UNIVERSITY OF CALIFORNIA SANTA CRUZ THE PHARMOCRATICS OF MISOPROSTOL: RACE, DRUGS, AND REPRODUCTIVE NEOLIBERALISM A dissertation submitted in partial satisfaction of the requirements for the degree of DOCTOR OF PHILOSOPHY in FEMINIST STUDIES by Cecelia Brun Lie-Spahn December 2019 The Dissertation of Cecelia Brun Lie-Spahn is approved: ____________________________________ Professor Neda Atanasoski, Co-Chair ____________________________________ Professor Felicity Amaya Schaeffer, Co- Chair ____________________________________ Professor Bettina Aptheker ____________________________________ Professor Neel Ahuja ____________________________________ Professor Patricia Zavella ____________________________________ Quentin Williams Acting Vice Provost and Dean of Graduate Studies Copyright © by Cecelia Brun Lie-Spahn 2019 ii TABLE OF CONTENTS List of Figures v Abstract vii Acknowledgments ix INTRODUCTION Tracking Misoprostol: A Material Approach to Reproductive Neoliberalism 2 Reproductive Health and Justice in a Neoliberal Context 8 Scholarly Interventions: The Limits of Economic Analysis 21 Methodologies: Object Phenomenology 26 Chapter Summaries 31 CHAPTER 1 Producing Pharmocratic Knowledge: The Corporate Citizen as American Patriot 39 Pharmaceutical Patriotism, Inc. 47 From War to “Concern and Action” 56 Erasing Pharmocracy, Making Pharmaceutical Subjects 63 Conclusion: Misoprostol and Abortion 81 CHAPTER 2 Imagining the Global South vis-à-vis Misoprostol 85 Imagining Brazilian Women: Vigilantes in “Wholesale Defiance” 91 Centering the Self in Investigative Journalism 97 Fantastic Markets: Temporalities of Underground Miso 104 Consequences: Redistributing Pharmaceutical Risk 113 iii CHAPTER 3 Benevolent Interventions 118 Producing Obstetric Knowledge: Axioms of Legality, Safety, and Risk 123 Labors of Evidence Production 132 Miso as a Surveillant Technology: Tracking Responsibilization 142 Conclusion: Rereading Possibilities 149 EPILOGUE Elephants in the Room 152 Bibliography 157 iv LIST OF FIGURES Figure 1: Photo of flea market in El Salvador ............................................................. 1 Figure 2: Cytotec packaging. ....................................................................................... 5 Figure 3: Pfizer advertisement in American Chemical Society, 1944 ....................... 39 Figure 4: Photo of U.S. ships said to be delivering penicillin to D-Day troops in Normandy, published in Spectrum, 1967 .................................................... 50 Figure 5: Photo of Pfizer design engineers and quality control personnel inspecting hip implants ................................................................................................. 66 Figure 6: Photo of physician and clincian in Pfizer’s “Transfer of Knowledge” campaign, 1981 ........................................................................................... 67 Figure 7: Photo of pysician and patients in Pfizer’s “Transfer of Knowledge” campaign, 1981 ........................................................................................... 68 Figure 8: Medical specialist and sales representative in Pfizer’s “Transfer of Knowledge” campaign, 1981 ...................................................................... 69 Figure 9: Cover image of Pfizer’s 1986 Annual Financial Report ............................ 71 Figure 10: Photo of Hans Eberhardt getting “back in form” with Feldene I.M. (Pfizer’s 1986 report) .................................................................................. 72 Figure 11: Dennis Ballweg’s cow farm in Sun Prairie, Wisconsin (Pfizer’s 1986 report) .......................................................................................................... 73 Figure 12: The women’s rowing team at Massachusetts Institute of Technology (Pfizer’s 1986 report) .................................................................................. 74 Figure 13: Unlabeled photo in Pfizer’s 1986 Annual Report. ................................... 76 v Figure 14, 15, 16: Ancient sculptures featured in the 1986 issue of Spectrum, Pfizer’s in-house science journal .............................................................................. 84 Figure 17: Graph in family planning study correlating “moral priority” with “epistemic standards” ................................................................................ 133 Figure 18: A table of recommendations concluding the Hobday et al. study .......... 140 Figure 19: “Postpartum hemoglobin values for all women followed up irrespective of place of delivery and use of study medication.” ................................... 145 Figure 20: Quotations from study subjects. ............................................................. 