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This chapter examines pharmaceutical policies in OECD countries. It describes the tension between national industrial policies promoting research and innovation; social policies financing access to health goods and services; and economic policies concerned with controlling the growth of public spending.

This chapter investigates the networks of calibration that surround the Food and Drug Administration as an institution of rarefaction. The chapter explores how different professional organizations, pharmaceuticals corporations, scholarly publications, and advocacy organizations attempt to and succeed at impacting the FDA’s efforts at cross-ontological calibration. As a part of this argument, this chapter rejects the hegemonic fallacy, as identified by Bryant, and argues that an effective approach to rhetorical-ontological analysis of science, technology, and medicine must proceed without facile appeals to hegemonic forces. Ultimately, this chapter extends the analyses of the sinus headache and fibromyalgia from the preceding chapter.

The Greek health care system relies on expensive medical inputs to deliver basic health care services, and is characterized by a lack of primary care focus, which disallows care integration and coordination, particularly in chronic care management. Consequently, care delivery remains fragmented and disjointed and often results in access to care disparities. This chapter proposes three areas where structural reform is essential to address budgetary constraints, improve coverage, and deliver better quality of care. First, the health care financing and contracting model and reimbursement mechanisms need to be overhauled. Transitioning to a funding system through general taxation would be advantageous in increasing levels of coverage over the short- to medium-term, but needs to be accompanied by significant changes in the provision and contracting of services to improve efficiency and quality. Second, the role of primary health care needs to be strengthened so that it becomes the backbone of health service delivery. And, finally, pharmaceutical policy needs fundamental review, including a re-alignment of the different incentives on the supply and the demand side. These reforms require a mix of structural and tactical interventions by decision-makers.

This chapter discusses the evolution of Chilean patent rights and the protection of non-disseminated information concerning the safety and efficacy of pharmaceutical products. The chapter is organized as follows. Section I presents the conceptual framework for the globalization of intellectual property and its local opposition. Section II describes the Chilean pharmaceutical market, showing how it is that it gave rise to a dispute involving largely private interests. Section III provides a chronological and systematic examination of the political opportunities Chile experienced in developing and implementing its international obligations, while Section IV concludes.

This chapter explores scholarly and practical efforts to adjudicate among conflicting practices and ontologies regarding the contested diseases fibromyalgia and the sinus headache. In so doing, Chapter 5 introduces the notions of rarefactive and constitutive calibration—i.e., the mechanisms and practices whereby new/proposed disease ontologies are delegitimized or accepted. The chapter documents how powerful institutions of rarefaction (like medical subspecialties and professional organizations) are able to use domain-specific principles of rarefaction (e.g. specific etiology or validated diagnostic criteria) to conduct rarefactive and constitutive calibration. This chapter concludes by exploring how rarefactive and constitutive calibration are sibling activities in that the same principles of rarefaction and modes of calibration are used to both legitimize fibromyalgia and delegitimize the sinus headache.

Arguments in favor of rights of self-medication have revisionary implications for existing drug approval policies and drug prohibitions. Specifically, in order to respect people’s rights of self-medication public officials should not prohibit competent adults from purchasing and using (almost) any drugs. These implications may seem dangerous to some readers, but the current system is dangerous as well, and patients cannot consent to the risks associated with prohibitive policies. Even if public officials adopted policies that respected patient’s rights of self-medication, people who are concerned about the dangers of using pharmaceuticals could still consult a physician, government certification, or other experts before using a drug. In the twentieth century, patients benefited from increasing acceptance of the doctrine of informed consent. Pharmaceutical freedom is the next step.

The conclusion to The Politics of Pain closes with a reflection on the many overlaps among new materialist, nonmodern, and biopsycosocial approaches to rhetorical studies, science and technology studies, and pain medicine. In so doing, the conclusion argues for an end to the cycle of hypercorrections as disciplines oscillate from realist modernist positions to anti-realest postmodern theories. Additionally, the conclusion revisits the different modes of calibration, authorizing resources, and discursive instantiations explored in the book. This calibration suite is presented as a useful resource for future inquiry. And, finally, the conclusion closes with suggestions for future horizons of inquiry within a fully rhetorical-ontological idiom.