EASA, 2006: EASA06: Europe and the world
Bristol, UK, 18/09/2006 – 21/09/2006
Medical anthropology, Europe and the world
Location Dept. Arch Anth LT1
Date and Start Time 20 Sep, 2006 at 17:00
This workshop will examine the process and politics of translation in the formation, dissemination and utilisation of components of medical knowledge between Europe and the rest of the world.
This workshop will examine the process and politics of translation in the formation, dissemination and utilisation of medical knowledge between Europe and the rest of the world. A classic focus of medical anthropology has been interactions between biomedicine (an indigenous medicine of modern Europe) and traditional medicine outside Europe. We will explore interrelations between European medical traditions and knowledges of health and the body, and their counterparts (both traditional and biomedical) elsewhere. This includes not just the export of European knowledge and practice but the import of non-European elements into the European; one current and longstanding example is the expropriation of traditional pharmaceuticals by an act of translation into European pharmacopoeias. The globalisation of biomedicine is seen in many other arenas. Medical research originating in Europe is increasingly being undertaken in developing countries, especially clinical trials and biobanking (the collection of biological material for genomic research, such as cord blood banking for stem cell therapy). Together with such initiatives, which are based on particular European notions of risk, vulnerability and control, come regulatory institutions such as ethics committees. How are these notions of risk and the future, or ethical concepts that accompany public debate on these developments in Europe and are based on European assumptions about personhood, autonomy and choice, being adapted and translated for local use? Bioethics and epidemiology are just two domains for exploring linkages between different configurations of medical knowledge. Other fields might include the diffusion of medical techniques (acupuncture, transplant surgery), technologies, pharmaceuticals, and marketing and regulatory mechanisms. Together with these issues, we invite reflection on the personal politics of researching medicine as Europeans and non-Europeans at home and abroad.
'…the medicine is finished': traces of Euro-African modernity in the remains of state medical science and disease control in Kenya
Medical anthropologists and historians of colonial medicine in Africa show that scientific medical research and disease control in Europe and Africa was integral to power, discipline and hegemony within the forms of government that marked the last two centuries' global European modernity. This interpretation arises from a mid-20th century imaginary: European scientists, working with government, exercise power and knowledge on African bodies and territories; and governments, scientists and citizens hope to enact some version of scientific, economic and political progress. Our paper adds an early 21st century perspective to this convincing historical picture: How does medical science in Africa look like, if we approach it not as a European endeavour in Africa, but as part of African modernity; and if we view it not in a characteristically modern, post-colonial frame, but from within the ongoing neoliberal restoration that transforms Africa and the rest of the world, including, reluctantly, Europe? What are its effects and virtues, when the separations between us-them, subject-object, and past-future, that sustain the modern order, are in doubt?
The question will be approached through a group of Kenyan scientific medical workers, who have conducted medical research and disease control for their government, throughout Kenya's independence. Their lives, views and recollections allow us to look back at modern African science. The commentary of these 'middle-men', dissolves the Euro-African contrast and inverts the narrative of progress. It invites reflection about the critique of modern regimes of power and knowledge that has now inspired us for a while. At a time when modern hopes and aspirations have moved out of reach, not just for African scientists, one wonders why many of us so miss this older modernity. What longing does the modern, European order call forth, now that the post-modern prophecies of its dissolution seem fulfilled? The elderly Kenyan scientific workers' experiences and achievements - and nostalgia - add to our understanding of a past African and European modernity, and of our present, shared predicament.
Malaria and malariology: the Portuguese experience (1900-1958)
Malariology stands as a meaningful example of the importance of colonial experience in European medical science. Starting from Laveran identification of parasites (Plasmodia protozoa) in the blood as the cause of malaria, malariology developed in two different settings - Europe and European colonies.
This paper raises some questions regarding the development of malariology and its outcome on public health policies in Portugal, during the first half of the twentieth century. Portugal was not a centre of meaningful scientific production; moreover, it was in the periphery of the European geo-political scene. However, Portuguese physicians followed attentively the development of malariology, trying to draw political attention to malaria which they had identified as a main public health problem in Portugal. At the same time, Portuguese physicians tried to keep pace with the international strategies towards malaria control.
My purpose is to: (1) briefly identify the social, political and cultural conditions behind the conception of malaria as a major public health threat in Portugal, and the related development of malariology; (2) to compare the action towards malaria control in the metropole and in the Portuguese colonies, especially in Africa (3) to rise some questions related to the mutual influence between malaria control experiences in the metropole and in the colonies.
'Wandering madness': local mental care in Port Gentil (Gabon)
This papers aims at discussing the various ways the town of Port Gentil addresses mental health problems. More in particular, it is concerned with one specific example, being the notorious "fous errants", who are wandering in the center and outskirts of the city. These men and women without any known relatives or fixed residence are often encountered naked and delirious. They represent the very expression of a specific local imaginary that considers them as being 'on the threshold with an invisible world'. Very recently, a French psychiatrist has been invited to Port Gentil to discuss a possible assessment of these individuals, but his example, namely the implementation of the actual policy as widely diffused in the French metropoles for the SDF (sans domicile fixe), has encountered strong resistance by the local community and especially by the various representatives of indigenous healing practices. this papers highlights the problematic dialogue between various social imaginaries regarding the specific domain of public mental health in Port-Gentil.
