ABSTRACT
This chapter explains how pharmaceuticals shape governance by foregrounding one setting in which such technologies be situated: decision-making about health care coverage, specifically pharmaceutical reimbursement. Two overarching arguments in this chapter are that situating pharmaceuticals in any particular locality recasts the identities and actions of various actors and forges new relationships between health problems and pharmaceutical-based solutions. The outcome was argued on the basis of structural and ideological aspects of the Swedish health care system, notably including the principle of equal access to health care. In the past decade, detractors have aimed intensified critique against the revolutionary model of biotechnology previously espoused by many researchers, policymakers and representatives of the pharmaceutical industry. New socio-technological networks emerge as incumbent structures that are reconfigured by the introduction of new technologies and attendant material and discursive practices. Raj notes that many existing systems for deciding coverage for so-called orphan drugs generally fail to acknowledge the problem of scarce resources.
