In the Journals

In the Journals, January 2021, Part 2

Some interesting themes include scientific uncertainty and methodological experimentation. Enjoy!

Health: An Interdisciplinary Journal for Social Studies of Health, Illness, and Medicine

From the Margins to Mainstream: How Providers of Autologous ‘Stem Cell Treatments’ Legitimise Their Practice in Australia (open access)

Casimir MacGregor, Alan Petersen, Megan Munsie

This article examines how Australian providers of unproven autologous ‘stem cell treatments’ legitimise these products and their practices. We focus on the strategies employed by providers in their efforts to create and sustain a market for procedures that have yet to be proven safe and clinically efficacious. Drawing on the work of Thomas Gieryn and Pierre Bourdieu and the findings of research involving an analysis of direct-to-consumer online advertising of clinics that sell purported ‘stem cell treatments’ and interviews with clinicians who provide them, we examine the mechanisms by which medical legitimacy for these products is established and defended. We argue that Australian providers employ a number of strategies in order to create medical legitimacy for the use and sale of scientifically unproven therapies. A key strategy employed by providers of stem cell treatments is to use markers of social distinction, drawing strongly on the symbols of science, to confirm their legitimacy and differentiate their own practices from those of other providers, who are posited as operating outside the boundary of accepted practice and hence illegitimate. We argue there is a paradox at the heart of the autologous stem cell treatment market. Providers aim to create legitimacy for their work by emphasising the potential benefits of their ‘treatments’, their expertise and the professionalisation of their practices in an environment where regulators are yet to take a firm stance; they are also required to undertake the challenging task of managing patients’ hopes and expectations that both enable and potentially jeopardise their operations and revenue. We conclude by suggesting that providers’ creation of symbolic capital to establish medical legitimacy is a crucial means by which they seek to bring unproven ‘stem cell treatments’ from the margins of medicine into the mainstream and to portray themselves as medical pioneers rather than medical cowboys who exploit vulnerable patients.

The “problem” of health: An Analysis of Health Care Provision in Canada’s Federal Prisons

Eilish Scallan, Kari Lancaste, Fiona Kouyoumdjian

The United Nations states that prisoners should enjoy the same standards of health care that are available in the community. Despite this, persons in prison experience barriers to care and face unique health challenges. Given the ways in which prisons shape health outcomes for incarcerated persons, it is important to interrogate how the provision of health care is governed in custodial settings. In this article, we examine one important aspect of governance: legislation governing the provision of health care in prisons. We view this issue through a critical lens, building on a body of poststructural scholarship which has illuminated how laws and policies are not merely tools of governance but also key sites for the production of meanings around social “problems,” including the “problem of health.” Taking Canada’s Corrections and Conditional Release Act as a case example and applying Carol Bacchi’s “What’s the Problem Represented to Be” analytical framework, we examine how the specific representation of “health” in this legislation works to produce effects for persons in federal prison. Three key themes are formed through this analysis. First, what constitutes “essential services” in the context of federal prisons is more limited compared with the broader community. Second, the dichotomy between the rights of persons in prison versus the protection of society that is produced in development of these laws has significant bearing on the treatment of those in prison. Third, this representation has negative effects on the health of persons in prison. In order to meet United Nations standards, greater attention must be paid to the ways in which laws and other governing practices reproduce inequities in health care provision in prisons.

Standard Tools for Non-Standard Care: The Values and Scripts of a Person-Centred Assessment Protocol

Doris Lydahi

This article uses a material semiotic perspective to study a highly influential model of healthcare policy and practice today: person-centred care. While person-centred care is often regarded as implying a turn away from technology and standardization towards more humanistic values in care, this article shows that mundane standardization technologies, such as an assessment protocol, are integral components of person-centred care. Building on interviews and observational studies at a Swedish hospital introducing person-centred care, the article analyses the person-centred protocol in situ. The article teases out three core concerns inscribed in the protocol: a concern for the patient experience and perspective, a valuing of evidence-based knowledge and a managerial imperative. The article illustrates how these contrasting values were rendered compatible through the continuous tinkering of healthcare professionals. Finally, it shows how users modified the script of the protocol under analysis and how relations between the three core concerns were adjusted in the process. The article concludes that tinkering and user–technology relations are of significance for the fate of person-centred care at large.

Health and Place

Researching at Sea: Exploring the ‘Swim-Along’ Interview Method (open access)

Hannah Denton, Charlie Dannreuther, Kay Aranda

Interest in researching embodied experiences of activity connected to therapeutic landscapes, spaces or places has led to a range of evolving methods that aim to move beyond traditional sit-down, talk-based qualitative modes of researching. Following the sensory turn, this paper explores a novel ‘swim-along’ method used to interview people whilst swimming immersed in sea water. By juxtaposing this with insights gleaned from a subsequent sit-down interview, the paper examines implications for deepening our understanding of visceral, sensory, embodied experiences, the methods we can use to access them and how these structure researcher/participant interaction.

