Anthropology of Biomedicine

MARGARET LOCK is Professor Emerita at McGill University, Montreal, Canada, Dept. of Social Studies of Medicine and Dept. of Anthropology. She is a Fellow of the Royal Society of Canada, Officier de L'Ordre national du Québec, Officer of the Order of Canada, and an elected Member of the American Academy of Arts and Sciences. Author and/or co-editor of 18 books and over 220 articles, Lock is a medical anthropologist whose work focuses on embodiment, comparative epistemologies of medical knowledge, and the global impact of biomedical technologies. VINH-KIM NGUYEN is Professor at the Graduate Institute of International and Development Studies in Geneva, Switzerland and at the University of Montreal, Canada. He is also Chair of Anthropology and Global Health at the Collège d'Études mondiales in Paris. He is a medical anthropologist and practicing physician who practices in infectious diseases and emergency care and has worked on the frontlines of global health efforts particularly in West Africa since 1994.

“The strength of this re-edited volume is that its analysis and criticism of biomedical practice can be transferred to comparable (and contemporary) negotiations over space and time.” - Curare - Journal for Medical Anthropology, VOL 44 (2021) 1-4

• Acknowledgements xiiiIntroduction 1The Argument 1Interwoven Themes 2Improving Global Health: The Challenge 4Biomedicine as Technology 5Does Culture Exist? 7A word About Ethnography 10Section 11 Biomedical Technologies in Practice 15Technological Mastery of the Natural world and Human Development 16Technology and Boundary Crossings 17Biomedicine as Technology: Some Implications 19Technologies of Bodily Governance 21Technologies of the Self 24The Power of Biological Reductionism 25Techno/Biologicals 262 The Normal Body 29Cholera in the Nineteenth Century 30Representing the Natural Order 31Truth to Nature 32The Natural Body 34A Numerical Approach 35Other Natures 36Interpreting the Body 38How Normal Became Possible 39When Normal Does not Exist 42Problems with Assessing Normal 43Pathologizing the ‘Normal’ 46Limitations to Biomedical ‘Objectivity’ 48Better than Well? 493 Anthropologies of Medicine 51The Body Social 51Contextualizing Medical Knowledge 53Medical Pluralism 55The Modernization of ‘Traditional’ Medicine 56Medical Hybridization 57Biodiversity and Indigenous Medical Knowledge 58Self‐medication 59A Short History of Medicalization 60Opposition to Medicalization 62The Social Construction of Illness and Disease and Beyond 64The Politics of Medicalization 68Beyond Medicalization? 71In Pursuit of Health 71In Summary 74Section 24 Colonial Disease and Biological Commensurability 79An Anthropological Perspective on Global Biomedicine 79Biomedicine as a Tool of Empire 81Acclimatization and Racial Difference 82Colonial Epidemics: Microbial Theories Prove their Worth 83Fear of Biomedicine 85Microbiology as a Global Standard 87Infertility and Childbirth as Critical Events 89Birthing in the Belgian Congo 90A Global Practice of Fertility Control 91Intimate Colonialism: The Biomedicalization of Domesticity 92Biomedicine, Evangelism and Consciousness 93The Biological Standardization of Hunger 94The Colonial Discovery of Malnutrition 95Albumin as Surplus 97The Biologization of Salvation 98In Summary 1005 Grounds for Comparison: Biology and Human Experiments 103The Laboratory as the Site of Comparison 103The Colonial Laboratory 104Experimental Bodies 106Rise of the Clinical Trial 107Taming Chance 109The Alchemy of the Randomized Controlled Trial 110The Problem of Generalizability 110Medical Standardization and Contested Evidence 112Anthropological Perspectives on Clinical Trials: The West African Ebola Epidemic 114‘Jiki’: A Clinical trial Amidst the Ebola Epidemic 116Context of the Clinical Trial 117Globalizing Clinical Research 118What Should Count as Evidence? 120Economies of Blood 121Experimental Communities: Social Relations 122In Summary 1246 The Right Population 127The Origins of Population as a ‘Problem’ 129Addressing the ‘Problem’ of Population 130Improving the Stock of Nations 131Contraceptive Technologies and Family Planning 133Indian Family Planning – meeting Quotas 135Increasing Fertility with Contraceptive use 139The One‐child Policy 140Biomedical Technology and sex Selection 145Contextualizing Sex Selection: India and ‘Family Balancing’ 146Contextualizing Sex Selection: Disappeared Girls in China 148Sex Selection in a Global Context 151Ghost Children, Little Emperors, Burgeoning Elders 153Reproducing Nationalism 155In Summary 157Section 37 Who Owns the Body? 161Commodification of Human Biological Material 162Objects of Worth and their Alienation 164The Wealth of Inalienable Goods 164A Bioeconomy of Human Biological Materials 165Who Owns the Body? 167Gifting Life 168Commodification of Eggs and Sperm 169Medical Tourism 171Immortalized Cell Lines 171The Exotic Other 174Biological Databases 177Concluding Comments 1828 The Social Life of Human Organs 185Bioavailability – Who Becomes a Donor? 