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The pharmaceutical, especially in its standard form as an orally ingested tablet or pill, fits into the classic Ingoldian (2000) definition of a 'tool'. It is a non-human instrument, mass-produced for a specific purpose which must be activated by human agency – they don't do very much if they are just left to sit in their bottles. So do we fetishize the pharmaceutical? This time I'm going to say no. Of course anything could theoretically be capable of being fetishized, but I would argue that this is not generally the case with the pharmaceutical. Very few people see pills as embodying the sacred, or as possessed of a moral character – for example we often use the contrasting words 'drug' and 'medicine' for the same physical substances, such as morphine say, depending on whether or not we consider their context of use to be appropriate or inappropriate. It is the use to which the pharmaceutical is being put by any given human agent that determines its moral character, not any prior essence that is contained or transmitted by the actual pharmaceutical. Pharmaceuticals don't even really represent anything, they do not act to concretize anything that is otherwise abstract, they are not animated and sign and signified are not conflated, because in this instance they are indistinguishable (see Ellen 1988:219). Therefore Neil Gaiman's statement that “opiates have become the religion of the masses” is really quite ironic since unlike actual religions, pharmaceuticals seemingly have no moral or social character in of themselves.

However, pharmaceuticals seem to be indispensable (no pun intended) to many of the more fundamental questions of 'thing theory'. The definitions and relationships between subjects and objects and the nature and location of agency. To use one of Latour's (1993) concepts, the pharmaceutical is a classic case of a 'quasi-object' or 'quasi-subject', like frozen embryos, artificial intelligences, genetic clones, cyborgs and all the rest. As what we like to think of as agentive human subjects, that is ourselves, really are made through and in relation to things like pharmaceuticals – and not just in that vaguely metaphorical way in which we talk about cars as a means through which we symbolize and perform social status or masculinity, or that clothing helps us to craft social identity. What kind of subject is the person suffering from psychosis without neuroleptics or the depressive, with or without anti-depressants. Such instances heavily problematize the comfortable categories of mind, body and thing.

I'll return to the relationship between mind, body and things shortly, but firstly I want to consider what agency is afforded or allowed by the materiality of the pharmaceutical. For pharmaceuticals can evidently be very powerful things, and not just for the people who take them. The global pharmaceutical industry is one of the most important in existence, and companies like Pfizer or Johnson & Johnson based in the US, or GlaxoSmithKline or AstraZeneca based in the European Union are well-recognized global brands. In 2003 alone the industry's total sales were estimated at $466 Billion dollars worldwide, half of which took place within the United States (Busfield 2006:297). Of course pharmaceutical corporations or 'Big Pharma' as it is widely known are often at the centre of major controversies in politics and the media, not least for the higher prices charged for non-generic medicines which are often too expensive for third-world health authorities to purchase in sufficient quantities. Also there has been a growing concern from more academic quarters with regards to the emergence of 'cultures of drug-use'. Joan Busfield (2006), for example, has argued that more and more problems are being classified as diseases, for which new patented drugs are being developed as cures - in the UK, the per capita consumption of prescriptions showed a 56% increase between 1989 and 2002. We are, it seems, increasingly becoming 'pharmaceuticalized subjects'. To give you an example of this so-called 'disease mongering' in 2003, GlaxoSmithKline helped to fund and publish research into the “common yet unrecognized disorder” of 'restless leg syndrome', which you will be relieved to hear can now be treated with the drug Ropinirole, which was approved in 2005, and developed by GlaxoSmithKline[1]. Much of the debate around this issue surrounds what or should not be classified as a 'real' illness or whether or not certain pills are overused and over-prescribed, or how accurate drug trials are in deeming these kinds of new pharmaceuticals 'effective' and 'safe'. That however is not really what I am concerned with here so much.

