Selling Immunity Self, Culture and Economy in Healthcare and Medicine

Mark Davis

• Publisher: Routledge
• Year: 2022
• Print ISBN: 9780367422356
• eBook ISBN: 9781000542134
• Topic: Psychology
• Subtopic: Diseases & Allergies
• Index: Psychology

Selling Immunity Self, Culture and Economy in Healthcare and Medicine provides a groundbreaking study of the ways in which immunity shapes life. Through its up-to-date discussion of immunity cultures, alongside detailed real-world examples, the book demonstrates how immunity is enmeshed in concepts of possessive individualism, self-defence and health consumerism.

The book explores the rich metaphorical powers of immunity and the life narratives it inspires with reference to the talk of scientists, immunology texts and popular science magazines. The author provides a detailed overview of the ways in which digital media can shape the immune self with reference to cultural and social theories, providing insight into how immunitary knowledge and products are consumed and the benefits and drawbacks this has for healthcare. The book considers the significance of immunity for individuals navigating the threats to health that arise with pandemics and superbugs, with a keen look into how these ideas surface in everyday life across the globe. Finally, the book also discusses economic bases of healthcare technologies bent towards the protection and restoration of immunity.

This book is essential reading for professionals within the fields of psychology, sociology, biomedical science, healthcare and other related disciplines. A broader audience will appreciate the book's attention on the ways immunity is understood to be a personal possession, an object of life craft, and the basis for healthcare consumerism.

1

Framing immunity

DOI: 10.4324/9780367810313-1

Immunity has long been implicated in the legal, pecuniary, and political obligations of the individual to collective life. Partly for those reasons, immunity is also a powerfully productive framing of biology that shapes understandings of the body, health and medicine. These multiple meanings and effects of immunity – across politics, scientific inquiry, health care and quotidian experience – provide the terrain for this book. The biosciences of immunity have delivered great insights and ushered in medical achievements in many areas, including, for example, the control and mitigation of infectious diseases through vaccine, antiviral and antibiotic technologies, the expansion of organ transplantation, and the management of infections common in chronic diseases, cancer treatments and major surgery. But immunity has other effects of a more prosaic kind that also need to be identified and understood for critical engagement with how we are governed in 21st-century modes of social production. Moreover, the interlacing of immunity with economic, market and transactional rationalities is a significant feature of how health and biomedicine are understood and practised.

Consider, for example, how immunity is referenced in advertising for consumer products, helping to sell them by adding value. Food products, probiotics and vitamins are promoted on the basis that they might protect the individual from infections or at least mitigate their effects. Some brand names reference immunity directly, for example, Organic Immunity SuperGreen Tea and Comvita Olive Leaf Extract Immune Support. The Blackmore company produces vitamins and probiotics and their website (blackmores.com.au) had consumer information sections on colds, flu and immunity, the benefits of zinc, exercise and diet and rebuilding and ‘respecting’ one’s immunity. Bellamy’s Organic, a manufacturer of baby milk formula, hosted a website (bellamysorganic.com.au), which had sections on how to boost immunity for children in winter and understanding a newborn’s immune system, among other information sources. The milk formulas themselves were offered to parents as ways to enhance the physical and cognitive development of the child, promoting strength and resilience. Importantly, too, the Bellamy’s Organic website informed parents that milk formula is a supplement and should be used in consultation with a medical professional. Products like these are therefore promoted to consumers who must themselves take on responsibility for seeking out biomedical expertise.

