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Regulation & Governance (2013) 7, 365386

doi:10.1111/j.1748-5991.2012.01152.x

Embedded regulation: The migration of objects, scripts, and governance

Emilie Cloatre
Kent Law School, University of Kent, Canterbury, Kent, UK

Robert Dingwall
Dingwall Enterprises and School of Social Sciences, Nottingham Trent University, Nottingham, UK

Abstract
This paper asks why an ofcially unregulated market in pharmaceuticals in a least developed country, Djibouti, behaves as if it were strictly regulated, with limited access to a small number of high-cost drugs. We use Actor-Network Theory (ANT) to show that the explanation is more complex than critics of the international pharmaceutical industry have supposed. Regulation and property rights generated in developed countries have become embedded in the drugs and black boxed to the point of invisibility. This has allowed them to travel to Djibouti with the drugs, while maintaining their effects in action. This case study develops our understanding of the way in which materials that are not designated as regulatory agents may still have regulatory impacts through their ability to enrol complex networks of actors, rules, values, and practices. Finally, it argues against the notion of law as a xed and distinctive space for action, as opposed to the ANT vision of a uid and contingent order, where law is part of a socio-technico-legal alliance that happens to achieve certain effects. Keywords: actor-network theory, development, intellectual property, pharmaceuticals, regulation.

1. Introduction This paper examines the way in which regulation can become embedded in material objects and practices and black boxed to the point where it becomes invisible to everyday analysis, while maintaining its effects in action. In doing so, the paper explores what Actor-Network Theory (ANT) can bring to the understanding of regulation, by allowing us to conceptualize materials as able to enrol complex networks of other actors, rules, values, and practices. Latour (1992) observed that everyday objects, like seat belts or speed humps in roads, can be made to act as regulatory instruments, shaping human behavior in predetermined ways. The ofcial grafti of Hermer and Hunt (1996) is another well-known form of action at a distance by regulators through the deployment of purpose-built materials (see also Hunt 1996; Lessig 1999; Lippert 2009). In this paper, we examine how the ability of materials to enrol other actors can result in regulatory effects being produced, in ways that may be unexpected, unintentional, or invisible to human regulators. The materials considered here are different from artefacts
Correspondence: Emilie Cloatre, Kent Law School (KLS), University of Kent, Canterbury CT27NS, UK. Email: e.cloatre@kent.ac.uk Accepted for publication 24 June 2012.
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explicitly designed or built to act as regulatory agents, of the kind discussed by Latour: they are not created as regulatory tools. Observing their mechanisms allows us to reect on the blurry denition of what the regulatory space, or regulations, may be. This paper, therefore, also responds to the recent recognition within regulation studies of the need to understand regulatory entities and activities beyond those represented by the institutions and work of ofcial national or supranational agencies. Our case study of the supply of pharmaceuticals to a least developed country, Djibouti, shows how ANT can assist in understanding the embedding of regulatory forces within materials, and their consequent inuence in new, unexpected, networks. The regulations embedded in pharmaceuticals by governance networks in France, and other developed countries, have travelled to Djibouti, where the pharmaceutical market is ofcially open, but is, in practice, limited to a small range of patented, branded, and expensive medications. An analysis of local networks demonstrates how these embedded regulations have met little resistance and how medicines have successfully enrolled key actors to create a de facto regulated market. We conclude by reecting on what ANT can add to the study of regulation more generally through its established tradition of exploring the heterogeneous ordering of society. Silent regulations, embedded in technologies, can be identied, described, and analysed, in ways that blur the limits and boundaries of the regulatory space. The legal space becomes similarly uncertain. We begin by introducing the key ndings from our case study, before turning to examine the elements of ANT used to analyse them. 2. Djibouti: market, drugs, and regulatory scripts Djibouti is one of the smallest and poorest countries in the world. It has a population of about 820,000 and GDP per capita of about $1,250 (World Bank 2010). While the state is reasonably effective, its capacity is limited by the populations size and relatively low level of education. In particular, Djibouti lacks the specialist scientic, technological, and cultural activities that generate a demand for the legislative and regulatory interventions that constitute and structure markets, including those for pharmaceuticals, in more developed countries. Intellectual property has only developed as a eld in Djibouti since its adoption of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement, and the consequent passage of implementing legislation in 2009, which has still to be brought into effect. State intervention in the pharmaceutical market has historically been very limited and there was no statutory protection for pharmaceutical patents prior to 2009. Emilie Cloatre (EC) carried out eldwork in Djibouti from January to April 2004. This included interviews with 25 local actors, primarily from the elds of public health, intellectual property, and trade and industry, with some observational data collected around interviews and in key settings, such as pharmacies and local markets. Snowballing was an important part of the process of recruiting informants: it is difcult to identify relevant actors from documents in Djibouti. Informants included staff within the ministries of health, and trade and industry; health professionals (doctors, and hospital and community pharmacists); a World Health Organization representative; the leaders of the World Bank programs on access to medicines then being implemented; and legal professionals and other policy actors with general knowledge and experience of the political and juridical context. They included both Djiboutian and French nationals (present in policy
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and political institutions and in the health eld). Several interviews were conducted with most of the actors involved over the period of this research, allowing statements to be interrogated and rened. Further, shorter visits and phone interviews have been carried out in subsequent years allowing developments to be observed. Policy documents were used when existing and available, but a signicant amount of information was simply not published as a result of both the predominant oral tradition in the country, highlighted by many informants, and the limited availability of information technologies common in developed countries. Observational visits were made to private pharmacies, to one hospital pharmacy, to the pharmacies communautaires introduced by the World Bank (described later in this paper), and to the site where the drugs distributed in these last were centrally collected and stored. The visits facilitated by pharmacists allowed statements in interviews to be followed up in a practice context, prompting further reections and questions focused on the history and properties of selected drugs. The sensitive political climate in Djibouti placed a particular stress on protecting the anonymity of informants. Although it had originally been intended to record interviews, informants were reluctant to agree to this and most of the data consists of extensive notes, reviewed after the event. Some stories remained incomplete and could not be clearly spelt out or elaborated by informants: those limitations are noted as appropriate. Nevertheless, given the relatively small size of the networks under scrutiny, and the signicant support from participants, a detailed picture of the pharmaceutical eld could be gained within the three months of data collection. This research was originally designed to explore the impact of the TRIPS agreement on the availability of patented drugs in Djibouti. The introduction of ANTs emphasis on the modes of action of things, unearthing the role of materials in social networks, generated broader questions about the deployment of drugs, how these acted in particular ways, and how their action related to ordering and regulating processes, such as those of patenting. Having accepted that materials are also the gathering of scripts and forces, we were led to explore the constant interaction between levels, actors, and networks, and the part that drugs and patents played in these multi-directional inuences. The analysis came to focus on the mechanisms for the procurement and distribution of pharmaceuticals, which, in turn, required a more general understanding of the health system. The situation in Djibouti has evolved since 2004, and it is important to locate this paper in its temporal context, as reecting a well-stabilized moment that allows us to investigate the role of medicines in regulating and ordering local pharmaceutical markets. By focusing primarily on the 2004 market, we are describing the situation prior to its entanglement with the networks of global institutions that have since imposed liberalization and transformed the systems. References are made to the current situation as appropriate, but the focus is on the market as it functioned for many years. Current developments can be understood fully only if we recognize what they are laid upon, and interacting with, which is not easy because of the continuing processes of entanglement and disentanglement between local and international actors. 