Pharmaceutical messianism and the politics of COVID-19 in the United States.

Throughout the COVID-19 pandemic, public officials in the United States - from the President to governors, mayors, lawmakers, and even school district commissioners - touted unproven treatments for COVID-19 alongside, and sometimes as opposed to, mask and vaccine mandates. Utilising the framework of 'pharmaceutical messianism', our article focuses on three such cures - hydroxychloroquine, ivermectin, and monoclonal antibodies - to explore how pharmaceuticals were mobilised within politicised pandemic discourses. Using the states of Utah, Texas, and Florida as illustrative examples, we make the case for paying attention to pharmaceutical messianism at the subnational and local levels, which can very well determine pandemic responses and outcomes in contexts such as the US where subnational governments have wide autonomy. Moreover, we argue that aside from the affordability of the treatments being studied and the heterodox knowledge claiming their efficacy, the widespread uptake of these cures was also informed by popular medical (including immunological) knowledge, pre-existing attitudes toward 'orthodox' measures like vaccines and masks, and mistrust toward authorities and institutions identified with the 'medical establishment'. Taken together, our case studies affirm the recurrent nature of pharmaceutical messianism in times of health crises - while also refining the concept and exposing its limitations.

Pampalibog: chemsex, desire and pleasure in the Philippines.

This article draws from qualitative interviews to provide the first in-depth exploration of reasons for engaging in chemsex in the Philippines. It articulates the many forms that drugs assume as pampalibog, or enhancers of libido, demonstrating the multidimensional pleasures of chemsex along overlapping sensorial and affective planes. By showing the inextricability of the corporeal to the affective, and of the emotional to the erotic, we contend that chemsex also involves the embodied and performed attainment of pleasure. As such, chemsex is both central to modern sexual scripts yet also a negotiable aspect of any sexual encounter. In constructing this rare account of drug use in settings of pleasure in the Philippines, we situate chemsex within a historical pattern of bodily tinkering and, more significantly, demystify people who use drugs by departing not only from global public health's pathologising approach to chemsex, but also from the scholarly tendency to locate drug use in the country within scenes of hardship and marginalisation.

'Kontra-partido': untangling oppositional local politics and healthcare devolution in the Philippines.

A long-recognized problem of healthcare devolution in many developing countries is its inextricability from the influences of local politics. This has been particularly self-evident in the Philippines, where, since the adoption of the Local Government Code of 1991, the devolution of health governance, planning, administration and service delivery has placed the health system largely under the control of individual provinces, cities, municipalities and villages or barangays. In this article, we utilize the notion of 'kontra-partido' (the Filipino term connoting 'oppositional politics') to concretize local, oppositional politics as a lived experience of health workers, government officials and ordinary citizens in the country. Through multi-sited qualitative fieldwork, we demonstrate how 'kontra-partido' politics ultimately worsens health outcomes in any locality. We show how such politics figures in the relational dynamics of health governance, often resulting in petty infighting and strained relationships among local health authorities; how it leads to the politicization of appointments and prevents the local workforce, especially those at the grassroots, from doing their jobs efficiently amid environments rife with hostile patronage; and how it impedes service delivery as politicians prioritize 'visible' projects (over sustainable ones) and selectively deliver health care to their known supporters. In turn, health workers and ordinary citizens alike have been actively negotiating their roles within this political milieu, either by joining the so-called political frontlines or by engaging in the transactional relationships that develop between politicians and their constituents during perennial election seasons. We conclude with a reflection on the vulnerability of health to politicization and the visceral consequences of 'kontra-partido' politics to health workers, as well as an identification of possible areas of intervention for future policy reform, given the deepening political polarization in the country and the upcoming implementation of the recently passed Universal Health Care Law.

Taking Flight: Narratives, Logistics, and Risks of Chemsex Scenes in the Philippines.

