Paper short abstract:

In the context of therapeutic drug discovery and development for neglected diseases, this paper contemplates how we can understand the molecules that lie at the heart of this process as important and desirable things, in order to entertain a discussion of value that emanates from these particular compounds.

Paper long abstract:

In "the Pharmaceutical Person", Emily Martin (2006: 8) states: "pills defy recognition of their complexity in an important way: they look like sweets." The scientific labour at the heart of the production of therapeutic drugs is alienated, and the complexity of the very materiality of molecules is often overlooked. My research investigates drug development for neglected diseases, and in this context I suggest going back to the very beginning, focusing on the molecules that lie at the heart of the process. Many actors involved in drug discovery and development - be it the pharmaceutical industry or not-for-profit organisations such as product development partnerships, foundations, and translational research centres - work from what are known as molecule libraries, in order to screen thousands of compounds in the hope of discovering a hit that will eventually become a therapeutic drug. In this paper, I focus on the molecules themselves, posing the following question: how can we understand molecules as important and desirable things? Through a consideration of molecules as commodities, and considering them in their very materiality, I argue that focusing on molecular compounds entails a critical discussion of value.

Paper short abstract:

The control of mosquito-borne diseases like malaria and dengue fever is premised on breaking the lifecycle of their vectors. This paper explores the role of an insecticide in the assembling of global protocols and their dis-assembly in the face of domestic ambivalences towards domestic insecticide.

Paper long abstract:

The multiply interlocking lifestyles and lifecycles of human and mosquitoes present a series of possibilities for intervention and the consequent 'control' of vector-borne diseases like dengue fever and malaria. This is often through the use of insecticides (e.g. larvicides, 'knock-down' sprays, insecticide treated bed nets (ITBs)). But while the use of insecticides for vector-control is framed within global health protocols, human-mosquito relations are located within diverse, spatially and temporarily dynamic microenvironments, complicating points for intervention in vector biology. Furthermore, mosquitoes, pesticides and human practices around them are also embedded within a series of wider social, political and economic relationships and spaces. In particular, 'home', the relationship of domestic to public space, and perceptions of responsibility and appropriate actions shift as mosquitoes, pesticides and people move between these spaces.

This paper explores how an ambivalent chemical compound, deployed at once to kill and preserve life, is assembled through global health protocols, but often dis-assembled (dissembled, even) in its relationships with people, spaces, and multiple other entities such as water barrels, resting mosquitoes or fridge drip trays. In doing so, it asks whether single object biographies are sufficient to capture the messiness and contingency of multiple actant relationships in the context of anti-dengue practices in contemporary urban India.

Paper short abstract:

This paper presents a biography of a vaccine for malaria, tracing its history and the networks of human and non-human actors linked together to develop, test and evaluate it. Exploration of this vaccine and its supporting networks reveals the ways in which it impacts larger global health networks.

Paper long abstract:

Medicines are not simply scientific and technical creations that prevent or cure illness; they have the power to shape the world, creating economic, political and social relationships and networks that support their development and dispersal. This can be understood through a biographical approach to medicines and the application of Actor Network Theory, which proposes that social phenomena come about due to networks involving both human and non-human actors. Taking a biographical approach, this paper traces the 30 year history of a vaccine for malaria, named 'RTS,S'. It explores the networks that have been created to support its invention, testing, and use and the actors enrolled in those networks. Developed and manufactured by the pharmaceutical company, GlaxoSmithKline (GSK) in Belgium, RTS,S was trialed in seven African countries from 2009 to 2014 with funding from the Gates Foundation and other public and private organizations. Drawing on ethnographic research at GSK in Belgium and a malaria vaccine clinical trial in Tanzania, this paper explores the vaccine from its birth in laboratories, to its clinical trials, to its evaluation for use across Africa. It traces its movements in diverse contexts, including the laboratory, clinical and business spheres, uncovering its various meanings and uses, and provides an examination of the networks through which the vaccine is financed, regulated, and researched. Through an examination of the multi-faceted social and political life of the malaria vaccine, it is revealed how the vaccine shapes larger global health networks aimed at economic development and malaria control.

Paper short abstract:

Pesticides are asked to be a remedial poison but not a poisonous remedy - to explore this paradox I trace the legacy of Paracelsian chemistry on modern toxicology and agrochemical politics.

Paper long abstract:

As with many hazardous materials, pesticides are subject to extensive testing during their development and use to ascertain levels of human and environmental risk. Pesticide toxicology is driven by the assumption that a perfect dose can be identified and quantified - a dose that exists as a remedial poison but not a poisonous remedy. This belief can be traced back to the alchemical philosophy of Paracelsus, a 15th century scholar, who coined the phrase 'the dose makes the poison.' In this paper I will try to unravel some of the scientific and moral paradoxes and underpinnings contained in Paracelsus' teaching, and how it shapes the rhetorical claims of those in support of or against pesticides today, who routinely invoke the Paracelsian spirit when arguing their case.

