This article examines the intersection of compassion and rights, and how the two concepts are constituted and wielded in the context of human clinical trials. Doron, an ALS patient who was recruited to a clinical trial, believed that he had the right to post-trial treatment according to the wording of an informed consent form he signed before joining the trial. However, the biotech company sponsoring the trial instead offered him ‘compassionate use’ access, i.e., access at its discretion rather than as a legal obligation on its part. I argue that under a ‘bioeconomy of value’, the human clinical trial regime has been subordinated to two competing discourses: that of compassion and that of patients’ rights. Both are interpreted and deployed differently by the different stakeholders, namely the patient, the biotech company, and the medical establishment. I argue that the adoption, by bioeconomy actors, of a social value discourse of compassion is designed to preserve a hierarchy that deprives the patient of their power and their rights. Simultaneously, this practice highlights the power of the biotech industry as a moral partner and ‘saviour’ in its relationship with patient organisations and its role as a medical–scientific actor in the Israeli healthcare system.
{"title":"Out of Compassion or Out of Rights? A Story about an Amyotrophic Lateral Sclerosis (ALS) Human Clinical Trial","authors":"H. Eyal","doi":"10.17157/mat.8.3.5102","DOIUrl":"https://doi.org/10.17157/mat.8.3.5102","url":null,"abstract":"This article examines the intersection of compassion and rights, and how the two concepts are constituted and wielded in the context of human clinical trials. Doron, an ALS patient who was recruited to a clinical trial, believed that he had the right to post-trial treatment according to the wording of an informed consent form he signed before joining the trial. However, the biotech company sponsoring the trial instead offered him ‘compassionate use’ access, i.e., access at its discretion rather than as a legal obligation on its part. I argue that under a ‘bioeconomy of value’, the human clinical trial regime has been subordinated to two competing discourses: that of compassion and that of patients’ rights. Both are interpreted and deployed differently by the different stakeholders, namely the patient, the biotech company, and the medical establishment. I argue that the adoption, by bioeconomy actors, of a social value discourse of compassion is designed to preserve a hierarchy that deprives the patient of their power and their rights. Simultaneously, this practice highlights the power of the biotech industry as a moral partner and ‘saviour’ in its relationship with patient organisations and its role as a medical–scientific actor in the Israeli healthcare system.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45002926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite a surge in initiatives to integrate foreign-trained physicians into local health systems and a drive to learn from localised humanitarian initiatives under the COVID-19 pandemic, we still know little about the on-the-ground strategies developed by refugee doctors to meet the needs of refugee patients. In Lebanon, displaced Syrian health professionals have mounted informal, local responses to care for displaced Syrian patients. Drawing on ethnographic work shadowing these healthcare providers across their medical and non-medical activities, we explore how clinical encounters characterised by shared histories of displacement can inform humanitarian medicine. Our findings shed light on the creation of breathing spaces in crises. In particular, our study reveals how displaced healthcare workers cope with uncertainty, documents how displaced healthcare workers expand the category of ‘appropriate care’ to take into account the economic and safety challenges faced by patients, and locates the category of ‘informality’ within a complex landscape of myriad actors in Lebanon. This research article shows that refugee-to-refugee healthcare is not restricted to improvised clinical encounters between ‘frontliners’ and ‘victims of war’. Rather, it is proactively enacted from the ground up to foster appropriate care relationships in the midst of violent, repeated, and protracted disruptions to systems of care.
