Introduction: Cultures of Medicine and Health in East and Southeast Asia

The eight articles in this special issue address culture-based aspects of health, medicine and medical research in five East and Southeast Asian countries: China, Taiwan, Singapore, Indonesia and Myanmar. The seven articles are products of the social science and humanities project entitled ‘Asian Biopoleis’, which begun in 2010 at the Asia Research Institute (ARI) at the National University of Singapore (NUS), but involving researchers from fourteen countries inside and outside the region (Clancey & Chen, 2013; Clancey, Graham, Bishop, & Fischer, 2013; Coopmans, Graham, Gelfert, & Clancey, 2012). At least two aspects of this project were globally unique. One was in the focus on medicine and public health as Asian practices and ways of living which had not previously been explicit in studies of the region. The other was in bringing together scholars based in and outside of Asia on a co-equal footing. Asian research sites have a long history of serving as points of comparison to Western ones, or as the targets of ethnographic trips funded by universities in other parts of the world. The current decade has, for the first time, seen Asian humanities and social science institutes, departments and research clusters emerge as true partners, and in some cases leaders, in the job of generating global knowledge about medical cultures in the region, lacking which, any generalisations about ‘global’ health and medicine would be woefully incomplete. ¹

The Asian Biopoleis project was dedicated to capacity-building in the region, which meant aiming for an authentic interdisciplinarity and multi-sitedness, and thus allowing for topics, approaches and locations one would have missed had the remit been too explicitly themed. Questions about Asia generated outside the region have arguably had a limiting effect on Asian scholars interested in setting their own research directions. Our horizon in this instance was closer to home: who was doing interesting work, with what new methodologies, in which new places? And what interesting questions were being generated through the ethnographic or archival encounter itself, rather than through a priori readings.

Some of the answers are in the articles which follow. One measure of the success of the project is that it soon moved beyond standard topics and questions, and even beyond ‘biomedicine’ in its strictest sense. Many Asian societies have plural medical and healthcare systems, most with pre-modern origins, so the encounters (historic and ongoing) of Western-derived ‘indigenous’ medical beliefs and practices are bound to have effected both of them. Likewise, the state is an actor in stories about medicine and health almost everywhere in the world, but the form this follows in Asia is often different, sometimes much less direct and other times far more so, than in Europe and North America. Despite the successful effort of the Asian Biopoleis project to network together social scientists from many countries, the networks built by Asian medical practitioners, regulators and policy makers between their own countries and those in the West are still often stronger and more sustained than those being built across and within the region. All of these themes and more are woven through the articles that follow.

Undertaking the cultural study of medicine, or declaring one’s subject to be ‘medical cultures’, opens the door to a range of modes (and styles) of writing. The early inclusion in this project of collaborators with backgrounds in anthropology, history, sociology, philosophy, communications studies, literary studies and other fields meant that we had the opportunity, if not an obligation, to consider themes beyond disciplinary conventions. It also meant carefully listening not just to the contents of what others were reporting, but how they chose to convey it. We hope readers of this collection, regardless of disciplinary background, will approach it in a similar vein. Whether analysing or describing, comparing or juxtaposing, categorising or storytelling, the articles collected here present a variety of valid choices. Indeed, broadening the accepted modes of scholarly writings about Asian medical cultures has been an implicit goal of our project, and one we thank this journal for supporting.

In ‘Exposed Biologies and the Banking of Reproductive Vitality in China’, Ayo Wahlberg explores the reality of the so-called jingzi weiji or ‘sperm crisis’ in China. More conceptually, he argues that the health of the human reproductive system (both male and female) as a marker for the degree of environmental degradation caused by human activities should be part of Anthropocene studies, which to date has been largely concerned with ecology. Wahlberg uses the term ‘exposed biologies’—as opposed to Margaret Lock’s ‘local biologies’—to describe this new relationship between the changing environment and the effects it has on the human body. Focusing on the Chinese body, however, Wahlberg also considers domestic policies such as the draconian one-child policy (which was recently abolished) as having an influence on China’s declining fertility rate, and the extremely fast-paced industrialisation that took place at the expense of the health of the Chinese population. In fact, Wahlberg describes urban living in China as ‘toxic living which ironically creates opportunities for sperm banks, given the increasing number of Chinese men diagnosed with severe sperm disorders’.