Chemsex - the use of specific, illicit substances to facilitate and enhance sexual encounters - has been documented extensively across the Global North using qualitative methodologies. Elsewhere, however, little is known about the phenomenon. Our article addresses this gap in the scholarly literature by exploring how chemsex encounters transpire in the Philippines. Through semi-structured interviews, we demonstrate the spatiotemporal nature of chemsex scenes, showing how people move between physical and virtual domains across time as they find sexual partners, procure drugs, and organize and attend the actual encounter. Consequently, the risks faced by chemsex practitioners - to health and to security - are also spatiotemporally plotted within intersecting physical and virtual risk environments, and best mitigated by a form of experiential expertise that is likewise temporally determined. Ultimately, chemsex scenes in the Philippines are distinguished from the rest of the world by the state-led "war on drugs." We consider our findings in the context of this war, showing how its very real and often fatal threats have shaped the way people navigate chemsex scenes and mitigate the risks through "counterpublic health" measures, and how its prominent ideologies and discourses are reflected in the ways by which people make sense of their drug use.

Not All Citations Are Equal: Reflections from Medical Anthropology in the Philippines.

Long before recent calls to decolonize anthropology, practitioners of "national anthropologies"-such as local anthropologists from/in/of the Philippines-have sought to implement a more inclusive kind of scholarship, and this has been reflected in their citational practices. Indeed, a look at the scholarly output of Philippine anthropologists would show a diverse set of citations that feature local scholarship, including those written in Filipino. As I will show in this article, however, not all citations are equal. Theoretical and methodological citations are typically drawn from Euro-American scholars while scholarship from the Global South is typically invoked as illustrative examples, as parallels, and to set context. Such citational practices, I argue, are a consequence of particular disciplinary histories and divergent priorities. They reinforce the inequalities of power and academic capital within medical anthropology, raising the need for more reflexivity not just about whom medical anthropologists cite but for what reasons.

Drug testing in Philippine schools: Historical overview and implications for drug policy.

With the stated aims of promoting "drug-free" campuses and "instilling in the minds of students" that drugs are harmful, drug testing in schools has been a feature of the Philippines' punitive drug regime for two decades, gaining prominence during the Duterte administration's war on drugs (2016-2022). Drawing on key informant interviews and a desk review of news articles and official documents, this paper presents a historical overview of this policy as well as its impacts on students, educational institutions, and Philippine society. The paper finds that the group most affected by drug testing in schools are the students themselves, who are placed at risk of discrimination and alienation. Schools are also affected by the policy, as it requires expending their human and financial resources. More broadly, the policy perpetuates longstanding popular notions on drugs, children, and the overall idea that individuals carry the "burden of proof" to demonstrate their worthiness for societal inclusion. Drug testing in Philippine schools is ineffective and misguided in its objectives, but it has received widespread support because of its social and political efficacies.

'Loob' and 'labas': Spatial constructions of safety and risk amid the COVID-19 pandemic in the Philippines.

This article argues that local constructions of risky and safe spaces, as articulated by the notions 'loob' (inside) and 'labas' (outside), informed popular and political responses to the COVID-19 pandemic in the Philippines, leading to an overemphasis on staying at home and, conversely, a general avoidance or fear of outdoor spaces that was at times reinforced by public health authorities. Practices and policies related to the pandemic response rendered this binary opposition between 'loob' and 'labas' visible, from regulations concerning the use of personal protective equipment to restrictions of access to outdoor spaces. While this emergent form of bodily proxemics was contested and negotiated over time, its tenacity throughout the pandemic underscores the importance of understanding how people spatialize risk in times of health crises.

Strong structuration analysis of patterns of adherence to hypertension medication.

Achieving blood pressure control is among the highest priorities for reducing the burden of cardiovascular diseases globally. Control is poor in the Philippines, especially in socioeconomically marginalised communities. This paper explores long-term adherence to anti-hypertensive medication in these communities, identifying 4 distinct medication adherence patterns. We draw on Strong Structuration Theory to explore motivations of action for those who are consistently adherent, consistently non-adherent, and those who became more or less adherent over time. We employ longitudinal qualitative methods comprising repeat interviews and digital diaries collected over 12 months by 34 participants. Twelve participants were consistently adherent, 9 consistently non-adherent, 9 increasingly adherent, and 4 increasingly non-adherent. For the consistently adherent, positive views about prescribed medication and family support encouraged adherence. Conversely, negative views of medication and lack of family support were notable amongst the consistently non-adherent, along with resistance to accepting a 'sick' label. A shift toward positive views of medication was detected amongst those whose adherence improved, along with worsening health and increased family support. A decrease in financial resources drove some participants to become less adherent, especially if they already held negative views toward medication. This study sheds light on the variety of medication adherence patterns among poor people with hypertension in the Philippines, as well as the complex web of elements influencing their treatment choices. The results point to the potential for measures that address concerns about medicines and increase family support.

Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems.

Racism, xenophobia, and discrimination are key determinants of health and equity and must be addressed for improved health outcomes. We conclude that far broader, deeper, transformative action is needed compared with current measures to tackle adverse effects of racism on health. To challenge the structural drivers of racism and xenophobia, anti-racist action and other wider measures that target determinants should implement an intersectional approach to effectively address the causes and consequences of racism within a population. Structurally, legal instruments and human rights law provide a robust framework to challenge the pervasive drivers of disadvantage linked to caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour. Actions need to consider the historical, economic, and political contexts in which the effects of racism, xenophobia, and discrimination affect health. We propose several specific actions: a commission that explores how we action the approaches laid out in this paper; building a conversation and a series of events with international multilateral agency stakeholders to raise the issue and profile of racism, xenophobia, and discrimination within health; and using our multiple platforms to build coalitions, expand knowledge, highlight inequities, and advocate for change across the world.

'Doing' hypertension: Experiential knowledge and practice in the self-management of 'high blood' in the Philippines.

Patients' embodied experiences do not always correspond to the biomedical concepts of particular diseases. Drawing from year-long fieldwork in the Philippines that involved semi-structured interviews, focus group discussions and digital diaries, we examine how individuals 'do' hypertension through their embodied experiences and the knowledge and practice that emerge from them. Drawing inspiration from Annemarie Mol's work on the notion of 'multiplicity' of disease, our analysis was informed by a commitment to privileging patients' embodied experiences and the multiple ontologies of hypertension. We find that for patients diagnosed with hypertension in the Philippines, symptoms enact illness; patients rely on their own embodied knowledge to define their illness' nature (e.g., diagnosis), experience (e.g., frequency of symptoms and non-chronicity) and praxis (e.g., self-care practices). We show how this knowledge gained from having embodied experiences of living with the disease interacts in various ways with biomedical knowledge, other diagnostic labels and clinical practices, to shape how hypertension manifests and is managed by patients. Beyond interrogating the relationship between what counts as a 'disease' and what is considered a 'symptom', our findings underscore the need to pay attention instead to the mutually co-constitutive processes of embodied experiences and disease categories in co-producing patient knowledge.

The Politics of Drug Rehabilitation in the Philippines.

The international consensus to end compulsory drug treatments and close forced rehabilitation facilities needs urgent transformation to country policies. In the Philippines, as with other countries in Asia, rehabilitation can be compulsory and is seen as the humane alternative to the "war on drugs." In this paper, we present the landscape of rehabilitation and narrate the ways in which people who use drugs are forced to undergo treatment. We unpack the politics behind rehabilitation and explain the sociocultural foundations that support compulsory treatment. We argue that a transition to a human rights-based approach, including voluntary alternatives in community settings, is possible by capitalizing on the reforms that are, unwittingly, the result of the "war on drugs."

"I Think I Have Enough for Now": Living with COVID-19 Antibodies in the Philippines.

Drawing on face-to-face and virtual fieldwork in the Philippines, I document the emergence of antibody testing as a popular practice among Filipinos during the COVID-19 pandemic, helping them make decisions about vaccines and other life choices. Antibodies gave people a sense of agency and control amid a health crisis for which political and medical authorities failed to offer certainty and hope, particularly at a time of vaccine scarcity and viral surges. However, by diverting attention from the health care system to individual immune systems, antibodies also reinforced the individual "responsibilization" that has characterized the Philippine government's pandemic response.

Decolonizing harm reduction.