{"title":"When Refugees Care for Refugees in Lebanon: Providing Contextually Appropriate Care from the Ground Up","authors":"Diane Duclos, F. M. Fouad, K. Blanchet","doi":"10.17157/mat.8.3.5159","DOIUrl":"https://doi.org/10.17157/mat.8.3.5159","url":null,"abstract":"Despite a surge in initiatives to integrate foreign-trained physicians into local health systems and a drive to learn from localised humanitarian initiatives under the COVID-19 pandemic, we still know little about the on-the-ground strategies developed by refugee doctors to meet the needs of refugee patients. In Lebanon, displaced Syrian health professionals have mounted informal, local responses to care for displaced Syrian patients. Drawing on ethnographic work shadowing these healthcare providers across their medical and non-medical activities, we explore how clinical encounters characterised by shared histories of displacement can inform humanitarian medicine. Our findings shed light on the creation of breathing spaces in crises. In particular, our study reveals how displaced healthcare workers cope with uncertainty, documents how displaced healthcare workers expand the category of ‘appropriate care’ to take into account the economic and safety challenges faced by patients, and locates the category of ‘informality’ within a complex landscape of myriad actors in Lebanon. This research article shows that refugee-to-refugee healthcare is not restricted to improvised clinical encounters between ‘frontliners’ and ‘victims of war’. Rather, it is proactively enacted from the ground up to foster appropriate care relationships in the midst of violent, repeated, and protracted disruptions to systems of care.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41969026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This research article critically interrogates the implications and unintended consequences of the World Health Organization’s purported elimination of leprosy as a public health problem. I explore how leprosy has been portrayed (for nearly a century) as something from the past, recalcitrantly lingering on into the present, but surely about to be gone—a temporal framing I call the ‘grammar of leprosy’. I recount the experiences of Daniel, my interlocutor in Tanzania, whose existence became a problem for his doctors. This problem they ultimately resolved by fabricating negative test results in order to record what they already knew: leprosy had been eliminated. I also analyse how researchers working for Novartis (the supplier of leprosy’s cure) continue to push for an always imminent ‘elimination’, while field researchers repeatedly caution about the potential problems of this approach. Finally, I reveal how the grammar of leprosy operates through a complex set of temporal politics, pulling into its orbit and being enabled by multiple interwoven temporalities. I conclude that—due to this grammar, the impossible subjects it produces, and the temporal politics through which it operates—leprosy elimination campaigns may have dire consequences for the lives of people with leprosy today, impeding rather than enabling treatment.
{"title":"The Grammar of Leprosy: Temporal Politics and the Impossible Subject","authors":"Laura A. Meek","doi":"10.17157/mat.8.3.5525","DOIUrl":"https://doi.org/10.17157/mat.8.3.5525","url":null,"abstract":"This research article critically interrogates the implications and unintended consequences of the World Health Organization’s purported elimination of leprosy as a public health problem. I explore how leprosy has been portrayed (for nearly a century) as something from the past, recalcitrantly lingering on into the present, but surely about to be gone—a temporal framing I call the ‘grammar of leprosy’. I recount the experiences of Daniel, my interlocutor in Tanzania, whose existence became a problem for his doctors. This problem they ultimately resolved by fabricating negative test results in order to record what they already knew: leprosy had been eliminated. I also analyse how researchers working for Novartis (the supplier of leprosy’s cure) continue to push for an always imminent ‘elimination’, while field researchers repeatedly caution about the potential problems of this approach. Finally, I reveal how the grammar of leprosy operates through a complex set of temporal politics, pulling into its orbit and being enabled by multiple interwoven temporalities. I conclude that—due to this grammar, the impossible subjects it produces, and the temporal politics through which it operates—leprosy elimination campaigns may have dire consequences for the lives of people with leprosy today, impeding rather than enabling treatment.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47038895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
From March to May 2020 in the UK, measures that became known across the world as ‘lockdown’ curtailed personal freedoms in order to curb the spread of the SARS-CoV-2 Coronavirus. While initial criticisms of lockdown focused on the adverse impacts of social isolation on wellbeing, this research article explores how lockdown creates new and altered proximities and intimacies as well as distances. During the initial UK lockdown, the ‘household’ and ‘home’ were deployed in public rhetoric as default spaces of care and security in the face of widespread isolation and uncertainty. However, emergent proximities created by bringing people together in the assumed safety of home also deepened existing inequalities and vulnerabilities. Using anthropological theory, third sector evidence, and ethnographic interview data we explore this process. We argue that understanding proximity and intimacy as fundamentally ambivalent, not normatively affirming, is central to recognising how pandemic responses such as lockdown reinforce and reproduce existing forms of inequality and violence.
