Table of Contents
Articles of the MAQ archive
This issue of Reading the Archives is focused on how technology has (and has not) appeared in MAQ. I bring a slightly distanced perspective as a medical anthropology-adjacent scholar of science and technology studies (STS), critical disability studies, and information studies, an intersection where technology is highly elaborated. From this perspective, technology itself appears as a kind of underexamined category within the MAQ archives. This is surprising given the way that central STS concepts such as multi-species relations, distributed agency, factishness, and others have a vibrant life in the journal. Given the turn toward STS in the journal, and perhaps in the field, this rather under-specified and under-articulated relationship to and space for technology may become a thing of the past. But the question of the place of technology has been and remains important and may well inform the way medical anthropology articulates its relationship to technology in the future.
The rest of this piece is structured as follows: I begin by discussing what the presence of technology looks like in this collection of MAQ articles. I then note five absences that I observed when selecting articles for this issue and reflect on how medical anthropology might be put into productive conversation with work on medical technology in adjacent fields.
MAQ articles that address technology appear to fall into two loose categories. One in which technology is situated in the enactment of medical authority and expertise, and another in which technology is examined as a factor in self-formation and embodiment, particularly of patients. The MAQ archives do a wonderful job of balancing the various ways in which medical technology reshapes relations between patients and providers, maintains or reformulates professional hierarchies and ways of knowing, establishes new clinical and moral standards of care, and affects how we think about ourselves, our bodies, and human difference.
Across both categories, the majority of articles that address technology explicitly are about reproduction, a realm in which technology is seen to belong the least and therefore be the worthiest of comment. Presumably this is because of the assumed ‘naturalness’ of reproduction and the disruption of this naturalness in the face of technology (Rapp 2001). Because obstetrics is one of the most longstanding domains within which (white male) medical expertise asserted itself, it is also an ideal point of departure for feminist analyses of medicine and technology.
In an early example, Robbie Davis-Floyd shows that obstetrics training socializes physicians into revering technology to such an extent that even obstetricians who philosophically support the humanistic model of birth end up supporting the technological model in practice (Davis-Floyd 1987). The effects of this training are pervasive, including the redefinition of birth as a pathological process, the subjugation of the patient’s bodily rhythms to practitioner routines and technological time, an insistent focus on body parts as a locus of intervention separate from the patient’s emotions, mind, and self, and a complete reliance on technology as a practical tool, a reliable safeguard against malpractice suits, and essential to good care. This article exemplifies the ‘technology and biomedical expertise’ category.
In a more recent example, Elaine Gerber highlights the way that reproductive technologies are part of patient self-formation. Pointing out that anthropological analyses of reproductive technology have focused on women who intend to carry their pregnancy to term, Gerber examines the experiences of women who opt for early abortion via the oral medication RU-486 in France (Gerber 2002). Countering mainstream critiques of the distancing and objectifying effects of technology, the article shows that RU486 can foster proximity and embodiment by making patients and physicians encounter the actual materials of pregnancy such as ejected fetal tissue. Thus, RU486 challenges the fetus-as-baby metaphor that is often used to argue against abortion.
Beyond the domain of reproductive technology, articles that focus on technology and biomedical expertise span a range of domains, from neurology to gastroenterology and from in-the-moment decision-making to the formation of healthcare policy. Some articles also reflect on the role of technology in the self-formation and embodiment of medical practitioners, thus bridging both categories of MAQ articles on technology.
Margaret Lock shows that technology-mediated norms are culturally situated (Lock 1996). Her work demonstrates that the use of electroencephalograms – devices that monitor brain activity – to demarcate death in the United States resulted from changes in medical thinking and consensus around the spatiotemporal characteristics of death, moving from the prior paradigm of death as a process to death as an event marked by insufficient brain activity. The main driver behind this change was to enable the timely harvesting of organs for implantation. In Japan, on the other hand, the concept of brain death is not as widely accepted because death is construed as a social event, with biological and cognitive deterioration being secondary concerns.
Diana Forsythe takes us into the realm of technology design, showing that by intention or by accident, medical informatics and computing privileges biomedical knowledge and desires over the knowledge and desires of patients, which contributes to silencing the voices of nurses and other ancillary care professionals, and ends up yielding neutral-seeming systems that nevertheless embody the assumptions and interests of physicians (Forsythe 1996). She does so through long-term participant observation in a project developing an intelligent information system designed to educate migraine patients. This article demonstrates technology’s potential to re-inscribe and perhaps worsen cultural biases and power differentials behind a neutral and objective veneer.
Returning to the hospital, Christian Simon shows that when medical practitioners read and discuss diagnostic images during case conferences, they do so in ways that demonstrate their professional status and position in addition to their image-reading abilities (Simon 1999). In addition to diagnosing patients, the case conference provides an important avenue to also diagnose practitioners’ capabilities and reassert professional hierarchies. The article construes MRI, CT, and other imaging technologies as both problematic and beneficial: problematic in that they stand in for patients in case discussions and beneficial in terms of improved precision and outcomes in the context of brain disorders. This is quite distinct from the context of childbirth, where technologies like the electronic fetal monitor have not been shown to improve the precision or outcomes of care (Wendland 2007).
Sharon Kaufman and Lakshmi Fjord problematize the moral and ethical norms that emerge when Medicare decides to cover a new technology or intervention (Kaufman and Fjord 2011). Through the case of liver disease and transplantation, the article shows that Medicare coverage decisions modify the standard of care – once Medicare decides to cover an intervention, providers, patients, and caregivers alike feel obliged to regard it as the only morally and ethically appropriate as well as medically recommended treatment option. Kaufman and Fjord propose that this ethical imperative driving us towards new and ever more invasive forms of intervention is a new mode of governance that is not visible to individual actors in the medical ecosystem despite being enforced or followed by them all.