Liz Chee Pui Yee’s ‘To Cure a Hundred Diseases: Animal Blood Therapies in Mao’s China’ relates a little-known story about the political construction of drug-based therapies beginning in the Great Leap Forward. Known in Chinese as Jixue Liaofa, Chicken Blood Therapy was a short-lived but intense craze for injecting raw chicken blood into human bodies. Through this example, Chee extends Sean Lei’s characterisation of Chinese medicine as ‘a new species’ that evolved during the Republican period, showing its continued evolution in the Mao era under different circumstances (Lei, 2014). While she draws a parallel between animal blood therapies and the larger Chinese movement for popularising innovation in science and medicine—known as qunzhong yundong—Chee also highlights influences such as China’s early scientific ties with the Soviet Union, and popular interpretations of the official slogan zhongxiyi Jiehe (Combine Chinese and Western Medicines). Chee points out that the blood therapies she chronicles are emblematic of a much larger obsession in the same period with drugs based on animal tissue, often extending them beyond traditional uses. In that sense, the craze for animal blood therapies in the 1950s–1970s presaged the current and continuing obsession for seeking animal-based drugs as ‘miracle cures’.

In ‘The currency of racial difference: Globalised biomedical knowledge production and the generative value of an “Asian” dataset’, Catelijne Coopmans and Margaret Tan Ai Hua discuss the creation of medical knowledge based on race at the Singapore Eye Research Institute (SERI). The article discusses how Singapore has capitalised on its multi-ethnicity to become a centre for race-based medical research, whose marketability has ironically increased in the global push for ‘personalised’ medicine. Coopmans and Tan attribute the success of the Singapore Epidemiology of Eye Disease Study Programme conducted at the institute to two main components. First, race or the idea of being racially different is reified through local policies. This purportedly helps create stability in the dataset, thus making Singapore a more ideal test bed for research on Chinese and Indian populations than China and India. Second, SERI has caught up and even surpassed most sites in the West that produce similar research, thus allowing for transnational comparisons to be made between labs in those sites and in ‘Asia’. While Coopmans and Tan report scepticism among researchers themselves about race-based models, Singapore has nevertheless successfully used this initiative to position itself as ‘a population laboratory for the world’.

In ‘A Tale of Two Genome Institutes: Qualitative Networks, Charismatic Voice, and R&D Strategies: Juxtaposing GIS Biopolis and BGI’, noted anthropologist Michael M. J. Fischer suggests a new approach to STS-related field studies. Focusing on what Fischer calls ‘qualitative networks’, the article questions existing characterisations of the two most high-profile genomics institutes in the region. The Genome Institute of Singapore (GIS) is not an icon of neoliberalism, he argues, but of careful state planning involving both ‘charismatic’ figures and well-resourced infrastructures. The growth of the Beijing Genome Institute (BGI), by contrast, owed far less to the state and more to the collaborative and entrepreneurial efforts of a few Chinese scientists and their American (and Danish) mentors. Fischer also introduces ‘juxtaposition’—instead of ‘direct comparison’—as a more appropriate method in conducting multi-sited ethnography since, to quote the author, ‘juxtaposition … [refrains from] moving too quickly to generalization and comparative evaluation’. Fischer represents the stories of the founding and development of GIS (Part 1 of this article) and BGI (Part 2) through interviews with top management, capturing their ‘charismatic voice(s)’, and paying attention to shifts in manpower and research objects as a reflection of larger institutional (especially R&D) changes.

Wenhua Kuo’s ‘Ethics as social institution: Tracing the techno-politics of human research in Taiwan’ critically traces the island’s development of a legal and ethical framework for governing medical research. Kuo draws on Sheila Jasanoff’s work to explain the case of Taiwan, one example being her notion of ‘unofficial bioethics’, which Kuo uses to argue that bioethics in Taiwan emerged out of haphazard circumstances. While recognising the influence of official acts—such as the Medical Care Act of 1986—Kuo shows that the process was more complicated than what a straightforward legislative history would allow. It was influenced by a host of different actors and agendas, some seeing bioethics as a democratising realm and others as a profit-making enterprise. The article also chronicles a number of events which triggered ethical concerns, from high-profile surgical performances that took place in the late 1970s and 1980s, to the establishment of the Taiwan Biobank, and analyses how these aided or hindered attempts to standardise the island’s Institutional Review Boards (IRBs). Kuo’s article provides a broad socio-political context for understanding the making/non-making of bioethics in Taiwan.

