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- Convenors:
-
Justin Dixon
(LSHTM)
Salla Sariola (University of Helsinki)
- Chair:
-
Bob Simpson
(Durham University)
- Format:
- Panels
- Location:
- Science Site/Engineering E101
- Start time:
- 7 July, 2016 at
Time zone: Europe/London
- Session slots:
- 2
Short Abstract:
This panel explores the notion of medical research as a form of development. That is, the ways in which medical research has become entwined in discourses of development, contributing to the improvement of local circumstances in the same moment that it strives to 'measure' them.
Long Abstract:
Since the 1990s there has been a substantial increase in the volume of medical research being conducted in low and middle income countries (LMICs). Despite travelling with explicit epistemological purposes, medical research shapes and constructs local realities in the same moment that it strives to 'measure' them. Material improvements, capacity building, even nation-building - aspirations such as these are woven into research cultures in ways that unsettle abstract biomedical futures. Mainstream bioethics has begun to acknowledge that researchers should contribute to improving local circumstances as well as ensuring access to licensed products. Indeed, capacity building and benefit sharing are now standard features of research initiatives, and the research enterprise more generally has become entangled in discourses of development.
Yet the idea of development as progress is problematic. What problems arise when practices that rely on inequities in health and wealth to generate data become engaged in their alleviation? Who gets to define what development means and how? To what extent do transnational research collaborations have genuine transformative potential? Or do developmental practices function to exacerbate existing inequalities and even generate novel ones? Answering these questions requires close attention to the everyday interactions between researchers, their local collaborators, and study populations, as well as the futures and moral visions that they enact. We therefore invite papers that grapple with the predicament of research as development - its possibilities and limitations, inclusions and omissions - and what this might mean for more responsible and responsive medical research in LMICs.
Accepted papers:
Session 1Rao Nadeem Alam (Quaid-i-Azam University)
Paper short abstract:
This paper presents the case of public health as an indicator of development in Pakistan. Public health faces the contest between indigenous knowledge/practices and contemporary medical research.
Paper long abstract:
This paper brings forth the role of culture in its classic sense as an important factor that constitutes and constructs the contested space of public health. This contest is between the research based knowledge and indigenous knowledge, the attempt is made to rationalize the development as a concomitant concept with research. The dichotomy is constructed to help make it a vivid idea where two alternative provisions are available to the population of Pakistan. This paper presents the two scenarios of research, one that helped adoption of indigenous knowledge and the other is advanced technology and industry based research. The example of the indigenous research is trial and error based inter-generational knowledge embedded in Ayurveda knowledge and prevalent among the Jogi (snake charmers) community and the other example of the other polarity is that of modern research about public health. Development is not limited to public health; rather it encompasses the economic and social aspects too that are coupled with public health. Therefore, development is reasoned following the reasoning style from Amartya Sen's (1999) idea of linking development with freedom. The paper is based on ethnographic fieldwork in rural Punjab among Jogi community. This paper will present the case of Pakistan, one of the Lower Middle Income Countries and will contribute to generate a debate about significance of public health as an indicator of development.
Sandalia Genus (University of Edinburgh)
Paper short abstract:
Hopes that a vaccine trial in Tanzania would lead to lasting development were unfulfilled, with impacts of the trial uncertain. Exploring how trial staff conceptually entwine medical research with development aspirations demonstrates the expectations they assign to research, and its limitations.
Paper long abstract:
Development practices are built on the premise that certain places are not only economically deprived but also temporally behind or stuck in the past. Development aims to bring low-income settings forward in time through improved infrastructure, health outcomes and education. Transnational medical research in low-income settings has been conceptualized as playing a role in development, helping bring modern medical practice and technology to impoverished settings. Focusing on a malaria vaccine clinical trial in northeastern Tanzania, this paper elucidates the connections between research and development, untangling the entwining of these projects; one to test a new vaccine and the other to assist in development. For trial staff, the idea that the research was helping to modernize Tanzania and bring it into the future was a prevalent perspective. Capacity building, the construction of laboratory and clinical spaces, improvements in the health care system, the provision of medical technology, and the education of communities were all cited as positive impacts of the trial. But as the trial drew to a close in 2013, its legacy was uncertain. The trial led to some improvements but also entrenched inequalities and many of its lauded impacts were finite. Hopes that the trial would bring lasting development gave way to a level of disappointment when the trial concluded. By exploring the ways that trial staff expressed their understandings of the research and its impacts, this paper teases out the various meanings and aspirations assigned to medical research and the connections research has with temporalities and development.
Justin Dixon (LSHTM)
Paper short abstract:
This paper explores the ways in which a research institute has altered the local context of health seeking and delivery through the ground-level conduct of TB vaccine trials.
Paper long abstract:
Clinical trials on new vaccines remain a high priority on the global TB research agenda given the devastating impact TB is having in the developing world and the continuing proliferation of drug resistant strains of the disease. The South African Tuberculosis Vaccines Initiative (SATVI) has been conducting vaccine trials in the Western Cape for 15 years, acting under the self-professed mandate to contribute to the 'greater good' of a new vaccine that will radically strengthen efforts at the primary healthcare level to combat TB.