3. The pharmaceutical market in Djibouti This section describes the dynamics of Djiboutis apparently unregulated pharmaceutical market in 2004, which drugs are, in practice, allowed to enter it, and how this selection
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takes place. Ofcially, very few regulations limited the availability of drugs, beyond basic rules aimed at preventing counterfeiting. There were no intellectual property rules and no regulations specifying conditions under which generic medicines might enter the country. The implementation of the TRIPS agreement was progressively bringing changes, but its practical impact was still uncertain (on the implementation of TRIPS in general, see Deere 2009). In the course of eldwork, however, it emerged that this market was more constrained, and far less exible, than its apparently unregulated nature might have led us to expect. Only specic ranges of drugs managed to enter the networks of supply, distribution, and prescription or sale. These were often the branded and patented, and the most expensive versions of medication available (on the links between patents and prices, see e.g. Balasubramanian 2002). There are obvious practical implications for a very poor country and it was puzzling that the cheaper generic versions of key medications produced in countries like India, South Africa, and Brazil had failed to enter this market. The pharmaceutical market of Djibouti is not homogeneous, and, in the rest of the paper, we will focus on its dominant part. However the exceptions are also interesting for what they tell us about other inuences and how these manage to enter parts of the market or subsystem linked to particular diseases. In 2004, the most substantial part of the Djiboutian pharmaceutical market (twothirds was the consensus estimate among informants, because they generally considered statistics in Djibouti to be unreliable), consisted of drugs sourced and distributed by the countrys two private pharmacists. They supplied most individual patients, and most of the drugs used by public hospitals. The medicines purchased and distributed through this private system fell within a narrow range, purchased from a small set of multinational companies. Most were under patent, or were the original version of a drug whose patent had expired elsewhere and which now faced generic competition in other markets. Generic medications, from any source, were almost completely absent. The pharmacists afrmed that they did not purchase generic drugs, and ECs visits to private pharmacies and public hospitals found that the observable drugs were branded; some branded generics sourced from large multinational companies were found, but in limited supplies. When asked, the pharmacists agreed that these were exceptions. Whilst largely unregulated in terms of proprietary rights, this part of the market appeared both narrow and constrained. Smaller, isolated, networks enrolled generics more extensively. The Organisme de Protection Social (OPS) runs a hospital targeted to Djiboutian employees, funded partly through public funds and partly through private employers contributions. Those entitled to treatment there would tend to choose it over public hospitals, and benet from free medication distributed by the OPS pharmacy outpatients in other hospitals needed to purchase their drugs from private pharmacies. The reputation of this hospital was also generally good, explaining why it was a preferred choice for those with entitlement. The OPS pharmacy was dependent largely on generic drugs, purchased through a specialized Dutch international wholesaler. A notable exception was anti-retroviral drugs (ARVs): the pharmacist stated that their regular supplier did not provide them, and they had not yet looked into alternative sources. In effect, the list of drugs supplied to this pharmacy (which was made available to us) was a list of out-of-patent generic drugs, whilst the patented drugs that were used in the hospital (ARVs) were purchased in their branded version. The OPS system remained compatible with European patenting rules.
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Donations have traditionally played a part in the pharmaceutical system of Djibouti, although this has been diminishing. Through these, a number of generic drugs entered the country and were redistributed to hospitals. Public health ofcials, and the pharmacists in charge of managing donations, all emphasized that this source had become highly problematic; quality control was an issue, and the poor t between the drugs donated and the needs of local hospitals meant that a substantial part of direct donations could not be used. The lack of ability to test or verify drugs in Djibouti also meant that any uncertainty about drugs, which was prevalent when dealing with generics, meant that they would not be used. The nal route by which some generic drugs entered Djibouti was through World Bank interventions. In particular, one project, implemented while this research was carried out, aimed at developing new points of entry for cheap basic medication targeted at the poorest part of the population that currently had no access (World Bank 2002). It created small pharmacies communautaires based in the poor neighbourhoods of the capital and other cities. They stocked only a very limited range of drugs (including paracetamol and aspirin, antibiotics, anti-diarrheals); these were in generic form and made available to the population for a symbolic cost. All drugs distributed through these pharmacies were out-of-patent. These exceptions were only a small part of the pharmaceutical market of Djibouti. They do, however, reect some relevant social considerations. Djibouti is characterized by a signicant gap between the very rich and the very poor (common in many developing countries), and a relatively small middle class. A signicant part of the resident population is French expatriates from a large military base or working through the different elements of a cooperation system. These foreign residents, together with the richer layers of the Djiboutian population, constitute a large part of the market served by the private pharmacists. For others, treatment is available either through public hospitals, as inpatients, or, for those with employment but limited resources, through the OPS. The pharmacies communautaires were created to cater for those that cannot access either the expensive private market, or the targeted system of the OPS, and who do not need or are unable to obtain admission to a public hospital the most deprived part of the population, which otherwise has no or very limited access to medicines. Counterfeit medication was mainly absent from the Djiboutian market in 2004, a very unusual situation in sub-Saharan Africa. Informants all stated that this was not a concern, while acknowledging that it was a surprising feature of the local system. Two informants mentioned concern about creams to lighten skin, but did not consider these to be medicines. This contrasts sharply with contemporary eldwork in Ghana, for example, where the issue of counterfeiting was spontaneously raised by all informants when discussing access to drugs. Observations in local shops and markets also failed to identify the usual offers of medicines that can easily be spotted in much of sub-Saharan Africa. The situation has now changed, and in further interviews carried out in 2011, the growth of this new market was deplored, and linked to the progressive liberalization that we discuss in the conclusion: Now you can buy medicines in corner shops; not on the streets yet, as we see in other places, but in many grocery stores. And of course these are often counterfeit, entering from Somalia. It is a real problem here now. So you know, liberalization . . . it has its downsides too!