Sometimes the putative immunity effects of a product are implied. Breakfast cereals and drink preparations offer users ways to build and shape bodies in desired ways and to enhance performance in the face of physical and cognitive challenges. In this way, the products draw on a common understanding of immunity as self-defence. For example, Milo is a malt extract powder for flavouring milk marketed in Australia. Adverts for Milo extolled the benefits of its components for the developing child. Nestle, which owns Milo, has its own strapline: ‘Good food, good life’, implying in a general way the link between food products and health. Also in Australia, two Kellogg’s breakfast cereals offer similar benefits and are markedly gendered. Nutrigrain until recently was promoted as a way for boys and men to become an ‘iron-man’. The Iron-man competition is a gruelling triathlon-style competition that includes running, cycling and surf swimming and has iconic status in Australian sporting masculinity (Connell, 2000). One marketing site for the cereal claimed, “Nutrigrain believes that with courage, strength and determination, anyone can be unstoppable” (Kellogg’s, n.d.-a) and featured storylines of men who have succeeded in ironman competitions. This notion of an ‘unstoppable’ body can be construed as a metonym for superlative corporeal vitality, a kind of immunity. The other Kellogg’s breakfast cereal, Special K, has been advertised as a way to reduce weight and is directed almost exclusively at women, a common advertising approach (Wolf, 1993). The website explained that the cereal was “Specifically designed with women’s wellness in mind, Special K offers a unique combination of essential nutrients to help support your overall wellbeing!” (Kellogg’s, n.d.-b). This strong gendering of food products is an important insight into the self-understandings that are at stake in the richly nuanced circuit of consumer desire, health and the body, and food product advertising. While these gendered notions of how to shape bodies and their performance might not directly name immunity or immune systems, they imply that the consumer can shape their health and fitness, which as we will see, is a concept that depends in large part on the assumption of immunity as defence of self from health threats. The use of ‘wellbeing’ in the text of the advertisement is embracing enough to imply immunity, a recurring device in advertising that makes reference to health. This book explores the implications of these powerful notions of immunity made plain or secreted in the circulation of consumer products, services and knowledge systems.

There are also examples of scientific and medical discoveries that have found their ways into consumer culture. As Emily Martin pointed out in her foundational book on immunity socio-cultures, Flexible Bodies (1994), Listerine is the well-known brand name for a range of antiseptic products. The brand name is a direct reference to Joseph Lister who pioneered the use of antiseptic surgery in the late nineteenth century. Similarly, penicillin is the name of the first antibiotic discovered in the 1920s and manufactured for use in the general population in the 1940s. According to Robert Bud (2007), penicillin has the quality of a brand name since it is has entered public consciousness and powerfully connotes the curative powers of biomedicine. Listerine and penicillin, then, help to connect science and medicine with consumer culture and imbue other health-oriented products with similar associations and virtues. Products like these, with their biomedical associations, help to establish the notion that the consumer can act on microbial threat to health, if they choose the right products.

Immunity entails some surprises too. Researchers have reported that mood might be associated with the functioning of the gut biome (Fung et al., 2017), leading some to speculate on the value of faecal transplants for the management of mental health (Archer, 2013). An article featured in Psychology Today, ‘A bug in the system’ (Marano, 2017), explored this connection between the microbiome and mood, including the notion that soldiers going to war could be treated to reduce anxiety by modifying their diets and the functioning of their microbiomes. As Ciara Kierans (2011) has shown in connection with organ transplantation, enlarged capacity to suppress the individual immune system has improved the prospects for life-saving organ transplantation because it has become less important to ensure the genetic-matching of donor and recipient to avoid rejection of the transplant. But this advantage has also increased the market for donated organs because more donors can be considered for more recipients. Biological immunity, or more properly the circle of bacterial life and death, has also been said to have led to CRISPR, the gene editing technology now being used to transform biomedicine (Doudna and Charpentier, 2014). CRISPR was said to have been first observed by a cheesemaker (Maxmen, 2015), who found that some yoghurt and cheese bacteria became resistant to viruses by snipping out and incorporating genetic information from them. CRISPR, among other possibilities, has been used to supposedly produce immunity to HIV infection (Liao et al., 2015). These examples show how the manipulation of immunity can give transformed commodity value to body and mind, body parts, gut-resident microbial life and genetic technology.

As these various examples suggest, immunity is not singular. It is more properly taken to be a variable effect of immunity-related assemblages rather than a particular, definite object. Moreover, immunity’s irreducibility and multiplicity are tied to its enormous biological and political complexity and its many uses in social worlds. Immunity is found in the effects produced in, and between, bodies through the co-ordinated action of knowledge, technologies, biomedicine, commerce, and individuals, to name a few components of immunity assemblages. Immunity is more akin, therefore, to a teleological principle by which the value and effects of the systematic organisation of biosocial life are weighed and shaped. This is an important insight as it helps to explain the open-ended ramifications of immunity-oriented rationality across science, health care, and in everyday life and sets the scene for investigating immunity assemblages in consumer culture.

Immunity is also exemplary of the co-constitution of bio-matter and power (Cohen, 2009). Some even argue that immunity is the capstone of biopolitical theory, as it is so multiply and powerfully biological and political. In an interview with Timothy Campbell, Roberto Esposito reflected on this relation of immunity and biopower:

We could conclude that it wasn’t modernity that posed the problem of immunization (in relation to the undoing of ancient communitarian practices), but rather that it is immunization that brings modernity into existence, or differently invents modernity as a complex of categories able to solve the problem of safeguarding life.