This paper explores the differential relationship that SATVI has with the TB hospital in which it is based and the primary healthcare clinics in the region. In particular, SATVI has contributed technologies such as digital X-ray machines to the hospital, greatly improving the ability of doctors to diagnose and manage complex cases of TB. Yet SATVI's 'contributions' at the primary healthcare level, where the majority of SATVI's day-to-day research activity takes place, are less to do with resource donation and more the indirect spinoffs of the research process (e.g. early case detection among participants). In fact, filling the voids left by, and even bypassing, the local clinic structures, SATVI's research potentially thrives at the expense of primary healthcare. This paper therefore examines the implication of clinical research in enduring inequities between primary and secondary care in post-apartheid South Africa.
Salla Sariola (University of Helsinki) Bob Simpson (Durham University)
Paper short abstract:
Focusing on clinical trials in Sri Lanka, we show how researchers harness research for objectives beyond scientific pursuit. However, ideas of ‘development’ can be incompatible and contradicting.
Paper long abstract:
This presentation explores the tangled relationship between biomedical research and development, with particular view on Sri Lanka. It is based on several years of joint work and ethnographic research of our on-going book project entitled 'Research as Development: international collaborations, clinical trials and bioethics in Sri Lanka'. The book concentrates on the cross-overs between research as systematic knowledge creation and innovation, and development as the orchestration of economic, material and human resources to achieve economic growth, improvements in well-being, sustainability and a range of other objectives. The loci of our interest are the international collaborations, and particularly clinical trials, which bring together researchers across differentials of power and resources.
We show how researchers and institutions work to advance their intellectual pursuits and national research cultures through international collaboration. Focusing on three controversies around ethics and clinical trials in Sri Lanka as a way to look at tensions around these activities illustrates the conceptual challenges of clinical trials and their regulation. Our analysis shows that ideas about what stands for 'development' can be incompatible and contradicting, and people disagree about the shape and kind of research cultures as well as the values embedded in the different notions of bioethics, leading to individual and institutional conflicts and compartmentalised regulatory structures.
Cassandra Yuill (City, University of London)
Paper short abstract:
This paper investigates research as development outside of its traditional geographical bounds, drawing from experiences working on a collaborative health intervention.
Paper long abstract:
The purpose of this paper will be to investigate research as development outside of its traditional geographical bounds, specifically the low-income area of Sunderland in North East England. I will draw from experiences working on a collaborative health intervention feasibility study, involving a variety of actors: academics, NHS staff, members of charities and public health organisations and participants from deprived communities.
The intervention, aiming to reduce hazardous co-sleeping and contradictory health messages about bed-sharing, involves an educational intervention about safe infant sleep and a novel "safe sleep space" for babies. While acceptability and expansion are common goals of those involved in the study, each individual has specific interests to promote and, ultimately, plays a role in the successes (or failures) of the project. As anthropologists, I argue that we are required to identify, incorporate and balance these potentially conflicting interests in order to pursue "meaningful" collaborative research with a developmental balance, resulting in limitations to the effectiveness of projects outcomes.
Building on the structure of this feasibility study, the paper will present how there is space for innovative anthropological research in England in the evolution of health messages and health care systems at home, despite the constraints. With this in mind, I will also tackle whether or not public health interventions may actually widen inequalities and consider the continued importance of applying anthropology in the local context.
Gemma Aellah (BSMS)
Paper short abstract:
This paper explores the ways transnational medical research and intervention in rural Kenya provides a structuring reference point for opportunity-out-of-reach that interplays with the visions and ambitions of youth who dream of, but can’t access its’ formal economic opportunities.
Paper long abstract:
What hopes and dreams unite and divide a human-landing catcher sitting outside his hut late at night sucking mosquitoes off his legs, a medical research fieldworker developing a model tree farm in the village where he works and the members of an impoverished community-based organisation laying a physical foundation-stone for a million-dollar dream AIDs orphanage that never comes? In a group of small villages in Western Kenyan transnational medical research and intervention has been an everyday feature of the social, physical and economic landscape for more than 30 years. Extremely high HIV prevalence, an ongoing health and demographic surveillance project and associated research programme based on transnational medical research collaborations ensures that medical research and intervention activities are the biggest provider of formal employment, material resources, new infrastructure and cash-flow in an area otherwise characterised by an informal and subsistence farming economy. Exposure to the city, to cosmopolitan living, class inequality and the wider world is carried into the village through these flows of people, resources, ideas and styles. This paper explores the ways medical research and intervention, therefore, provides a structuring reference point for endless potential opportunity and opportunity-out-of-reach that interplays with the dreams and ambitions of the majority of youth living in these villages who dream of, but can't access, either medical research's formal economic opportunities or former avenues to stability through education and government/industry employment.