ASA06: Cosmopolitanism and Anthropology

Panel 20

The Cosmopolitics of Health - Stefan Ecks, Ian Harper and Rebecca Marsland

Room: CBA 0.021 x 30

Panel abstract

The contemporary ‘cosmopolitics’ of health are largely driven by biomedical interventions around the world. The ‘globalization’ of biomedicine has already been widely discussed. Despite the fact that biomedicine has sometimes been dubbed ‘cosmopolitan medicine’ by medical anthropologists, an in-depth engagement with the question of cosmopolitanism (as opposed to globalization) has not yet happened, and this panel seeks to address this gap.

Medical practitioners claim adherence to a universalized body of knowledge that transcends boundaries of nation-states. The swift global spread of evidence-based medicine and ‘best practice’ beyond local experiences is a working example of this. Activist practitioners of medicine, including organizations such as Medicines Sans Frontiers, define their mission in recourse to cosmopolitan values. In this view, the duty to treat all suffering human beings on equal terms entails the right to cross national boundaries if the need arises. Cosmopolitanism in biomedicine can, of course, be seen as a mirror image of the cosmopolitanism of disease itself: HIV/AIDS, TB, SARS, and most recently, bird flu, all disregard national boundaries and compel action from supra-regional and supra-national organizations. As such, ‘cosmopolitan’ medicine entails political, legal, and ethical dimensions that are little discussed in recent theories on ‘globalization’.

Yet, if biomedical practitioners define themselves as ‘citizens of the world,’ does the same apply to their patients? There is growing evidence that the claims of patients to receive certain kinds of biomedical treatments are also increasingly cosmopolitan. Examples include transnational patient groups lobbying for the availability of antiretroviral drugs. Similarly, is it only biomedical doctors who can claim universalized citizenship, as opposed to practitioners of other systems of healing? Non-biomedical healing practices have followed global movements of people, for example, practitioners of Chinese medicine are found in East Africa, and African healers practice in London. That there is a growing trend among non-biomedical healers to model their own strategies of professionalization along the standards of biomedicine has often been pointed out. Yet to what extent does the professionalization of non-biomedical practices entail a move towards global citizenship? If biomedical knowledge is universal, where does that leave other medical systems? Indeed, biomedicine goes so far as to adopt non-biomedical practitioners and ‘ethnopharmaceuticals’ as 'local knowledge' into its own project, e.g. by training practitioners to work with simplified biomedical technologies. Is this form of boundary work ‘cosmopolitan’ or rather its opposite? Another trend that this panel wants to explore is the emergent emphasis on ‘corporate global citizenship’ among pharmaceutical companies. If doctors and patients can be citizens, can pharmaceutical corporations be world citizens, too?

Convenors

Stefan Ecks, University of Edinburgh stefan.ecks@ed.ac.uk
Ian Harper, University of Edinburgh, ian.harper@ed.ac.uk
Rebecca Marsland

PAPERS

Pharmaceuticals in the constitution of cosmopolitan medicine

Stefan Ecks, University of Edinburgh

"Biomedicine" has been called by many names. "Cosmopolitan medicine" is one of them. This term suggests that biomedicine is the only type of healing that truly transcends local contexts. Biomedical practitioners usually stake this claim in reference to "science," "objectivity," and "best evidence." This paper analyzes the claim to cosmopolitanism by shifting attention from human actors to a peculiar type of nonhuman actor on which biomedicine crucially depends: pharmaceuticals. Much more than doctors and health professionals themselves, pharmaceuticals seem to circulate freely around the world without ever losing their powers in "local contexts." This seems to be in contrast to all forms of non-biomedical healing that seem hopelessly dependent on "meaning" and "social" interactions. Despite their transformative powers, pills are usually seen as passive objects that are used by active subjects according to their needs. This model assumes that a patient first experiences illness symptoms, then tries to understand the causes of ill-being, and only then seeks out a drug that cures the symptoms. Yet pharmaceuticals can have transformative powers even in the absence of active ingredients (the so-called placebo effect), or even in the absence of belief in their efficacy. The mere presence of pharmaceuticals can change illness perceptions. There are also many cases in which the introduction of a drug precedes the diagnosis of symptoms that can be treated with it. Only if pharmaceuticals are not seen merely as passive objects can the question be asked: what makes biomedicine cosmopolitan? The paper discusses this issue in relation to antidepressants in Kolkata (Calcutta), India.