Race and The Spatialisation of Risk During the 2013–2016 West African Ebola Epidemic (open access)

Lioba A. Hirsch

This paper examines the spatial navigation of risk by international health responders working in Ebola Treatment Centres (ETCs) during the West African Ebola epidemic. Drawing on Black studies and geographies it argues for a race-conscious analysis of spatial strategies of risk aversion in order to highlight the geographical, postcolonial and racial inequalities at the heart of the West African Ebola response. Based on interviews with international health responders to Liberia and Sierra Leone, it argues that the spatial organisation of ETCs perpetuated non-equivalence between Black and white lives and contributed to the normalisation of Black suffering and death.

Medical Anthropology

Dissonance of Choice: Biomedical and Lived Perspectives on HIV Treatment-Taking (open access)

Shona Horter, Janet seeley, Sarah Bernays, Bernhard Kerschberger, Nomthandazo Lukhele, Alison Wringe

Treat-all recommends prompt treatment initiation for those diagnosed HIV positive, requiring adaptations to individuals’ behavior and practice. Drawing on data from a longitudinal qualitative study in Eswatini, we examine the choice to initiate treatment when asymptomatic, the dissonance between the biomedical logic surrounding Treat-all and individuals’ conceptions of treatment necessity, and the navigation over time of ongoing engagement with care. We reflect on the perspectives of healthcare workers, responsible for implementing Treat-all and holding a duty of care for their patients. We explore how the potentially differing needs and priorities of individuals and the public health agenda are navigated and reconciled. Rationalities regarding treatment-taking extend beyond the biomedical realm, requiring adjustments to sense of self and identity, and decision-making that is situated and socially embedded. Sense of choice and ownership for this process is important for individuals’ engagement with treatment and care.

Necropolitics in the “Compassionate” City: Care/Brutality in San Francisco

Andrea M. Lopez

In San Francisco in the United States, the urban precariat is governed simultaneously by two logics of intervention that are highly contradictory: compassion and brutality. In this article, I explore the contours of violence embedded in humanitarian governance for unstably housed/homeless women who use drugs as they navigate care systems for their health and well-being. I use Mbembe’s concept of necropolitics to examine how women embody an anticipation of death, at the same time as they manage their risk for actual death in engagements with care in a city paradoxically known for its progressive, compassionate principles of intervention for those who are most marginalized

Self-Medication and the Pharmaceutical System in Cambodia

Eve Bureau-Point, Carine Baxerres, Sena Chheang

Based on an ethnographic study of the Cambodian pharmaceutical system conducted in an urban and a rural setting between January 2015 and June 2016, we report on the complex dynamics surrounding the issue of self-medication in that country. We describe the history of the circulation of pharmaceuticals in Cambodia, and we discuss the contemporary relationship individuals have with these medicines and with those who distribute them. We illustrate the specific dynamics of the pharmaceuticalization of Cambodian society, where private drug vendors are playing a key role.


Global HIV Interventions and Technocratic Racism in a West Papuan NGO

Jenny Munro

In the era of scale up, global donor-driven HIV activities are transforming NGO work by demanding administrative, technical, and data-oriented activities. Drawing on interviews and participant observation in an NGO in the West Papuan city of Manokwari between 2011 and 2014, I attempt to understand why Indigenous Papuan NGO employees were steadily replaced by non-Indigenous migrant settlers, mainly of Javanese heritage, to deliver HIV services. I show that new rivalries, technical roles, performance targets and efficiency rhetoric intersected with existing racialization to produce a preference for Javanese employees, who were assumed to be more compliant and professional than their Papuan counterparts and to operate more easily within the technocratic regime imposed by donor expectations. I use the term technocratic racism to describe the way that global HIV rationalities intersect with ethnic stereotypes and gendered racial ideas to make possible certain HIV workers and not others. I contribute to anthropological literature on the delivery of HIV services by showing how a technocratic approach to HIV/AIDS intervention intersects with a settler-colonial context to gradually exclude Indigenous employees. Approaches that allow for relational, independent and flexible services would assist to decolonize HIV responses in West Papua.

Science, Technology, and Human Values

Ruination Science: Producing Knowledge from a Toxic World

Sebastian Ureta

The multiple environmental crises our planet is experiencing forces us to change the ways we engage with it, especially the ones developed by scientific disciplines such as toxicology. In particular, widespread degradation should lead us to develop scientific practices that take environmental ruination as a framework condition, not only as an object of analysis. In doing so, we should take into account the practice of science at laboratories located in the peripheries of global science, institutions that have coexisted with extensive environmental and material decay from their very onset. Contributing to this task, this paper analyzes the case of Centro Nacional del Medio Ambiente (CENMA), an environmental chemistry laboratory located in Santiago, Chile. Established in mid-1990s, decades of continual budget cuts left it in a state of almost terminal ruin. In its struggle to remain relevant, CENMA developed an alternative kind of scientific practice, ruination science. Although always precarious, ruination science also tends to be well adapted to engage with impurity, resilient but fragile, and ethically entangled, prioritizing attachment and compromises over the application of certain standard recipes or procedures. Beyond its particularities, CENMA’s ruination science provides us with several valuable keys to better deal with worlds facing multiple kinds of anthropogenic degradation.

