Table of Contents

Acknowledgments xii

Introduction 1

Improving Global Health: The Challenge 3

Biomedicine as Technology 4

Does Culture Exist? 6

A Word about Ethnography 9

Outline of Chapters 11

Part I: Technologies and Bodies in Context 15

1 Biomedical Technologies in Practice 17

Technological Mastery of the Natural World and Human Development 19

Technology and Boundary Crossings 20

Biomedicine as Technology: Some Implications 22

Technologies of Bodily Governance 24

Technologies of the Self 27

The Power of Biological Reductionism 29

Techno/Biologicals 30

2 The Normal Body 32

Cholera in the 19th Century 33

Representing the Natural Order 35

Truth to Nature 35

The Natural Body 37

A Numerical Approach 38

Other Natures 39

Interpreting the Body 42

How Normal Became Possible 43

When Normal Does Not Exist 46

Problems with Assessing Normal 47

Pathologizing the “Normal” 50

Limitations to Biomedical “Objectivity” 53

Better Than Well? 54

3 Anthropologies of Medicine 57

The Body Social 57

Contextualizing Medical Knowledge 60

Medical Pluralism 61

The Modernization of “Traditional” Medicine 63

Medical Hybridization 64

Biodiversity and Indigenous Medical Knowledge 65

Self-Medication 66

A Short History of Medicalization 67

Opposition to Medicalization 70

The Social Construction of Illness and Disease 71

The Politics of Medicalization 75

Beyond Medicalization? 78

In Pursuit of Health 79

In Summary 81

4 Local Biologies and Human Difference 83

The End of Menstruation 84

Local Biologies 90

Rethinking Biology in the Midst of Life’s Complexity 92

Is Biology Real? 93

Kuru and Endocannibalism 95

Racism and Birth Weight 98

Of Microbes and Humans 99

Antibiotics and Resistant Microbes 102

Debates about the Origin of HIV 103

In Summary 108

Part II: The Biological Standard 111

5 The Right Population 113

The Origins of Population as a “Problem” 115

Addressing the “Problem” of Population 117

Improving the Stock of Nations 118

Alternative Modernity and Indian Family Planning 123

The One-Child Policy 127

Biomedical Technology and Sex Selection 132

Contextualizing Sex Selection: India and “Family Balancing” 133

Contextualizing Sex Selection: Disappeared Girls in China 136

Sex Selection in a Global Context 139

Reproducing Nationalism 142

In Summary 144

6 Colonial Disease and Biological Commensurability 146

An Anthropological Perspective on Global Biomedicine 147

Biomedicine as a Tool of Empire 148

Acclimatization and Racial Difference 149

Colonial Epidemics: Microbial Theories Prove Their Worth 151

Resistance to the Biomedicalization of Epidemics 153

Microbiology as a Global Standard 154

Infertility and Childbirth as Critical Events 157

Birthing in the Belgian Congo 158

A Global Practice of Fertility Control 160

Intimate Colonialism: The Biomedicalization of Domesticity 160

Biomedicine, Evangelism, and Consciousness 162

The Biological Standardization of Hunger 163

The Colonial Discovery of Malnutrition 164

Albumin as Surplus 166

The Biologization of Salvation 168

Madness 170

In Summary 174

7 Grounds for Comparison: Biology and Human Experiments 176

The Laboratory as the Site of Comparison 177

The Colonial Laboratory 178

Experimental Bodies 179

Rise of the Clinical Trial 180

Taming Difference by Chance 183

The Alchemy of the Randomized Controlled Trial 184

The Problem of Generalizability 184

Medical Standardization and Contested Evidence 187

Globalizing Clinical Research 188

Creating Markets for Biomedical Technologies in Developing Countries 190

Testing Biomedical Interventions for the World’s Poor 192

Disputes over Perinatal HIV Transmission Trials 192

What Should Count as Signifi cant Evidence? 196

Living with Vampires: Perceptions of Research 197

Experimental Communities: Social Relations 200

In Summary 202

Part III: Moral Boundaries and Human Transformations 203

8 Who Owns the Body? 205

Commodification of Human Biologicals 206

