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Situated bio-regulation: Ethnographic sensibility at the interface of STS, policy studies and the social studies of medicine

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Abstract

Several years ago, both authors engaged in research into bioscience and biomedical regulation in Asian countries. One of us (BP) explored why the regulatory and discursive embedding of human embryonic stem cell research in Israel was much more permissive than elsewhere. The other author (AW) sought to understand the conditions under which traditional herbal medicine came to be mobilised in Vietnam’s national health delivery system to an extent that it is now considered one of the most integrated in the world. In both cases, we found that to understand science policies and regulatory frameworks we needed to go beyond official documents and expert interviews, and instead move the meanings of social conventions, political, legal and social histories, as well as other informal practices, into the focus of our studies. Exploring these conditions of possibility for the regulatory configurations in our case studies meant bringing what we call ‘ethnographic sensibility’ to our research. This article discusses the implications of this approach, which often entails rendering visible the contradictions and ‘disorders’ in what seems coherent and orderly.

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Notes

  1. Heantos is a herbal remedy for drug addiction developed by Tran Khuong Dan during the 1980s and modernised in collaboration with scientists at the Institute of Chemistry in Hanoi since the mid-1990s (see Wahlberg, 2008).

  2. Wagenaar’s analysis, which is underpinned by a comprehensive discussion of interpretive policy analysis scholarship, illustrates this problem. What he calls one of the main problems of the work he analysed is congruent with what we would describe as a lack of ethnographic sensibility: ‘the temptation to engage in a restricted version of the qualitative research process, including the widespread tendency to consider public policy a text’ (Wagenaar, 2011, p. 79).

  3. Although we also distinguish our approaches from the forms of ‘studying up’ explored by Shore and Nugent (2002) which aim to study the cultures of elite groups.

  4. The aspect of nation building played a prominent role in both case studies. We discuss it in detail elsewhere (for Israel, see Prainsack, 2005; Prainsack and Hashiloni-Dolev 2009. Portugese’s (1998) and Kahn’s (2000) work on this topic is seminal. For Vietnam, see Wahlberg, 2006, 2012; Monnais et al, 2012).

  5. An example outside of the scope of the ‘thinkable and sayable’ in our own communities of academics and practitioners concerned with the social studies of biomedicine and the biosciences would be to call for carrying out medical experiments on the poorest members of the society in country A without their consent because they would not be able to defend themselves. Such a statement would infringe almost everything that within our communities is accepted as a self-evident truth, such as that exploitation of human beings is reprehensible, and so on. Thus, such a statement would have no space within the boundaries of what can meaningfully be thought and said within that community.

  6. ‘The womb of the Arab woman is my strongest weapon’. Yasser Arafat quoted from Foa (2002). See also Kanaaneh (2002).

  7. ‘Integrated’ refers to the extent to which non-biomedical forms of medicine such as herbal medicine or acupuncture are present in national systems of medical research, medical training and medical practice (Bodeker and Kronenberg, 2002).

  8. Ho Chi Minh’s Viet Minh soldiers fought wars of independence against France (1946–1954) and America (1965–1975).

  9. This is not to say that tensions do not exist (especially when it comes to resource allocation), rather in overall terms, an emphasis on combination and integration is prevalent.

  10. For an overview of anthropological debates about studying elites, see Nader (1972) and Shore and Nugent (2002).

  11. This approach has been discussed under the labels of ‘respondent validation’, or ‘member checking’; see Sandelowski (1993), Angen (2000),Turner and Coen (2008). We prefer the term ‘feedback cycles’ to indicate that what we have in mind is not the application of the positivist concept of ‘validity’ to interpretive approaches – which would then result in finding that the data are ‘right’ or ‘wrong’; but rather the incorporation of our informants’ reflections on our findings into our findings.

  12. The Icelandic Health Sector Database project was formally initiated in 1998 by a law that licensed a local company to establish one of the world’s largest resources for genetic and genomic epidemiological research, by integrating health records, ancestral records and DNA from all Icelanders. While specific permission from individuals was required for their DNA to be included, the inclusion of health and ancestral records was done by means of presumed consent. The Health Sector Database never fully materialised; one of the pitfalls was that family physicians refused to pass on the health records they held. For more details, see Pálsson and Rabinow (2005), Pálsson (2007), Fortun (2008).

  13. Work in the tradition of ‘sociology of expectation’ has put forward a very similar argument. See, for example, Brown et al (2000), Brown and Michael (2003), Franklin (2007).

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Acknowledgements

Conversations with Yael Hashiloni-Dolev and Corinna Kruse have informed and inspired this article. We are grateful to Klaus Høyer, Ingrid Metzler and Hendrik Wagenaar for very helpful comments on earlier versions of this manuscript. We also thank Margaret Sleeboom-Faulkner and Seyoung Hwang for their invitation to a workshop on Stem Cell Research in Asia (University of Sussex, December 2008), which provided the opportunity to start working on this article. Last but not least, we express our gratitude to the three referees for BioSocieties and the editors for their intellectual generosity and their patience.

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  1. Department of Social Science, Health & Medicine, King’s College London, Strand Campus, Strand, London, WC2R 2LS, UK

    Barbara Prainsack

  2. Department of Anthropology, University of Copenhagen, Denmark

    Ayo Wahlberg

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  1. Barbara Prainsack
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Correspondence to Barbara Prainsack.

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Prainsack, B., Wahlberg, A. Situated bio-regulation: Ethnographic sensibility at the interface of STS, policy studies and the social studies of medicine. BioSocieties 8, 336–359 (2013). https://doi.org/10.1057/biosoc.2013.14

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