(2006, unpaginated)

Esposito referred to immunization in the sense of the suspension of individual obligations to others as a method by which the optimisation of life is brought into being. This relation of the individual to collective existence is a core feature of biopolitical systems and frames biomedical inquiry and consumer culture. The scholarship of Esposito and others foregrounds immunity’s productivity for late modern biopolitical rationality, but also points out important contradictions that will become relevant in the chapters to follow.

Immunity is also rich with metaphors and narratives of embodied vitality and the threat of illness, something that has not escaped advertisers, journalists and writers on science. In some accounts, immunity is a field of pitched military conflict: of powerful microbes invading and the response in kind of embattled bodies, supplying, therefore, a ready-made war lexicon and endless images and storylines for popular culture representations of immunity (Martin, 1994). In other versions of immune system operation, metaphors of border security, surveillance and detection reign in ways that resonate with the politics of globalisation, migration and resurgent nationalism. In others, immunity is seen as more akin to a “mobile brain”, a networked communication system much like the nervous system (Martin, 1994, p. 110), a view in keeping with how digital media environments are conceptualised (Tauber, 2017). The chapters to follow explore effects of immunity metaphors and narratives, with particular reference to consumerism and the shifting topography of twenty-first century public health.

It is also important to recognise that immunological understandings of health and disease are partial and evolving. For example, Elie Metchnikoff and Paul Ehrlich jointly won a 1908 Nobel Prize for Medicine though each put forward a different theory of immune function. Metchnikoff, a biologist by background, emphasised phagocytosis – the consuming of biological matter by cells of the body – and gave science an early account of immunity as self-defence. Ehrlich’s research focussed on cytotoxins and the chemistry of the immune system. This pattern of immunology’s multiplicity has continued. In 2018 James Allison and Tasuku Honjo shared the 2018 Nobel Prize for Medicine. Allison was awarded the prize for discovery of immunotherapy for cancer and Honjo for processes of immunity acquisition and antigen memory. This century-long history of achievement in immunology reiterates the view that the immune system is not easily reduced to singular mechanisms.

Some features of immunity evade immunological explanation. For example, it is not fully understood why the human foetus – as genetically different from the mother – is not normally rejected in pregnancy, casting some doubt on the idea that immunity is always a biological defence of a genetically distinct single body (Martin, 2010). The as yet incomplete project of immunological understanding also stands in contrast with immunity’s taken-for-granted, generally accepted status in the popular imagination and the repeated use in consumer culture of the principle of immunity as protection of the body. It is important to reflect on what it is that consumers are purchasing in the name of immunity, to grapple with how health and the body are being made in current circumstances.

The argument developed in this book, then, acknowledges that immunity is a pre-eminent biopolitical imaginary that operates across science, medicine, care of the self, media, commerce and into everyday life. Immunity assemblages of great dynamism and complexity are valued for the effects they have in bodies and in health, at times commodifying bodies themselves. Understanding how immuno-economics permeate health care and potentially destabilises its foundations, particularly under neo-liberal transformation of health care provision, is a dynamic that needs to be investigated for shaping effective public policy and communications on health. This book troubles uncritical, taken-for-granted uses of immunity by examining its sometimes obvious, sometimes implicit, commodification in media rich social worlds, with the aim of expanding options for action on threats to health.

How can immunity be sold?

‘Selling immunity’ has several meanings for the argument to follow. Straightforwardly, I mean to refer to how consumers are invited to acquire goods, services and knowledge as means to tend to immunity, generate knowledge about it, monitor it, and transform it. The examples of immune-boosting tea, milk formula and breakfast cereals, already noted, fit this perspective, though there are many other ways in which immunity appears in commodity culture. The analysis of immunity in commodity culture enables reflection on how immuno-economic principles produce identities, relationships, corporeal value, affects and therefore shape responses to health risks.