Narrowing and expansion of the use of Chinese Medicine in two European countries - Italy and France
For the last thirty years, non-conventional forms of medicines have undergone a remarkable expansion and growth. Among these medical practises, those coming from China are without a doubt very important, and particularly the acupuncture. I have chosen to study from a historical and anthropological point of view the insertion and reception of this medical practise in two European countries, France and Italy. More precisely, I'm interested in the physician figure that decide to practice Chinese Medicine (often the acupuncture). I have also chosen to give to my work a comparative dimension, studying the situations in France and in Italy, two countries where the processes of integration and recomposition of Chinese medicine are not the same, although linked by exchanges concerning the teaching and the integration of Chinese Medicine.
This analysis permits to outline a field of cultural and social meeting ground, where the contributions of two medical traditions (conventional medicine and Chinese medicine) are searching and finding shape as they mix and are accepting compromise. Their practice demonstrates and proves their efficiency and, at the same time, they are gaining institutional acceptance and are in public demand. All this makes us wonder about both the motivations, and the future aspirations connected in this example of cultural exchange.
Of rumps and pumps, or, where did the clysters go: notes on an anthropology and history of European and non-European medicine
When two well-heeled European women met in the eighteenth century, and the conversation turned to the 'secret of a good complexion', then the advice offered by one to the other was: 'have an enema'. If bloodletting was the rage in the 19th century (the number of leeches imported into France grew from 300,000 to 33 million between 1824 and 1837), the enema was the eighteenth century rage. Flavoured teas like lemon, orange, chamomile and peach, all in search of complexion and beauty, were had (literally) bottom up. But this scatological obsession was fashionable only because the enema was believed to be therapeutically efficacious and, along with bloodletting, the purge, the emetic and cupping, was a therapeutic mainstay from the time of Galen. Where did the enema and the clysters go? They were re-born as "colonic irrigation" across the Atlantic; they 'reappeared' in the European 'underground' under the aegis of Naturopathy as 'pure' water enemas; they continued to survive in the European 'overground' as household remedies, especially administered to children; and they may soon storm Europe and the world as strong (as opposed to the current association of herbal and alternate with being 'mild') oil and Kashayam enemas as part of an 'authentic' Kerala Ayurvedic panchakarma therapy.
In this paper I would like to use the enema as an icon to argue that the distinction between European and Indian or Chinese medicine, at least as far as the 'pre-modern' is concerned, may be misplaced. While there is a virtual identity in terms of certain cardinal therapeutic procedures, it could be argued that the underlying theory, while not identical, bears a family resemblance, which allowed for a ready translatability. I would further like to argue that what appears to be a string of alternative European therapies was once the reigning orthodoxy recast. And non-European alternate practices like the panchakarma is virtually identical to what used to be the therapeutic mainstay in Europe. How are we to make sense of this? I suggest that we can make sense of this only if we attempt to break down the distinction between East and West and orthodox and heterodox both within and without Europe. I attempt to do this through a kind of three way comparison between naturopathy in the UK and India, between Naturopathy and biomedicine both in the UK and India, and between Naturopathy and Ayurveda and Yoga in India. I will do this by following the clyster around in the hope that it is not only good for one's complexion but also good to think with.
Regulatory frustrations: how the evaluation of reproductive materials hampers human embryonic stem cell research in Japan
In July 2004, following the regulation of research cloning in the UK and the cloning success of Huang Woo-Suk in Korea, Japan's government's Council for Science and Technology Policy decided to permit the cloning of human research embryos. Despite major organisational and financial efforts to stimulate the life sciences (the Millennium Project, the establishment of various national and governmental bioethics committees and strategies), Japan in 2006 still has no regulation for embryo cloning. There are only a few scientists concentrate on human ES cells; and, research groups interested in human embryo cloning are hard to find. Moreover, apart from patient groups that fervently encourage research into stem cell therapies and a few religious groups that oppose it, a majority of the population has hardly any idea what stem cells are about.
This paper explores the reasons for the apparent failure to stimulate research in human embryonic stem cells and the reasons for the lack of a broad public discussion. I shall do this by discussing the role of various 'cultures' related to the organisation and development of ES cell research and embryo/ocyte donation in Japan. I argue that rather than spiritual culture, two other cultural factors are crucial to the research and regulation of body materials: a culture of safety and affluence, and the organisational culture of decision-making in Japan.
Contrasting Japanese religious-cultural concepts of 'life' with European ones, I show how they are of great relevance to the way in which various groups of people express their agreement or opposition to embryo and/or ocyte donation. Second, I argue that the lack of concern of a majority of the people can be understood only in the context of the ways in which the government and media provide information and the way in which bioethics decision-making is organised in Japan. Finally, I show that the meaning of embryo donation is linked to the way in which Japanese society has come to emphasise the urgency of infertility problems over that of mass-abortion. As a result of the valuation of these reproductive materials, the donation of ocytes and embryos as resources for science research constitutes a problem hESR.
