| Pharmaceutical companies in their local ecologies have a contentious relationship to human health and well-being. They produce substances which can save, extend, or improve the quality of human life. However, their production facilities are also sources of pollution toxic to people and to the environment. In Puerto Rico the pharmaceutical industry is central to the island's economy, and enforcement of environmental regulations has taken a backseat to economic development. In the north coast town of Nocora [pseudonym], there are over a dozen drug factories representing four multinationals, the highest concentration per capita in the world. Based on 16 months of fieldwork in Nocora, this dissertation explores the multiple roles of pharmaceutical corporations as polluters, economic providers, and as social actors.;The findings suggest that in spite of recent efforts by companies to act in more socially responsible ways, some segments of Nocoreno society bear a substantial burden of negative health and quality-of-life outcomes as a consequence of the pharmaceutical factories' activities. The qualitative and quantitative data gathered also present a broader picture of Nocoreno social relations, showing how philanthropic actions of the companies serve to cement their place in local political rituals and their relationships with elites, while failing to address the needs of local residents. These data suggest that expert knowledge in public health and environmental science is used to maintain privileged access between these corporations and government agencies, and to discredit resident concerns about pollution.;This study is one of a few seeking to unite the concerns of critical medical anthropology with those of political ecology, and demonstrates concretely how the well-being of human citizens can be sacrificed for the benefit of corporate entities. It argues that a radical redistribution of technical knowledge, as well as recognition of the existing knowledge bases of local communities, is necessary to achieve long-term mutual accountability for the environment. Mutual accountability between residents, government, and corporations is also crucial to addressing the environmental health concerns of small communities, so often told that their concerns have no scientific basis, or that their health problems are caused solely by their own behaviors. |