Paper short abstract:

This paper engages with current interests in anthropology and tangential social sciences in the notion of things having sentience or even a voice.

Paper long abstract:

The idea of non-human objects speaking has an illustrious pedigree. From mosquitoes to matsukake mushroom spores, from handkerchiefs to handguns, non-human entities in the social sciences are positively gabbling. This paper argues that much of the storying which gives things speech is based on a distorted imaginary of nature. Using the cigarette as a case study of a global assemblage with ventriloquistic aspirations, following Holbraad (2011) I ask what a speaking cigarette might say. What language would it speak? Do people speak on the cigarette's behalf, or does the cigarette speak through them? What does this say about the power relationships between people, things and global health?

Paper short abstract:

Drawing on ethnographic interviews with smokers in Canada, Australia, the USA and England, we explore the relationships forged between smokers and cigarette packets, which we suggest differ from how they are legislatively imagined.

Paper long abstract:

The cigarette packet has long been a cultivated element of its appeal - from the gleaming case of Benson and Hedges' premium 'Gold' brand to the rugged masculine appeal of Marlboros and the feminine refinement of Virginia Slims. The idea that the 'charisma' of branding might be used against it has been a key thread in tobacco control since the turn of the twentieth century, and reaches its epitome in so-called 'plain packaging' legislation - introduced in Australia in 2012 and due to be implemented in the UK in May 2016. Evident in both the enactment of such legislation and industry efforts to overturn it is the assumption that packets do things. Thus, despite the diametrically opposed agendas of the tobacco industry and public health, both groups share the assumption that the hand that controls the packet rules the smoker. This power is seen to be enacted unilineally and hierarchically via the branded aesthetics of the packet - of either danger or desire, depending on who is in charge - to fundamentally shape smokers' responses to its content. In this paper we take seriously the idea of the agency of objects, but in ways rather different from studies on cigarette packaging that have proliferated to date. Drawing on ethnographic interviews with smokers in Vancouver, Canada; Canberra, Australia; San Francisco, USA and Liverpool, England we attend closely to the experienced (as opposed to assumed) relationships forged between cigarette smokers and packets, which we suggest are rather different from how they are legislatively imagined.

Paper short abstract:

In the context of an increasing push in healthcare towards technologically-mediated self-management of chronic conditions, we discuss the potential complications arising from the introduction of self-monitoring technologies into non-western environments by describing a study undertaken in Blantyre, Malawi.

Paper long abstract:

This study, with fieldwork to be completed in June 2015, is a preliminary investigation of self-monitoring health technologies in urban Blantyre, Malawi, and their impact on lay people's perceptions of illness, wellbeing and their engagement with health services.

Currently, several biomedical technologies are available for purchase for use at home without the supervision of a healthcare professional. These include technologies for self-diagnosis such as pregnancy tests and rapid diagnostic tests for malaria, and devices aiding self-management of chronic conditions such as diabetes.

However, little is currently known about the extent to which these technologies are available and used in resource poor settings, or of the ways these 'self-monitoring' devices affect their users' perceptions of health and wellbeing, their ownership of health agendas and their health-seeking behaviours.

This study aims to identify self-monitoring technologies currently available in Blantyre and to investigate their roles and meanings in the community through semi-structured interviews with users. We will explore concepts of bio-sociality, new types of 'patient-hood', the 'fluidity' of objects, and the often under-acknowledged degree to which technologies are appropriated by users to make them better fit their lives. In particular, we will consider how technology can empower people in situations where they experience inadequate healthcare, or highlight possible conflicts between self-testing and people's engagement with healthcare services.

The results will be used to generate hypotheses on the impact of self-monitoring technologies on the health and agency of users in resource-poor settings, particularly in Sub-Saharan Africa, laying the foundations for further research.

Paper short abstract:

This paper explores the Insulin Pump as material-semiotic node, as a potential form of intra-action. It asks after the location of agency in the Insulin Pump and its users, as well as inquires after the politics of differential access to Insulin Pump technology and education globally.

Paper long abstract:

Following Joe Dumit's (Dumit 2014) exposition of the "implosion project," an activity designed after Donna Haraway's characteristic writing of implosions, this paper takes the Insulin Pump as material-semiotic node, as an ideologically generative device at the same time that it is a very real, highly material, life-saving object. Of what is the Insulin Pump composed? Is it only plastic, batteries, and wireless technology? Or is it also intra-action: matter, meaning, and agency combined in a biotechnological device differentially distributed across the globe?

This paper will begin by exploring the Insulin Pump after the New Materialism of Karen Barad, incorporating also Haraway's trope of the "cyborg." It will next attempt to trace differential access to Insulin Pump technology across the domain of global health, understanding this object as both modern medical technology and identity-constituting phenomenon. It will inquire after agency and the Insulin Pump, wondering if we locate this agency within the user of the Insulin Pump, within the pump itself, or in the entanglement of the two. Are Insulin Pump users and their machines, then, better understood as a type of becoming?