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This research did not engage explicitly with traditional medicine, although informants were asked about its role and relevance. Most informants discounted its contribution. Although it certainly plays a part in providing health care to the most deprived parts of the population, it is again less visible than is the case in many African countries. In particular, herbal remedies were rarely seen on market stalls, and were not openly sold in the way that they are in other parts of Africa. Overall, the pharmaceutical market(s) of Djibouti, although ofcially unregulated by patents, appeared to incorporate rather strict rules about what might or might not enter. In the course of this research, no drug was identied that was sold on the ofcial market in Djibouti that could not have been sold in the highly regulated markets of developed countries with well-established intellectual property systems. In fact, even many cheaper drugs sold in these ofcially regulated markets, such as generic versions of drugs whose patents had expired, only appeared in Djibouti in the exceptional circumstances of the World Bank pharmacies and the OPS. Reciprocally, in both cases, the drugs selected still responded to some basic regulatory-like criteria; the generics were versions of drugs no longer under patent anywhere in the world, rather than the generic equivalents of patented drugs produced by alternative processes in countries like India, where product patents had not been legally recognized until the implementation of TRIPS in 2005 (Karandikar 1994; Redwood 1994; Koshy 1995; Henderson 1997; Keayla 1999). Strong barriers to entry were operating in practice if not in law. Despite the absence of local regulation, or any equivalent policy decision, established behavior and practices clearly resulted in limitations on the drugs being enrolled into the pharmaceutical networks within Djibouti. Some power was acting that achieved the regulatory outcome of protecting monopolies on pharmaceutical innovation or branding without the explicit and visible frameworks that create and enforce patents and other intellectual property rights. Although not exceptional, this case is rather unusual. First, because markets that are ofcially unregulated by patents are increasingly rare, with growing pressure on developing states to implement intellectual property (IP) standards, and with many developing states having previously had some form of IP legislation. Second, because many developing countries have actively attempted to inuence local pharmaceutical markets to increase access to generics. For example, as a comparison, the Ministry of Health in Ghana has endeavoured to extend the use of generic medicines, and other African countries have implemented some form of access to medicines policy (Ghana Ministry of Health 2008). This does not mean that the use of generics does not remain limited in these places, and a close look at the situation on the ground often demonstrates that health professionals are still either not relying on generics in the way the government suggests, or nding it difcult to convince patients to accept them. The specicity of the example of Djibouti stems from the systematic exclusion of generics from the supply and distribution system, rather than from the difculty in getting patients to use generics. This story raises a number of issues about the nature of regulatory processes, and the role that various actors play in it. One particular question is overarching: how does a market that is ofcially unregulated adopt a shape that is so strictly bound, limited, and ordered? An ANT approach would suggest that regulations have been embedded into drugs, and carried as part of their associated scripts. Drugs could be conceived as complex objects, black boxes of power, regulations, relationships, values, acting together with chemical entities that manage to retain their socio-technical shapes in crossing national
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or jurisdictional boundaries and drifting into new and unexpected networks. In the remainder of this paper, we turn to elaborating upon this approach, starting by recalling the main concepts of ANT that are relevant to this claim, and linking them to current trends in regulation theory. 4. Actor-network theory and the study of regulation When analysing how a specic eld is regulated, it is now established that both formal rules and incentives or disincentives created by the state to constrain and direct behavior can be relevant (Hancher & Moran 1989; Jessop 1990; Baldwin et al. 1998; Braithwaite & Drahos 2000; Morgan & Yeung 2007). Governmentality studies have also broadened our understanding of the varied ways in which state inuence can be exercised (Miller & Rose 1990; Rose 1999). The concept of soft regulation has also been used to direct attention to the more social and functional attempts to regulate (Jacobsson 2004, p. 356; see also Sisson & Marginson 2001). The progressive expansion of what may be understood to constitute regulation has extended scholarly interest to encompass all mechanisms of social control including unintentional and non-state control (Baldwin et al. 1998, p. 4; see also Baldwin & Cave 1999; Clarke 2000; Black 2002a,b), and the practices of everyday regulation embedded in purpose-built materials (Hermer & Hunt 1996). Within this perspective, an understanding of regulation demands an analysis that is not conned to rules and strategies, but also embraces organizations and practices that can constrain the behavior of those who encounter them. Here, we want to explore specically the regulatory role of materials. In order to do so, we turn to ANT, and its recognized tradition for analysing the role that materials play in social networks. ANT has established itself largely for its understanding of society as a complex and uid set of heterogeneous networks (Latour 2005). In these networks, materials play an essential role, and are fully blown actors who deploy effects and powers in ways that are not different from those commonly attributed to humans (Callon 1986a; Latour 1992; Law 2008). By resisting grand theorizing and remaining focused on the empirical, ANT is a tool to study the connections and associations that link people and objects, dene their participation in a eld or network of action, and assign relevant properties to them a really crude method to learn from the actors without imposing on them an a priori denition of their world-building capacities (Latour 1999, p. 20). By insisting on the fragility of predened categories, and the importance of materiality for social networks, ANT has established itself as the key method in social sciences that enables researchers to explore the potential and actual forces deployed by materials, and to investigate the mechanisms employed by things, within heterogeneous networks, to produce order, stability, and regular alliances (Law 1994). Traditionally, ANT researchers have seen order and stability as local and contingent epiphenomena generated by a particular set of relationships, and have sought to describe how they are achieved (Law 1992a). Processes of ordering, therefore, are central to ANT studies. At the core of the approach is an attention to the way in which actors create alliances and connections that draw the social into an organized network with an appearance of stability (Law 2008). The notion of enrollment, used throughout this paper, reects those mechanisms of mobilizing others and making others act in a certain way. The process of ordering in ANT encompasses regulatory processes as some of the ways in which actors enrol and inuence
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others into falling into particular patterns of order and behavior (Barry 2001; Rooke et al. 2012). These patterns are always contingent and fragile, and their origin may remain obscured, but the role of materials in maintaining them is essential. A nal, general point on ANT of importance here is its irreductionist nature. If everything is to be understood as an effect of fragile connections, nothing can ever be reduced to or explained by any xed, predetermined category or phenomenon. Examples of notions that are challenged by ANT authors as explanatory categories are power, knowledge, and capitalism. ANT does not deny that these exist, but understands them as being effects rather than causes, and as being part of the explained (or to be explained), rather than part of the explanatory possibly as a reaction to the dominant critical Marxist tradition in French sociology against which early ANT writers positioned themselves in the early 1970s. For Latour, knowledge is more than an abstract concept or a reference point, as becoming familiar with distant events requires (. . .) kings, ofces, sailors, timber, lateen rigs and trade; similarly using the term power would be a mistake because the reckoning of lands, the lling-in of logbooks, the terring of the careen, the rigging of a mast, cannot without absurdity be put under the heading of this word (Latour 1987, p. 223). Using an example explored in the remainder of this paper, the power of global pharmaceutical companies cannot be explained purely by referring to an established power in a global capitalist market, but will be