Abstract
It is understandable, then, that medicine should have had such importance in the constitution of the sciences of man [sic] – an importance that is not only methodological, but ontological, in that it concerns man’s being an object of positive knowledge. (Michel Foucault, The Birth of the Clinic. 1979: 197)
There is little dispute among anthropologists about the profound impact of biomedicine on different facets of human existence. The vast and ever growing body of studies of biomedical practices stands testimony to this important anthropological concern. Margaret Lock and Vinh-Kim Nguyen’s book deploys this vast body of anthropological studies as its source to provide an insightful and thought-provoking analysis of biomedicine that has encyclopedic scope. The focus of the book, as Lock and Nguyen state at the outset, is ‘directed toward the vibrant entanglements of human activity in connection with biomedical technologies’ (p. 5). The concern for the authors is not, however, simply physical embodiments of biomedicine, i.e. technologies. Rather, as they argue, ‘biomedicine is itself a technology’ (p. 11). ‘[T]he science of biomedicine’, as they elaborate, ‘is actively constructed by technology – biomedical technology. By extension, this means that health-related matters are routinely “objectified” as technological problems’ (p. 18). Nevertheless, biomedical technologies are not ‘straight-forward application of scientific knowledge’ (p. 11). Biomedicine, according to them, ‘despite its grounding in science, is a site of struggle about control and interpretation of what will count as legitimate truth claims’ (p. 82).
Intrinsic to the intellectual concern of Lock and Nguyen, as the book explicitly and implicitly makes evident, is an intertwining of two approaches. On the one hand, they utilize Foucauldian analytics to explore how biomedicine represents ‘regimes of truth’ within and through which normal/universals are constituted – thereby highlighting biomedicine’s operation as a ‘technology of self’ as well as a ‘biopolitical’ strategy (or strategies). On the other hand, their anthropological focus makes them not only take cognizance of the local (culture, biology, political economy, etc.) but to posit the local as central to biomedical practice. They put it succinctly – ‘our position is that local variables significant for health and illness – social and biological – must be taken account of’ (p. 362).
An Anthropology of Biomedicine critically investigates ‘biomedical technologies in practice’ by effectively and innovatively combining these two analytical approaches. Lock and Nguyen are aware of difficulties and limitations of both the approaches (though the tensions of combining them are still evident, particularly when genealogies of biomedicine get represented as linear histories with origins). They write,
two significant developments make straightforward application of Foucault’s categories to contemporary biomedical technologies problematic. The first is the advent of what we call ‘techno/ biologicals’…The second is the deployment of biomedical technologies outside the parameters of the state. (p. 18) recognition of the way in which culturalism contributes to the perpetuation of inequities and injustice within and among societies is crucial, especially when it is recognized that the majority of individuals today are no longer immersed in a situation where a dominant cultural ideology exerts a hegemonic hold over them. (p. 9)
Armed with quite literally the vast literature on biomedical practices, Lock and Nguyen carefully and exhaustively show how the body (individual as well as the social body) becomes the prime target of biomedicine. Constitution of the normal/normative ‘body’ thus became the first task of biomedical technologies. According to the authors, such an exercise has been inseparable from a broader shift: ‘Knowledge produced about the body and its management in health and illness was firmly situated in the domain of “objectified” nature’ (p. 32). Nevertheless, as they point out, there are continual slippages between the normal and the morally right as well as between ‘objective’ and ‘subjective’ accounts of biomedical states. The implications of such slippages even though profound are often ignored within biomedical practices. Writing about childbirth the authors categorically state:
What must be emphasized…is not only the discrepancy between authoritative and subjective accounts about what constitutes a ‘normal’ birth but, further, the assumption made on the part of the majority of obstetricians that their knowledge can be applied without modification to all births, regardless of marked cultural, socioeconomic, and even biological differences among pregnant women. (p. 49)
