ENS, Lyon, France
10-13 September 2013
Charlotte Brives (LAM – UMR5115), Frédéric Le Marcis (IRD & ENS-Lyon) & Josiane Tantchou (LAM-UMR5115)
Jean-Pierre Dozon (EHESS), Didier Fassin (Princeton & EHESS), Wenzel Geissler (LSHTM), Marc-Eric Gruénais (U Bordeaux), Bruno Latour (Sciences Po – Paris), Anne-Marie Moulin (CNRS), Vinh Kim Nguyen (U Montréal), Kaushik Sunder Rajan (U. Chicago), Laurent Vidal (IRD)
Research in what is called the anthropology of health (in France) and medical anthropology (in the English speaking world) share a common concern for how bioscience, biotechnology, and biomedicine raise issues at the heart of contemporary society. Francophone and Anglophone anthropologists have worked theoretically side by side (but sometimes in ignorance of each other) to examine health inequalities, patterns of resort, pharmaceutical developments, public health policies, interventions on populations. They have placed the body in context and decentered biomedical notions of health and illness as they have revealed changing definition of old age and death or the patenting of life. These developments index a transforming relationship between humanity and health, one made visible in the relationship between subjectivity, misfortune –embodied or not – and the forms of political engagement these incite. This research, sensitive to how life is not at the heart of our ways of thinking and doing politics, remains haunted by Foucault's works on biopower and, increasingly, the care of the self.
Science and technology studies (STS) has over the past 30 years shown how scientific production creates new standards and values, how such works fans out through complex networks, each time redefining the world in which we live. STS research on biomedicine has also grown, but often isolated from conversations and debates in the anthropology of health and medical anthropology. These two disciplinary solitudes (medical anthropology and STS) have been maintained by critics that accuse STS of inadequate fieldwork and a heavy-handed approach to forcing data to fit pre-established theoretical framework, or critics of medical anthropology who complain that rich accounts of local illness knowledge and practice are too often opposed to a monolithic and "black-boxed" version of biomedicine. Yet can we still do without a real exchange between these two disciplines?
While the paradigm of evidence-based medicine seems to enjoy unquestioned legitimacy today, everyone agrees that this legitimacy is the byproduct of ongoing work engaging life sciences experts, health specialists and of the mobilization of social and political dynamics.
Thus evidence-based medicine is the result of an effort which, although taking the appearance of evidence, is the result of a process aiming at building its own legitimacy. Based on processes rather than given facts, evidence-based medicine is at the heart of the debate we hope to develop during this meeting. The foundations of such omnipresence of evidencebased medicine has to be studied, in that it allows the understanding of the logic of practices associated with it in contemporary societies. The primary objective of this conference is therefore to open, or rather to broaden, the space for exchanges between anthropology of health and science studies around evidence based-medicine: what are its contributions, its limitations, but also its constraints? How does it produce, impose or recompose within its everyday activities norms and standards of care? How does it redefine our conceptions of health, body and ailments afflicting us? How does it change our system of values? How does it influence the politics defining policies implemented within our health systems?
As a rough guide we suggest three main questions that will define our meeting. Although we invite papers to enroll concerning these three questions, they are far from exhaustive.
In most developing countries research activities are conducted within health systems. Clinical trials, scaling up interventions, and various tests and trials are inscribed into multiple dimensions. On the one hand they take part in the production of knowledge at a global level and turn research frameworks into spaces within which many questions are examined. Furthermore, this knowledge produced by researchers from the South (often in collaboration with researchers from the North) is mobilized to help a particular policy along, to defend such or such modification of an international recommendation (e.g. WHO). The problematic link between knowledge produced in these contexts, even from an operational logic standpoint, is rarely discussed. How does one go from protocol, from a test by its very nature "beyond real life" (as scientists like to put it) to public health recommendations and to practical implementations in the field? What are the rationales at stake, what are the operations of translation? What are the negotiations involved between researchers, public health specialists and political actors from global to local stances? It seems to us quite useful to read these negotiations through the lenses of the historical development of medical evidence (Marks 1999). Trial participants are indeed people who remain with their own history and daily life. Health workers have their own conception of medicine and care, which they developed through their experiences. Political, economic and social contexts vary, so do the schools of thoughts. Within trial set ups, trajectories and ontologies are multiple and the production of facts adds further to the different social worlds into which individuals are inscribed. Therefore the issue is not only to understand the production of biomedical facts in the light of the context (presence of other types of medicines, influence of religion and of the socio-political), but also to understand how this production comes to construct ontologies, professional environments, and ways of life. What does it imply for individuals, patients or health professionals? What ontologies of the body, health or disease are emerging from these practices and what is their impact? What consequences can this specific practice of medicine have on the actors involved, willingly or not? And how can we from this questioning conceive ethics or at least try to reframe some of its foundations, or else notice some inadequacies of its standardization? It is clear from these lines that we stand here far from the reductionist label attached to science, quite the opposite. We would rather understand how a new wealth and complexity find their origins in these practices, how within the space of clinical trials it is not so much the opposition of two worldviews which is displayed, rather it is their productive encounter.