done more usefully by exploring the ways in which their inuence is deployed in various other localised networks. Developing this idea further, he explains why we need to focus on how material strategies for acting at a distance are deployed to generate these different effects: We need to get rid of all categories like those of power, knowledge, prot or capital, because they divide up a cloth that we want seamless in order to study it as we choose (. . .). The question is rather simple: how to act at a distance on unfamiliar events, places and people? Answer: by somehow bringing home these events, places and people. How can this be achieved, since they are distant? By inventing means that (i) renders them mobile so that they can be brought back; (ii) keep them stable so that they can be moved back and forth without additional distortion, corruption or decay and (iii) are combinable so that whatever stuff they are made of, they can be cumulated, aggregated or shufed like a pack of cards. If those conditions are met, then a small provincial town, or an obscure laboratory, or a puny little company in a garage, that were at rst as weak as any other place, will become centres dominating at a distance many other places. (Latour 1987, p. 223). Callon has focused specically on revisiting the usefulness of the notion of capitalism in much of his writing, and our analysis below takes a similar approach to revisiting the relationship between the explained and the explanatory. When asked about the role of concepts such as capitalism in his analysis, in an interview with Barry and Slater, he summarizes what is also the more general understanding of ANT on such notions: I would say that we no longer have macro-structures. The idea of the existence of macro-structures is very far from the description we are trying to give. As I said, it doesnt mean that there are only local localities, because what is provided by this description is precisely a double logic of local framing and connections between localities. In these terms, some localities are able to control other localities. So what
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has to be explained is precisely the progressive construction of connections, and of localities that are able to control other localities (. . .) So I would not say that you have structures and that you have positions within these structures, and from this position you can deduce or explain some opposition or some conicts about how to structure economic markets given the fact that this structuration depends on how congurations which mix property rights, certain forms of technological developments as well as other things. It doesnt mean that there is no structuring process, but that the structuring process as such is at stake. (Barry & Slater 2002, p. 295). 4.1. Material forces ANTs claim that materials are actors, in the same way as humans, is counter-intuitive to many and deserves closer attention (Amsterdamska 1990; Collins & Yearley 1992; Lee & Brown 1994). A starting point is ANTs understanding of power and of how social actions are realized. In ANT, power is an effect, rather than a given, and originates from the alliance between heterogeneous actors. Materials and humans, and their respective role in generating these effects, are impossible to isolate. More generally, any actor, human, non-human, or more likely, hybrid, is always only enabled by the particular set of connections it has established with others. Continuity and interdependency are key to social action and to the process of ordering (Law 1992a). Power, then, is the outcome, rather than the starting point, of a relationship, evidenced by the co-construction of the parties to that relationship. Mao Tse-Tung used to say that power grew out of the barrel of a gun, but it could only do so because of the connections between the person with the gun, the gun itself, and the person at whom it was pointed. As documented encounters between modern and traditional societies underline, the target of the weapon needed to recognize the lethal properties embedded in the gun for this network to function in the way that Mao claimed. The gun threatens and can be seen as acting and directing the behavior of others, but its action is co-dependent on its relationship with the holder and with those it is pointed at. The source of action becomes diffused and is the result of the interrelationship between those involved, but the gun is an actor in the ordering mechanisms at play in a way that is not fundamentally dissimilar to the action of others. This example is from an account of an encounter between Spanish adventurers and coastal people in modern Ecuador or Peru early in 1528: . . . they begged him to discharge an arquebus that he carried because he had done it on the ship several times in the presence of some Indians, which was the reason why the others knew about it . . . When the arquebus discharged, many of the Indians fell to the ground, and others screamed . . . (The cacique) asked Candia for the arquebus and poured many cups of their maize wine into the barrel, saying Take it, drink, since one makes such great noise with you that you are similar to the thunder of the heavens. (de Cieza de Lon 1998, pp. 112113). Power, actions, and ordering become multi-directional and co-dependent processes action is interaction. This leaves the role of materials to be more determinant than in most sociological analysis. If movement, events, and ordering are the results of the interaction of heterogeneous actors, and if the very social existence of such actors is dependent on a constant interaction between hybrid entities, the source or origin of action cannot be allocated purely to humans any more than it can be allocated purely to
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materials. Instead, deployments and existence are constant back and forth movements between different layers of a mixed network. The concept of symmetry articulates the analytic position that any actor-network dened as the gathering of sets of connections in a particular locus (Latour 1999) should be understood and dened only through the links that lead it to act in the way that it does, rather than on the basis of shapes it could be expected to take according to a prior denition (Law 1992b). It invites us to revisit the place we grant to non-humans within sociological analysis; it also implies a layered analysis of the nature of things, and an acknowledgment that they are inherently complex subjects. This is not to say that all materials will secure active roles in networks in ways that are uniform or undifferentiated indeed, the relative inuence of human actors is similarly dependent on their relationships with other, human and non-human, actors. Latour (2005, p. 39) uses the concepts of mediators and intermediaries to explain this point: An intermediary, in my vocabulary, is what transports meaning or force without transformation: dening its input is enough to dene its output. For all practical purposes, an intermediary can be taken not only as a black box, but also as a black box counted for one, even if it is internally made of many parts. Mediators, on the other hand, cannot be counted just as one; they might count for one, for nothing, for several or for innity. Their input is never a good predictor of their output, their specicity has to be taken into account every time. Mediators transform, translate, distort and modify the meaning of the elements they are supposed to carry. The regulatory role of materials will similarly vary, not only across materials but also across space and time. For example, the relative ordering power of branded/patented medicines varies according to where they are their role in Djibouti differs from that they are enabled to exercise in other parts of the world and when they are deployed their relative inuence in 2004 being different from what it is in 2012 after the local market has become enrolled into new global networks. 4.2. Whats in a thing? Materials are not simple or single entities. Their role and inuence is both the mediation and the expression of forces that are embedded in broader patterns and histories. One signicant aspect of their complexity is the fact that technical artefacts come with scripts that embody morals and politics (de Vries 2007, p. 783). They respond to a set of expectations attached by their creators, which they carry with them as they move into and across new networks (Callon 1986b; Law 1986; de Laet & Mol 2000). These loaded materials, when deployed into new social networks, can participate in reproducing effects and powers that originated elsewhere and become embedded in them. Once scripts, connections, potentialities, history, politics, have become embedded into a material, this black box will be experienced as a single, unied entity for many of the actors it encounters. As it acts and moves across networks, the material will deploy its inuences and that of the many scripts it embeds. It will also, often, work in ways that are unforeseen and unexpected by its creators, drifting away from the original plan (de Laet & Mol 2000). These drifts may sometimes be read or experienced as a failure to act by the material, but will, in fact, often be a case of them simply doing something different from what had been expected.
