, Volume 7, Issue 1, pp 50–71

New diagnostics for multi-drug resistant tuberculosis in India: Innovating control and controlling innovation

  • Nora Engel
Original Article

DOI: 10.1057/biosoc.2011.23

Cite this article as:
Engel, N. BioSocieties (2012) 7: 50. doi:10.1057/biosoc.2011.23


Among the challenges for tuberculosis control is the emergence of multi-drug resistance, which has led to the search for new diagnostic solutions worldwide. The focus of this article is the interplay between innovation of diagnostics for multi-drug resistant tuberculosis in India and control through standardization of operational and technical processes. Innovation in diagnostics is closely related to processes of standardization. As a form of social ordering, standardization not only controls patients, bacteria, artefacts, health-care staff and medical providers, but also the diagnostic process as such. On the basis of qualitative fieldwork, I analyse the innovative efforts of a demonstration project for a new test by an international NGO and the development of tests by smaller players. The main argument is that a balance is needed between the extremes of controlling the diagnostic process through standardization in such a way that it becomes exclusive for particular local settings or expertise, and innovating a diagnostic test without standardizing operational processes, which is not programmatically feasible. These negotiations between innovation and control can be found in situated assessments, yet require flexibility in standardization.


health-care innovation standardization flexibility of standards situated assessment multi-drug resistant tuberculosis India 

Copyright information

© The London School of Economics and Political Science 2012

Authors and Affiliations

  • Nora Engel
    • 1
  1. 1.Department of HealthEthics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht UniversityMaastrichtThe Netherlands

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