This paper will finally ask what type of biological citizens can be created by the Insulin Pump. Does differential access to Insulin Pump technology globally constitute different types of biological citizens? Is a politics of equal access only possible when we understand the Insulin Pump as inert, as an object about which we can produce authoritative scientific knowledge on improved health outcomes? Or can we locate within global health a place for the Insulin Pump as material-semiotic node?

Paper short abstract:

My paper aims to analyse the specificities of a Global Health technology and suggests that this is best done by conceptualizing its systemic and infrastructural implications.

Paper long abstract:

The paper takes an on going trend in Global Health action as a starting point in which a focus on 'frugal' technologies is anticipated to solve very specific diagnostic and therapeutic issues especially in developing countries. While this trend oddly resembles the 1970s/80s discourse on 'appropriate technologies' the programmatic realisation and implementation of novel Global Health technologies goes beyond this movement. Underlying this dynamics we find the assumption that a replication of costly and complex western health systems in resource poor settings is not only unrealistic to be achieved but even no longer desirable. The paper takes the empirical example of introduction of Malaria Rapid Diagnostic Tests (RDTs) in Uganda as a case in point to understand the implications not only for the diagnostic landscape but more important for the organisation of public health infrastructures. Inspired by an STS perspective I follow Peter Redfield's notion of "bio-expectations" which are inscribed in humanitarian goods that are designed to cater needs 'outside' Global Health. Here I will extend the analytical scope and ask what happens when these technologies become integrated as viable part of a state public health system. Additionally I will contrast my results with Lakoff's two regimes of Global Health (humanitarism/security) and ask if this division still holds purchase for the more systemic scope and implications of 'frugal' Global Health technologies.

Paper short abstract:

In this paper, I ask how to bring the oxygen tank, a ‘thing’ that transforms a substance from invisible to visible, and intangible to tangible, into focus. I will consider whether existing theories and concepts are adequate for ‘following the thing’ in this case, both theoretically and practically.

Paper long abstract:

Our unequivocal dependence on oxygen comes into sharp, and often traumatic focus when the normalcy of breathing is disrupted by illness. When the lungs can no long sufficiently oxygenate the blood, supplemental oxygen is needed, and home-based oxygen machines or cylinders (i.e. tanks) become part of life - an extension of one's body. What was once free, through commodification and global trade, comes at significant cost to health systems and individuals and is of key concern for global health. Ethnographic research on chronic obstructive pulmonary disease (COPD) in Uruguay (2009-2014) found sharp divisions in access to oxygen along economic and geographic lines. Furthermore, while the oxygen tanks moved around the country, the humans dependent upon them found their mobility restricted to a few meter radius. These perplexities and inequalities begged further research with an explicit focus on oxygen. In December 2015, with National Research Foundation of South Africa funding, I will begin tracing oxygen in its commoditized form in South Africa and Uruguay. I plan to follow oxygen from its macro-economic position as a global medicinal oxygen industry, to its everyday salience for people with lung-disease, stopping along the way to examine other curious forms, such as its leisurely consumption (ex: 'oxygen bars'). In this paper, I ask how to bring the oxygen tank, a 'thing' that transforms a substance from invisible to visible, and intangible to tangible, into focus. I will consider whether existing theories and concepts are adequate for 'following the thing' in this case, both theoretically and practically.

Paper short abstract:

Morphine has a special role in Tanzanian palliative cancer care. Prescribing and dispensing morphine is at first a way to ease pain, but additionally an act of care where there is no resource for psychosocial and spiritual support. It substitutes and complements palliative care practices.

Paper long abstract:

Through rapid demographic transition NCDs have recently received attention in Sub-Saharan Africa. Among those cancer stands out with the highest mortality and fastest deterioration. For many patients curative treatment is no possible and pain management and palliation becomes first and only priority. But holistic palliative care seems a luxury as most patients are dying anyway and financial and human resources are needed elsewhere.

My PhD research took place in Tanzania's only specialized cancer hospital between 2012 and 2015. It is intended to show how and in what extent professional and private care is provided. Tanzania is one of few African countries where liquid morphine is available. Especially cancer patients benefit from the legalisation and availability to cope with their pain.

During the course of my research I observed a strong shift in morphine usage: from being restricted and exclusively handled by the palliative care team, to widely available on other wards and prescribed to most patients. In the meantime, there is a bottle of morphine on every patients' beside table. Additionally, a limited number of highly technological dispensing machines facilitated easy and exact use for a few dozens of patients.

Beside relieving patients from pain, administering morphine seems as a way to deal with high numbers of patients and their needs for treatment and attention where staff and treatment options are scarce. As medical professionals avoid extensive and emotional conversations and information disclosure remains fragmentary, prescribing and dispensing morphine is substituting and complementing palliative care practices.