An Anthropology of Biomedicine

Citation

Lock, M., & Nguyen, V.-K. (2018). An Anthropology of Biomedicine (2nd ed.). Wiley-Blackwell.

Chapter Summary

The second edition has an introduction, sixteen chapters in five sections, an epilogue, notes, a bibliography and an index, in about 560 pages. The publisher describes it as introducing biomedicine from an anthropological perspective, exploring how material bodies are entangled with history, environment, culture and politics. It draws on historical and ethnographic work to question the assumption that there is a universal human body that can be uniformly standardised. The second edition adds chapters on microbiology and the microbiome, on global health, and on the self as a sociotechnical system, and revises the others. The sections carry no titles in the contents; the groupings below follow the section breaks.

Introduction

The introduction sets out the book's argument and its interwoven themes. Its headings include "Improving Global Health: The Challenge", "Biomedicine as Technology", "Does Culture Exist?" and "A Word About Ethnography".

Section 1: Chapters 1–3

Chapter 1, Biomedical Technologies in Practice. The sample chapter shows the book's starting point: biomedical technologies are not neutral devices but are shaped by medical and political interests and cultural norms. It draws on Ludwik Fleck's idea that scientific phenomena result from technical intervention, and on Michel Foucault's notion of biopower, and it distinguishes technologies of bodily governance from technologies of the self. It introduces "techno/biologicals", technologies partly constituted from human biological material.

Chapter 2, The Normal Body. Beginning with cholera in the nineteenth century, the chapter follows how the idea of the natural and the normal body was built, through representations, numerical approaches and the history of the "normal", and ends by questioning biomedical "objectivity" and the idea of being "better than well".

Chapter 3, Anthropologies of Medicine. The chapter surveys approaches in the anthropology of medicine: the social body, medical pluralism, the modernisation of "traditional" medicine, and the history and politics of medicalisation.

Section 2: Chapters 4–6

Chapter 4, Colonial Disease and Biological Commensurability. The chapter treats biomedicine as a tool of empire, with sections on acclimatisation and racial difference, colonial epidemics, childbirth and fertility control, and the standardisation of hunger and malnutrition.

Chapter 5, Grounds for Comparison: Biology and Human Experiments. The chapter concerns the laboratory as a site of comparison and the rise of the clinical trial, including the randomised controlled trial and its generalisability, with a section on a clinical trial during the West African Ebola epidemic and on "economies of blood".

Chapter 6, The Right Population. The chapter traces the idea of population as a "problem" and the policies it prompted: family planning, India's quotas, China's one-child policy, sex selection and the demographic consequences.

Section 3: Chapters 7–9

Chapter 7, Who Owns the Body? The chapter examines the commodification of human biological material, including gifts of life, eggs and sperm, medical tourism, immortalised cell lines and biological databases.

Chapter 8, The Social Life of Human Organs. The chapter concerns organ donation and transplantation, including the shortage of organs, the invention of a new definition of death, and altruism, entitlement and commodification.

Chapter 9, Making Kinship: Infertility and Assisted Reproduction. The chapter looks at assisted reproductive technologies and infertility statistics, and compares assisted reproduction in the United States, Egypt and Israel.

Section 4: Chapters 10–12

Chapter 10, The Sociotechnical Self. One of the chapters added in this edition, it examines "technologies of the self" in biomedicine, from the unconscious and post-traumatic stress disorder to psychopharmaceuticals and addiction.

Chapter 11, Genes as Embodied Risk. The chapter covers genomic hype, geneticisation, genetic testing and screening, race and genetic testing, preimplantation genetic diagnosis and the question of a neo-eugenics.

Chapter 12, Global Health. Also new, the chapter asks what global health is and how it differs from international health, and looks at metrics, markets for diagnostics and drugs, humanitarianism and "philanthrocapitalism", and anticipation of epidemics.

Section 5: Chapters 13–16

Chapter 13, From Local to Situated Biologies. The chapter begins with the end of menstruation and develops the idea of local biologies through kuru, racism and birth weight, and Agent Orange in Vietnam, and asks "Is Biology Real?".