{"title":"'Stay Home, Stay Safe': Proximity as Vitality and Vulnerability Under Lockdown","authors":"Leo Hopkinson, Lydia House","doi":"10.17157/mat.8.3.5143","DOIUrl":"https://doi.org/10.17157/mat.8.3.5143","url":null,"abstract":"From March to May 2020 in the UK, measures that became known across the world as ‘lockdown’ curtailed personal freedoms in order to curb the spread of the SARS-CoV-2 Coronavirus. While initial criticisms of lockdown focused on the adverse impacts of social isolation on wellbeing, this research article explores how lockdown creates new and altered proximities and intimacies as well as distances. During the initial UK lockdown, the ‘household’ and ‘home’ were deployed in public rhetoric as default spaces of care and security in the face of widespread isolation and uncertainty. However, emergent proximities created by bringing people together in the assumed safety of home also deepened existing inequalities and vulnerabilities. Using anthropological theory, third sector evidence, and ethnographic interview data we explore this process. We argue that understanding proximity and intimacy as fundamentally ambivalent, not normatively affirming, is central to recognising how pandemic responses such as lockdown reinforce and reproduce existing forms of inequality and violence.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45483566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Every ethnographer balances participation and observation during fieldwork in their own unique way. For those whose primary role is participation, field notes represent an avenue for reflecting on trends that may not be immediately obvious when one is mired in the ethnographic setting. The author, an emergency physician and anthropologist, reflects on racial injustices and transformations in biomedical rituals to do with death and dying, from the front lines of the COVID-19 pandemic.
{"title":"Breathing and Dying in 2020","authors":"A. Chary","doi":"10.17157/mat.8.3.5280","DOIUrl":"https://doi.org/10.17157/mat.8.3.5280","url":null,"abstract":"Every ethnographer balances participation and observation during fieldwork in their own unique way. For those whose primary role is participation, field notes represent an avenue for reflecting on trends that may not be immediately obvious when one is mired in the ethnographic setting. The author, an emergency physician and anthropologist, reflects on racial injustices and transformations in biomedical rituals to do with death and dying, from the front lines of the COVID-19 pandemic.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45405502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Within the last decade, challenges of diagnosis have emerged on the global health agenda, accompanied by an expansion in the use of point-of-care and rapid detection devices in low-resource contexts where laboratory facilities are scarce. Few studies have explored how these changes are shaping people’s diagnostic journeys and their modes of accessing such technologies. In this paper I show how sick people and their families in a peri-urban area in Burkina Faso attempt to access diagnostic technologies and make themselves visible to the healthcare system through papers. In this context, I show how referral papers and diagnostic papers take on significance for people as they attempt to access care and diagnostic technologies and ‘carry’ knowledge between different levels of the healthcare system. The use of papers is often an uncertain undertaking, as they remain unintelligible to the sick and the layperson. I highlight how the form of the papers makes a crucial difference to the ways that sick people are able to use them. Papers and diagnostic technologies present both opportunities and challenges, and simultaneously engender hope, uncertainty, disappointment, and despair for the sick seeking a cure. Uncertainties, especially financial ones, arise with the possibility of new referrals and diagnostic tests, and along the way many give up or are immobilised when faced with diagnostic ambiguity.
{"title":"(In)Visible Disease: Motions and Emotions Engendered by Papers and Diagnostics of People Accessing Healthcare in Burkina Faso","authors":"Pia Juul Bjertrup","doi":"10.17157/mat.8.3.5103","DOIUrl":"https://doi.org/10.17157/mat.8.3.5103","url":null,"abstract":"Within the last decade, challenges of diagnosis have emerged on the global health agenda, accompanied by an expansion in the use of point-of-care and rapid detection devices in low-resource contexts where laboratory facilities are scarce. Few studies have explored how these changes are shaping people’s diagnostic journeys and their modes of accessing such technologies. In this paper I show how sick people and their families in a peri-urban area in Burkina Faso attempt to access diagnostic technologies and make themselves visible to the healthcare system through papers. In this context, I show how referral papers and diagnostic papers take on significance for people as they attempt to access care and diagnostic technologies and ‘carry’ knowledge between different levels of the healthcare system. The use of papers is often an uncertain undertaking, as they remain unintelligible to the sick and the layperson. I highlight how the form of the papers makes a crucial difference to the ways that sick people are able to use them. Papers and diagnostic technologies present both opportunities and challenges, and simultaneously engender hope, uncertainty, disappointment, and despair for the sick seeking a cure. Uncertainties, especially financial ones, arise with the possibility of new referrals and diagnostic tests, and along the way many give up or are immobilised when faced with diagnostic ambiguity.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45546022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article explores the top-down production of the statistics frequently circulated in global health. These data must first originate in a place like the public hospital in Saint-Louis, Senegal, in doctor’s offices and laboratories and medical archives. At their root, these data are an accumulation of individual bodies, experiences, and intimate diagnostic moments. This aggregation turns the afflicted into categories and statistical regimes that shape a global health understanding of diabetes specifically, and noncommunicable diseases broadly. This article explores the individual diabetes diagnostic moment itself and the politics of the current nosology of Type 1 and Type 2, a seemingly neutral dichotomy that belies colonial relationships between Senegal, slavery, sugar production and consumption, and the effects these relationships have on contemporary conceptions of diabetes diagnosis in Senegal and global health.