The construction of drug quality: a comparative study of the pharmaceutical industry in the European and Indian contexts
The present paper posits that the concept of drug quality in the pharmaceutical industry is a constructed one and hence variable across time and space. The tendency on the part of regulatory agencies in different countries to insist on stringent adherence to their specific set of quality protocols has led to the reification of drug quality in terms of certain physio-chemical parameters. Through case studies of two drugs, which have been the focus of quality related contestations in India and in Europe, the paper broadly seeks to provide a comparative understanding of the parametric variability among the drug quality protocols enforced by different regulatory bodies in terms of the norms invoked by the pharmaceutical firms at different stages of the drug discovery and development process and their justifications for invoking these norms. Further, the paper also examines how the other interest groups like regulatory bodies and consumer interest groups view the norms invoked by the industry and the extent of agreement between the norms adopted by the industry, those enforced by regulatory bodies and the norms espoused by consumer interest groups with respect to drug quality. The contestations over these norms have been broadly examined in terms of the system of meanings, values, worldviews and interests of these three groups, their organizational imperatives and the prevailing policy regimes in India and Europe. In doing so, the paper also posits a dialectical relationship between innovation and regulation in the pharmaceutical industry. The paper highlights the processes through which the contestations articulated by these three interest groups shape knowledge claims relating to therapeutic drugs in its journey from bench to bedside and the trade-offs between different value choices held by the contesting groups involved in the crafting of drug quality norms.
How Big Pharma's 'global corporate citizenship' is translated in India
An increasing number of European and American drug companies are claiming to hold "global corporate citizenship" (GCC). Defined as a dialogic engagement with significant stakeholders, GCC aims to uphold and propagate universal human rights within corporate boundaries and beyond. For drug companies, GCC entails not only a promise to ease access to medications for all patients, but also to spread disease awareness and "health literacy" around the world, in both developed and developing countries. Drawing on recent fieldwork in Kolkata (Calcutta, India), this paper explores how GCC is translated by doctors in general practice. Focusing on the official and unofficial messages conveyed in "depression awareness" workshops held by a large multinational company, it describes how GCC slogans are adapted to postcolonial notions of citizenship, with often paradoxical results. For example, Kolkatan GPs routinely prescribe antidepressants without telling their patients about the medications. Does this subvert ideas of global corporate citizenship, or might it support them in unforeseen ways? How are different projects of pharmaceutical citizenship aligned or in conflict with each other?
Innovation goulash: techno-medicine, nationalism, colonialism, and the market in magnetic resonance imaging development in the UK, India, and the US
Innovation in science, technology, and medicine, particularly in the analyses of its transnational and global scape, often reflects a "west" versus "non-west" divide - science, technology, and medicine are shown to have developed in the west and then they are deployed in the non-west. At first glance the story of MRI, a cutting-edge medical technology, seems to be no different. In 1987, when the first MRI was installed in India, the US had nearly 900 MRI in use and General Electric Medical Systems, a multinational company based in the US, was a global market leader in MRI development and supply. Then in 2003 Paul Lauterbur, an American scientist, and Peter Mansfield, a British scientist, received the Nobel Prize for their contribution to the development of MRI. These simple empirical "facts" may seem to be telling reminders of techno-medical innovations in western and non-western societies. An analysis of innovation based on such empirical facts (which is not uncommon) is, however, also reflective of a reductionist and Eurocentric understanding of science and medicine. These empirical facts hide as much as they tell about the history of MRI. This paper shows how issues of nationalism, colonialism, and the market played crucial roles in MRI research and development. An opening up of the "black box" of science (and associated Eurocentric historiography) will allow us to understand the uneven and hierarchical topography of techno-medical research.
International knowledge relations: the case of bioethics
In the rapidly burgeoning field known as international or comparative bioethics, a fundamental binary is often in evidence. At one level are to be found abstract, codified, translatable and transferable norms which encircle the globe like an ethically charged stratosphere made up of protocols, declarations and guidelines held together by the energy of international committees and conferences. On the other hand, there are the 'local moral worlds', which Kleinman  so effectively described, and in which actual persons struggle to achieve their own versions of human flourishing. Out of this rather problematic binary that pits the 'developed' against the 'developing world', other binaries may be unpacked: global versus local, universalism versus relativism, modernity versus tradition, rhetoric versus reality, and with these come a well-worn conceptual apparatus of western geography, philosophy and history and the notion that there is a 'divide' which must be 'bridged'. Yet, what are missing from these formulations are the complex mediations and articulations that already connect first world researchers with third world subjects. One might therefore reasonably ask, just what is the nature of the opposition given that at various levels there is activity underway to create, shape and contextualise sets of relations that go way beyond the paradigmatic relationship between researchers and their human subjects? By what mechanisms is the global ethics of human subject research made into workable structures in particular contexts? What are the locally felt motivations to organise around emergent forms of ethical knowledge and practice? Drawing on case materials collected during research in Sri Lanka, this paper maps the development of bioethical discourses and draws attention to some of the knowledge relations that emerge around recent developments in biomedical research and technology.