Citizenship, Medical Expertise and the Capitalist Regulatory State in Europe

This article demonstrates how the concept of citizenship can be used to analyse the regulatory state, with particular reference to the safety and efficacy of pharmaceutical products in Western Europe. Empirical evidence on the citizenship dynamics of medicines regulation in Europe, which is drawn from documentary and interview data, is marshalled to interrogate theories of the decline in medical authority and `disorganized capitalism'. It is argued that late modernity has seen a pharmaceutical sector in which consumers have become more active and critically reflexive citizens, but the decline in producer power or in medical authority by the fracturing of expertise (or otherwise) has been minimal. It is concluded that the balance of evidence shows that the sector is highly organized, producer-driven, oligopolous and standardized, rather than disorganized, fragmented and flexible, despite consumers' growing activism and reflexivity.