Biosocial Worlds offers a series of anthropological reflections on the relations between human and non-human life. Arguing against a traditional separation of the ‘biological’ and ‘social’, the book explores the spaces in between, with a view to rethinking ‘the biosocial’. The chapters engage with constructions of health and disease in different environments, embracing a more-than-human and biosocial perspective to encourage anthropological engagement with biology beyond deterministic projections.
Of particular relevance to AMR research is Jens Seeberg’s chapter on the biosocial dynamics of multidrug-resistant tuberculosis in India, from a bacterial perspective. He explores the failure of Directly Observed Therapy (DOTs) in terms of interrupted exposure (or contamination) of bacteria to TB treatment, rather than standard public health explanations of inappropriate protocols and, defaulting and non-compliance. Through this analysis, he moves beyond a focus on individual behaviour, to highlight the political economy of health systems and treatments, and their contribution to the development of drug resistance.
Medicines are typically thought of as chemical structures with biological effects on the ill. But medicines are also material things with cultural and symbolic meaning. In this ground breaking work, the authors propose that we think about ‘the social lives of medicines’. Consider, for example, the social life of a commercialised pharmaceutical: These are highly sought after commodities that circulate the globe, entering pharmacies, drug shops, people’s homes and their bodies.
From labs in London, to drug trials in India, to markets around the world, medicines are exemplars of globalisation. They swiftly move into local societies, transforming both health systems and lives. At the same time, medicines are intimate and personal things. As the authors write, medicines are “swallowed, inserted into bodies, rubbed on by anxious mothers, used to express care and intimately empower the uncertain individual” (3). Simply put, medicines are “social and cultural phenomena” with more than just biological effects on an individual body. By looking at medicines as if they lead social lives, we get a new way to understand how their value is cultural, economic, political, and personal.
This book explores the unintended consequences of compassion in the world of immigration politics. Miriam Ticktin focuses on France and its humanitarian immigration practices to argue that a politics based on care and protection can lead the state to view issues of immigration and asylum through a medical lens. Examining two “regimes of care”—humanitarianism and the movement to stop violence against women—Ticktin asks what it means to permit the sick and sexually violated to cross borders while the impoverished cannot? She demonstrates how in an inhospitable immigration climate, unusual pathologies can become the means to residency papers, making conditions like HIV, cancer, and select experiences of sexual violence into distinct advantages for would-be migrants. Ticktin’s analysis also indicts the inequalities forged by global capitalism that drive people to migrate, and the state practices that criminalize the majority of undocumented migrants at the expense of care for the exceptional few.
In Life Beside Itself, Lisa Stevenson takes us on a haunting ethnographic journey through two historical moments when life for the Canadian Inuit has hung in the balance: the tuberculosis epidemic (1940s to the early 1960s) and the subsequent suicide epidemic (1980s to the present). Along the way, Stevenson troubles our commonsense understanding of what life is and what it means to care for the life of another. Through close attention to the images in which we think and dream and through which we understand the world, Stevenson describes a world in which life is beside itself: the name-soul of a teenager who dies in a crash lives again in his friend’s newborn baby, a young girl shares a last smoke with a dead friend in a dream, and the possessed hands of a clock spin uncontrollably over its face. In these contexts, humanitarian policies make little sense because they attempt to save lives by merely keeping a body alive. For the Inuit, and perhaps for all of us, life is “somewhere else,” and the task is to articulate forms of care for others that are adequate to that truth.
When lives are dominated by hunger, what becomes of love? When assaulted by daily acts of violence and untimely death, what happens to trust? Set in the lands of Northeast Brazil, this is an account of the everyday experience of scarcity, sickness and death that centres on the lives of the women and children of a hillside “favela”. Bringing her readers to the impoverished slopes above the modern plantation town of Bom Jesus de Mata, where she has worked on and off for 25 years, Nancy Scheper-Hughes follows three generations of shantytown women as they struggle to survive through hard work, cunning and triage. It is a story of class relations told at the most basic level of bodies, emotions, desires and needs. Most disturbing – and controversial – is her finding that mother love, as conventionally understood, is something of a bourgeois myth, a luxury for those who can reasonably expect, as these women cannot, that their infants will live.
In The Antibiotic Era, physician-historian Scott H. Podolsky narrates the far-reaching history of antibiotics, focusing particularly on reform efforts that attempted to fundamentally change how antibiotics are developed and prescribed. This sweeping chronicle reveals the struggles faced by crusading reformers from the 1940s onward as they advocated for a rational therapeutics at the crowded intersection of bugs and drugs, patients and doctors, industry and medical academia, and government and the media.
During the post–World War II “wonder drug” revolution, antibiotics were viewed as a panacea for mastering infectious disease. But from the beginning, critics raised concerns about irrational usage and overprescription. The first generation of antibiotic reformers focused on regulating the drug industry. The reforms they set in motion included the adoption of controlled clinical trials as the ultimate arbiters of therapeutic efficacy, the passage of the Kefauver-Harris amendments mandating proof of drug efficacy via well-controlled studies, and the empowering of the Food and Drug Administration to remove inefficacious drugs from the market. Despite such victories, no entity was empowered to rein in physicians who inappropriately prescribed, or overly prescribed, approved drugs.
Now, in an era of emerging bugs and receding drugs, discussions of antibiotic resistance focus on the need to develop novel antibiotics and the need for more appropriate prescription practices in the face of pharmaceutical marketing, pressure from patients, and the structural constraints that impede rational delivery of antibiotics worldwide. Concerns about the enduring utility of antibiotics—indeed, about a post-antibiotic era—are widespread, as evidenced by reports from the Centers for Disease Control and Prevention, academia, and popular media alike. Only by understanding the historical forces that have shaped our current situation, Podolsky argues, can we properly understand and frame our choices moving forward.
Cheese is alive, and alive with meaning. Heather Paxson’s beautifully written anthropological study of American artisanal cheesemaking tells the story of how craftwork has become a new source of cultural and economic value for producers as well as consumers. Dairy farmers and artisans inhabit a world in which their colleagues and collaborators are a wild cast of characters, including plants, animals, microorganisms, family members, employees, and customers. As “unfinished” commodities, living products whose qualities are not fully settled, handmade cheeses embody a mix of new and old ideas about taste and value. By exploring the life of cheese, Paxson helps rethink the politics of food, land, and labor today.
The Republic of Therapy tells the story of the global response to the HIV epidemic from the perspective of community organizers, activists, and people living with HIV in West Africa. Drawing on his experiences as a physician and anthropologist in Burkina Faso and Côte d’Ivoire, Vinh-Kim Nguyen focuses on the period between 1994, when effective antiretroviral treatments for HIV were discovered, and 2000, when the global health community acknowledged a right to treatment, making the drugs more available. During the intervening years, when antiretrovirals were scarce in Africa, triage decisions were made determining who would receive lifesaving treatment. Nguyen explains how those decisions altered social relations in West Africa. In 1994, anxious to “break the silence” and “put a face to the epidemic,” international agencies unwittingly created a market in which stories about being HIV positive could be bartered for access to limited medical resources. Being able to talk about oneself became a matter of life or death. Tracing the cultural and political logic of triage back to colonial classification systems, Nguyen shows how it persists in contemporary attempts to design, fund, and implement mass treatment programs in the developing world. He argues that as an enactment of decisions about who may live, triage constitutes a partial, mobile form of sovereignty: what might be called therapeutic sovereignty.