Making bodies comparable
The rise of biology as a discipline, the development of statistics, and the practice of care, helped make bodies commensurable and standardizable, condition sine qua non for the development of biomedicine. However this configuration is by no means fixed. It is in fact constantly changing. Indeed, bodies are not comparable in nature and it is biomedicine's tour de force along with sciences in general to let us think they are (Latour 1997). Research carried out in Medical Anthropology highlights the idiosyncrasies peculiar to the living, and understand the materiality of the body as the product of history, social change and ongoing interactions between humans, their environment and the context in which they live, what Lock and Nguyen have summarized by forging the term "local biologies" (Lock and Nguyen 2010). When one considers human beings as unique both in terms of their genomes as in terms of their everyday experiences, there is reason to believe that the biological sciences can only produce partial picture, snapshots of the materiality of bodies. This observation allows us to offer another reading of biomedical failures and permits a better understanding of some of the problems associated with the implementation of biomedical and clinical research results originating from different contexts. Moreover it also allows for further reflection on the consequences of the biomedicalization of life and its impact on subjectivities, on the relationship that individuals have with themselves, with their image, their body, or their identity. The question of both the commensurability of the body and the generalization of data is at the heart of the issues we wish to see addressed during our meeting: while clinical trials along with the emergence of new technologies, and biomedical experiments in general are geographically and historically situated, their results can be generalized to give rise to public health policy. We are interested in all the dimensions of this journey: how, at the experimental level, is the body turned comparable to the point of adding them up, one to another? How do we produce the data? How does one objectify the living? However, this journey cannot account for its 'success', or rather cannot give an answer the age old question "why does it work", a question we must immediately replace with "how does it work." How does one render bodies comparable? How does one produce knowledge, how does one generalize to the point of making recommendations sometimes leading to real public health policies? And what are the consequences? An approach articulating science (in its most concrete modalities) and politics (at the more global scale) is strongly expected.
Standardizing practices, practicing standards
We all know that standardization is at the heart of the production of scientific statements, whether it be practices (Berg, 1997), protocols (Timmermans and Berg, 2003), or even living entities such as cells (Landecker, 2009) or organs (Hogle, 2009). This standardization aims at making facts transportable to other places, with other actors, to make them immutable mobiles (Latour). However, science studies have taught us that such standardization is never complete, never perfect. This is due to the many idiosyncrasies of the living on the one hand, and on the other to the fact that the reproducibility of a result, of a technology or statement lies foremost in the reproducibility of the conditions of their production, and therefore in the standardization of a large number of elements. Therefore, once produced, how are such data, facts, tools, technologies treated to be translated, transported, and distributed? And how are they received? Many studies in medical anthropology underline the richness and diversity of contexts in which they must take root, which sometimes means a temporary or permanent inconsistency between proposed health policies and local contexts in which we want to implement them. How are these contexts "redefined" by these policies and technologies, and with what consequences? How do experiences of populations, health, and people in the interface between science and politics fit? Of course, on this topic historians are probably better equipped than anthropologists to address this issue (Packard 1989, Vaughan 1991; Jochelson 2001) although anthropologists are not totally out of the picture (Dozon 1985, Carton 2003). People themselves are not a passive receptacle for biomedical technologies, practices, or even health policies, policies that carry the characteristic of being based on a type of amnesia when people on their side do remember (Fassin 2006). Today's recommendations may be echoing previous policies (i.e. indoor residual spraying and community mobilization in the fight against malaria). To forget this means not taking into account the history of health policies nor the memory of the people or contexts. How do patients cope with, bypass, reinvent, adapt or adjust pragmatically to implemented medical practices and technologies? How is history mobilized to understand the present? What are the continuities (or breaks) between the colonial and postcolonial eras that matter? For the African continent we invite the panelists to try and answer the question of the place and status of life science in times of necropolitics (Mbembe).
Our meeting in its purpose and questioning is inherently interdisciplinary. We claim therefore an interdisciplinary openness and invite representatives from various disciplines to propose papers (history, political science, anthropology, sociology, science studies but also clinical research, public health ...). Although the fieldwork of conference organizers mainly takes place on the African continent, papers based on other continents are most welcome. Beyond the relevance and quality expected for papers in an international symposium, their selection will be based on the appreciation of their grounding in a real fieldwork. We give to fieldwork a broad meaning: it may be archival or ethnographic. We expect original contributions based on work in progress or recently completed. We will pay particular attention to research including a historical dimension. Indeed we consider it necessary to articulate ethnography with a reflection based over a long time period. Research based on the use of archives will therefore be most welcome.
Deadline for abstract submission (500 words) : December 15th, 2012.
Notification of acceptance : March 1st, 2013
Deadline for papers : July 1st, 2013.