186The Biopolitics of Organ Transplants 187A Shortage of Organs 190Inventing a New Death 192The Good‐as‐dead 194Struggling for National Consensus 197A Rapacious Need for Organs 199The Social Life of Human Organs 200When Resources are in short Supply 204Liminal Lives 206Does the Body Belong to God? 207Altruism, Entitlement and Commodification 2099 Making Kinship: Infertility and Assisted Reproduction 213Assisted Reproductive Technologies 214Problematizing Infertility Figures 215From Underfertility to Overfertility 216Reproducing Culture 222Assisted Reproduction in the United States 224Assisted Reproduction in Egypt 227Assisted Reproduction in Israel 230ART and the Reproduction of Normalcy 234Global Hubs of Conception 237Section 410 The Sociotechnical Self 241The Biological Boundary Between Self and Other 241The Sociotechnical Self 242Technologies of the Self 243Technologies of the Self in Biomedicine 244The Unconscious as Technology of the Self 245The Discovery of an Unconscious Self 246­Unlocking the Pathogenic Secret 247The Pathogenic Secret as a Mode of Subjection 248The Making of Posttraumatic Stress Disorder 248The Practitioner‐self 251Producing the Self Through Talking Technologies: Technologies of Health Promotion 252Technologies of Empowerment 253Technologies of Self‐help 254Confessional Technologies 255The Globalization of the Unconscious 257Beyond Freud to the Neurosciences 259The Psychiatric Self 259Psychopharmaceuticals 260Addiction and the Lie 263Conclusion 26411 Genes as Embodied Risk 265From Hazard to Embodied Risk 266From Generation to Rewriting Life 267Genomic Hype 269Geneticization 271Genetic Testing and Human Contingency 272Genetic Citizenship and Future Promise in America 275Biosociality and the Affiliation of Genes 276Community‐based Participatory Research 277Genetic Information and Hybrid Causality 277Genetic Testing in the Era of Personalized Medicine 279Genetic Screening 280Screening as a Collective Endeavour 282Race and Genetic Testing 284Preimplantation Genetic Diagnosis 286Is a Neo‐Eugenics Looming on the Horizon? 28712 Global Health 291What is Global Health, and How is it Different from International Health? 292Metrics and the Global Clinic 296Botswana’s Cancer Ward 297Leukaemia in the Indian Ocean 298Value in Global Health: A Global Market for Diagnostics and Drugs 300When Markets don’t Work 301Medical Humanitarianism and ‘Philanthrocapitalism’ 303Regimes of Anticipation in Global Health: Epidemics Fast and Slow 304An Anthropology of Preparedness 305The Politics of Anticipation 307Conclusion 309Section 513 From Local to Situated Biologies 313The End of Menstruation 314Local Biologies 319Kuru and Endocannibalism 320Racism and Birth Weight 323Agent Orange and Foetal Abnormalities in Vietnam 324An Abundance of Local Biologies 326Local Biology and the Erosion of Universal Bodies 328Rethinking Biology in the Midst of Life’s Complexity 329Is Biology Real? 330In Summary 33214 Of Microbes and Humans 335The Microbial Arms Race 337Warfare and Iraqibacter 339Debates About the Origin of HIV 340From Versus to Commensals: Microbiomes and Metagenomes 345The Human Ecosystem 34615 Genomics, Epigenomics and Uncertain Futures 349Divining the Contemporary 349Amassing and Systematizing DNA 350The APOE Gene and Alzheimer’s Disease 351Genetic Testing for Late‐onset Alzheimer’s Disease 353Interpretations of Risk Estimates 355Dethroning the Gene? 356Eclipse of the Genotype–phenotype Dogma 357Does a Programme for Life Exist? 358Learning (Again) to Live with Uncertainty 359Epigenetics: Overtaking Genetic Determinism 360From Epigenesis to Epigenetics 361Molecular Epigenetics and the Reactive Genome 362Miniaturization of the Environment 364Embedded Bodies 365Epigenetics and the Womb 366Food as Environment 367Social Deprivation 367Ageing and Epigenetics 368From Causality to Contingency 36816 Molecularizing Racial Difference 371Molecular Biology and Racial Politics 375The Molecularization of Race 377Bioethnic Conscription 377Racialized Allelic Variation 379Mexican Genomics 380Discordant Genomic Knowledge 381Commodifying ‘Race’ and Ancestry 382Looping Effects 383Epilogue 385Notes 389Bibliography 467Index 529