In the Journals

In the Journals: March 2013 (PART 1)

There were quite a number of interesting articles related to anthropology, science, and medicine in this month’s round up of journals including those from American Anthropologist, Social Science and Medicine, Journal of the Royal Anthropological Institute, Philosophy, Ethics, and Humanities in Medicine, Science in Context, and Science, Technology, & Human Values. Happy reading!

 

American Anthropologist

Of Foams and Formalisms: Scientific Expertise and Craft Practice in Molecular Gastronomy

Sophia Roosth

This article situates molecular gastronomy as a compelling example of how scientific practices and rationales sometimes percolate outside of professional scientific fields, where they can become aestheticized and fetishized, commodified and consumed. Roosth argues that molecular gastronomy is one case in which the explanatory ground usually occupied by anthropology hasbeen supplanted by science. She asks two critical questions: 1) how does scientific authority justify or invalidate quotidian practices and vernacular, practical, and embodied knowledge; and 2) what becomes of traditional objects of anthropological thought—things like foodways, nationalism, authenticity, nostalgia, and sensation—when scientists seek to explain them scientifically, and by explaining them, “improve” them? By surveying a social movement in which practitioners shuffle culinary, scientific, and anthropological expertises in talking about, making, and eating food, Roosth argues that French molecular gastronomists by seeking to formalize and scientize French cuisine, they also work to codify French culture. In short, culture is here an object of chemistry.

 

Social Science and Medicine

Investigating the affordability of key health services in South Africa

Susan Cleary, Steve Birch, Natsayi Chimbindi, Sheetal Silal, Di McIntyre

This paper considers the affordability of using public sector health services for three tracer conditions (obstetric care, tuberculosis treatment and antiretroviral treatment for HIV-positive people), based on research undertaken in two urban and two rural sites in South Africa. The authors find that there were significant differences in affordability between rural and urban sites; costs were higher, ability-to-pay was lower and there was a greater proportion of households selling assets or borrowing money in rural areas. There were also significant differences across tracers, with a higher percentage of households receiving tuberculosis and antiretroviral treatment borrowing money or selling assets than those using obstetric services. As these conditions require expenses to be incurred on an ongoing basis, the sustainability of such coping strategies is questionable. Policy makers need to explore how to reduce direct costs for users of these key health services in the context of the particular characteristics of different treatment types. Affordability needs to be considered in relation to the dynamic aspects of the costs of treating different conditions and the timing of treatment in relation to diagnosis. The frequently high transport costs associated with treatments involving multiple consultations can be addressed by initiatives that provide close-to-client services and subsidized patient transport for referrals.

 

‘We view that as contraceptive failure’: Containing the ‘multiplicity’ of contraception and abortion within Scottish reproductive healthcare

Siân M. Beynon-Jones

Within contemporary Scottish policy guidance, abortion is routinely configured as evidence of a resolvable problem with the healthcare provision of contraception. This article draws on interviews with Scottish health professionals in order to explore how, and in what form, realities of contraception/abortion are sustained within abortion practice. It also demonstrates how a novel conceptual approach could be used to develop existing social scientific analyses of the provision of techniques of fertility prevention. Mobilizing insight gained from STS studies of the complex socio-material practices through which realities are enacted (or ‘performed’), Beynon-Jones’ analysis illustrates the complex socio-material work required to enact abortion as evidence of a ‘problem’ with contraception that is resolvable within the healthcare consultation. This work renders visible the ontologically ‘multiple’ nature of contraception/ abortion, with important implications for both social science and policy approaches to these techniques of fertility prevention.

 

Putting knowledge to trial: ‘ADHD parents’ and the evaluation of alternative therapeutic regimes

Claire Edwards and Etaoine Howlett

The role of patients’ organizations in shaping (medical) knowledge about particular health conditions and illnesses sheds light on notions of informed patienthood and the dynamics of lay-expert knowledge in the context of medicalization. This paper considers dynamics of knowledge production in relation to a specific condition area, Attention Deficit Hyperactivity Disorder (ADHD), by investigating how parents of children with ADHD are intervening in knowledge creation about the effectiveness of different treatments for the disorder. It draws on qualitative research carried out with organizations representing parents of children with ADHD in Ireland, to explore how parents have commissioned evaluations of alternative interventions to medication. Drawing on analysis of interviews with both parents and professionals active in the arena of ADHD, documentary evidence, and observation at parent organizations’ events, the study demonstrates how parents’ interventions have sought to expand the therapeutic domain of ADHD beyond the exclusive realm of biopsychiatry, and the dilemmas they face in making their experiences count in a context where the need for evidence has become paramount in the governance of health.