Is the anti-malarial 'wonder-drug' Artesunate a Traditional Chinese Medical (TCM-drug) or a Western medical drug?

Elisabeth Hsu, Oxford University

This paper concerns a controversy currently dealt with in terms of the biomedical profession only, disregarding claims to knowledge and practices of "alternative modernities" based on globalised local and regional medical practice and knowledge, that make the issue more ambiguous and less easy to arbitrate than generally assumed. It concerns an absolutely vital question to traditional healers in East Africa, and Africa, at large, in African nation-states forbid them to sell biomedical drugs for which one has to have a license. These laws account for a biomedical categorisation of the world of drugs, which assumes that clear boundaries between biomedical and traditional herbal drugs can be made but as the example of Artesunate shows, the issue is, from an anthropological viewpoint, one of negotiated conventions and fluid boundaries.

To be sure, there are 'traditional herbal drugs' that from a biomedical viewpoint are 'adulterated' by chemically produced biomedical substances (e.g. TCM drugs, and also Kenyan, Tanzanian, and other local 'herbal' drugs), and they cause side effects for which ongoing ethnography provides ample evidence. However, from the actors' viewpoint, i.e. the sellers of these drugs, the issue is not one of 'adulteration' but of, say they say, a 'modernisation' of their age-old cultural knowledge. The claims of both sides are explored in this paper by examining specific cases of Chinese medical formula drugs that are currently sold on the East African coast. Artesunate was according to the doctors who sold it one of them, it is in fact the most frequent over-the-counter purchase in Chinese medical clinics, because only a year ago, no resistance had ever been recorded (but see headlines in recent newspapers based on a study published in the Lancet 2005).

Medical Cosmopolitans: Locating Knowledge in Tanzania

Rebecca Marsland, School of Oriental and African Studies

Starting from the premise that it is possible for there to be different styles of being cosmopolitan, I will consider (un)cosmopolitan medical practices in Tanzania. Cosmopolitanism is defined largely through relations to place (being ‘of the world’), but also it has come to mean an attitude – a rejection of cultural ‘authenticity’ and an openness to alternative forms of knowledge. I will explore this through ethnographic instances of biomedical and ‘traditional’ practice in Tanzania.

In terms of place, Tanzanian biomedical practitioners must practice a craft whose origin is epistemologically ‘elsewhere’ (Europe) and yet claims to be universal. The universality that is claimed for biomedical knowledge, and that gives it its putative ‘cosmopolitan-ness’, paradoxically is the same universality that makes biomedicine epistemologically parochial, in that its knowledge-making becomes internally localised. This makes it impossible for Tanzanian biomedical practitioners to subscribe to non-universal forms of knowledge whose origins are associated with their ‘home’. On the one hand, this rejection of locality is exactly what makes biomedicine cosmopolitan, on the other hand, it creates a strange bifurcation since it compels it to reject cultural ‘hybridity’ (with all the problems that terminology suggests), which is supposedly another characteristic of the cosmopolitan.

‘Traditional’ medical practitioners in Tanzania have a less ambivalent relation with the cosmopolitan. Whilst they are associated with ‘local knowledge’, and might be imagined to be the opposite of the cosmopolitan, in fact they are relatively free to traverse systems of knowledge; they are itinerate in both terms of location and epistemology.

Somewhere between the practitioners are the disease organisms that drive their work – as Ulrich Beck (2004) has noted, the dangers associated with global risks exert a pressure on social actors, who might otherwise be at odds, to cooperate. Thus, I end by asking whether entities such as ‘malaria’ or ‘HIV’ can be considered as ‘cosmopolitanizing’ in that they drive networks between practitioners of either persuasion.