“Technoscience and Global Health”
Susan E. Bell, Bowdoin College and Anne E. Figert, Loyola University, Chicago
Abstract: Medicalization is a key concept used in the social and medical sciences since the 1970s that refers to how and why more and more problems have become defined in terms of illnesses or disorders and treated with medical interventions. In the past decade scholars have been reviewing its capacity to explain complex and often contradictory global interactions among medicine, the pharmaceutical industry, and fields of science and technology ranging from genetics and transplant medicine to molecular biology and global population science. In this paper we consider the utility of additional concepts - biomedicalization, pharmaceuticalization, and geneticization - along with medicalization, for explaining these global interactions. We look back over the past forty years and ahead to the next decade. We argue that alone each of the concepts captures distinct processes, that each is related to the others, and that each sometimes overlaps with another. We ask the questions: How and under what circumstances do these processes overlap? How and under what conditions does one or more of the concepts illuminate them? In addition, we also argue that studies beginning in the US, UK, and the West are insufficient for understanding global dynamics, particularly the global dynamics of health inequality. Finally, we argue in favor of moving sideways, of drawing from multiple disciplinary perspectives in history, sociology, anthropology, and STS, in order to move forward.
Re-Imaginings: ‘Medicalization’ and Technoscience in the 21st Century
“Reimagining Race and Ancestry: Biomedicalizing Difference in Post-Genomic Subjects”
Janet K. Shim, Sara L. Ackerman, Katherine Weatherford Darling, Robert A. Hiatt, and Sandra Soo-Jin Lee, University of California, San Francisco
Abstract: This paper examines how race, ethnicity, and ancestry are taken up in gene-environment interaction (GEI) research on complex diseases such as heart disease, diabetes, and cancer. Recently, GEI approaches have become common in investigations of the racial and ethnic disparities that characterize such conditions. Using in-depth interviews and ethnographic observation at scientific conferences, we explore how GEI researchers use and interpret race and ethnicity in their work. We found that aspects of race and ethnicity are still deeply routinized ways of characterizing groups to elucidate disease etiology, but that 20th century methods of self-identification exist alongside 21st century methods ascertaining genetic ancestry. We compare and contrast the different techniques involved in these two sets of methods, as well as the claims that they make and the different meanings that are ascribed to them implicitly and explicitly by the scientists who use them. We reflect on how these technoscientific means both reiterate and re-imagine definitions and logics of difference, the role of medical science in studying and intervening on them, and in turn, the kinds of subjects we humans are and ought to be. By analyzing how notions of race, ethnicity, and ancestry are actually being taken up in ongoing GEI studies of complex diseases, we provide a critical window into the increasingly complex ideas about human differences and their role in producing health disparities that characterize the post-genomic era.
“A New Biopolitics of Gender and Health? ‘Gender-specific Medicine’ and Pharmaceuticalisation”
Ellen Annandale, University of York, UK
Abstract: Gender has been intimately connected with medicalisation and pharmaceuticalisation since at least the 1960s. The rapid growth over the last decade in the research and practice of ‘gender-specific medicine’ (GSM) holds out the potential for a qualitatively new phase in this complex relationship. GSM emphasises male/female difference; is biologically and socially reductionist, and conceptualises the body as fragmented components and disease processes rather than holistically. It dovetails neatly with present-day neoliberal, market-driven approaches which place considerable emphasis on healthcare as a good to be consumed and with popular gendered assumptions of inherent biological differences in relation to the body in health and illness. GSM is heavily bankrolled by the pharmaceutical industry, most notably in the field of ‘sexual medicine’, but also with increasing reference to other areas, such as cardiology. It advocates more ‘efficient’ pharmacotherapy, raising the question of whether the gender-specific body is poised to become as new carrier of biovalue in the manner described by Waldby. Given the proposition that ideas about bodies and social groups are ‘mobilised in pursuit of various social, political, economic, scientific, and medical agendas’ (Epstein 2007), this paper explores the extent to which the ‘gender-specific body’ (Annandale and Hammarstrom) holds out the potential for the construction of a new market segment and the extension of pharmaceutical markets and, if so, with what consequences.
