Peak Pharma Toward a New Political Economy of Health

This book argues that we have reached the 'peak' of a particular model for pharmaceutical production - the neoliberal value model that has been in place since the early 1980s. 'Peak' designates a state where a value model's contradictions become exacerbated to a point where the system cannot but change: it is a point where an industry's products become too expensive and its resources exhausted, and where the coalitions that have held up that particular value model disintegrate. In other words, it is the point where an industry collapses under its own greed, of having captured too much value for itself, leaving none to the other actors in the system.

Peak Pharma argues that the neoliberal pharmaceutical system is reaching its 'peak' in several vital respects - peak pricing, peak concentration, peak financialization, and peak expansion. It uses the term to signal the crisis and possible end of an era-defining business model in the pharmaceutical sector. The book presents a synthesis of the authors' decade-long empirical investigations into social movements contesting the pharmaceutical market. It brings together a large body of knowledge that is currently spread across political economy, sociology, STS, organization studies, and the history of medicine, to follow the neoliberal dynamics that have engendered an acceleration toward 'peak' over the span of the last 40 years. It traces the emergence of different voices and groups that have contested this evolution, particularly around specific crisis points and revelatory moments, including the fight for access to HIV/AIDS medicines, the global health era, pharmaceutical corporate social responsibility, the advent of personalized medicine and digital health, Covid-19, and others. The authors trace the shifting coalitions between the pharmaceutical industry, patient organisations, and governments that kept propping up the neoliberal value system throughout this evolution. They show that the recent acceleration toward peak has led many centrist voices from patient organizations, academia and politics to start changing course from market repair to imagining alternative pharmaceutical economies, prominently including imaginaries around the pharmaceutical commons. The book closes with a set of recommendations for policy makers and civil society actors interested in fostering an alternative political economy of health.

This is an open access title available under the terms of a [CC BY-NC-ND 4.0 International] licence. It is free to read at Oxford Scholarship Online and offered as a free PDF download from OUP and selected open access locations.

Susi Geiger, Full Professor of Markets, Organizations, and Society, University College Dublin, Ireland,Théo Bourgeron, Chancellor's Fellow, School of Social and Political Sciences, University of Edinburgh

Susi Geiger is a Full Professor of Markets, Organizations, and Society at University College Dublin, Ireland. Her current research focuses on issues of distributive justice and the collective good in these markets. She was recently appointed as a member of the WHO Technical Advisory Group in pharmaceutical pricing policies. Geiger is also an active member of Access to Medicines Ireland; she has just completed an ERC Consolidator Grant on market failures in pharmaceutical markets and she has held other prestigious grants and visiting fellowships in the past.


Théo Bourgeron is a Chancellor's fellow at the University of Edinburgh, in the School of Social and Political Sciences. His work lies at the intersection between economic sociology and political economy and he explores how financial capitalism affects people's health, especially by looking at the financialisation of pharmaceuticals. He has done visiting and postdoctoral stays in Sciences Po (France), University College Dublin (Ireland), UC Berkeley (USA), and the MPIfG (Germany).