Claims and disclaimers: whose expertise counts?

Medical anthropologists have long recognized that interactions between state, clinical, scientific and lay participants transform understandings of illness. There are competing claims to knowledge in such interactions, which may be in tension with concepts of jurisdictional authority and assumptions about what constitutes different types of expertise. This paper focuses on the regulatory processes of the Food and Drug Administration in order to examine the social processes involved in negotiating and sustaining domains of knowledge across various boundaries of authority. I use the example of the way roles of commercial interests, patient interest groups and federal oversight agencies in defining and caring for health "problems" appear to be shifting with new modes of circulating information about prescription drugs. What counts as "medical expertise" when decisions about taking pharmaceuticals are moved away from former gatekeepers (physicians and insurance plans) to patients who are reframed as consumers? In this reordering new questions are raised about the location of risk and responsibility, and relations of credibility, authority and expertise.