Celine Coderey’s ‘Drugs’ life: Accessibility and use of biomedical drugs in Rakhine State (Myanmar)’ relates how the Rakhine people perceive and make use of Western pharmaceuticals. Coderey notably observes that the Rakhine people tend to apply indigenous medical principles when using Western drugs. In her words, ‘[the drugs] acquire new meanings as they are re-framed within traditional concepts’. Focusing on provincial Myanmar instead of the cities, Coderey’s research aims to influence policy decisions on the provision of healthcare in places where the vast majority of Burmese live. Nevertheless, Coderey places her study within the larger political economy of Myanmar to give an understanding of the distribution network for drugs, as well as the types and qualities available. She also explains the healthcare services provided by both public and private sectors, but argues they are inadequate in meeting the population’s needs. Coderey highlights the resort to unlicensed pharmacists who sell mostly expired, inferior or even imitation drugs as a problem arising from lack of government investment in healthcare. She also makes much of cultural (mis)perception as a major inhibitor to proper drug provisions.

Gregory Clancey’s ‘Hygiene in a landlord state: Cleanliness, germs and chewing gum in late 20th century Singapore’ gives overdue historical context to Singapore’s post-colonial branding as ‘clean and healthy’. Clancey argues that one neglected frame for understanding the rigour with which Singapore pursued such values was its unusually comprehensive re-housing campaign, resulting in what he terms a ‘Landlord State’. The normative functions of urban governments as arbiters, or builders of strategic infrastructure, were so extended in Singapore’s case as to create a new species of city, which its inhabitants were essentially re-trained to occupy. Clancey follows the two post-independence bureaucracies most directly tasked with infrastructural policing, the Health Ministry and the Housing & Development Board, revealing their trials, successes and compromises. A principle trial involved Singapore’s relation to chewing gum, which Clancey’s article traces from its nineteenth century introduction to its late twentieth century characterisation as a tool of infrastructural sabotage.

Hans Pols’ article ‘Health and Disease in the Tropical Zone: Nineteenth-century British and Dutch Accounts of European Mortality in the Tropics’ was not a product of the Asian Biopoleis project, but is very much in its spirit. We include it here to give deeper historical depth and greater geographic range to our collection. It has been well-reported by historians that prior to the popularisation of the germ theory, and even after, European accounts of illness in ‘the tropics’ often pointed to the climate as a cause of disease. Pols’ article points out that this view was not uncontested, however, and was often modified by social and cultural explanations having little to do with geography. The moral standing of the settler population, how they laid out their city, wore their clothing, and even planted their trees were all considered factors bearing on mortality by one or another colonial author. Contrasting English and Dutch colonial views of health in Batavia, he demonstrates that nationalist sentiments based on colonial rivalries also coloured reports about the city’s propensity towards illness and disease.

Taken together, these articles constitute a richly coloured snapshot of current STS-related research on cultures of health and medicine within East and Southeast Asia. The plurality of those interests and approaches itself represents progress. Scholars based in this region are, in contrast to the past, clearly more confident in choosing objects and approaches generated from their own field sites and/or archives. Two articles in this collection—those of Fischer and Coopmans/Tan—continue the strong interest in Singapore’s emergent biomedical community with which our project began. Indeed ‘Biopolis’ (the name of Singapore’s biomedical research city) served as the projects’ thematic badging. Clancey’s article, while not about Biopolis, also advances another of the project’s original vectors: excavating the city-state’s medical history as a way towards explaining its current condition. Two other articles—those of Wahlberg and Kuo—represent the equally strong interest in institution-building in China and Taiwan (and elsewhere in East Asia) which our non-Singaporean collaborators regularly brought to our workshops. Two other articles—those of Chee and Coderey—demonstrate an interest in the interaction between biomedicine and what might be called (with qualifications) ‘indigenous’ medicines, which was hardly apparent when our project began in 2010, but which has steadily grown in the past three years. Pols’ article reminds us that many of the issues raised by the Asian Biopoleis project are not new, despite its contemporary emphasis that health, and particularly the health of cities, has been a major factor in characterising Asia since the colonial era. While the Asian Biopoleis project comes to a formal end with the publication of this volume, it will hopefully continue to influence the way health and medicine in Asia are written about as cultural categories.