Janina Kehr, Hansjörg Dilger, and Peter van Eeuwijk
The health sector is one of the largest and most rapidly growing branches of the global economy. The world’s biggest pharmaceutical companies earn hundreds of billions of dollars per year, thereby exceeding many countries’ gross domestic product. The health sector is also predicted to be the largest source of employment creation in the decades to come, all over the world. Economised forms of health provision and disease prevention generate financial values, for instance in private insurance schemes or high-risk, experimental treatments. On the other hand, publicly funded health care – which has raised societal expectations and hopes for a very long time in most parts of the world – is increasingly being confronted with funding cuts, and in some cases with drastic austerity policies. Furthermore, situations of recent or long-term scarcity in health care systems produce existential uncertainties and concerns in relation to (both formal and informal) medicine and care worldwide. All these examples show how pervasive and commanding many aspects of economics and finance – and the values and logics that the highly advanced capitalist world order is inflicting on all domains of human existence and wellbeing – has become over the last decades, not least with regard to the omnipresent politics and practices of neoliberal governance.
This special issue explores the deep entanglements between medicine, law, politics, morality and economy in the contemporary world order and asks how these entwinements shape illness experiences and forms of treatment and care in the varying locations and contexts of Egypt, Tanzania, Brazil and India. By introducing the concept of ‘transfiguration’, we highlight the highly ambiguous, ever-evolving and increasingly transnational character of these processes in the vastly contested and power-ridden fields of medicine and wellbeing. We also argue that a moral economy approach can figure as a lens to disentangle and disaggregate these different fields’ values and practices analytically and to account for the need to reflect systematically on people’s struggles for a ‘good life’ in the context of profit-driven and often highly exclusionary economies and their impacts on health care systems. Against this background, the contributions to this special issue ask, through a shared theoretical concern, how medicine, illness experience and medical knowledge production coalesce under the condition of ‘excessive’ economies in relation to subjectivities, materialities and values. In conclusion, we ask which ethical and political demands arise for anthropologists as novel, strongly politicised and morally loaded fields of research open up; and how we can respond to the challenges of doing research in the capital-intensive fields of medicine and health and act accordingly in our investigations and writings.
The contributions to the special issue were first presented at the trinational conference entitled “Transfigurationen: medizin macht gesellschaft macht medizin” (University of Basel, February 2017), which celebrated and reflected upon twenty-five years of Medical Anthropology Switzerland within the Swiss Anthropological Association, twenty years of Work Group Medical Anthropology within the German Anthropological Association, and the establishment of the Vienna Dialogues in Medical Anthropology in 2012. At this conference, the highly ambiguous impact of economic transfigurations on individual and collective wellbeing was also exposed prominently in Andrea Muehlebach’s keynote speech, which explored how everyday lives in the context of austerity measures in Southern Europe are permeated and governed by late capitalist, neoliberal markets in unprecedented affective and transnationalised ways. More insights into the themes of and contributions to the conference can be obtained in the previously published reports by Mira Menzfeld (H-Soz-Kult), Laura Perler and Francesca Rickli (Somatosphere / Blog Medizinethnologie), and Max Schnepf (Medicine, Anthropology, Theory).
Janina Kehr, Hansjörg Dilger and Peter van Eeuwijk
„Introduction: Transfigurations of Health and the Moral Economy of Medicine: Subjectivities, Materialities, Values“
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This special issue explores the deep entanglements between medicine, law, politics, morality and economy in the contemporary world order and asks how these entwinements shape illness experiences and forms of treatment and care in the varying locations of Egypt, Tanzania, Brazil and India. By introducing the concept of ‘transfiguration’, we highlight the highly ambiguous, ever-evolving and increasingly transnational character of these processes in the vastly contested and power-ridden fields of medicine and wellbeing. We also argue that a moral economy approach can figure as a lens to disentangle and disaggregate these different fields’ values and practices analytically and to account for the need to reflect systematically on people’s struggles for a ‘good life’ in the context of profit-driven and often highly exclusionary economies and their impacts on health care systems. Against this background, the contributions to this special issue ask, through a shared theoretical concern, how medicine, illness experience and medical knowledge production coalesce under the condition of ‘excessive’ economies in relation to subjectivities, materialities and values. In conclusion, we ask which ethical and political demands arise for anthropologists as novel, strongly politicised and morally loaded fields of research open up; and how we can respond to the challenges of doing research in the capital-intensive fields of medicine and health and act accordingly in our investigations and writings.