The question I wish to raise is more related to how is it that, and by which processes, does the pharmaceutical come to be so powerful and enable whole networks of power relations involving an enormous range of human and non-human actors to come into being. The pharmaceutical industry only really emerged in its modern form in the post-war period with the creation of the first mass-produced prescription drugs of the early 1960s, including such things as Valium (or diazepam) and the first oral contraceptives. What the emergence of the pharmaceutical industry entailed was a creation of a network of connections between things that had previously been unconnected, a constellation of ' overlapping interests' was formed, in which each of the different components had varying, yet complimentary goals. Those interested components include, obviously, the scientists who conduct research and development whose careers depend on their ability to produce useful knowledge and technologies - the commercial companies themselves who wish to sell their pharmaceuticals at a profit - the consumers who desire new solutions to the ever-increasing numbers of illnesses to which they can fall prey – the medical profession, who want to be able to offer solutions to their patients' problems and often find that few things are easier of faster by way of treatment than to prescribe a pill, an activity over which they hold a legal monopoly and which is the source of much of their authority – the state which seeks to manage all matters which fall under its ever-expanding remit, even the well-being of its citizen's bodies and minds, and therefore provides the regulation and testing authorities which declare new drugs to be safe and effective and suitable for use – and of course lets not forget the pharmaceuticals themselves which propagate rapidly through this constellation of allied interests. We might argue that the pharmaceutical is not a conscious entity and therefore doesn't really have any 'interests', but then neither is the state, a mere abstraction, which nonetheless seeks to reproduce itself like the pharmaceutical, like the patients who need their heart medication to stay alive and like the corporations which need constant and expanding sales to stay in business. Power is all about maintaining one's ability to reproduce. I would insist that the pharmaceutical only comes into being as a pharmaceutical, in that it is made to be a reproducing entity from the event of its inception, one which will fill a continuous need on a wide scale. Thus reproduction is an essential part of the nature of the pharmaceutical as much as anything else – it is hardwired into the make-up of the pharmaceutical as we imagine that the need to biologically reproduce is hardwired into our own genes.

So what I'm getting at is that the power of the pharmaceutical does not lie in it being an effective tool for the treatment of various medical conditions. Rather it is in its ability to unite interests of various kinds that makes it so potent, and it does this through a scientific process whose purpose is not to manufacture facts, as is sometimes suggested, but rather to manufacture 'causes'. To explore this idea further, I want to try a brief thought experiment. Supposing that you have three chemical substances, two solids and a liquid, lets call them A, B, and C, and a clever scientist discovers that by mixing them together he is able to produce an unstable compound which he calls 'explodium'. This compound comes to be a valuable commodity since it is very useful in warfare, it gets made into bombs and explosive shells. In effect it becomes a whole industry, the three component compounds are mined on a massive scale, people become rich from their production, territories which contain them are considered more valuable and fought over and so on. Things that were previously unconnected have been connected in a powerful way. What our scientist did was to look at a serious of effects, the explosive capacity of explodium, the mixing of various compounds and assign to them a cause i.e. The mixing of A, B and C creates D, which is an explosive, for whatever reason he outlines. Then suppose a few decades later a different scientist revisits the issue and discovers on further experimentation that in fact liquid C is not necessary at all for the manufacture of explodium. What had actually been necessary was to combine A and B with heat, and it was only because C was itself produced through a highly exothermic reaction that it seemed to be necessary to produce D, but actually any hot liquid, even water, would have done the job. And so everything within the network changes, C becomes a worthless substance, and the scientist has from the same effects, crafted an entirely new cause, which is powerfully transformative with regards to everything else in our constellation of interested parties. My point then is that effects are real, but causes are always, everywhere, socially constructed, but constructed nonetheless from real effects. Remember that both causes were equally effective in their ability to understand and permitted the regular production of the explodium compound.

So to return to the pharmaceuticals and their creators, what is occurring is the assignation of two different causes, to two different sets of effects. The effects being the symptoms of the designated disease, and the consequences of introducing various chemicals into the body as observed under laboratory conditions. The first cause that is crafted is the explanation for the disease; its pathology, and the second is to account for how the introduced chemicals effectively cured it, the first and second causes clearly coming to interact with each other. Few things unite disparate interest groups better than shared belief in a cause, after all. This process is not unique to scientific contexts of course - when the Azande diviner from Central Africa consults the Benge oracle[2] to determine if a recent illness or death has been caused by witchcraft, he asks a question to a chicken and then feeds it a solution containing strychnine, if the chicken dies then the answer is an affirmative, if it lives, then the answer is a negative – this system in fact was once used for criminal trials. Here again we see a powerful linking of causes and effects, and through them various interests, which the Benge oracle, represented by the chicken and the strychnine facilitates. But the difference between oracular divination and the pharmaceutical industry and other scientific producers of causes, is that the scientists have created for themselves the uniquely powerful environment of the laboratory. A place where the scientist can not only examine effects, but create them and control them, thus it is possible to manufacture an ever proliferating number of causes because one is able to manufacture an unlimited number of effects in the process we refer to as experimentation. Unlike in the real world, by which I mean everything outside the laboratory, the scientist is able to create effects that relate directly to the causes, or 'hypotheses' he or she wishes to test, and thus the laboratory is uniquely productive and powerful because it allows more effective causes to be manufactured, causes which are better at predicting and being used to manipulate the world of effects. It is able to do this precisely because the causes and effects, in the context of the laboratory, are brought into being together, as part of the same creative process.

