An Anthropology of Biomedicine

Margaret Lock, Vinh-Kim Nguyen, Margaret M. Lock

• Publisher: Wiley-Blackwell
• Year: 2018
• Print ISBN: 9781119069133
• eBook ISBN: 9781119069157
• Edition: 2
• Topic: Social Sciences
• Subtopic: Cultural & Social Anthropology
• Index: Social Sciences

In this fully revised and updated second edition of An Anthropology of Biomedicine, authors Lock and Nguyen introduce biomedicine from an anthropological perspective, exploring the entanglement of material bodies with history, environment, culture, and politics. Drawing on historical and ethnographic work, the book critiques the assumption made by the biological sciences of a universal human body that can be uniformly standardized. It focuses on the ways in which the application of biomedical technologies brings about radical changes to societies at large based on socioeconomic inequalities and ethical disputes, and develops and integrates the theory that the human body in health and illness is not an ontological given but a moveable, malleable entity.

This second edition includes new chapters on: microbiology and the microbiome; global health; and, the self as a socio-technical system. In addition, all chapters have been comprehensively revised to take account of developments from within this fast-paced field, in the intervening years between publications. References and figures have also been updated throughout.

This highly-regarded and award-winning textbook (Winner of the 2010 Prose Award for Archaeology and Anthropology) retains the character and features of the previous edition. Its coverage remains broad, including discussion of: biomedical technologies in practice; anthropologies of medicine; biology and human experiments; infertility and assisted reproduction; genomics, epigenomics, and uncertain futures; and molecularizing racial difference, ensuring it remains the essential text for students of anthropology, medical anthropology as well as public and global health. 

Section 1

1
Biomedical Technologies in Practice

Biomedical technologies have histories that inevitably come into being with an idea often stimulated by a random or unexpected observation that then initiates a series of experimental procedures. Many technologies never progress beyond this initial phase, but others are put into production and eventually applied in medical care. However, the application of a biomedical technology does not simply depend on its medical use alone, but is deeply influenced by prevailing medical and political interests and cultural norms, as well as by overarching ideas about the most promising directions for progress and mastery of the condition of the human body. Biomedical technologies are not merely devices or machines, such as blood tests and neuroimaging scanners that permit the routinized application of scientific knowledge; neither are they ethically and morally neutral.

At the experimental stage, biomedical technologies enable manipulations that intervene in animal and human bodies revealing previously unknown or inaccessible ‘objects’, thus making them factually ‘real’. At times chance intervenes in the creation of these material entities or ‘technophenomena’. The improbable chain of events in 1928 that led the Scottish researcher Alexander Fleming to observe the antibiotic properties of the rare mould, Penicillium notatum, is a well‐known example of the humble origins common to many biomedical technologies. Fleming rather carelessly left an open Petri dish smeared with Staphylococcus bacteria on his laboratory bench by an open window while he went away on a two‐week holiday. When he returned, the yellow‐green growth of the bacteria was surrounded by a clear halo produced by a mould that had accidentally drifted down from a mycology unit above into Fleming’s London lab one floor below. Various unconfirmed reports about the effectiveness of the mould had already been reported prior to Fleming’s ‘discovery’, but he was the first to grow a pure culture of Penicillium resulting in a new technophenomenon that he named ‘penicillin’. However, it was not until 1942 that sufficient observations and experiments had been carried out and adequate quantities of penicillin produced for it to be put formally into production in the United States, and then initially only on a small scale. It took even longer for ordinary doctors to appreciate its value and learn that the drug should be administered intravenously to be effective.

Ludwig Fleck argued in the first half of the twentieth century that phenomena that scientists work with are the products of technologies, practices and preconditioned ways of seeing and understanding. Fleck’s argument is that every scientific phenomenon exists only as a result of a technical intervention on the part of scientists,¹ and that creating a firm separation between the worlds of research and of application (such as is commonly done between the laboratory and the clinic) is entirely inappropriate. In other words, biomedical technologies are anchored as part of one or more ‘sociotechnical systems’ that straddle institutions including hospitals, laboratories, biotech companies and the state.² The phenomena that result from their application coalesce as the accepted biological, clinical and epidemiological facts of biomedical practice. Such routinized practices are transportable across vast distances and are capable of marshalling yet more phenomena as a result of systematic interventions into patient bodies or human populations, thus producing yet more facts. In other words, biomedical technologies bring about transformations, resulting in newly discovered knowledge about the material world that, in turn, influences subsequent interventions. This insight informs our position that the science of biomedicine is actively constructed by technology – biomedical technology. By extension this means that health‐related matters are routinely ‘objectified’ as technical problems, to be solved through the application of technology and the conduct of science, and are, by definition, therefore, decontextualized in practice. Objectification tends to make opaque moral assumptions embedded in the actual application of any given technology as the following chapters will show.