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Examples of the enrolment and deployment of scripts have been given in previous ANT studies. For example, Williams-Jones and Graham (2003) analyse how genetic tests developed to evaluate risks of breast cancer became loaded with assumptions, meaning, and selected values, including particular stances on the role of markets, family organization, body image, and maintenance, and on acceptable levels of quality and quantity of life. As a result, the marketing of the test is simultaneously the promotion of these normative positions as part of the script that denes the tests role in a network of researchers, manufacturers, providers, and users. Similarly, the drugs that are followed in our studies carry with them a signicant political history, and, we argue, signicant regulatory inuences. 5. Unpacking black-boxed drugs Drugs can be unpacked in many ways, depending on the network under scrutiny: ANT studies have provided empirical examples of medical devices as multidimensional and complex objects (Singleton 1998; Mol 2002). The process of transforming drugs from chemical entities into social objects through the intervention of physicians and pharmacists has been documented (Dingwall & Wilson 1995). However, drugs are also socio-legal objects constituted by regulatory actions that distinguish legal and illegal drugs and dene a set of criteria and processes by which new entities are assigned to one category or the other (e.g. Rooke et al. 2012). There are a range of liminal spaces within these processes, where drugs may pause while their nal status is determined. The nal classication also has various renements that determine who can grant and receive access to particular drugs under particular conditions. This regulatory environment is a source of connections, scripts, and values that become embedded into the drugs and black-boxed.When the drugs cross national boundaries, however, these scripts can travel with them, especially when they are moving to a country that lacks the resources or expertise to open the box and make its own determination of the status of its contents. In this way, for example, drugs in Djibouti may be deployed as if strict patent standards had to be followed. Patents grant inventors quasi-exclusivity in a market for a certain product over a period of time. They are both the result and the expression of a series of associations that generate the power of specic institutions (for analyses of the complexity of patents, see Bowker 1992; Pottage & Sherman 2010). This can be deconstructed at several levels, both from the political economy strategies that are implied in the concept of patents and in their global regulation (Sell 2003), but also at the level of meaning that they hold for pharmaceutical companies. Most patents are held by a few companies, exemplifying their signicant power, but also perpetuating it by allowing them exclusive rights and the benets that ensue. Patents have implications for relations of dominance and the relative ability for national actors to challenge established practices (Sell 2003). The drugs that enter Djibouti are inscribed with a particular history of inuences and relationships, and concomitant forms of regulatory power. They are produced and rst marketed in a specic national context, by the large multinational companies that dominate the global pharmaceutical market. These companies have developed extensive networks enrolling wholesalers, pharmacists, doctors, and patients around their products. The regulatory environment of these drugs and the political and economic context of their deployment are essential to their modes of action. These products were created in an
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environment where patent law actively shaped the constitution of the drug as a sociolegal object to the extent that it entered the black box. Even where the patent has expired, its imprint is retained in the history of the product and its associated scripts. Part of this is perpetuated by another crucial and entangled dimension of modern medicines their brand. Brands often become the public face of individual drugs, and play a signicant part in consumer delity: their power is nonetheless heavily linked to, and dependent on, that generated by patents. In creating market exclusivity for a signicant period of time, patents participate in giving branded original drugs a specic place within patients experiences and medical practices. Whilst one may argue that the brand then substitutes itself to become more signicant than patents in generating the specic inuence of particular drugs, its relevance is signicantly shaped by the monopoly it obtained for many years. In this paper, we take the position that, although the brand and the patent assigned to individual drugs play a joint part in shaping their identity, patents generate and produce the conditions that enable the brand and the drug to be settled into particular routines. From an ANT perspective, then, drugs become a complex site of power, relationships, potentialities, and inuences. Here, the specic regulatory environment that has enabled particular drugs to develop a given identity can remain inuential in settings with different regulatory contexts. Once materials become understood as loaded black boxes, and the core principle that the action of materials and humans should be understood in symmetrical terms is accepted, the origin and source of regulatory forces becomes a uid yet complex matter. Drugs become a particular kind of immutable mobiles, dened by Latour as objects that hold their shape, physical as well as relational, while travelling long distances. For Latour, immutable mobiles are essential in building Empires, and stabilizing relationships of power. Drugs, in this way, play their own part in specic processes of power building, and carrying through regulatory forces long distances (Latour 1987, pp. 227236; Law & Singleton 2003). ANT does not sit well with unidirectional notions of causality: ANT relationships are primarily about interactions. Following patents and their manifestations implies accepting the role that pharmaceutical companies play in their existence and inuence. But although this power is expressed through patents and deployed through drugs, both patents and drugs are more than simply the expression of an established form of power deployed by pharmaceutical companies: they are also individual entities that go on to be deployed and act in a variety of settings, from pharmacies to patients bodies, adopting a range of roles in the process, and establishing their own relationships. Pharmaceutical companies create brands, but the importance of branding is determined by the response of users. The classic example is, of course, the failed rebranding of Coca-Cola in 1985, where consumer resistance completely undermined the companys attempt to relaunch the product in the face of growing competition from Pepsi (McCampbell 1997). The remainder of this analysis builds on ANTs irreductionist approach to capitalism. The power of pharmaceutical companies is explored through its manifestation in Djibouti, rather than as a starting point. We show how the immutable mobiles that are branded drugs participate in stabilising the networks of inuence that pharmaceutical companies have developed in Djibouti. In turn, we explore how various sets of relationships have come to stabilize the role of branded medicines in the public health system, through movements of entanglement and disentanglement that are specic to these particular products.
