After the technology revolution swept South Asia at the end of the 20th century, outsourcing was regarded as a mutually beneficial product of globalization. Call centers and IT systems outsourced by American multinational companies gave many young Indians well-paying jobs, while company costs for expensive expertise were reduced.
A new interface for outsourcing has surfaced in the United States-India relationship, shedding more light on the nature of first world-third world globalization.
Rapid advancements in biotechnology and genomics have caused a vast range of pharmaceuticals to emerge from American labs. With some drug trials requiring over 20,000 subjects to meet Food and Drug Administration (FDA) safety and efficacy standards, these advancements do not correlate with a decrease in enrollment rates of homeland subjects. To get these drugs on the market, pharmaceutical companies are looking abroad for quick and inexpensive recruitment. What better a spot than the liberal and impecunious home of a billion people - already the global hub of outsourcing?
Quick, inexpensive, efficient and profitable are the qualities pursued by market-driven economics. Outsourcing of late-phase clinical trials by American pharmaceutical companies to India exemplifies this model in the global realm. However, if a broader conception of globalization is established, and economic considerations are surpassed, we begin to perceive many social inequalities and cultural conflicts caused by officious global leverage.
If we look closely at the outsourcing of clinical drug trials, we see that leverage of this sort perpetuates health inequities. Unlike with informational technology outsourcing, the targeted population is information-naive and "treatment-naive" (on no medication, so drug interactions are avoided) individuals. That is, lower-class citizens are sought rather than brainy computer science graduates. Forget informed consent, forget review boards and forget exclusionary screening. Instead, welcome intimidation and coercion.
Moreover, existing health disparities inherent to impoverished areas in India are exacerbated by clinical trial outsourcing. Interactions of "Western" biomedicine and public health on the global stage result in homogenization of health habits such as diet and daily activity. This can be extremely dangerous to the indigenous, natural fiber of India's rural and poor populations. A "Western" pill, or any form of health care for that matter, is an appealing luxury for these populations, regardless of its inefficacy or hazardousness. Finally, corruption and destitution in countries such as India cause patients, and physicians who administer clinical trials, to participate solely for financial incentives.
Enough has been said about the lack of consideration by U.S. pharmaceutical companies for health outcomes in Indian society. But globalization involves (at least) two states, so what about the Indian economy? Is it not possible that coercion and lack of informed decision-making are a result of India's ineffective governance?
Born less than 60 years ago, independent and democratic India relies on liberalization, privatization and globalization (LPG) as the fastest route to modernity. India's New Economic Policy of 1991 - the official introduction of LPG - has, remarkably, persisted until today. Phrases such as "any intervention by the state - in the form of controls, subsidies, selective production, etc. - will distort prices and make the resulting allocation inefficient, thus hindering economic growth;" and "any deviation from [LPG] will entail avoidable social costs" were created by the economist who governs India today.
For this reason, United States-India market synergies such as outsourcing are eagerly pursued by India to enhance its economy. And there is no doubt that India is experiencing the best economic upturn in its history, and one of the greatest in world history.
Nevertheless, the state is not accountable to citizens on the community level. Just as globalization is a postulation of world progress, democracy is a postulation in India's progress - neither is it fully put into practice in a village health clinic nor on the banks of the Ganges. These theories may point to more freedom, but in a state that is unaccountable, human development staggers when citizens are not involved in decisions that affect their health. Lower classes in India are subordinated such that their political freedom and self-autonomy are limited. Humans lose dignity when subjected to the powerful wills of foreign companies. When multinationals create rules instead of local and state institutions, public health suffers.
The extension of outsourcing from mutually beneficial information exchange to detrimental clinical trial recruitment by American pharmaceutical companies teaches us much about globalization on the local level in India, especially in terms of health outcomes. For this to be visible, globalization theory must be expanded from market-driven economic considerations to social and cultural ones too.
On the other hand, the legitimacy of clinical trial outsourcing to India teaches us that India's economy, and governance, is also market-driven. This is why the last fifteen years in India have been marked with unparalleled economic achievement. Perhaps it is time for India to refocus its economic energy to domestic affairs and true democracy. The protection of human rights and societal health should be first priority for the state. Only then can India progress and transcend a first world-third world globalization relationship that fosters health inequity.