In this essay, I show that notwithstanding the undeniable colonial origins of punitive drug policies around the world, such policies have figured in nationalist projects and populist platforms in various postcolonial states, and today they are viewed as local responses to the 'drug problem.' Instead, it is harm reduction and other efforts to reform drug policies that are seen as a colonial, or Western, imposition. I argue that to overcome such perceptions, there is a need to decolonize harm reduction alongside decolonizing drug policies. I conclude by offering recommendations toward this move, including involving Global South actors in leadership positions within the harm reduction movement, supporting pilot harm reduction programs in postcolonial states, and highlighting local scholarship.

Medical populism and the politics of dengue epidemics in the Global South.

With millions of cases and thousands of deaths every year in Asia and Latin America, dengue fever continues to be of global public health significance. This article uses the concept of 'medical populism' to analyse the political construction of the 2019 dengue epidemics in Bangladesh, the Philippines, and Honduras. Through this framework, we examine the narratives of these outbreaks by reconstructing how political actors simplified the discourse, spectacularised the crises, offered multiple knowledge claims, and forged divisions between the people and 'dangerous others'. Taken together, our case studies, obtained through government, journalistic, and scholarly sources, illuminate the role of medical populists (who are almost always politicians) in defining and responding to public health emergencies, underscoring the performative dimension of disease outbreaks. By detracting attention from less spectacular but more substantive policies and programs, these 'performances' of health crises perpetuate health inequities, especially in fragile democracies like the aforementioned Global South countries. We conclude by reflecting on the implications of medical populism to public health, health communications, and the inevitable recurrence of epidemics.

Pharmaceutical messianism and the COVID-19 pandemic.

As part of their populist performances during disease outbreaks, public officials and politicians tend to offer 'miracle cures' or 'wonder drugs' that can supposedly treat or prevent the disease in question. This article analyzes contemporary instances of what we call 'pharmaceutical messianism' and proposes four characteristics for this phenomenon, namely, that it: (1) emerges during times of extraordinary health crisis; (2) builds on pre-existing knowledge, practices, and sentiments; (3) borrows from medical, often heterodox, authority; and (4) involves accessible, affordable, and/or familiar substances. Demonstrating the analytic value of our framework, we present three case studies, constructed using academic and journalistic sources, during the COVID-19 pandemic: hydroxychloroquine in France, ivermectin in the Philippines, and Covid-Organics in Madagascar. We conclude by identifying some implications of our findings on public health and avenues for future research.

(De)constructing 'therapeutic itineraries' of hypertension care: A qualitative study in the Philippines.

Hypertension, a major risk factor for non-communicable diseases, remains poorly controlled in many countries. In the Philippines, it is still one of the leading causes of preventable deaths despite the accessibility and availability of essential technologies and medicine to detect and treat hypertension. This paper characterizes the 'therapeutic itineraries' of people with hypertension from poor communities in rural and urban settings in the Philippines. We employ longitudinal qualitative methodology comprised of repeat interviews and digital diaries using mobile phones from 40 recruited participants in 12 months. Our findings demonstrate that therapeutic itineraries, rather than being organized according to categories that stem from the structure of the health system (i.e., diagnosis, treatment, follow-up, adherence), diverge from clinical pathways. Therapeutic itineraries begin at a stage we label as 'pre-diagnosis' (PD). Following this, itineraries diverge according to two possible entry points into the healthcare system: via incidental diagnosis (ID) whereby participants were diagnosed with hypertension without deliberately seeking care for hypertension-related symptoms and symptom-driven diagnosis (SD) whereby their diagnosis was obtained during a clinical encounter specifically prompted by hypertension-related symptoms. Participants whose itineraries follow the SD route typically oscillated between periods of regular and intermittent medical treatment, while participants who were diagnosed incidentally (ID) typically opted for self-care As we follow our participants' therapeutic itineraries, we explore the confluence of factors informing their care journey, namely, their conceptions of hypertension, their social relationships, as well the choices and trade-offs they make. We conclude with policy implications from our findings, chief of which is our proposition that models of care based on mere access and availability of clinical interventions fail to reflect the complexity of people's lay understanding and their lived experiences of hypertension and are thus ultimately unhelpful in improving its control.