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In Djibouti, the drugs that are able to work and enroll other actors are only those that conform to certain standards of IP that do not ofcially exist in Djibouti. This results in a particular set of economic and social consequences that are different from those that might have been expected solely by reference to the ofcial local regulations. Interestingly, the embedded regulations appeared capable of being even more inuential than in their home contexts: rather than fading with the time limits that are usually attributed to patents, this regulatory inuence appeared to continue indenitely, preventing generic versions of out-of-patent drugs from penetrating the Djiboutian market. In ANT terms, the drugs that either were or had been under patent were the only actants in a signicant part of the pharmaceutical market. This leads us to interrogate, in the following section, how these materials became the site and expression of regulatory inuences, and how these drugs became both the expression of and actors in the particular ordering of an ofcially unregulated market.

6. The drug import system of Djibouti and the embedding of foreign patents The power and action of drugs in Djibouti is codependent on four different factors: the role of pharmacists; advertisement and marketing; shipping; and doctors and patients practices and expectations. We shall consider each in turn before characterizing their interactions, in order to understand how a specic range of drugs participates in ordering very strictly the dominant part of the pharmaceutical market. 6.1. Pharmacists as passage points At the time of eldwork, most drugs entering Djibouti were imported by private pharmacists. The only exceptions were those selected for the OPS, the World Bank pharmacies, and the donations mentioned above, which entered through direct channels, which were estimated to constitute less than a third of the pharmaceutical market. These pharmacists acted as what ANT would describe as a passage point, a narrow gate through which actors could enter or leave a network (Callon 1986a). As a result, the enrollment of these pharmacists was most inuential in the choice of drugs that would enter the market. The Ministry of Health had no control or inuence over what either pharmacist chose to import, beyond the standards set for the prevention of counterfeit medication. The choice of specic versions of drugs (generic or branded) was left entirely to the pharmacists so that their enrolment took place directly and was not hampered by the pressure of any competing network. This contrasted with the position in the World Bank pharmacies and OPS where import decisions were made by reference to standards formulated outside Djibouti in environments that were capable of probing the socio-legal contents of the drugs black box and making independent decisions. A key element explaining the limited range of drugs available in the main part of the market was the enrolment of pharmacists by major drug companies based predominantly in France, and, therefore, acting within a different regulatory context that had become embedded in the conditions of manufacturing and supply. Pharmacists worked only with a limited number of companies, and bought a specic set of drugs from these companies preferably the original version of medicines. They explained this through a number of factors.
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6.2. Advertising and information One was the circulation of information between drug producers and pharmacists: pharmacists in Djibouti imported and distributed drugs they knew about, so that only drugs that had been brought to their knowledge would enter the country. They had few resources for investigating other possible sources of supply and evaluating their quality and reliability. Moreover, their quasi-monopoly meant that they lacked any commercial incentive to seek cheaper sources, since the cost of the more expensive medication supplied would ultimately be borne by patients and hospitals. Here the specic social context of Djibouti mentioned earlier is relevant; the gap between rich and poor is such that it may be more rewarding to sell at higher prices to those who can afford it than to lower prices to a point sufcient to enable the poor to afford treatment. As a result, pharmacists were drawn to the most accessible drugs rather than the cheapest, and by the known and established (to them) drugs, rather than the new ones. Lower-cost suppliers did not have access to the same channels to deliver information to these pharmacists so their products could not compete to enroll them. The drugs that successfully entered the Djiboutian market were those that came easily to pharmacists, accompanied by information about their indications and quality. They had generated marketing resources from their multinational creators that brought the private pharmacists into their sales network, and established themselves as essential actors in the Djiboutian pharmaceutical market network: although the marketing strategies deployed in Djibouti may not have been radically different from those seen in other countries, their impact was unusually effective. The deployment of key material objects was particularly instrumental in securing and stabilizing relevant connections, in a poor country with limited resources. Leaets, posters, advertising pens, and writing pads were commonly sent from France directly to pharmacists in Djibouti. While these might be considered trivial gifts in the context of a developed country (although recent reforms to industry codes indicate that this is changing; see ABPI 2011), they had substantial relative value in a poor one. Representatives from multinational pharmaceutical companies, often based in the region, also regularly visit the country. In one case, a permanent representative was based in Djibouti, and organized monthly medical seminars that were also used as a platform to advertise targeted products. Such contacts are an important source of continuing medical education in a country with limited provision: a medical school was only established in 2007. The more general links maintained between Djibouti and France also led private pharmacists to travel regularly to France, where they met representatives of companies with whom they had established relationships. There were, in particular, annual pharmacy-related meetings in Paris, which added personal contact to the profusion of materials sent over to Djibouti. Importantly, once rst procured by pharmacists, specic drugs would become powerful entities that would spontaneously reenrol pharmacists without the intervention of humans or companies. The peculiar system of Djibouti and lack of intervention, inuences, or incentives for choice soon made those drugs the permanently preferred selection for pharmacists. Whilst multinational companies played an active role in the original choice of procurement, this deliberate action was soon replaced by routines in which the front-line, patented drug imposes itself on the importers. In a classic ANT fashion, drugs became simultaneously objects, actants, and mediators in the relationships between pharmacists and producers, but also developed an independent role for themselves in the daily practices of pharmacists.