Objects of Worth and Their Alienation 208

The Wealth of Inalienable Goods 209

A Bioeconomy of Human Biologicals 210

Who Owns the Body? 211

The Commodification of Eggs and Sperm 213

Immortalized Cell Lines 216

The Exotic Other 218

Biological Databases 220

Concluding Comments 226

9 The Social Life of Organs 229

Bioavailability – Who Becomes a Donor? 230

A Shortage of Organs 234

Inventing a New Death 236

The Good-as-Dead 239

Struggling for National Consensus 241

The Social Life of Human Organs 244

When Resources Are Short 248

Altruism, Entitlement, and Commodifi cation 252

10 Kinship, Infertility, and Assisted Reproduction 254

Assisted Reproductive Technologies 255

Problematizing Infertility Figures 256

From Underfertility to Overfertility 257

Reproducing Culture 264

Assisted Reproduction in the United States 266

Assisted Reproduction in Egypt 269

Assisted Reproduction in Israel 273

ART in Global Perspective 277

Part IV: Elusive Agents and Moral Disruptions 281

11 The Matter of the Self 283

The Discovery of an Unconscious Self 284

Unlocking the Pathogenic Secret 285

The Pathogenic Secret as a Technology of the Self 286

The Making of Post-Traumatic Stress Disorder 287

The Practitioner-Self 289

The Sources of Therapeutic Effi cacy 290

The Self’s Therapeutic Powers 292

Technologies of Health Promotion 295

Technologies of Empowerment 296

Technologies of Self-Help 297

Confessional Technologies 298

Conclusion 301

12 Genes as Embodied Risk 303

From Hazard to Embodied Risk 304

From Generation to Rewriting Life 306

Genomic Hype 308

Geneticization 310

Genetic Testing and Human Contingency 311

Genetic Citizenship and Future Promise in America 315

Biosociality and the Affi liation of Genes 316

Genetic Screening 319

Preimplantation Genetic Diagnosis 325

13 Genomics, Epigenomics, and Uncertain Futures 330

Dethroning the Gene? 332

Eclipse of the Genotype–Phenotype Dogma 333

Epigenetics: Beyond Genetic Determinism 335

Epigenomics 337

The APOE Gene and Alzheimer’s Disease 339

Genetic Testing for Late-Onset Alzheimer’s Disease 343

Interpretations of Risk Estimates 345

Learning (Again) to Live with Uncertainty 347

14 Human Difference Revisited 348

Molecular Biology and Racial Politics 351

The Molecularization of Race 353

Commodifying “Race” and Ancestry 356

Looping Effects 357

Epilogue 359

Notes 365

Bibliography 430

Index 490

About the Author

Margaret Lock is the Marjorie Bronfman Professor Emerita inthe Department of Social Studies of Medicine and the Department ofAnthropology at McGill University. Among her numerous awards arethe Gold Medal for Research by the Social Sciences and HumanitiesResearch Council of Canada and the Wellcome Medal of Britain'sRoyal Anthropological Society. In 2005 she was awarded both aKillam Prize and Trudeau Foundation Fellowship. She is the authorand/or co-editor of 14 books and has published more than 190articles. Vinh-Kim Nguyen is a physician and a medicalanthropologist. He practices medicine in Montreal at theClinique l'Actuel, which specializes in HIV and hepatitis,and the Emergency Department of the Jewish General Hospital, andteaches at the University of Montreal where he is an AssociateProfessor in Social Medicine. As a researcher, he isaffiliated with both Global Health Unit of the Montreal UniversityHospitals' Research Centre and the Max Planck Institute for SocialAnthropology in Halle, Germany. He was recently awarded the Auroraprize for his research by the Social Sciences and HumanitiesResearch Council of Canada.

Reviews

It will be of enormous use to students and researchersconcerned with the sociality of biomedicine for years to come,offering both an impressive coverage of subject matter and momentsof original argumentation. (Sociology ofHealth & Illness, 2011) "Beyond this, the book should provide a useful reference forsocial scientists working in areas related to the intersection ofculture and biomedicine." (Choice , 1 April 2011)