 

Journal of the Royal Anthropological Institute

Sabar: body politics among middle-aged migrant Pakistani women

Kaveri Qureshi

This article explores the relationship among suffering, Islamic moral concepts, subjectivity, and agency within a cohort of middle-aged women who migrated from Pakistan to Britain in the 1960s and 1970s as the wives or daughters of industrial workers. These women were preoccupied with their ageing bodies and complained about the cumulative assaults on their health they had experienced, and which they felt had been neglected by health professionals and family alike. By examining how these women bear chronic illness through a discourse of sabar (patience or silent forbearance), Qureshi shows how women were able to transform their illness into a selfless and virtuous consequence of shouldering the burdens of kinship. Sabar suggests passive acceptance or fatalism to some observers, but by attending to everyday contexts of friendship, family, and inter-generational relations and how women situate their illness in a religious and eschatological frame, Qureshi shows that there are tensions between self-sublimation and self-assertion in the practice of sabar and that women actively appropriate rather than passively imbibe the norm of sabar. Finally, Qureshi argues that ethnographic attention to subjectivity and reflexivity are crucial to understanding sabar as an agential capacity.

 

Philosophy, Ethics, and Humanities in Medicine

Cardiovascular medicine at face value: a qualitative pilot study on clinical axiology

Adalberto de Hoyos, Rodrigo Nava-Diosdado, Jorge Mendez, Sergio Ricco, Ana Serrano, Carmen Flores Cisneros, Carlos Macías-Ojeda, Héctor Cisneros, David Bialostozky, Nelly Altamirano-Bustamante and Myriam M Altamirano-Bustamante         

Cardiology is one of the subspecialties in which evidence-based medicine is predominant but presents ethical dilemmas that are very unlikely to be solved solely based on the available clinical evidence. The ethical dilemmas specific include, among others, issues arising from the decisions to be made between what can be done and what should done related to chronic ischemic cardiopathy, acute coronary is chemic syndrome. Ethical deliberation is needed to decide whether to resurrect a patient in the case of a heart attack or malignant arrhythmia, the use of scarce resources in the case of organ transplantation, the process of informed consent and the role of the living will. In view of these dilemmas, an urgent necessity arises in cardiology to reinforce the pairing of values-based medicine and evidence-based medicine. By conducting qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter, the authors hold that the ends of medical practice (curing, healing and caring) encompass both evidence-based medicine and values-based medicine, and that clinical practice values are closely related to those of life history. They argue that this is important when developing the ethical formation of medical students, and healthcare employees, and that knowledge of the axiology of healthcare professions can be applied to the selection of candidates who seek to study and pursue these careers.

 

Should trainee doctors use the developing world to gain clinical experience? The annual Varsity Medical Debate – London, Friday 20th January, 2012

Barnabas J Gilbert, Calum Miller, Fenella Corrick, and Robert A Watson

The 2012 Varsity Medical Debate between Oxford University and Cambridge University provided a stage for representatives from these famous institutions to debate the motion “This house believes that trainee doctors should be able to use the developing world to gain clinical experience.” This article brings together many of the arguments put forward during the debate, centering around three major points of contention: the potential intrinsic wrong of ‘using’ patients in developing countries; the effects on the elective participant; and the effects on the host community. The article goes on to critically appraise overseas elective programmes, offering a number of solutions that would help optimize their effectiveness in the developing world.

 

Science in Context

Citizen, Academic, Expert, or International Worker? Juggling with Identities at UNESCO’s Social Science Department, 1946-1955

Teresa Tomas Rangil

This article explores the links between the competing scientific, disciplinary, and institutional identifications of social scientists working for international organizations and the nature of the work produced in these establishments. By examining the case of UNESCO’s Social Science Department from 1946 to 1955, Rangil shows how the initial lack of organizational identification diminished the efficiency and productivity of the Department and slowed down the creation of an international system for research in the social sciences. She then examines how the elaboration of such identification resulted from a period of trial and error during which several national, academic, and scientific models were explored. Rangil concludes that only the discourse of “moral sensitivity” kept the Department together at a time when disillusions regarding internationalism, the destabilization of the meaning of nation, and suspicion towards some Western disciplines rendered unacceptable the universalization of a single international social scientific identification.

 

Biobricks and Crocheted Coral: Dispatches from the Life Sciences in the Age of Fabrication

Sophia Roosth

Roosth asks what “life” becomes at a moment when biological inquiry proceeds by manufacturing biological artifacts and systems. In this article, she juxtaposes two radically different communities, synthetic biologists and Hyperbolic Crochet Coral Reef crafters (HCCR). Synthetic biology is a decade-old research initiative that seeks to merge biology with engineering and experimental research with manufacture. The HCCR is a distributed venture of three thousand craftspeople who cooperatively fabricate a series of yarn and plastic coral reefs to draw attention to the menace climate change poses to the Great Barrier and other reefs. Interpreting these two groups alongside one another, Roosth suggests that for both, manufacturing biological artifacts advances their understandings of biology: in a rhetorical loop, they build new biological things in order to understand the things they are making. The resulting fabrications condense scientific and folk theories about “life” and also undo “life” as a coherent analytic object.