Partly as a consequence of this market-place immunity, I also conceptualise health promotion technologies and communications as necessarily fashioned as consumer products. Vaccine hesitancy in different nations and populations (Yaqub et al., 2014), and resistance by some (Meharry et al., 2013), has led health promoters to adopt persuasion techniques borrowed from advertising and popular culture to encourage vaccination (Cunningham and Boom, 2013). These persuasion techniques are combined with legislation that compels parents to vaccinate their children if they wish to use child-care (Mello et al., 2015) and requires vaccination among health care workers as a condition of employment (Wicker and Marckmann, 2014). Public health experts have also reported that some healthcare providers do not vaccinate themselves because they believed that they were healthy and therefore failed to see that their own vaccination might help to protect the health of their vulnerable patients (Davis et al., 2013). Some of those interviewed as part of research on swine flu spoke of their immunity when asked if influenza virus infection could be prevented, but rarely of vaccines (Davis et al., 2016). The consensus was that flu was difficult to avoid, so the strength of one’s immune system was crucial for mitigating the effects of a likely infection. This book reflects on the socio-cultural conditions under which it is necessary to ‘sell’ technologies like vaccination, why they might be seen as individual benefits and not necessarily collective ones, and how immunity can be so automatically construed to stand in for vaccination, against expert advice.

I also use ‘selling immunity’ to consider how, under neo-liberal economic rationalities, it is necessary to ensure the competitiveness and benefits of the knowledge systems of immunity. This imperative came to light in the discourse of immunologists I interviewed when they spoke of the need to promote the value of their research to ensure funding for their often challenging, costly and time-consuming work. Perspectives like these reveal how economic rationality is not only a condition of researchers’ working life, but tied to the life of immunological knowledge.

In a related sense, I am also concerned with the cost efficiency rationality that appears to have been linked with immunity-related biotechnologies. The emergence, for example, of innovative, self-administered, and rapid (20-minute) diagnostic technologies for HIV has ushered in an era of testing, diagnosis and treatment-based prevention in the global effort to reduce the transmission of the virus and moderate its damaging health effects (Matt, 2015). People wanting to know if they are infected with HIV can acquire a saliva test over the counter and within minutes find out their HIV serostatus. These self-testing technologies are possible for influenza and other microbes and are being considered for use in health systems across the globe (Wilson et al., 2010). This notion of consumer self-diagnosis, in particular, does much to transform the orthodox approaches to the management of pandemics and emerging infectious diseases (Arnold, 2012). Notably, self-testing is justified in terms of economic efficiency, because it can reach more individuals (Fernandez-Balbuena et al., 2014), with the added benefit that the consumer pays for the technology themselves. Self-funded testing, however, raises questions of equity of access for those less able to afford testing, increased financial burden on those with complex health conditions, and the participation of individuals for culturally and linguistically diverse backgrounds. For these reasons, HIV self-testing is subject to “stratified biomedicalization” (Banda, 2015, p. 32). HIV testing is emerging as a partially privatised, stratified biotechnology, with many of the ramifications associated with private health care, and is consequently transforming how health care is organised and how individuals manage threats to their health. Examples like the HIV self- and rapid-tests help to foreground the nexus of biotechnology, economic transformation and immunity.

This book explores the many ways in which immunity can be valued, promoted, marketed but also the related ways public health communications borrow from consumer culture and help to deepen possessive individualism and self-defence immunity. It considers the ways in which economic rationalities of cost saving and market competition are expressed in the design of public health approaches and the production of immunological knowledge. Exploring the ways in which immunity is threaded through with different modes of exchange and economic rationalisation helps to deepen this book’s focus on immunity assemblages. This approach is valuable because it examines immunity outside the confines of the laboratory, clinic and public health intervention.

Critical framings of immunity socio-cultures

This book benefits from critical engagements with immunity, including Michel Foucault’s accounts of biopower and biopolitics traced into perspectives on immunity socio-cultures. Donna Haraway’s (1999) critique of the nature-culture divide is an important theme and provides a link with science and technology studies. Roberto Esposito’s (2011) elaboration of the philosophical and political tensions that arise when immunity and community are considered together also informs what follows, as does his account of the paradox entailed in uses of immunity that license the destruction of life as a basis for its protection. Shildrick has developed a “post-humanist biophilosophy” (2015, p. 95) account of immunity from the viewpoint of organ transplantation, a method of analysis that produces a different reckoning of immunitary possibilities. Successful transplantation requires suppression of the host immune system and recipients have also been found to exhibit microchimerism, that is, biomatter from the donated organ travels through the body of the host. This biological phenomenon troubles simple notions of immunity as self-defence, which is an important theme in the chapters to follow.

The argument I make in Selling Immunity owes much, howe...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• List of illustrations
• Acknowledgements
• Series Editor Preface
• 1. Framing immunity
• 2. What can immunity do?
• 3. Immunological narratives
• 4. The popularisation of immunology
• 5. Immunity and digital media
• 6. Immune selves
• 7. Fragile immunitary economies
• 8. Immunity and its discontents
• References
• Index