[transfiguration; moral economy of medicine; subjectivities; materialities; values]
Mustafa Abdalla
„Transfigurative Experiences of Sickness. Medical Regimes, Disease Commodification, and Professional Patients in Egypt“
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This article sheds light on emerging subjectivities and collective actions of a group of patients, whom I call “professional patients” to reverse their marginality, unemployment status and ailing health. Towards this end, this group commodifies and maintains disease, and sells knowledge about it by engaging in disease work to improve their economic and social conditions and accordingly reshape their precarity. In this regard, I argue that, professional patients, by commodifying their disease and entering disease markets, by selling knowledge next to bedside and in examination scenarios, they transfigure their disease into a generative force that guarantees them social empowerment, economic autonomy and opens new possibilities for them and their families to gain economic and social capitals that enable them to improve their livelihoods and to manage the disease itself. Such activities reveal a situation in which disease has gained an economic value. It has been transfigured into a capital and has become, for certain groups, a primary source of income. [transfiguration, disease commodification, professional patients, disease markets, structural violence, Egypt]
Sandra Bärnreuther
„From Urine in India to Ampoules in Europe: The Relational Infrastructure of Human Chorionic Gonadotropin“
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From urine in India to ampoules in Europe describes the commodity chain of the hormone human chorionic gonadotropin (hCG) between the 1960s and 1990s. The transfiguration of hCG from an impotent waste product in India to a prized pharmaceutical in Europe was made possible by promises of productivity. These promises mobilized a gendered, classed, and racialized relational infrastructure that made the fertility of the urban poor in Kolkata available and valuable for reproductive medicine in the global North. Traces of these relations, however, were obscured by framing transactions as donations, providing return gifts, and declaring urine as raw material. In this article, I make hCG’s relational infrastructure legible. Showing how the pharmaceutical has come into being through manifold relations, allows me to analyze processes of valuation that go beyond biological extraction and chemical metamorphosis. [pharmaceuticals, hormones, urine, relational infrastructure, valuation, commodity chains, reproductive medicine, India]
Maria Lidola
„Recht auf Gesundheit, citizenship und die Moralökonomie einer sozialmedizinischen Versorgung vulnerabler Bevölkerungsgruppen in Rio de Janeiro“
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The Right to Health, Citizenship and the Moral Economy of Social Medicine in Rio de Janeiro’s Favelas: In the course of the 2000s, primary healthcare-based family clinics were established throughout Rio de Janeiro’s favelas in order to guarantee the Brazilian Constitutional Right to Health, especially for vulnerable populations. The underlying Family and Community Health Program aimed to not only incorporate these populations into public health care but also to transform their conceptions, practices and values regarding health and illness accordant to the Brazilian social medicine approach. But as in other resource poor settings of primary health care, this transformative process was faced with dissatisfaction on the local ground, by the patients as well as by the medical staff. The paper takes a closer look at this scenario of transfiguration by reflecting on the role of differentiated citizenship and vulnerable subjectivities of the favela population within the underlying moral economies of social medicine. Therefore, the paper traces back the historical overlapping of urban social inequality, the Brazilian Right to Health approach and local forms of citizenship claims of the urban marginalized population. The concept of transfiguration will offer an analytic lens to understand this process of transformation in its inconstancy, encompassing the people involved and their subjectivities, their practices of subjectivation but also resistance and agency, their normative expectations and lived experiences. [Right to Health, Social Medicine, Brazil, Citizenship, Favela]
Andrea Buhl
„Transfiguration(s) of Palliative Care. The Moral Economy of End-of-Life Care in a Tanzanian Cancer Hospital“
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Palliative care is an internationally acknowledged concept focusing on patients with life-threatening diseases and their caregivers. It aims to meet individual physical, psychosocial and spiritual needs with a multidisciplinary ‘holistic’ approach. This idea, originating from Europe, is promoted globally as universal “human right to health” (WHO 2017). The article takes a closer look at the implementation of palliative care provision in a Tanzanian cancer hospital, where the number of cancer cases is constantly rising, and thus, those with a need for palliative care. In this place, concepts of global health meet local realities consisting of high numbers of advanced cases and scarcities of treatment and care. These constantly changing conditions are discussed in light of the newly introduced idea of ‘transfiguration’ and in relation to the concept of moral economy, as the implementation of palliative care is mainly driven by moral reasoning. The transfigurative processes evolve in different directions: On one hand, the initial idea of palliative care is intended to transfigure in-hospital caring practices. On the other, it is construed as an adaptive approach, which should fit into local hospital contexts. This article discusses the apparently opposed processes of transfiguration of and in palliative care. [palliative care, cancer, Tanzania, sub-Saharan Africa, hospital ethnography, institutionalized care]
Gabriela Hertig
„Making the Cells Work. Rendering Autologous Stem Cell Therapies Viable in India“
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Stem cell therapies in India are criticised internationally as well as within the country because they are not considered to be safe and efficacious from the perspective of normative science and clinical translation. They were also not regulated by law between 2013 and 2017, the period on which this article focuses. In this article, I unpack the everyday unfolding of the provision of stem cell treatments and the dynamics of how these therapies were rendered viable as well as their limits in a contentious regulatory and scientific context. I elaborate on how autologous stem cell therapies were positioned as ‘procedures’ after the Indian government announced that it would make clinical trials mandatory for all stem cell ‘products’ in 2013. Drawing on ethnographic research in clinics and focusing on the providers’ perspective, I detail how these cells were made to work in clinical practice through a ‘holistic approach’ that involved elaborate treatment protocols and the cooperation of patients in caring for the cells. This approach is a complex healing practice which I situate at the intersection of local and global norms of research and biomedical translation, healthcare markets, and their regulation in the Indian context. [stem cells, regenerative medicine, India, therapy, clinical practice, policy]
