An Anthropology of Biomedicine 2e

Acknowledgements xiii Introduction 1 The Argument 1 Interwoven Themes 2 Improving Global Health: The Challenge 4 Biomedicine as Technology 5 Does Culture Exist? 7 A word About Ethnography 10 Section 1 1 Biomedical Technologies in Practice 15 Technological Mastery of the Natural world and Human Development 16 Technology and Boundary Crossings 17 Biomedicine as Technology: Some Implications 19 Technologies of Bodily Governance 21 Technologies of the Self 24 The Power of Biological Reductionism 25 Techno/Biologicals 26 2 The Normal Body 29 Cholera in the Nineteenth Century 30 Representing the Natural Order 31 Truth to Nature 32 The Natural Body 34 A Numerical Approach 35 Other Natures 36 Interpreting the Body 38 How Normal Became Possible 39 When Normal Does not Exist 42 Problems with Assessing Normal 43 Pathologizing the 'Normal' 46 Limitations to Biomedical 'Objectivity' 48 Better than Well? 49 3 Anthropologies of Medicine 51 The Body Social 51 Contextualizing Medical Knowledge 53 Medical Pluralism 55 The Modernization of 'Traditional' Medicine 56 Medical Hybridization 57 Biodiversity and Indigenous Medical Knowledge 58 Self-medication 59 A Short History of Medicalization 60 Opposition to Medicalization 62 The Social Construction of Illness and Disease and Beyond 64 The Politics of Medicalization 68 Beyond Medicalization? 71 In Pursuit of Health 71 In Summary 74 Section 2 4 Colonial Disease and Biological Commensurability 79 An Anthropological Perspective on Global Biomedicine 79 Biomedicine as a Tool of Empire 81 Acclimatization and Racial Difference 82 Colonial Epidemics: Microbial Theories Prove their Worth 83 Fear of Biomedicine 85 Microbiology as a Global Standard 87 Infertility and Childbirth as Critical Events 89 Birthing in the Belgian Congo 90 A Global Practice of Fertility Control 91 Intimate Colonialism: The Biomedicalization of Domesticity 92 Biomedicine, Evangelism and Consciousness 93 The Biological Standardization of Hunger 94 The Colonial Discovery of Malnutrition 95 Albumin as Surplus 97 The Biologization of Salvation 98 In Summary 100 5 Grounds for Comparison: Biology and Human Experiments 103 The Laboratory as the Site of Comparison 103 The Colonial Laboratory 104 Experimental Bodies 106 Rise of the Clinical Trial 107 Taming Chance 109 The Alchemy of the Randomized Controlled Trial 110 The Problem of Generalizability 110 Medical Standardization and Contested Evidence 112 Anthropological Perspectives on Clinical Trials: The West African Ebola Epidemic 114 'Jiki': A Clinical trial Amidst the Ebola Epidemic 116 Context of the Clinical Trial 117 Globalizing Clinical Research 118 What Should Count as Evidence? 120 Economies of Blood 121 Experimental Communities: Social Relations 122 In Summary 124 6 The Right Population 127 The Origins of Population as a 'Problem' 129 Addressing the 'Problem' of Population 130 Improving the Stock of Nations 131 Contraceptive Technologies and Family Planning 133 Indian Family Planning - meeting Quotas 135 Increasing Fertility with Contraceptive use 139 The One-child Policy 140 Biomedical Technology and sex Selection 145 Contextualizing Sex Selection: India and 'Family Balancing' 146 Contextualizing Sex Selection: Disappeared Girls in China 148 Sex Selection in a Global Context 151 Ghost Children, Little Emperors, Burgeoning Elders 153 Reproducing Nationalism 155 In Summary 157 Section 3 7 Who Owns the Body? 161 Commodification of Human Biological Material 162 Objects of Worth and their Alienation 164 The Wealth of Inalienable Goods 164 A Bioeconomy of Human Biological Materials 165 Who Owns the Body? 167 Gifting Life 168 Commodification of Eggs and Sperm 169 Medical Tourism 171 Immortalized Cell Lines 171 The Exotic Other 174 Biological Databases 177 Concluding Comments 182 8 The Social Life of Human Organs 185 Bioavailability - Who Becomes a Donor? 