EDITORIAL NOTES

Examining biomedicine
On distancing and visibility

Eileen Moyer and Vinh-Kim Nguyen

A major goal of MAT was to provide a forum for ongoing and emerging debates that
mobilize the social sciences and humanities to address issues raised by the global expansion
of biomedical ideas and technologies. As medical anthropologists outside of the United
States, we were struck by both the dominance of US-based scholarship and its growing
isolation from a larger pool of engaged thinking that it rarely acknowledged. The lack of
engagement with scholarship from outside the United States was justified by the prevailing
assumption that theoretical debate and innovation was unlikely to come from scholars
whose work was more ‘applied’ and therefore beholden to a dominant biomedical
epistemology.

We were acutely aware that most medical anthropology journals were rarely read or even
known where we work in Africa, Asia, and the Middle East. Most practitioners and activists
we worked with did not perceive academic medical anthropology to be relevant to their
struggles. For instance, the paucity of medical anthropology scholarship on the massive
humanitarian, political, and ecological catastrophe wrought by the ongoing conflict in the
Middle East is perhaps the most striking – and perhaps not surprising – example, given the
close relations between powerful US academic anthropologists and US foreign policy and
international aid institutions. Relatively little attention to the urgent challenges of global
health efforts, digital firewalls, and at times hermetic prose kept many readers and ‘organic
intellectuals’ at bay. Producing an open-access, readable, and visually engaging journal, we
hoped, would help to break down both material and academic walls and promote theorizing
from outside the dominant Anglo-American academy.

Medicine Anthropology Theory 3, no. 3: i–v.

© Eileen Moyer and Vinh-Kim Nguyen. Published under a Creative Commons Attribution 4.0 International license.
ii Examining biomedicine

With this, our seventh issue, it is clear that MAT has indeed become a venue for theoretically
productive, empirical, and engaged scholarship in and of biomedicine around the globe. This
issue continues ethnographic engagements with biomedicine and histories of biomedical
technologies to bring forth strong thematic oppositions that can be glossed as
visibility/invisibility and distance/intimacy. Perhaps the clearest statement of the stakes
comes from Cinzia Greco’s discussion of the ethical and epistemological contradictions that
emerge when ‘activism’ is viewed as antithetical to science: as Greco points out, distancing is
a way of making invisible. Before returning to these thematic oppositions, we propose to
briefly frame how anthropologists have constituted biomedicine as an object for empirical
scrutiny and theoretical production.

Conceptually, anthropological studies of biomedicine trace their genealogy to E. E. Evans-

Pritchard's seminal study of witchcraft (1937), which demonstrated the rationality of
witchcraft as a system for managing misfortune, and established a comparative framework
for the anthropology of medical systems, including biomedicine: the ‘modern’ form of
medicine that emerged with the rise of the modern state. Several articles in this issue
complicate a simple narrative that links biomedicine and (European) state formation. A
powerful alternative narrative emerges from Alexander Friedrich and Stefan Höhne’s
important theoretical article, translated from the German for this issue’s ‘Found in
Translation’ section, which argues that a key infrastructure of the biopolitical state is the
ability to cool, and therefore slow, life itself – what the authors call the Frischeregime. The
refrigeration of blood, tissues, cells, embryos, and so on equips the invisible, deep
infrastructure of biomedicine as a regime for managing the very substance of vitality. The
state–biomedicine nexus is also complicated by Gaurav Datta’s essay, which uses audio
recordings and photography to document a Catholic HIV clinic for terminally ill patients, a
regime of pastoral power as yet unarticulated to that of the state. More generally, these
photos evoke and thereby add to other ethnographic works that examine what happens
when biomedicine and regimes of clinical care function untethered to a functioning state
apparatus.

The theme of visibility is present not only in Datta’s audiovisual essay, but also runs through
the article by Sara Offersen and colleagues, the reviews of Salmaan Keshavjee’s Blind Spot,
Francesca Cancelliere’s review of the translation of Hervé Guibert’s important AIDS
memoir Cytomegalovirus, and Gabriel Girard’s exploration of the traces AIDS has left on
Montreal’s urban landscape. These concerns with visibility and biomedicine bring us back to
Michel Foucault’s argument in The Birth of the Clinic. The ‘clinical gaze’, he argued, was
formed in the nineteenth century with the conjunction of hospital-based medicine, social
welfare systems that concentrated (largely poor) patients in hospitals, structured observations
of patients and the lessons discovered at autopsy, and laboratory-based investigations of
disease states (Foucault [1963] 2003). Foucault’s thesis pointed to the structures of
Medicine Anthropology Theory iii