Cloaking the Pregnancy: Scientific Uncertainty and Gendered Burden among Middle-class Mothers in Urban China

Jialin Li

In this article, I use radiation-shielding maternity clothes (cloak) as a window to explore motherhood and reproductive uncertainty in urban China. By engaging with literature on scientific uncertainty and intensive mothering, I argue that the scientific uncertainty over the possible negative impact of electromagnetic radiation (EMF) on pregnancy has led to a situation in which uncertainty is being socially reproduced by experts, markets, and policy makers through different media channels. Middle-class mothers do not fully believe that the cloak is scientifically trustworthy. But under the influence of social networks and the ambient awareness of the reproductive crisis related to environmental pollution and the pressures of modern life, middle-class mothers still choose to wear the clothes for a variable period of pregnancy for psychological feelings of safety. In the end, they choose to cloak their pregnancies (to perform responsible motherhood) but immediately claim their suspicions of the cloak (to perform their scientific knowledge).

Governing Uncertainty or Uncertain Governance? Information Security and the Challenge of Cutting Ties (open access)

Rebecca Slayton

Information security governance has become an elusive goal and a murky concept. This paper problematizes both information security governance and the broader concept of governance. What does it mean to govern information security, or for that matter, anything? Why have information technologies proven difficult to govern? And what assurances can governance provide for the billions of people who rely on information technologies every day? Drawing together several distinct bodies of literature—including multiple strands of governance theory, actor–network theory, and scholarship on sociotechnical regimes—this paper conceptualizes networked action on a spectrum from uncertain governance to governing uncertainty. I advance a twofold argument. First, I argue that networks can better govern uncertainty as they become more able not only to enroll actors in a collective agenda, but also to cut ties with those who seek to undermine that agenda. And second, I argue that the dominant conception of information security governance, which emphasizes governing uncertainty through risk management, in practice devolves to uncertain governance. This is largely because information technologies have evolved toward greater connectedness—and with it, greater vulnerability—creating a regime of insecurity. This evolution is illustrated using the history of the US government’s efforts to govern information security.

Methodology, Legend, and Rhetoric: The Constructions of AI by Academia, Industry, and Policy Groups for Lifelong Learning (open access)

Rebecca Eynon, Erin young

Artificial intelligence (AI) is again attracting significant attention across all areas of social life. One important sphere of focus is education; many policy makers across the globe view lifelong learning as an essential means to prepare society for an “AI future” and look to AI as a way to “deliver” learning opportunities to meet these needs. AI is a complex social, cultural, and material artifact that is understood and constructed by different stakeholders in varied ways, and these differences have significant social and educational implications that need to be explored. Through analysis of thirty-four in-depth interviews with stakeholders from academia, commerce, and policy, alongside document analysis, we draw on the social construction of technology (SCOT) to illuminate the diverse understandings, perceptions of, and practices around AI. We find three different technological frames emerging from the three social groups and argue that commercial sector practices wield most power. We propose that greater awareness of the differing technical frames, more interactions among a wider set of relevant social groups, and a stronger focus on the kinds of educational outcomes society seeks are needed in order to design AI for learning in ways that facilitate a democratic education for all.

Making Digital Territory: Cybersecurity, Techno-nationalism, and the Moral Boundaries of the State

Norma Mollers

Drawing on an analysis of German national cybersecurity policy, this paper argues that cybersecurity has become a key site in which states mobilize science and technology to produce state power. Contributing to science and technology studies (STS) work on technoscience and statecraft, I develop the concepts of “territorialization projects” and “digital territory” to capture how the production of state power in the digital age increasingly relies on technoscientific expertise about information infrastructure, shifting tasks of government into the domain of computer scientists and network engineers. The notion of territorialization projects describes states’ ongoing struggle to mobilize science and engineering in order to transform globally distributed information infrastructure into bounded national territory and invest it with patriotic meaning: making digital territory. Digital territory, in other words, is nationalized information infrastructure: it includes building and monopolizing infrastructure as well as normative ideas about nation—who is a digital citizen, and who isn’t; or what constitutes “good” and “bad” digital citizens. Nationalizing information infrastructure and placing statecraft into the hands of scientists and engineers might indicate an emerging form of “techno-nationalism”—a combination of nationalist and technocratic tendencies—raising urgent questions for STS scholarship to investigate the consequences of territorialization projects for justice, democracy, and civic life.


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