186 The Biopolitics of Organ Transplants 187 A Shortage of Organs 190 Inventing a New Death 192 The Good-as-dead 194 Struggling for National Consensus 197 A Rapacious Need for Organs 199 The Social Life of Human Organs 200 When Resources are in short Supply 204 Liminal Lives 206 Does the Body Belong to God? 207 Altruism, Entitlement and Commodification 209 9 Making Kinship: Infertility and Assisted Reproduction 213 Assisted Reproductive Technologies 214 Problematizing Infertility Figures 215 From Underfertility to Overfertility 216 Reproducing Culture 222 Assisted Reproduction in the United States 224 Assisted Reproduction in Egypt 227 Assisted Reproduction in Israel 230 ART and the Reproduction of Normalcy 234 Global Hubs of Conception 237 Section 4 10 The Sociotechnical Self 241 The Biological Boundary Between Self and Other 241 The Sociotechnical Self 242 Technologies of the Self 243 Technologies of the Self in Biomedicine 244 The Unconscious as Technology of the Self 245 The Discovery of an Unconscious Self 246 Unlocking the Pathogenic Secret 247 The Pathogenic Secret as a Mode of Subjection 248 The Making of Posttraumatic Stress Disorder 248 The Practitioner-self 251 Producing the Self Through Talking Technologies: Technologies of Health Promotion 252 Technologies of Empowerment 253 Technologies of Self-help 254 Confessional Technologies 255 The Globalization of the Unconscious 257 Beyond Freud to the Neurosciences 259 The Psychiatric Self 259 Psychopharmaceuticals 260 Addiction and the Lie 263 Conclusion 264 11 Genes as Embodied Risk 265 From Hazard to Embodied Risk 266 From Generation to Rewriting Life 267 Genomic Hype 269 Geneticization 271 Genetic Testing and Human Contingency 272 Genetic Citizenship and Future Promise in America 275 Biosociality and the Affiliation of Genes 276 Community-based Participatory Research 277 Genetic Information and Hybrid Causality 277 Genetic Testing in the Era of Personalized Medicine 279 Genetic Screening 280 Screening as a Collective Endeavour 282 Race and Genetic Testing 284 Preimplantation Genetic Diagnosis 286 Is a Neo-Eugenics Looming on the Horizon? 287 12 Global Health 291 What is Global Health, and How is it Different from International Health? 292 Metrics and the Global Clinic 296 Botswana's Cancer Ward 297 Leukaemia in the Indian Ocean 298 Value in Global Health: A Global Market for Diagnostics and Drugs 300 When Markets don't Work 301 Medical Humanitarianism and 'Philanthrocapitalism' 303 Regimes of Anticipation in Global Health: Epidemics Fast and Slow 304 An Anthropology of Preparedness 305 The Politics of Anticipation 307 Conclusion 309 Section 5 13 From Local to Situated Biologies 313 The End of Menstruation 314 Local Biologies 319 Kuru and Endocannibalism 320 Racism and Birth Weight 323 Agent Orange and Foetal Abnormalities in Vietnam 324 An Abundance of Local Biologies 326 Local Biology and the Erosion of Universal Bodies 328 Rethinking Biology in the Midst of Life's Complexity 329 Is Biology Real? 330 In Summary 332 14 Of Microbes and Humans 335 The Microbial Arms Race 337 Warfare and Iraqibacter 339 Debates About the Origin of HIV 340 From Versus to Commensals: Microbiomes and Metagenomes 345 The Human Ecosystem 346 15 Genomics, Epigenomics and Uncertain Futures 349 Divining the Contemporary 349 Amassing and Systematizing DNA 350 The APOE Gene and Alzheimer's Disease 351 Genetic Testing for Late-onset Alzheimer's Disease 353 Interpretations of Risk Estimates 355 Dethroning the Gene? 356 Eclipse of the Genotype-phenotype Dogma 357 Does a Programme for Life Exist? 358 Learning (Again) to Live with Uncertainty 359 Epigenetics: Overtaking Genetic Determinism 360 From Epigenesis to Epigenetics 361 Molecular Epigenetics and the Reactive Genome 362 Miniaturization of the Environment 364 Embedded Bodies 365 Epigenetics and the Womb 366 Food as Environment 367 Social Deprivation 367 Ageing and Epigenetics 368 From Causality to Contingency 368 16 Molecularizing Racial Difference 371 Molecular Biology and Racial Politics 375 The Molecularization of Race 377 Bioethnic Conscription 377 Racialized Allelic Variation 379 Mexican Genomics 380 Discordant Genomic Knowledge 381 Commodifying 'Race' and Ancestry 382 Looping Effects 383 Epilogue 385 Notes 389 Bibliography 467 Index 529