according to a commonly used framework. Such incentives include: the magnitude of out-of-pocket costs to patients, the generosity of reimbursement to physicians and hospitals, regulation of the use of new technologies or the supply of physicians, regulation of competition, and the structure of hospital ownership. Each team also reviewed how care for heart attacks has changed in their country over the past decade.
The book will be of enormous importance to health economists, medical researchers and epidemiologists, and policymakers.
Mark McClellan is Associate Professor of Economics and of Medicine and, by courtesy, of Health Research and Policy, Stanford University. He is a National Fellow, the Hoover Institution. Daniel P. Kessler is Associate Professor of Economics, Law, and Policy in the Graduate School of Business, Stanford University, and a Research Fellow, the Hoover Institution.

As new medical technologies are developed, more and more human tissues—such as skin, bones, heart valves, embryos, and stem cell lines—are stored and distributed for therapeutic and research purposes. The accelerating circulation of human tissue fragments raises profound social and ethical concerns related to who donates or sells bodily tissue, who receives it, and who profits—or does not—from the transaction. Catherine Waldby and Robert Mitchell survey the rapidly expanding economies of exchange in human tissue, explaining the complex questions raised and suggesting likely developments. Comparing contemporary tissue economies in the United Kingdom and United States, they explore and complicate the distinction that has dominated practice and policy for several decades: the distinction between tissue as a gift to be exchanged in a transaction separate from the commercial market and tissue as a commodity to be traded for profit.

Waldby and Mitchell pull together a prodigious amount of research—involving policy reports and scientific papers, operating manuals, legal decisions, interviews, journalism, and Congressional testimony—to offer a series of case studies based on particular forms of tissue exchange. They examine the effect of threats of contamination—from HIV and other pathogens—on blood banks’ understandings of the gift/commodity relationship; the growth of autologous economies, in which individuals bank their tissues for their own use; the creation of the United Kingdom’s Stem Cell bank, which facilitates the donation of embryos for stem cell development; and the legal and financial repercussions of designating some tissues “hospital waste.” They also consider the impact of different models of biotechnology patents on tissue economies and the relationship between experimental therapies to regenerate damaged or degenerated tissues and calls for a legal, for-profit market in organs. Ultimately, Waldby and Mitchell conclude that scientific technologies, the globalization of tissue exchange, and recent anthropological, sociological, and legal thinking have blurred any strict line separating donations from the incursion of market values into tissue economies.

This volume revisits the Nobel Prize-winning economist Kenneth Arrow’s classic 1963 essay “Uncertainty and the Welfare Economics of Medical Care” in light of the many changes in American health care since its publication. Arrow’s groundbreaking piece, reprinted in full here, argued that while medicine was subject to the same models of competition and profit maximization as other industries, concepts of trust and morals also played key roles in understanding medicine as an economic institution and in balancing the asymmetrical relationship between medical providers and their patients. His conclusions about the medical profession’s failures to “insure against uncertainties” helped initiate the reevaluation of insurance as a public and private good.

Coming from diverse backgrounds—economics, law, political science, and the health care industry itself—the contributors use Arrow’s article to address a range of present-day health-policy questions. They examine everything from health insurance and technological innovation to the roles of charity, nonprofit institutions, and self-regulation in addressing medical needs. The collection concludes with a new essay by Arrow, in which he reflects on the health care markets of the new millennium. At a time when medical costs continue to rise, the ranks of the uninsured grow, and uncertainty reigns even among those with health insurance, this volume looks back at a seminal work of scholarship to provide critical guidance for the years ahead.

Contributors
Linda H. Aiken
Kenneth J. Arrow
Gloria J. Bazzoli
M. Gregg Bloche
Lawrence Casalino
Michael Chernew
Richard A. Cooper
Victor R. Fuchs
Annetine C. Gelijns
Sherry A. Glied
Deborah Haas-Wilson
Mark A. Hall
Peter J. Hammer
Clark C. Havighurst
Peter D. Jacobson
Richard Kronick
Michael L. Millenson
Jack Needleman
Richard R. Nelson
Mark V. Pauly
Mark A. Peterson
Uwe E. Reinhardt
James C. Robinson
William M. Sage
J. B. Silvers
Frank A. Sloan
Joshua Graff Zivin

Good news first? The good news is that Americans today are living longer, in part because of continual advances in healthcare. But the bad news is that with our aging population larger than ever before, nothing is being done to ensure that we can continue to afford the increasing costs of care. How Medicare—with the Bush administration's reforms and a slumping economy—will meet the needs of its recipients without adequate financing is among the most pressing issues facing this country today.

Daniel N. Shaviro sees the future of our national healthcare system as hinging on the issue of funding. The author of books on the economic issues surrounding Social Security and budget deficits, Shaviro is a skilled guide for anyone seeking to understand the financial aspects of government programs. Who Should Pay for Medicare? offers an accessible overview of how Medicare operates as a fiscal system. Discussions of Medicare reform often focus on the expansion of program treatment choices but not on the question of who should pay for Medicare's services. Shaviro's book addresses this critical issue, examining the underanalyzed dynamics of the significant funding gap facing Medicare. He gives a balanced, nonpartisan evaluation of various reform alternatives—considering everything from the creation of new benefits in this fiscal crunch to tax cuts to the demographic pressures we face and the issues this will raise when future generations have to pay for the care of today's seniors.

Who Should Pay for Medicare? speaks to seniors who feel entitled to expanded coverage, younger people who wonder what to expect from the government when they retire, and Washington policy makers who need an indispensable guidebook to Medicare's future.