 

Science, Technology, & Human Values

Special Issue: Entanglements of Science, Ethics, and Justice

Why Justice?: Introduction to the Special Issue on Entanglements of Science, Ethics, and Justice

Laura Mamo and Jennifer R. Fishman

This special issue assembles papers that consider relations among science, ethics, and justice. The papers are drawn from a 2011 National Science Foundation-sponsored workshop that brought together interdisciplinary scholars to consider, incorporate, and attend to the meanings, uses, and social consequences of ethical questions and justice ideals in technoscientific projects. Mamo and Fishman argue that although science and technology studies (STS) has engaged justice as a matter of concern, it must go further to examine justice frameworks more explicitly and to participate in efforts that seek justice in ways that are associated with, yet distinct from, the study of ethics. They offer this special issue as a starting point for thinking about justice and ethics in STS and about STS in/of justice; for engaging with other scholars and activists yearning for analyses of how we might imagine and enact more ‘‘just’’ technosciences, scholarship and futures; and to align with STS projects committed to studying and understanding values embedded in technoscientific practices and the situatedness of those involved in their making, diffusion, and (intended and unintended) use. The papers included in this special issue examine public participation, the production of knowledge, what counts as consent, ownership of biomaterials, and others. Together, the papers raise questions about new directions and articulations of power, justice, and inequalities in science and technology studies.

 

On the Emergence of Science and Justice   

Jenny Reardon

Reardon examines recent developments in genomic science and personal genome scanning to consider the ways genomics offers a framework for universal notions of justice. It does so, she argues, by creating a space for thinking about and engaging collectives or ‘‘populations’’ instead of individuals. Reardon regards ‘‘ethics’’ as being far more tied to dominant institutional forms, including bureaucracy, audit cultures, and legal accountability. In contrast, she argues, the ‘‘justice’’ offered by companies such as 23&Me offers opportunities to transcend closed and constricting forms of bureaucracy.

 

Genomic Justice for Native Americans: Impact of the Havasupai Case on Genetic Research

Nanibaa’ A. Garrison

Garrison examines how the Havasupai tribe court decision has trickled down to the practices and values of scientists and institutional research board (IRB) committees in the United States. Through interviews with genomic scientists and chairs of IRBs, Garrison demonstrates how larger issues of justice, group consent, and open consent are considered by IRB members in light of the court decision and how this might affect research ethics in the future.

 

Justice as Measure of Nongovernmental Organization Success in Postdisaster Community Assistance

Barbara L. Allen

Allen leads her analysis of environmental justice by examining environmental justice activist efforts to rebuild New Orleans after Hurricane Katrina. Concerned with how to measure the success of a self-proclaimed ‘‘justice intervention,’’ Allen directly engages with a normative question: in what ways can technologies, strategies, and techniques of postdisaster rebuilding be judged from an environmental justice perspective? And, specifically, how can their success be measured along lines of ‘‘justness’’? In posing this question, Allen examines what is meant by ‘‘justice’’ within the EJ framework and then applies this to the post-Katrina response and ways to measure and understand that response.

 

Changing Knowledge, Local Knowledge, and Knowledge Gaps: STS Insights into Procedural Justice

Gwen Ottinger

Ottinger asks what yardstick ought to be used to assess justice, and in particular, to describe the limits of those extant yardsticks. She uses insights from STS to describe the limitations inherent in using procedural justice—that is, the ability of people affected by decisions to participate in making them—as the goal for environmental social movements. Through empirical research of the perspectives of the residents of New Sarpy, Louisiana, she questions the sole use of procedural justice as a way of achieving environmental justice because it cannot take into account the necessarily partial nature of scientific knowledge. Ottinger thus questions the one-time only decision-making approach most commonly used in these cases and argues for ongoing opportunities for participation and to consent to local hazards, since both ‘‘scientific’’ and ‘‘local’’ knowledges change over time.

 

Justice in the Context of Family Balancing

Michelle L. McGowan and Richard R. Sharp

Michelle McGowan, a gender scholar, and her colleague, bioethicist, Richard Sharp, address sex selection practices in the context of assisted reproduction. McGowan and Sharp bring forward the voices of users of reproductive technologies of sex selection as they explain and defend their reproductive practices using their own working definitions of ethical/just sciences. The authors examine how to assess technoscientific practices using measures of ethics and justice. To do so, they place ‘‘expert bioethics’’ and feminist perspectives on reproductive inequality and power in conversation with one another by analyzing interviews with prospective parents about the meaning and use of sex selection technologies, and how they justify their choices. As an empirically grounded assessment of ethical tensions in a medical context of assisted reproduction, the article forces consideration of the materiality of practice in assessing justice and ethics as objects. Yet, as the authors demonstrate, these are not separate from many of the feminist justice concerns raised in reproductive justice statements.


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