{"title":"Diagnosing Diabetes, Diagnosing Colonialism: An Ethnography of the Classification and Counting of a Senegalese Metabolic Disease","authors":"E. Bunkley","doi":"10.17157/mat.8.2.5137","DOIUrl":"https://doi.org/10.17157/mat.8.2.5137","url":null,"abstract":"This article explores the top-down production of the statistics frequently circulated in global health. These data must first originate in a place like the public hospital in Saint-Louis, Senegal, in doctor’s offices and laboratories and medical archives. At their root, these data are an accumulation of individual bodies, experiences, and intimate diagnostic moments. This aggregation turns the afflicted into categories and statistical regimes that shape a global health understanding of diabetes specifically, and noncommunicable diseases broadly. This article explores the individual diabetes diagnostic moment itself and the politics of the current nosology of Type 1 and Type 2, a seemingly neutral dichotomy that belies colonial relationships between Senegal, slavery, sugar production and consumption, and the effects these relationships have on contemporary conceptions of diabetes diagnosis in Senegal and global health.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45013202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article explores how scientists learn to detect ‘pre-cancer’, a new diagnostic category defined by the risk of developing the titular disease. This process entails the observation of ‘raw signals’ that stand for potential molecular and metabolic changes in animal and human tissues and their validation as ‘candidate biomarkers’. I draw on ethnographic fieldwork conducted alongside a multidisciplinary group of researchers—physicists, biologists, mathematicians, computer scientists, and engineers, among others—all of whom worked as part of a research programme investigating the early signs and detection of cancer in the UK. ‘Signals’ detected through scientific experiments are intimately entangled with the sensing technologies and analytical techniques used. As previously unknown microscopic realities emerge, scientists seek to negotiate the uncertainty surrounding the identification and validation of signals as candidate biomarkers before they can be tested in clinical trials.
{"title":"Learning to See Cancer in Early Detection Research","authors":"I. Pérez","doi":"10.17157/mat.8.2.5108","DOIUrl":"https://doi.org/10.17157/mat.8.2.5108","url":null,"abstract":"This article explores how scientists learn to detect ‘pre-cancer’, a new diagnostic category defined by the risk of developing the titular disease. This process entails the observation of ‘raw signals’ that stand for potential molecular and metabolic changes in animal and human tissues and their validation as ‘candidate biomarkers’. I draw on ethnographic fieldwork conducted alongside a multidisciplinary group of researchers—physicists, biologists, mathematicians, computer scientists, and engineers, among others—all of whom worked as part of a research programme investigating the early signs and detection of cancer in the UK. ‘Signals’ detected through scientific experiments are intimately entangled with the sensing technologies and analytical techniques used. As previously unknown microscopic realities emerge, scientists seek to negotiate the uncertainty surrounding the identification and validation of signals as candidate biomarkers before they can be tested in clinical trials.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44305527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Early during my fieldwork on the social life of the microbiome in Toronto, I was asked ‘Do you believe in microbiome testing?’ This question invited me to evaluate the science of the direct-to-consumer (DTC) test. In this Position Piece, I consider this question in a more expansive manner so as to position the test in its social and economic context. The distribution and public uptake of such a DTC test require scientific expertise but also marketing, capital investments, and clinical labour. This test requires consumers to do the work of stool collection and the reproductive labour of diet changes in their domestic spaces. I have learned that the microbiome is part of the quest for alternative ways of living and being healthy. Broadening the question to consider more than just the science expands the frame from one of scientific efficacy and individual consumption to one that considers the financialisation of health and the politics and environments of post-Pasteurian and post-industrial contexts.