Blurring the commonly accepted division between the natural and the social body, Lock and Nguyen highlight the interplay between modes of social control and that of biological definition of the body and the disease. Excavation of the social in constituting the natural also leads them to challenge the ‘assumed biological universality of the human body’ (p. 83). Through the debates about the origin of HIV, for example, they emphasize ‘the importance of considering how the human body is situated within local ecologies in addition to the effects produced by history, politics, and economics’ (p. 103). However, their aim is not to dismiss the role of biology or biomedicine. They state,
In arguing for a situated body, one where biosocial differentiations may produce over time a local biology, we are of course refuting neither the value of biological knowledge nor the effectiveness of biomedicine. However, we suggest that there are limits to our ability to account for and predict illness on the basis of biology alone. (p. 108)
More broadly, they claim, ‘[b]iological facts…are technophenomena that constitute only a partial view of reality’ (p. 109). A similar position is articulated in the next section of the book, which is focused upon the constitution and application of the biological standards. The biological standard of ‘the right population’, with its 18th-century origin in the biopolitical strategies that sought to systematize and naturalize it as such, as they point out, is yet another technophenomena that has been (and continues to be) constituted through the entanglements of the biological/natural and the social:
Populations do not exist in nature, rather they are technophenomena – the result of the way in which clusters of people are formally defined by colonial powers, nation states, and local government as specific entities for a variety of purposes, including the statistical establishment of bodily norms, promotion of health and wellbeing, development of medications by means of clinical trials, and so on. (p. 114)
The issue here is not merely the invisibility of such entanglements within biomedical discourse. Rather, anxiety towards biological differences is implicated in the imperial strategies that accompany biological experiments, as is evident even in present-day drug trials as they continue to expand to different parts of the world. As Lock and Nguyen point out, ‘[t]he reality of human difference is a fundamental challenge to the interpretation of these natural experiments’ (p. 181). The entanglements of the biological and the social get further complicated with the emergence of what Lock and Nguyen call ‘techno/biologicals’ – ‘technologies that are in part constituted from human biological material’ (p. 18). ‘[T]echo/biologicals enable the transformation of living cells, tissues, and organs into agents that facilitate research, or else substitute or replace faulty, inadequate, or failed body parts and mechanisms’ (p. 30). ‘These medicalized objects are packaged as products available for consumption as part of contemporary enterprise culture’ (p. 265). Be it commodification of sperms and eggs, organ trade, or possibilities arising out of recent genomic research – techno/biologicals, as this book continually highlights, ‘trouble’ the natural/biomedical.
Technophenomena, as Lock and Nguyen show in the last section of the book, are also implicated in ‘how the self is made “real”’ (p. 284). Their concern, however, is not only how the self is constituted through a set of operations on ‘bodies and souls, thoughts, conduct and way of being’ (Foucault, 1988: 18). In part because, according to them, ‘biomedicine largely does not expect its consumers to adhere to a specific notion of who they are and how they come to experience themselves’ (p. 284). More broadly, their concern with how the self is made real is with the purpose of showing
that ethnographic consideration of biomedical technologies of the self challenges the distinction between the purportedly ‘objective’ approach of biomedicine and the ‘subjective’ basis of traditional medicine and requires us to seriously reconsider a duality between self and body, as well as their corollaries, culture and biology. (p. 284)
An Anthropology of Biomedicine is without doubt a book with encyclopedic scope that would be useful to scholars from a variety of disciplines. For a book that covers such a wide range of studies in order to critically and exhaustively locate the genealogy of biomedicine, there are some strange absences, for example, studies of biomedical visualization. Moreover, interweaving of Foucauldian analytics with ethnographic approach is precarious at times (in part because of inherent tension between these two approaches). Nevertheless, Lock and Nguyen’s book is an exemplary intellectual feat that challenges the ‘embedded assumptions present in the assemblages of biomedicine’ (p. 364). It offers a radically new approach by carefully highlighting the role of the local (biology, culture, politics, economy, technology, selves, populations, etc.) in the practice of biomedicine. It is the reference book that anybody interested in biomedicine should have in his/her library.