Public health experts often describe care in India’s private sector as ‘chaotic,’ ‘substandard,’ ‘profit-driven,’ and ‘arbitrary.’ Discourse tends to focus on the ‘predatory behavior' of doctors who demand consultation fees and kickbacks for everything from medicine, to laboratory tests, to specialist referrals, and even hospital stays. These practices are ethnographically observable. However, this discourse does not take into account the multiple uncertainties, ethical complexity, and personal relationships involved in providing care in exchange for money in a setting of scarce personal and public resources. Situated at the very end of a value chain designed to make money from health, or the lack thereof, private physicians find themselves embroiled in moral peril. In this article, I engage what it means to make a livelihood in a context such as this by considering the economic, moral, and epistemic practices that physicians and their patients use to create and evaluate the value of pharmaceuticals in Mumbai’s slums. Based on over a year of clinic ethnography and interviews with family physicians, specialists, pharmacists, and pharmaceutical wholesalers, I trace how physicians manage the effects of a pharmaceutical value chain that produces profit by fulfilling patient’s health needs and desires.

中文翻译：

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Zahir 博士的困境：印度私人医疗网络中的金钱和道德

公共卫生专家经常将印度私营部门的医疗描述为“混乱”、“不合标准”、“受利润驱动”和“任意”。话语倾向于关注医生的“掠夺行为”，他们要求从药物、实验室检查、专家转诊，甚至住院治疗等所有方面收取咨询费和回扣。这些做法在人种学上是可以观察到的。然而，该论述并未考虑在个人和公共资源稀缺的情况下提供护理以换取金钱所涉及的多重不确定性、伦理复杂性和个人关系。位于旨在通过健康或缺乏健康赚钱的价值链的最末端，私人医生发现自己卷入了道德危机。在本文中，我通过考虑医生和他们的病人用来创造和评估孟买贫民窟药品价值的经济、道德和认知实践来探讨在这样的背景下谋生意味着什么。基于一年多的临床民族志和对家庭医生、专家、药剂师和药品批发商的采访，我追踪了医生如何管理通过满足患者的健康需求和愿望来产生利润的制药价值链的影响。