Chapter 14, Of Microbes and Humans. The microbiology chapter added to this edition concerns the microbial arms race, debates about the origin of HIV, and microbiomes and metagenomes.

Chapter 15, Genomics, Epigenomics and Uncertain Futures. The chapter covers the APOE gene and Alzheimer's disease, risk estimates, the questioning of the genotype–phenotype model and epigenetics.

Chapter 16, Molecularizing Racial Difference. The chapter treats molecular biology and racial politics, bioethnic conscription, racialised allelic variation, Mexican genomics and the commodifying of "race" and ancestry.

Epilogue

A closing epilogue precedes the notes, bibliography and index.

Key Concepts

Section 1

• Biomedical technologies as sociotechnical systems: technologies anchored in institutions, which help produce the facts they apply.
• Biopower and technologies of the self: Foucault's terms for management of populations and for self-transformation.
• The normal body: the history of how the "normal" became a measurable category.

Sections 2–3

• Medicalisation: the extension of medical categories and authority to more areas of life.
• Clinical trial: the experimental form for comparing treatments, with its problem of generalisability.
• Commodification of human biological material: eggs, sperm, cell lines and databases as objects of exchange.

Sections 4–5

• Sociotechnical self: the self produced through biomedical and psychological technologies.
• Local biologies: the idea that biology differs by place and circumstance.
• Epigenetics and microbiomes: the new biological frameworks treated in Chapters 14–15.

Critical Analysis

Strengths

• A unifying argument. The introduction and Chapter 1 set up biomedicine as technology and the body as malleable, and the later sections test the idea across topics.
• Wide range of topics with specific cases. The contents show detailed cases, such as the West African Ebola trial, India and China population policy, sex selection, assisted reproduction in three countries and the APOE gene.
• Updated edition. The new chapters on the microbiome, global health and the sociotechnical self respond to developments since the first edition, and the publisher states that references and figures were updated throughout.
• Recognition and structure. The publisher notes that the first edition won the 2010 PROSE Award for Archaeology and Anthropology, and the book is organised in five sections that help a reader choose a route.

Limitations

• Demanding and long. At about 560 pages the book introduces a dense theoretical vocabulary (biopower, techno/biologicals, sociotechnical systems) from the first chapter, which asks for a reader who is comfortable with social theory.
• Not a general survey of medical anthropology. The book's focus is on biomedicine as technology; the experience of illness is treated more fully in other books on the course list.
• Selective use likely. Sixteen topic-focused chapters, each with many subsections, are more than a single course will usually cover, so a course will probably select among them.
• Rapidly dating content. The publisher itself calls the field fast-paced, and the genomic and global health material will need supplementing with recent sources.

Where It Fits in the Course

Within this medical anthropology course, Lock and Nguyen's book is the advanced, theory-driven study of biomedicine itself. Joralemon and Sundal's Exploring Medical Anthropology is a concise introduction that presents the main perspectives even-handedly and is a good first step. Wiley and Allen's Medical Anthropology: A Biocultural Approach combines biology with cultural perspectives and suits students who want the biological background that Lock and Nguyen assume. Brown and Closser's Understanding and Applying Medical Anthropology is a reader that gives classic and recent articles.

Byron Good's Medicine, Rationality and Experience and Arthur Kleinman's The Illness Narratives address medical knowledge and illness experience from interpretive and clinical angles. They complement Lock and Nguyen, who turn the lens on biomedical technologies and their social consequences; reading Kleinman first gives a gentler entry to the illness side of the field.

How to Use This Book

It is designed for students of anthropology, medical anthropology, and public and global health. An introductory course in social, cultural or medical anthropology is the sensible preparation.

A practical plan:

• Core: the Introduction and Chapters 1–3 for the framework, then Chapters 4–5 on colonial medicine and human experiments.
• By interest: reproduction and the body in Chapters 6–9; self, genes and global health in Chapters 10–12; the biological chapters (13–16) for those interested in genomics, microbiomes or race and molecular biology.
• Close: the Epilogue.

Read with a reader or a shorter textbook for ethnographic examples, and take note of the sections that the notes and bibliography point to when preparing essays.