Medicine Anthropology Theory
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MedTech in Tanzania: Reflecting and Making Judgments
No full textStudying cutting-edge technologies in the domains of medicine built by Tanzanian experts operating on the margins of global techno-science has often led me to fall into a Manichean outlook. That is, seeing these processes in which technologies are built from rather than merely for the country, as either dispiriting evidence for another technological fix or as an encouraging sign pointing towards the building of new sovereign techno-science futures. Given our own expertise as social scientists, we are expected not to succumb to such binary reasoning and develop more sophisticated approaches. In this Position Piece, I propose that given the doggedness of such binaries that I suggest we might all be liable of falling into, we should work hard to develop a curiosity and reflectiveness about our own judgements and the process of making them.
‘Health Data Saves Lives’, But Which Lives?: The Non-Imagination of Ecological Peril in Precision Medicine
No full textPrecision medicine is a field of future promise. Its imaginary is that ‘health data saves lives’. But which lives and at what costs? In this position piece, we direct attention to how non-imagination (Prainsack 2022) operates in the field of precision medicine. We argue that central actors in the field, along with social scientists researching it, non-imagine the relevance of environmental collapse to the pursuit of precision medicine, despite its huge energy consumption and focus on prolonging human lives in places that contribute the most to climate change. This non-imagination raises questions about how we as medical anthropologists approach and theorise the ‘life politics’ at the centre of anthropological studies of the life sciences. In light of the current ecological peril, we advocate for extending the discipline’s focus from the governance of life in politics, labs, and clinics to the governance of ‘earth-life’
Automating Dietary Expertise: The Challenge of Making a Food-Tracking App for Everyone
No full textDigitally tracking food and eating has become a widespread activity. Scholars in anthropology, sociology and science and technology studies have problematised the personal and social implications of dietary tracking and the metrification of food and eating. Metrification has contributed to the emergence of new types of relevant expertise and new experts of eating and health. This warrants in-depth research to better understand the forming, negotiation, establishment and effects of new expertise.
Drawing on a sociomaterial perspective, this article explores these questions by reflecting on the development of an automated dietary tracking and intervention app. The article focuses on seeking feedback on mock-ups and prototypes of the app from potential users and non-users in ‘go-alongs’ and interviews, and in focus groups. The analysis revealed that the delegation of dietary expertise to an automated system poses a challenge for many participants. They emphasised what is neglected in the process—including their dietary but also bodily and sociocultural expertise. Our study contributes to an understanding of how dietary tracking and delegating expertise to an automated system appeals to users whose food values align with metrics used in the app but also users who accept to delegate specific forms of care to the technology
Embodied Ecologies: How We Sense, Know and Act to Reduce Cumulative Chemical Exposures in Our Everyday Lives
No full textOur worlds and lives are awash with industrially-produced chemicals. This dizzying array of chemicals includes compounds, interactions, and health effects that are poorly, if at all, understood. While the vast majority of both natural and social science research continues to focus on the toxicities of single compound or classes of compounds, we propose a theoretical and methodological framework to attend to cumulative toxicities—known, unknown, interacting and in flux—in everyday life. Our approach builds on the empirical, methodological, and theoretical work of urban political ecology (UPE), anthropology of embodiment, and science and technology studies (STS), and uses radical cartography and ethnographic methods to gain insight into urban pollution’s complex and uneven entanglements, which are inseparably chemical, social, and ecological. We are developing this approach in three phases: ethnographically attending to the sensorial experiences and embodied knowledges of those most affected; creatively and cartographically producing representations and evidence; and identifying and supporting existing modes of action and harm reduction practices. Currently transitioning between the first and second phase, here we also share fresh insights from our recently wrapped grand tours of collective explorations
Field Notes on Fluid Illness
No full textIllness is fluid. It can cross bodily boundaries, across space and time, and permeate entire families and communities. This is especially apparent in places where people have come to rely on one another in order to withstand austerity and state disregard. Here I share a creative revision of field notes from home visits with a family living with debilitating illness in rural Guatemala. Through their experience, I contemplate how vulnerability and illness are not merely hardships to be endured but can also be conditions productive of collective action, resistance, and new forms of belonging
Data on the Mind: How the Data on the Use of Force in Psychiatry Interacts with Professional Judgment
No full textPsychiatric clinicians and managers increasingly use data to monitor the use of force on psychiatric patients. In this study, we describe how Danish authorities simultaneously emphasise a need for close data monitoring and tell a story of failure: rather than reducing force, they claim that data monitoring of mechanical restraint has simply replaced this type of force with other types. We show here how the official narrative of failure is based on highly selective data practices. It inadequately conveys the efforts of the psychiatric staff, with potentially negative implications for the development of clinical judgment. While the authorities and many clinicians support continued data monitoring, we argue a need to rethink the role of data in relation to force and to better appreciate how data practices affect understandings of expertise. We base our analysis on policy papers and official reports on monitoring practices in Denmark, secondary analysis of data from these monitoring practices, as well as observations from and qualitative interviews with clinical managers, administrators and clinicians. By engaging these policies and practices, we point to a need for a new form of anthropological engagement with the data politics currently shaping psychiatric expertise.
Voicework and The Disarticulation of Young People’s Mental Health Needs
No full textThis article is about anthropological research ethics amid the simultaneous hyper-valuation of young people’s voices and the disarticulation (the process of making inarticulate) of their mental health needs. I reflect on my experience of recording a podcast about mental health treatment with young people in a moral context where ‘voicework’ was prominent. Following feminist critiques of ‘voice’ and ‘choice’, I argue that critical concerns usually associated with ‘giving voice’—authenticity and empowerment—are limiting as means of ethically relating to needs, since they presume personhood rests on coherence, intentionality and articulate expression. Instead, I resolve to adopt a research ethics that focuses on articulating needs, rather than platforming voices. This account urges researchers—myself included—to do better in confronting the non-responsiveness of care systems
‘The Donors are Everything’ Precarity and the Political Economy of Global Health Science
No full textBased upon an ethnography of two biomedical, scientific research institutes in Uganda funded primarily by donors in the Global North, this article examines the political economy of knowledge production in global health science. Specifically, I use the concept of precarity to illustrate the ways in which funding instabilities for scientific research shape the making of knowledge. I do this at three levels: the macro level of funding institutions, the meso level of research institutes, and the micro level of individual projects. Through analysing the experiences of researchers in these institutional environments, I elucidate the ways in which the political economy of global health science—particularly short-term, grant funding—constrains and enables knowledge production. I thus argue that for many scientists the priority of renewing or obtaining funding supersedes that of conducting research that is closely tied to local issues. Whilst I do not contend that the latter is unimportant to scientists, this article highlights the existential precarities fomented by the possibility of not being funded and argues that they play a substantial role in influencing the foci of global health science research projects, thus alienating them from the needs and interests of the people they are intended to benefit
Silence as Presence: Affective Spaces of Silence and Care
No full text‘Giving voice’ can be an empowering metaphor for the process of creating space for another’s perspective, allowing for their experience to be noted and attended to. Yet it is also a metaphor that relies on a particular form of articulation. Voice and narrative share many of the same strengths and limitations: for some, they are powerful tools of sense making and communication; but for others they can elude important forms of experience and fail to capture many of the more inchoate aspects of lived life in general. What happens in those moments when words fail, or are simply absent? In addressing this question via fieldwork in a community space in Osaka, I explore how silence can constitute an affective space of care. Shared silences are felt in their duration, the passing of time brings them about. In these contexts, silence is not merely an absence, but an index of presence