So that is the story that emerges when we look at the pharmaceutical and work our way outwards into the constellation of interests. Obviously this perspective is inspired by Latour's (1988) work, particularly the Pasteurization of France, in which he looks at Pasteur's identification of the anthrax microbe and how it rippled out into French society, dramatically transforming it. In my final few minutes I wish to use the pharmaceutical as a means to look inward, inside the human subject, and here I think Gell's (1998) work, especially with regards to the notion of the distributed mind and object agency provides a more useful starting point. Indeed, I don't think that such different perspectives need be exclusive or contradictory with regards to each other. I briefly touched on the issue of minds, bodies and things earlier and the question I want to ask is what happens to the thing, the object like the pharmaceutical when it is utilized. For pharmaceuticals, use always entails consumption and therefore by implication, 'destruction'. Drugs, especially psychotropics do much to complicate our notions of mind and human agency. Who is the agent in cases of addiction to Valium say, or alcohol. When the mind, that is the locus of the agency with which we choose to define ourselves, is so easily manipulated, even constituted by mere things, what happens to our much-vaunted subjectivity. For example there is currently a lot of interest in the new field of pharmacogenetics, which seeks to develop drugs that are specifically targeted to interact with each patient based on an analysis of their individual genomes. Pills that control us interacting with the DNA that controls us – human subjectivity clearly is not what it used to be.

Part of the problem I think is our reified concept of the mind as this unreachable pure core of thought and the ultimate site from which agency is bestowed. Gell's (1998) concept of the distributed mind is a useful one here, but the distributed materiality of the mind does not just extend outwards into art objects or idols, but inwards as well. After all, where does material culture stop and the 'natural' body begin. We are perhaps used to thinking that some parts of our bodies, like hair and skin can be considered as material culture since they are often altered and styled for various 'cultural' purposes. Yet what about a transplanted heart? Or the norepinephrine and dopamine, the neurotransmitters we alter when we introduce something like Ritalin into the body. Neurotransmitters, organs and everything inside our bodies, and inside our heads, are as much part of material culture as that which is on the outer surface, or which extends beyond us. Neurotransmitters, and pharmaceuticals when they are taken into our bodies are created as part of the material culture that makes up our distributed minds – they affect us, and have the power to influence us just as much as a great work of art. The mind is not some fount in which objects are imbued to act as vehicles for its primary agency, all these objects that make up the distributed mind, within the body and without, a demarcation that is in itself very artificial, have agency in relation to each other, not in relation to some mystical mental core. They all form a constellation of interests that derive their agency and their interests from each other. Placebos don't work because the mind is more powerful than the body, and pharmaceuticals don't work because the body is more powerful than the mind - they both work because mind and body or one, or rather what we call the mind is actually found in the distribution itself, it is not a prior essence which then comes to be distributed. We often debate whether not the perceived agency of objects is something that is real, or whether it is merely a projection, something which only exists in the mind, and if it only exists in the mind, then does it somehow come to possess some sort of reality if everyone happens to believe in it. So what I think the pharmaceuticals tell us is that it is ultimately our concept of the mind that is the greatest of such illusory projections, and not as we often tell ourselves - the projector.

Busfield, J. 2006. Pills, Power, People: Sociological Understandings of the Pharmaceutical Industry. Sociology 40(2):297-314

Evans-Pritchard, E. E. 1976 [1937]. Witchcraft, Oracles and Magic Among the Azande. Clarendon Press, Oxford.

Gell, A. 1998. Art and Agency: An Anthropological Theory. Clarendon Press, New York.

Ingold, T. 2000. 'Tools, minds and machines: an excursion in the philosophy of technology'. In Ingold, T. The Perception of the Environment: Essays in Livelihood, Dwelling and Skill, pp. 294-311. Routledge, London.

Latour, B. 1988. The Pasteurization of France. Harvard University Press, Cambridge.

Latour, B. 1993. We Have Never Been Modern. Harvard University Press, Cambridge.

[1] Source: The Guardian, 11 April 2006

[2] See: Evans-Pritchard (1976) for the classic account of Azande divination practices