This approach builds on and extends the work in the 1960s and 1970s of the French philosopher Michel Foucault. He argued that, commencing in the seventeenth century, management by the state began to be accomplished through the expansion of practices of regulation, discipline and surveillance directed at individuals. At the same time, government of ‘populations’ – of what Foucault termed le vivant (‘the living’) – was brought about through the use of technologies such as the census. Foucault coined the term ‘biopower’³ to describe the means by which government is exercised in the form of technologies that, although not machines, are nonetheless machine‐like in their systematic and codified generation of objects for management as well as new knowledge. Foucault’s formulation encourages an examination of a broad range of practices as biomedical technologies. Shortly before his death Foucault introduced a distinction between, on the one hand, technologies of bodily governance that he termed ‘objectifying practices’ and, on the other hand, technologies of the self used to transform one’s own body and mind through, for instance, spiritual exercises, public acts of contrition and confession.⁴ Together, these technologies have resulted in forms of embodiment, experiences and behaviours that many people assume are ‘natural’, resulting in the ‘making up’ of kinds of people that did not previously exist.⁵

We argue that two significant developments since Foucault’s time make straightforward application of his categories to contemporary biomedical technologies problematic. The first is the advent of what we call ‘techno/biologicals’, technologies that are in part constituted from human biological material, thus troubling ‘natural’ categories about self and other and producing new forms of life. The second is the increasing deployment of biomedical technologies outside the parameters of the state, whether in the developing world or in industrialized economies, by non‐governmental organizations (NGOs) and private actors who seek to achieve specific health goals independently of a systematic government‐monitored approach to public health. In light of these developments, understanding emerging forms of biopower requires careful scrutiny of biomedical technologies in practice.

Technological Mastery of the Natural world and Human Development

A belief that mastery of the natural world could be achieved through scientific investigation and the application of ‘machine power’ was central to Enlightenment thinking.⁶ By the nineteenth century, writers as different as Herbert Spencer and Auguste Comte explicitly associated developments in science and technology with progress and the advancement of human kind. Spencer argued that the degree to which people are able to control the natural world is an indication of the degree of their civilized status,⁷ and the anthropologist Edward Tylor, in his book Primitive Culture, sought to rank cultures according to their ability in ‘adapting nature to man’s ends’, with savages at the lowest end of the spectrum and educated peoples of Western Europe at the highest end.⁸ Of course there were a good number of well‐known dissenters to a position that celebrated the progress brought about by science and technology, but these people were in the minority.⁹

Signs of this ‘honourable’ and ‘audacious’ struggle against ‘brute matter’¹⁰ were evident in Europe from the fifteenth century on; the work of Leonardo da Vinci, Nicolaus Copernicus, Andreas Vesalius, followed later by Francis Bacon, Galileo Galilei, Isaac Newton and many others, provides evidence of an epistemological upheaval characterized today as the ‘scientific revolution’, one in which the world is made known through systematic investigation and transformed to what is assumed to be the better by means of the application of technologies. In the eighteenth and nineteenth centuries this approach was indispensable to the industrial revolution in northern Europe, one of the principal intentions of which was to improve the well‐being of the masses, if only so that they might be better able to endure excessively hard work.¹¹ It also brought about worldwide exploration and colonization, including the systematic extraction of wealth in the form of natural materials of all kinds, both for building and engineering feats and for scientific investigation in laboratories and medical schools.¹²

One strand of early scientific thought that became extremely influential in both British and Continental thinking of the eighteenth century, and is particularly relevant for the argument that we make in this book, culminated in Isaac Newton’s experiments on optics, mathematics and me...

Table of contents

• Cover
• Title Page
• Table of Contents
• Acknowledgements
• Introduction
• Section 1
• Section 2
• Section 3
• Section 4
• Section 5
• Epilogue
• Bibliography
• Index
• End User License Agreement