“Is there a Global Right to Pharmaceuticals? Essential Medicines in Historical Perspective”
Jeremy Greene, Johns Hopkins University
Abstract: Campaigns to increase global access to pharmaceuticals for HIV/AIDS, malaria, TB, and a series of neglected tropical diseases have become central to the emerging 21st century field of global health. To the historian, this provokes a central question: how is it that pharmaceuticals (a field largely equated with downstream, curative biomedical interventions) have taken on such a prominent role in the field of public health (a field more self-consciously concerned with upstream, preventive, non-biomedical approaches towards health interventions)? This dilemma is not new, and can be traced back at least a half century. As with the development of antiretroviral drugs in the 21st century, the mid-20th-century development of earlier 'miracle drugs' such as penicillin likewise produced moral and humanitarian crises on a global scale by transforming mortality and morbidity into geographic functions of access. As belief in the efficacy of biomedical therapeutics grew over the 20th century, these objects became global in at least two senses: on the one hand, unlike many other modes of healing, they were global in that they were generally assumed to work the same everywhere, independent of social, ecological, or individual context. On the other hand they were simultaneously global in that their production, distribution, and consumption was explicitly not the same everywhere--and instead moved between highly concentrated nodes (historically in the global North, though increasingly found elsewhere) and broad tracts of ‘pharmaceutical deserts’ in ways which mapped closely with other vectors of global politics and economies in the mid to late 20th century. This paper explores the history of essential medicines as a critical window into the history and philosophy of global health, the political and moral structure of international development, the globalization of the pharmaceutical industry, the changing role of the state in defending the rights of its citizens, and the flows of information, commodities, and consumerism in an increasingly transnational world.
“Prescriptions and Proscriptions: Moralising Sleeping Pills”
Jonathan Gabe, Catherine Coveney, and Simon Williams, Royal Holloway, University of London, UK
Abstract: The pharmaceuticalisation of insomnia is a contentious issue. Sleeping pills get a “bad press” due to their potential for addiction and other side effects, including increased mortality risks. Expert bodies in the UK and US have long advised that prescription hypnotics should only be used to treat severe cases of insomnia, in low doses and for short periods of time. Despite efforts to reduce hypnotic prescribing in primary care/family medicine, long term prescribing is still common and prescription rates remain fairly stable in both countries. Relatively little qualitative social science research has been conducted into how people who have been prescribed sleeping pills understand and negotiate their use in the context of their everyday lives. In this presentation I draw on focus group data from the UK to elicit collective views on and experiences of hypnotic use across a range of social contexts. It was found that respondents drew on a variety of moral discourses which functioned to allow them to present themselves as responsible and reflexive users/ non-users, to rationalise their patterns of use and justify modifications they made to their treatment regimens. This research contributes to recent sociological work on the pharmaceuticalisation/de-pharmaceuticalisation of everyday life by showing how people negotiate the moral ambiguities involved around taking a medicine when there have been attempts by the medical profession to reduce its consumption.
“Global Genomics and the Hunt for Human Difference”
Catherine Bliss, University of California, San Francisco
Abstract: The Human Genome Project ushered in an era of DNA research in a global context and a massive drive to create technoscientific solutions for an international populace. Throughout these developments, the U.S. and U.K. have dominated the large-scale sequencing efforts that underpin research and development. In particular, the U.S. National Institutes of Health has led the broadest international efforts to characterize human biodiversity. My talk will explore what it means to produce a global population science under the auspices of Western preoccupations about human difference. I will focus on the ways that American concerns about race have shaped the global regime of DNA technoscience, producing a medicalization that hinges on the racialization of genomes.
“Environment as Exposome, Environment as Ecology: Regimes of Perceptibility and the Social Determinants of Health”
Sara Shostak, Brandeis University and Margot Moinester, Harvard University
Abstract: More than a decade into the postgenomic era, the improvements to individual and public health that serve as the primary rationale for massive public investiture in human genomics research have yet to be realized. Researchers in both the social sciences and life sciences have argued that one of the paradoxes of the HGP is that it highlights the role of the environment as a “major piece of the puzzle” of human health and illness. A defining focus of contemporary life sciences research is elucidating the mechanisms and effects of “gene-environment interaction.” However, to extend the metaphor, there is no agreement regarding the size, shape, or location of this puzzle piece – or pieces. This paper compares efforts to meet the challenge of measuring and conceptualizing the environment in two very different epistemological traditions. First, we examine exposomics, an emergent postgenomic field that seeks to characterize life course environmental exposures (including lifestyle factors) from the prenatal period onward. The unit of analysis in exposomics is the individual, with measures taken from inside individual bodies. We contrast the environment as made visible in exposomics with measurements of the environment in contemporary research on neighborhood effects on health. Neighborhood effects research focuses on processes and institutions that cannot be reduced to the individual level. This comparison elucidates the very different conceptualizations and techniques of measuring the environment that characterize the postgenomic moment. Further, it suggests that the tensions between different disciplinary approaches to the environment – and whether or how they are resolved – have emerged as a central tension in efforts to understand the production of health and illness.