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6.3. Routes and shipping Shipping routes, in the broad sense, were another factor in restricting the range of medication entering the Djiboutian market, and strengthening the power of drugs that had originally been procured (for an insight into the links between space, power, and networks, see Law 1986; Murdoch 1998). Djibouti is a difcult country to reach, with a very limited number of international ights. Pharmacists therefore emphasized issues of access and reliability in accounting for their choice of medication providers. This led them to privilege those that could easily ship their products by means of the few regular ights that served Djibouti. It also led them to maintain long-term relationships with a few known and trusted providers, and with tried and tested drugs. The constraints on shipping differentially linked the Djiboutian pharmacists with pharmaceutical rms based in or close to the French market: the main connection is three ights per week from Paris, supplemented by various regional links within East Africa and the Gulf. Drugs that could travel easily along this route could present themselves in Djibouti and assemble local actors in ways that were less available to potential competitors. These various factors explain how the dual action of targeted strategies form multinational groups, and routines and habits of pharmacists who had limited incentives to look for variety or novelty, resulted in a specic range of drugs becoming particularly inuential in the Djiboutian market. The above reasons also help explain why those drugs would have come from powerful and established multinational producers. However, further insights are needed to understand how the specic version of each drug that was originally patented, rather than a more diverse selection from French companies (including generics produced by multinationals), tended to be the one originally enrolled and enabled to enroll on a quasi-permanent basis. Here we turn to the decisions and practices of doctors and patients in Djibouti. 6.4. Doctors, patients, and patented drugs The public health networks of Djibouti are comprised largely of French, or Frenchtrained, doctors. This is changing, with the creation of a local medical school and the recruitment of a growing number of graduates from other African medical schools, but these alternatives are still at a nascent stage. The teachings of French universities, and the practices of doctors in France, are, therefore, highly inuential in determining the habits and routines of doctors established in Djibouti. One practice that impacts on the network engagement between specic sets of drugs and the Djiboutian market is that of predominantly prescribing branded medications to patients. This is common behavior in France, and as doctors in Djibouti explained in interviews with EC, their training and early career practice often led them to learn the branded rather than the generic name (Kapferer 1997; Larrieu & Houin 2000). Because of the tight links between patents and brands, the branded versions of the drugs that are prescribed by doctors are those of the original and patented (or ex-patented) versions. Research on this practice tends to indicate that this is essentially due to the ease of memorizing and writing branded names, and therefore the link between patents and this practice is indirect. Nonetheless, the version of the drug prescribed becomes, de facto, the patented drug, perpetuating and extending the role of patents through day-to-day practices. The outcome was that prescriptions in Djibouti tend to be written for a brand name rather than for a generic formulation, and prescriptions were commonly written for patented or ex-patented
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versions of drugs. Prescriptions themselves are, then, objects that embed the career history of their authors and their interactions with other regulatory environments. They are both literal and metaphorical scripts that join the drug as a social object with the drug as a socio-legal object. Little resistance is opposed locally to the work of these branded drugs in enrolling local networks, allowing the embedded regulations to express themselves quite easily. In particular, neither pharmacists nor patients seek, or are made to seek, alternatives to the brands prescribed by doctors. As we have seen, pharmacists do not have specic incentives to lower the price of their medicines and there is no strong demand from patients to obtain substitution of branded medication for generics. In particular, the common misconception among patients that generic medicines are different from branded medicines means that they expect to receive the exact medication that is specied on their prescription that is, the branded version. This phenomenon was possibly exacerbated by the fact that Djiboutians often had difculties in accessing a doctor, and did not want to see the doctors decision overruled by the pharmacists in relation to their choice of medication. Again, the social context is relevant here, and it is important to keep in mind that the patients who constitute the customer basis of private pharmacies tend to have a relatively high income, whilst the large very poor part of the population is reliant on the limited free medication provided elsewhere and often has simply no access to drugs. These different factors exercised pressures that resulted in the production of a very ordered network, in an ofcially unregulated market. A feature of this network is its settled and static nature, and the ability for individual drugs to become quasi-obligatory passage points in the main Djiboutian market. In effect, the regulatory framework designed within France and other developed states, to provide inventors with market incentives, became part of the history and scripts embedded within drugs, and reproduced some of its effects in the Djiboutian context. Interestingly, these regulatory inuences grew stronger in this new context than they were in their original networks, as their temporal limits appeared not to fade. 7. Conclusion on ANT, materials, and the silent embedment of regulations This case study is a story of ordering and regulating, and of the relative power that materials can accrue in these processes. It invites us to reect on the capacity of ANT to enable us to perceive and deconstruct social order, and to demonstrate how day-to-day interactions are managed, between ordering and fragility. It also brings us to question labelling strategies in processes of ordering: in this example, labels are difcult to attribute. What we observed are the regulatory patterns that emerge in part through and from the enrolling power of materials, which are neither intentional nor unintentional, state- nor non-state-based, and borrow some features from what is usually perceived as the legal, but perhaps not sufciently to justify describing the process as one of legal ordering. This reects the emphasis of ANT on the uidity of the social and the problems of classications, dichotomies, and attempts to establish predenitions. In this conclusion, we unpack these different ideas and questions. 7.1. ANT and the construction of society At the core of ANT is an attention to the process of ordering: the close links between ANT and ethnomethodology are well known in that respect, and both approaches have con380
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centrated on demonstrating both the constructed stability and the inherent fragility of everyday orders and practices (for a critical engagement with both traditions, see LeighStar 1991). ANT is fundamentally designed to help us unpack the ordering of society: in this example, it enabled us to understand how the pharmaceutical market of Djibouti had become stabilized in a particular way. In doing so, however, a core strength of ANT is to actually demonstrate how much order is, in fact, needed for, and unavoidable in, the everyday. As demonstrated in ethnomethodology, and most famously illustrated by Garnkels (1967) breaching experiments, daily practices are dependent on tacit practices that generate order: when this order is challenged, it does not take long for the system to start falling apart. ANTs approach to demonstrating the ordering of the everyday is different rather than making it apparent by showing what happens when this order is challenged, it seeks to describe how the assemblages that produce order are generated, and the role that all actors, including materials, play in doing so. This process of deconstruction is instrumental in enabling us to understand the range of mechanisms at play. Practices fall into patterns that may disappear from sight and stop being perceived as constructions, but remain, nevertheless, the result of specic processes that lend society its stability. Relationships are constituted, and this constitution is the result of fragile assemblages that can be challenged at any time. These processes of ordering are signicant, and loaded with practical implications. Here, for example, the power of drugs themselves to generate a certain form of pharmaceutical market has signicant implications for prices and access. It also has more positive consequences, such as the exclusion of an actor much deplored across sub-Saharan Africa, but kept away from the Djiboutian market in 2004 namely counterfeit medication. This heterogeneous ordering of society implies that an assessment of the role of regulatory tools, such as patents, needs to involve looking beyond the law. The impact of pharmaceutical patents should not be assessed exclusively by considering the relevant pieces of legislation, but also by observing the power of medicines that embed and perpetuate patents, and the factors that result in stabilizing the inuence and dominance of particular drugs in a market. Processes of ordering that take place in daily practices may become labelled in different ways for example as legal or regulatory or follow patterns that are commonly associated with a certain eld or strategy. However, the example we chose here also highlights the fragility of the process of labelling itself, and enables us to question the analytic value and limitations of those concepts, and some of their associated terminologies. 7.2. Materials as regulators The potential for materials to make us do things has long been established, and examples abound, from sleeping policemen, to hotel key chains, to sound devices forcing drivers to wear their seatbelts (Latour 1992). In many ways, our lives are constantly inuenced by what we can or cannot materially do, and regulators have long understood that using materials can be a very effective way to inuence their specic publics. But the examples most commonly explored are very different from that given here: in particular, they are all examples in which the materials are specically designed with the aim of shaping behavior. Their modes of action are then analysed and illustrated. This
