As Alexa Dietrich begins her research into the environmental impact of the pharmaceutical industry on the small Puerto Rican community Nocorá, she attends a patron saint festival. There a friend introduces her to a local activist, Francisco, an expert in environmental health. Dietrich tells Francisco about her work investigating the effects of industrial drug manufacture on the local environment and people. Francisco wordlessly pulls his finger across his throat; she asks him if he means that she shouldn’t be asking these questions. He tells her no, but that he can give her a simple answer to her scholarly inquiry:

“El impacto es…nos matan.” The impact is…they’re killing us. His tone was calm, quite simply matter-of-fact. “Oh, not today, not tomorrow, but little by little, it will kill us all.” (4)

In The Drug Company Next Door, Dietrich investigates the nexus of activism, corporate money, and politics surrounding drug manufacture in Nocorá, Puerto Rico. She collects a rich technical and activist literature demonstrating the drug factories’ horrific effects on the region’s famously pure aquifers, on local wildlife, and on coastal areas disfigured and sterilized by industrial sludge; she also charts the political, economic, and social impact of drug manufacture, showing its subtle and obvious effects on local politics, social life, and community action.

Dietrich’s narrative follows the work of many leading medical anthropologists (Farmer, Biehl, Petryna) in its deep, nuanced account of structural violence. Unlike much other critical medical anthropology, which focuses on individual and collective suffering, politics and history, Dietrich also successfully integrates the methods and insights of environmental anthropology. In addition, her attention to the ravages of heavy industry on Nocorá’s environment is moving and theoretically engaged (calling to mind Whitmarsh’s work on Barbados).

The pharmaceutical industry came to Nocorá over forty years ago, replacing a publicly-owned sugar processing plant. Dietrich traces the history of the region with an eye to social justice and structural violence. Citizens of Nocorá have always related to labor with deep ambivalence, she discovers; the sugar plant was a vital source of jobs and community identity, but it also involved physically degrading labor that Nocoráns associated with an old-fashioned or un-modern way of life; the drug companies, on the other hand, deliberately and skillfully associate themselves with ideas of economic development, health (their products, after all, have become central to healthcare), high technology, corporate social responsibility (“CSR,” a subject that Dietrich treats with enormous insight) and progress.

The problem with this, Dietrich explains, is that the drug companies have promised something that they have never delivered. For forty years the citizens of Nocorá have believed that the drug industry’s presence in their town would offer high-paying careers. The reality is that the drug companies, none of which are Puerto Rican owned, came to Nocorá because of Puerto Rico’s favorable tax status, pliant environmental regulations, and most tragically because of the local abundance of beautifully pure water. They did not establish factories in Nocorá to attract labor; Dietrich stresses that the pharmaceutical jobs available for relatively uneducated local people are few and menial. Highly credentialed outsiders, some Puerto Rican and some from the mainland, run the factories. What they produce, locally, is not jobs but industrial effluent (sometimes the color of green antifreeze) and noxious vapors that wake locals in the night with their almost unbearable foulness; Dietrich wryly demonstrates that this literal and metaphorical bad odor reveals a great deal about the relationship between Big Pharma and Nocorá.

This is not to say that the presence of Big Pharma has benefited no one in Nocorá; Dietrich shows in great detail how industry remittances and tax payments, all legal and aboveboard, have flowed copiously and directly into municipal accounts. This has allowed the town’s alcalde, Estrella Martinez, to mold himself into a permanent and nearly autocratic ruler, shaping the town physically, politically, economically, and socially according to his own desires and, most critically, representing the pharmaceutical industry in a notably positive light and integrating pro-pharma and pro-industry messages into nearly every aspect of community life.

The Drug Company Next Door is ambitious, successful, closely reasoned, vivid, exciting, enormously distressing, and challenging on a political and theoretical level. Dietrich’s writing is so good that I would recommend this book for use at any level of anthropological study, from undergraduate all the way up. Her attention to environment and community is refreshing and virtuosically skillful. Her book also gives a valuable methodological template for researchers who wish to conduct similar studies (and they are needed) into the political-economic life of the drug industry. Dietrich is a master of tracing connections:

Three Kings Day, the final act of the traditional Christmas season in much of Latin America, is celebrated in a number of municipalities by gift giving on a monumental scale, from alcaldes to local children. Nocorá was no exception, and one acquaintance assured me that Martinez’s generosity was gaining him a regional reputation. “I know people who’ve come from several towns over,” she told me. Thousands of children lined up in a well-cordoned-off and tightly managed enclosure to receive one of several options […] I stood chatting with Martinez a few moments, as he grinned at the lines of people, telling me that this practice was a long-standing cultural tradition that he took particular pleasure in following. (87)

Without Dietrich’s sensitive, brilliant anthropological detective work, we would have no way to know that this charming folkloric scene took place under the (sometimes literal) mephitic cloud of industrial poison.

Ari Martin Samsky, Washington University in Saint Louis

Dietrich, Alexa S. The Drug Company Next Door: Pollution, Jobs, and Community Health in Puerto Rico. New York University Press, 2013. Read More at NYU Press.