Poisonously single-minded: public health implications of the pharmaceuticalization of leishmaniasis in Colombia

Abstract

ABSTRACT Cutaneous leishmaniasis is a vector-borne disease transmitted by sandflies that causes skin ulcers. In Colombia, this disease mainly affects rural populations and combatants of the armed conflict. The state management of leishmaniasis is pharmaceuticalized – centered on a highly toxic drug called Glucantime. Drawing on critical views of the pharmaceuticalization of public health and the implications of the massive use of drugs in colonial contexts and developing countries, this article establishes an interdisciplinary dialogue between biomedical literature and ethnographic data. I explore the consequences of a public health model based on an old, toxic, and potentially deadly pharmaceutical to control a mostly benign skin disease. I argue that while it is necessary to guarantee that all people have access to antileishmanial therapies, there remain dangers associated with Glucantime that puts into question its predominant use in Colombia. This case shows that pharmaceutical access alone, and drug-centered models in particular, not only represent limited views of public health but can have disastrous consequences for those affected by disease and marginalization.