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example is very different. Medicines are not developed with the aim of shaping social behavior, or at least not in the way experienced in Djibouti and described above. Their regulatory function is part of broader patterns of ordering, and both the result and the enactment of the action of others. Their inuence is derived from the successful enrollment of a complex set of actors, made possible in part by the absence of any competing local system designed to regulate the market. However, once certain relationships have stabilized and materialized, the drugs are granted a form of power that makes them a permanent feature of the local market, without any clear point of human decisionmaking or clearly articulated regulatory strategies. In ANT terms, patented drugs are key actors in the pharmaceutical market of Djibouti, and mediators of a certain type of relationships that links patients, drug companies, pharmacists, doctors, and many others. They are multi-layered actors carrying complex political scripts and histories, and are themselves made to act as they do because of these scripts and other movements and relationships. Nonetheless, at a certain point in the ordering process, scripts and mobilizing mechanisms discreetly disappear from sight, and in the day-to-day of patients, pharmacists, and doctors, those drugs adopt settled positions which give them a de facto monopoly. The action of those complex materials results in perpetuating certain regulatory patterns, which limit what can or cannot enter the market and reach patients. Similarly, although some of the patterns of inuence exercised here can be traced back to pharmaceutical companies or the former colonial powers, the entanglement of patented drugs within routines and practices also dictates some of the limits to the direct inuence that can be played by those actors outside Djibouti. In a market where health professionals tend to prescribe the original version of a drug, multinationals wishing to export their own branded generics meet the same difculties that other general producers will experience. Similarly, cooperation programs run by the French Government to support the Ministry of Health saw their own inuence being limited by the shape of the local market. The ordering of the local market, once the routine drugs have become settled as a certain selection of medicines, becomes difcult to control or regulate from a specic center of inuence. The example demonstrates how some of the dichotomies that have remained, as the eld of regulation studies has broadened, may be unworkable when attention is being brought to this wider set of regulatory materials those that are not designed to be such. As we saw above, regulation studies have progressively turned their attention to new forms of regulation, including unintentional and non-state. Whilst looking at regulatory materials certainly enables us to extend even further the scope of what we consider as regulation, it also invites us to question whether classications and categories, such as intentional/unintentional, state/non-state, can be truly meaningful. ANT suggests that regulations can exist in ways that cut across these dichotomies and make them unworkable. Whether pharmaceutical companies, states, and regulators abroad or pharmacists unofcially acting as policymakers, can be proven, intentionally, to regulate the market of Djibouti through patents, is doubtful. Of course multinationals actively promote and advertise their products, as we have seen, but this is different from expecting these to gain market exclusivity. Similarly, this targets both branded drugs and generics produced by these companies. Drugs themselves are one node of the ordering network that is deployed here, and once established become an enrolling and ever-present actor in the local market. The regulation of the local market is also the result of a range of factors that are not directly attributable to the intention of multinational companies or
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indeed of individual pharmacists such as the absence of local ofcial regulations by the Djiboutian government, the training of doctors based in Djibouti, or the transport infrastructure of the country. The situation could be described as being less than intention yet more than coincidence. Similarly, the state-based/non-state-based dichotomy is hard to uphold in this context. Patents are state-based instruments and play an essential role as part of the scripts that enable medicines to enrol other actors in the way described above. Yet the agency of medicines is largely independent from any state decision and certainly not the result of the proactive role of the Djiboutian state. Distinguishing between state and non-state becomes articial at best, in this context, and meets the broader claims of ANT on the uidity of objects and processes, and the lack of viability of predened categories and dichotomies. The regulatory inuence played by materials in general, and branded/patented drugs in the context of Djibouti, also needs to account for their inherent fragility and the constant possibility of transformations and renegotiations. Since 2004, the pharmaceutical market of Djibouti has changed. Although some of the patterns highlighted above have persisted, a level of liberalization has also taken place, broadening signicantly the range of drugs available in the country. This is in part the result of a stronger involvement of international organizations in Djibouti, and of the growth of the pharmacies communautaires set up by the World Bank, for example. The increased access to cheap medication has, in turn, resulted in challenges to some of the established features highlighted above, such as the reluctance of health professionals to explore new directions for importing and prescribing. Competing networks have developed for specic patients and with their own boundaries and limitations in terms of which range of drugs, where they came from, or to whom they should be allocated. These have reached a stage where they are sufciently established to inuence the dominant market. These competitors could only grow with the direct intervention of institutions and individuals that challenged the routine established action of patented drugs, and proposed the inclusion of new entities and the replacement of those expensive but powerful ones. The growing market in counterfeit medicines has also been a key feature of the changes in the local market since 2004; it will also have played a part in reshaping expectations and understandings in relation to the cost of health care and the procurement of medicines. With their entanglement in new global and local networks, the role of branded/patented drugs has in turn become more constrained and more limited. The shifts in regulatory powers become one of movement across heterogeneous networks rather than straightforward movements of control and ordering in any singular and predetermined direction. 7.3. In search of the law Importantly, this example also allows us to push the boundaries of what we may or may not describe as legal connections. The specicity of this example, and one of its interesting features, is also that we are dealing here with a generally accepted legal form of regulation patents. As a consequence, this example is one where materials work to express a legal form of regulation away from the letter of the law, away from the intentionality of legal creators, and aside from state-based networks. In doing so, it offers the prospect of applying the concept of uidity central to ANT to the legal eld, and demonstrating that there is no more legal space than human networks, or natural, as opposed to social, spaces. Instead, we see varieties of alliances in which certain effects
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are produced that come to be read as particular phenomena. In the way ANT has participated in replacing conceptions of the social by the socio-technical, we become invited to rethink the legal as the socio-legal, or perhaps more accurately as the socio-technico-legal.

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