{"title":"Positioning Human Microbiome DTC Tests On the Search for Health, Data and Alternatives Amid the Financialisation of Life","authors":"Alexandra Widmer","doi":"10.17157/mat.8.2.5127","DOIUrl":"https://doi.org/10.17157/mat.8.2.5127","url":null,"abstract":"Early during my fieldwork on the social life of the microbiome in Toronto, I was asked ‘Do you believe in microbiome testing?’ This question invited me to evaluate the science of the direct-to-consumer (DTC) test. In this Position Piece, I consider this question in a more expansive manner so as to position the test in its social and economic context. The distribution and public uptake of such a DTC test require scientific expertise but also marketing, capital investments, and clinical labour. This test requires consumers to do the work of stool collection and the reproductive labour of diet changes in their domestic spaces. I have learned that the microbiome is part of the quest for alternative ways of living and being healthy. Broadening the question to consider more than just the science expands the frame from one of scientific efficacy and individual consumption to one that considers the financialisation of health and the politics and environments of post-Pasteurian and post-industrial contexts.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44508466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Beaudevin, L. Berlivet, S. Boudia, C. Bourgain, Maurice Cassier, J. Gaudillière, I. Löwy
This article follows the introduction of COVID-19 polymerase chain reaction (PCR) diagnostic tests in France. It shows how, at the intersection of science, medicine, politics, and policy-making, the test, trace, and isolate (TTI) strategy played out during the first months of the pandemic against a backcloth of multiple shortages. In so doing, the authors move beyond trite explanations (such as ‘French public health’s backwardness’) to highlight how successive policy inflections affected the national response to the pandemic. The piece analyses the shifting French political discourse surrounding (scarce) COVID-19 tests while exploring ad-hoc regulations and guidelines as well as the intense ‘bricolage’ that they triggered in the field of clinical medicine. The authors contend that the limitations of the testing infrastructure in France during the first half of 2020 shaped the decision to resort to lockdown. The research article sheds light on two coexisting registers of professional uses of reverse transcription-polymerase chain reaction (RT-PCR) assays—a ‘public health use’ and a ‘clinical use’—and highlights the changing political and social relevance of these two registers, with scarcity as a major determinant of these changes. One of the striking aspects of the introduction of COVID-19 tests in France therefore lies in the enduring gap between the dynamics of the epidemic and the dynamics of testing. In this respect, the French situation is neither extreme nor unique, which makes this case study a relevant basis for the international comparison of testing practices in different phases of the COVID-19 pandemic.
{"title":"‘Test, Test, Test!’: Scarcity, Tinkering, and Testing Policy Early in the COVID-19 Epidemic in France","authors":"C. Beaudevin, L. Berlivet, S. Boudia, C. Bourgain, Maurice Cassier, J. Gaudillière, I. Löwy","doi":"10.17157/MAT.8.2.5116","DOIUrl":"https://doi.org/10.17157/MAT.8.2.5116","url":null,"abstract":"This article follows the introduction of COVID-19 polymerase chain reaction (PCR) diagnostic tests in France. It shows how, at the intersection of science, medicine, politics, and policy-making, the test, trace, and isolate (TTI) strategy played out during the first months of the pandemic against a backcloth of multiple shortages. In so doing, the authors move beyond trite explanations (such as ‘French public health’s backwardness’) to highlight how successive policy inflections affected the national response to the pandemic. The piece analyses the shifting French political discourse surrounding (scarce) COVID-19 tests while exploring ad-hoc regulations and guidelines as well as the intense ‘bricolage’ that they triggered in the field of clinical medicine. The authors contend that the limitations of the testing infrastructure in France during the first half of 2020 shaped the decision to resort to lockdown. The research article sheds light on two coexisting registers of professional uses of reverse transcription-polymerase chain reaction (RT-PCR) assays—a ‘public health use’ and a ‘clinical use’—and highlights the changing political and social relevance of these two registers, with scarcity as a major determinant of these changes. One of the striking aspects of the introduction of COVID-19 tests in France therefore lies in the enduring gap between the dynamics of the epidemic and the dynamics of testing. In this respect, the French situation is neither extreme nor unique, which makes this case study a relevant basis for the international comparison of testing practices in different phases of the COVID-19 pandemic.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41999690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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