148 vi ABSTRACT The Pharmocratics of Misoprostol: Race, Drugs, and Reproductive Neoliberalism By Cecelia Brun Lie-Spahn This dissertation is about underground markets for misoprostol (“miso” or Cytotec), a drug originally created in the 1980s to treat stomach ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs), but which is frequently used off- label to treat postpartum hemorrhage, induce labor, and induce abortion. In the cross-hairs of some of the most polarizing debates in mainstream U.S. political discourse—immigration, abortion, and the War on Drugs—depictions of off-label miso-use vacillate from hyper-racialized images of flea markets and drug cartels to hope for a future of unconstrained reproductive health options, a vision in which miso symbolizes the cornerstone of medical, technological, and social progress. However, Pfizer—the mega pharmaceutical company that owns, manufactures, and distributes miso under the brand name “Cytotec”—is overtly absent from these discourses. To bring the pharmaceutical machinery that has so successfully eluded these discourses back into the picture, I resituate discourses about underground misoprostol within the neoliberal structures from which it emerged in the post-World War II period, bringing together two key conceptual frameworks: (1) the reproductive justice movement’s long-held emphasis on women of color organizing and intersectional, radically inclusive, community-based, and comprehensive vision of reproductive freedom; and (2) Kaushik Sunder Rajan’s concept of vii “pharmocracy,” wherein pharmaceutical philanthropy acts as a modern form of extractive capitalism. I argue that the pharmocratic scripts of modernity and cultural backwardness reproduced in discourses about underground misoprostol reflect the dangerous proliferation of an updated version of bootstraps individualism I refer to as “reproductive neoliberalism”: the idea that, in lieu of state-provided equitable and holistic reproductive care, women can still achieve reproductive autonomy through entrepreneurial, legal, and pharmaceutical prowess. The individualist language of reproductive neoliberalism in Pfizer’s annual financial reports, mainstream liberal journalism, and family planning research about underground miso invisibly authorizes the uneven transfer of legal and medical liability away from pharmaceutical corporations, such that individuals are made to bear legal, medical, affective, and cultural liabilities—forms of conscripted labor inherent in the act of transgressing federal licensing and malpractice laws, as well as in the fear of accidental injury (bodily, emotional) to oneself or someone else in the process. viii ACKNOWLEDGMENTS As I imagine most dissertators feel, this was the biggest academic project I’ve ever worked on. It also took a bicoastal village to get me through it. Thank you to my co-chairs, Neda Atanasoski and Felicity Amaya Schaeffer, for their patience and persistence, for trusting my learning process, and for giving me the language to embrace my intellectual intuition; Bettina Aptheker, for her extraordinarily generous feedback and mentorship, and whose letters I still return to as a model of transformative teaching; Pat Zavella, for keeping me firmly rooted in the reproductive justice framework; and Neel Ahuja, for his steady encouragement. Thank you to Taylor Ainslie, for coordinating my defense and making sure all the details went smoothly. Thank you to Connor Atlas Lie-Spahn for your love and support, for being my co-conspirator, for believing I can finish this and making a world for us in which I can/could/did, and for bearing with me through 5+ years of graduate school and then marrying me anyway; Siv Lie, my big sister and role model, who inspires me to trust my instincts, to be accountable to them, and to write them with precision; Davindar Singh, who pushes me to take on evermore complicated worldviews and cuisines; Ken and Karen Spahn, for welcoming me into a family of extraordinary love, support, and guidance; Camerin Spahn, for being a role model of feminist openness and resilience; Caley, Chris, and Rey Morton, for creating the most wonderful vision of life after dissertating; Wendy Schor-Haim, Pam Cobrin, ix and Laurie Postlewate, for reminding me that “this is just a project,” for teaching me everything I know about writing and teaching, and for believing I can finish this project even more than I ever did; my writing group—Meredith Benjamin, Vrinda Condillac, Katy Lasell, Duygu Ula, Penelope Usher, and Alexandra Watson—for coaching me through my most fraught drafts and providing spot-on advice (both in real life and in my dreams) and plenty of wine; Anna Ehrlich, Erin Kara, and Amarynth Sichel, for your profoundly supportive friendship and our sacred weekly huddles;