intelligibility – what he would later theorize as episteme – that emerge from the clinic and
constitute it as a centre of authorization. By ‘authorization’ here we refer to practices that
produce authoritative knowledge, that produce authors of narratives (the subjectivities of
patients and physicians), and that allow transactions to occur through systems of
commensurability, as in when blood is extracted and exchanged for knowledge in the form
of blood tests or clinical trial data. The pieces in this issue point to the work of authorization
that continues to spill forth from the clinic, embedding itself in subjectivities (Offersen et
al.), economic regimes (Glabau, Keshavjee), built environments (Borgstrom, Datta, Girard),
and memories (Cancelliere, Girard). These pieces also contribute to destabilizing the
assumed continuum between ‘normal’ and ‘pathological’ (Canguilhem 1972) that informs
biomedical thinking. Structured observations of populations through epidemiological
research, the growth of a vast pharmaco-therapeutic industry, and biotechnologies were
added onto the structure of biomedicine resulting in ‘biomedical platforms’ spanning
laboratories, clinics, and populations. The paper by Offersen and colleagues on the
potentiality of bodily symptoms shows how the clinical gaze is internalized and experienced
by ‘ordinary’ Danes, as bodily changes evoke potential future pathologies.

‘Medicalisation’ refers to the reframing of social problems in medical terms, and the gradual
processes of normalisation and social control that result (Conrad 1992). More recently,
‘biomedicalisation’ has been introduced to account for how advances in biomedical
knowledge about molecular processes and epidemiological outcomes have introduced
powerful linkages between genes, behaviour, and risk (Clarke et al., 2003). In this view,
control and normalisation have been replaced by the ways in which individuals govern
themselves in order to achieve health. Theoretically, these concepts mark a shift from Erving
Goffman’s sociological theories to those of Foucault, notably his theory of biopower.
Biopower spans two poles: that of techniques for disciplining the body and that of
techniques disseminated more broadly through the modern state's attempt to foster healthy
populations through public policy and infrastructure. Biomedicine stitches these two poles
together, most tightly in the arena of reproduction and sexuality, but more generally in the
application of biomedical knowledge to prevention and care. Gaps remain between these
sutures, as Kim Sue’s investigation into the diagnosis of ‘failure to thrive’ explores. What
these gaps show, the author argues, is the powerful hold the state continues to have over life
and death, and how it produces resistances captured and labelled as ‘FTT’. Erica
Borgstrom’s photo essay on hospices and the ‘#notdingy’ campaign in the United Kingdom
also captures a moment of resistance, in this case against the assumption that hospice care is
equivalent to abandonment and decay.

While the ‘bio’ in ‘biomedicine’ refers to biology as the frame through which health is to be
understood, in ‘biopower’ the ‘bio’ refers to the attempt to exercise power through the
iv Examining biomedicine

government of bodies and populations. Paul Rabinow (1992) introduced the influential
concept of ‘biosociality’, which initially referred to the emergence of social relations around
biological self-understanding but has been applied more broadly to highlight biomedical
forms of social relations. In this vein, notions of biological or biomedical citizenship have
been used to examine how patient groups make claims on the state, NGOs, and the
international community, while leaving unquestioned the ‘biological’ as an organizing
concept (Fassin 2006). More recently, the concept of biocapital has provided an analytical
framework to account for the growing role of biotechnologies in biomedicine (Rajan 2006).
‘Biocapital’ therefore refers to the political and economic arrangements that have made it
possible to manipulate living substances such as cell lines, ova, and genes to produce value,
notably through the exchange of commodities. The related concept of bioavailability points
to how populations are made available for harvesting of living substances such as organs for
transplant (Cohen 2005). Miriam Waltz and Fiona Ross’s examination of the nodes through
which breast milk is channelled as therapeutic substance, commodity, and gift in a large
public South African hospital highlights how the circulation of living substances challenges
moral categories. Maternal milk is unlike cell lines or tissue cultures in that it embodies a
profoundly intimate relationship, yet here it circulates impersonally, through tubes and
machines. A similar conundrum exists in the tensions generated by the imperative to prevent
serious allergic reactions by equipping those with food allergies with expensive devices
(‘Epipens’) that inject adrenaline in the event of a reaction. This issue shows the power of
biomedical technologies to confuse distance and intimacy, care and management.

We are grateful for the quality of the scholarship that continues to be submitted to MAT and
for the thoughtful and extensive feedback provided by our external peer reviewers. A special
thanks is reserved for Jenna Grant, who is stepping down as section editor of Book and Film
Reviews, and we extend a warm welcome to Rita Isabel Henderson from the University of
Calgary, who joins our team as incoming editor of that section. Finally, we would like to
acknowledge once again the tremendous support we have received from our host
institutions, the University of Amsterdam and the Graduate Institute in Geneva.

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Illness, and US Biomedicine’. American Sociological Review 68, no. 2: 161–94.
Medicine Anthropology Theory v

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