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Abstract:
Why an economic sociology of health care markets? Surprisingly, while neoclassical economics has well-developed models of competition, it has a fairly impoverished understanding of markets. If economists treat the firm as a black box, the same is equally true of the market. Without a better theory of health care markets and how public and private elements interact, judges will be constrained in their ability to formulate workable antitrust policy, and legislators will be constrained in their ability to formulate a more rational competition policy. Much of my past work has sought answers to these questions looking, as an economist and antitrust lawyer, from the inside out. This essay is an effort to examine health care markets from the outside in, through the lens of economic sociology, rather than traditional economic theory. The principal aid in this process will be Neil Fligstein's book, "The Architecture of Markets: An Economic Sociology of Twenty-First-Century Capitalist Societies". The analysis proceeds as follows: Drawing upon Fligstein's insights, Part II highlights four general fallacies of neoclassical economic understandings of markets (fallacies, at least, from a sociological perspective). Part III uses the tools of economic sociology to construct an architecture of health care markets. Part IV considers the implications of the foregoing on three issues that are significant to the future of medical antitrust law: What are the implications for efforts to construct a competition policy in health care? What are the implications for efforts to better cultivate dynamic efficiency? Finally, what are the implications of economic sociology for the antitrust state action immunity doctrine, the principal tool courts use to police the boundary between the public and private sides of economic markets?

Abstract:
History is rife with conflicts between indigenous peoples and outsider groups. These confrontations have a timeless and often tragic quality. They are revealing because they juxtapose sometimes radically different manifestations of the human condition, and highlight tensions between divergent and often contradictory worldviews. While past conflicts played out under the rubric of colonialism or Manifest Destiny, today's confrontations are undertaken in the name of economic development. One such drama is underway in the Northeast Provinces of Cambodia, with substantial funding from the Asian Development Bank (ADB). But contemporary development stories are different from older stories of colonization. Development agencies are exporting aid and technical assistance, with the dual objectives of market building and state building. Increasingly, these initiatives have social as well as economic components. Modern development comes complete with roads, schools and health clinics, along with pledges to reduce poverty. This is not all. Indigenous communities are now invited to participate in the process of their own development. Where such participation is not possible, development agencies will expend additional resources to build the indigenous capacity to do so.

This paper focuses on "development" as embodied in the policies and practices of international agencies like the World Bank and the Asian Development Bank. It examines economic development as its own distinct set of beliefs and attempts to frame and justify a narrative of "development as tragedy." Indigenous Peoples in Cambodia face other obvious threats, such as land grabbing, deforestation and environmental degradation. These threats reflect the more naked avarice of economic markets and a predatory state. As such, these threats are more consistent with a narrative of "development as exploitation." The narratives of exploitation and tragedy are complementary and not competitive. Each teaches different lessons. A tragedy in the Aristotelian sense is a drama that invokes deep feelings of fear and pity in the audience. The sense of tragedy is driven by the protagonist's adherence to a mistaken set of briefs that inevitably condemns his conduct to have disastrous consequences, foreseeable to the audience but often not the actor. This article critically evaluates certain ADB Reports on indigenous peoples to learn not so much what the Reports teach about native tribes, but what they reveal about the worldview and mistaken beliefs of the ADB and modern industrial societies. These documents are used as artifacts. Theories about economic development act like mirrors, revealing important insights into the belief systems of modern societies. A careful analysis of the Reports illustrates how the problems of indigenous peoples are often mere projections of the ADB's own beliefs, beliefs that are themselves largely driven by the Bank's underlying economic models. Framing the problem as a conflict between disparate worldviews further reveals the limitations of participation as a policy tool.

Development, Indigenous Peoples, Cambodia, Worldviews

Abstract:
A clash between a union of Cambodian sex workers and a team of international researchers funded by the Bill and Melinda Gates Foundation led to the cancellation of an important HIV/AIDS prevention study. The union was demanding better disclosure of information, insurance against the threat of long-term study-related side effects, and assurances of future access to the study drug (tenofovir) if it proved effective in preventing HIV transmission. The union was also demanding to be taken seriously as a stakeholder in the joint fight against HIV/AIDS. The Cambodian controversy highlights the inability of first world ethical standards to meet the needs of international medical research. A study protocol obtaining Institutional Review Board (IRB) approval in the U.S. or Australia cannot simply be exported to a country like Cambodia. This article details the science and politics of the tenofovir trials and explores how the tensions of third world research might be better mediated in light of emerging international standards

Abstract:
Cambodia is undergoing dramatic political, economic and social changes, placing new pressures on minority groups and vulnerable peoples. Some changes are driven by Cambodia's uniquely troubled history. Other forces are global, affecting Cambodia and all other nations in the region. This essay introduces a volume of edited papers presented at an International Conference in Siem Reap, Cambodia, sponsored by the Center for Khmer Studies with the support of the Rockefeller Foundation as part of their Capacity Building in Cambodian Higher Education Program.

Important insights can be gained by looking at the lives of those living on the margins. An appreciation of margins, minorities and borderlines teaches a number of object lessons, but it also suggests an enlightening method of analysis. Margins identify fault lines, demarcating borders where powerful tectonic plates rub against each other, whether these plates represent conflicting social institutions or the forces of transcendent, but ill-defined processes like nation-building, economic development or globalization. Engaging the lives of real people caught on these margins can lead to new understandings of the often invisible forces shaping and reshaping Cambodia and the region.

The problems of ethnic groups are one concern. Transnational and cross-border influences are creating new challenges and opportunities for ethnic minorities. The Cham and other Muslim communities are reconnecting to international Islam. Labor markets cross national boundaries. Vietnamese migrant workers travel to Cambodia, as Cambodian workers travel to Thailand. International loans, agencies and programs targeting "development," itself an often disruptive cross-border force, are transforming many Cambodian institutions and redefining traditional social margins in the process. This clash of forces is most profoundly felt by the indigenous peoples of the northeast, but the papers also examine other minorities and vulnerable groups who have been systematically denied access to important social resources. Theories of social exclusion teach that the landless, street children, victims of domestic violence and gay and lesbian persons are on the margins of different Cambodian institutions and that borders are not only of a geographic nature.

Cambodia, Minorities, Social Exclusion, Margins, Social Change

Abstract:
The American health care system embodies a complex amalgamation of fractured and conflicting parts. As such, any call to enhance quality or competition necessarily presupposes some ability to introduce greater harmony and coordination. But how does one make a complicated system work well? Dynamic theories of economics stress the significance of section mechanisms, learning, and adaptive modes of behavior in directing markets toward more efficient outcomes under conditions of uncertainty. Unfortunately, the American health care sector suffers from intense factional divisions. Policy makers need a more self-conscious understanding of the interactive and often conflicting effects of regulation if the health care system is to be reshaped in a manner that will generate more desired social outcomes. Evolutionary theories of economics can provide the conceptual framework in which such a restructuring could take place. This article examines how health care quality and competition can be improved through a better understanding of dynamic economic processes and evaluates the Federal Trade Commission and Department of Justice 2004 report Improving Health Care: A Dose of Competition in light of these perspectives.