Scott Stonington demonstrates that the temporary suspension of uncertainty in medical decision-making is the main utility of technology in fast-paced environments such as cardiac intensive care units (Stonington 2020). This is a refreshing take, because the article phenomenologically examines the role of technology in expert rationality, moving away from objectification, authority, and other common themes. Stonington shows that the “data richness” that characterizes present-day critical care environments primarily helps physicians trust themselves in the moment of decision-making, even when the data is not ultimately useful in terms of the outcome (e.g., patient mortality).
Medical technology is thus a tool of many and mixed potentials. A tool for thinking with, for making sense of bodily experiences, for reshaping lay and expert knowledge hierarchies as well as social, ethical, and legal relations.
Now for the absences revealed by surveying the archive with an eye informed by the elaboration of technology in adjacent fields such as STS. First, from this perspective MAQ articles that address technology tend to retain the field’s traditional focus on the narratives, experiences, and practices of patients over those of physicians, nurses, and other healthcare professionals, who predominate in STS. This issue intentionally emphasizes the category of biomedical expertise to provide examples where anthropologists have worked to complicate understandings of the positions and perspectives of healthcare practitioners (see also (Wendland 2019)).
Second, this scholarship focuses on imaging technologies such as ultrasound, PET, MRI, and CT scans, all of which produce lifelike visualizations. This is in contrast to representational technologies that produce sounds, traces, and other inscriptions, such as fetal monitors, electroencephalograms, and electrocardiograms. By contrast, these representational technologies have received attention in feminist anthropology, history of technology, and information studies. I believe that a deeper examination of these other technologies within medical anthropology, or perhaps a reflection on their dispreference as objects of anthropological analysis, might help us go further towards answering the question of “the specificity of the visual as a form of (scientific) knowledge” as distinct from other ways of knowing and expressing (Burri and Dumit 2008).
Third, the equity implications of routinizing embodied difference through technology has received relatively little attention in the MAQ archives. This is starting to change through recent works in medical anthropology and adjacent fields that attend to specific sociohistorical assumptions and biases embedded in technology and their implications for health and equity. Pulse oximeters and medical decision-support algorithms have recently been shown to encode racial bias: Black patients and patients of color have to be sicker on average to receive the same level of intervention as white or light-skinned patients (Moran-Thomas 2020; Vyas, Eisenstein, and Jones 2020). This bias can occur due to a range of reasons including largely monochromatic clinical research samples, as well as differential health outcomes being explained via racial and ethnic difference alone (instead of accounting for the effects of systemic racism). This growing body of work (see e.g., Moran-Thomas 2020; Roberts 2012; Fausto-Sterling 2012; Hailu 2019; Braun 2014; Benjamin 2019; Vyas, Eisenstein, and Jones 2020) represents an opportunity to think in more explicit ways about the relationship between experience, inequality, and technology, within the frame of medical anthropology.
Fourth, work on medical technology tends to be situated in the global north. With some notable exceptions (e.g., Friedner 2015, 2022; Lock 1996; Moran-Thomas 2019; Inhorn and Tremayne 2012; Inhorn 2015), there remains the need to attend to global and transnational accounts that move beyond those geographies. Finally, I was also struck by the whiteness of the MAQ archives, and how few and far between non-western and non-white scholars and scholarship are in the conversation. This gap is also reflected in the adjacent fields of STS and information studies and are central to the reparative work being done in fields such as postcolonial science studies and Indigenous STS.
The way technology is elaborated in these adjacent fields also speaks to the imminent place of technology in medical anthropology. I find that technology itself appears somehow outside the scope of analysis, deconstruction, and certainly reimagination in the MAQ archives. There are detailed discussions regarding how patients and practitioners make sense of waveforms on fetal monitors or how waveforms came to be the primary mode of representing heart beats, but few articles veer towards technological specificity: how visuality operates when a fetal monitor spits out a paper strip versus recording data on hard drives and other digital storage solutions, or how ways of knowing may be affected by technical details such as the relationship between the monitor’s sampling rate and display resolution. This may be due in part to anthropology’s commitment to a vision of the social imagined as distinct from the technological; in part to the reduced exposure to and unfamiliarity with engineering and technology building skills; and in part to the lack of incentives for medical anthropologists, whose subjects are usually those needing or providing support around health and healing, to engage with technical communities. Given the applied and translational potential of medical anthropology in particular, I think it would be fantastic to have anthropologists working alongside, critiquing, and intervening in technological development as equals and not as subordinates, as Scheper-Hughes and Singer proposed regarding medical anthropology and the healthcare professions (Singer 1990; Scheper-Hughes 1990). Some anthropologists have already done what I am proposing, and Brigitte Jordan provides a particularly fantastic example. Jordan’s chapter, titled “Authoritative Knowledge and Its Construction,” presents a centrally anthropological analysis of hospital birth that results in concrete recommendations for alternative ecologies of labor that both address technology and imagine how technologies could help us turn social hierarchies on their head (Jordan 1997). The implications of anthropological analyses of technology do not need to be immediately translatable but could instead propose critical and speculative points of departure aimed towards better futures.
I also want to be conscious of what it is that I am asking of medical anthropologists. Medical anthropology has taught me a lot and opened many new ways of thinking that would have been impossible if I had remained in the information studies and STS realms. As someone who has struggled with writing this brief essay for over a year, given the competing demands of advancing my own research, networking with scholars in my own mix of disciplines, and establishing my identity as a new faculty member in the midst of a pandemic; I recognize that this labor of extending oneself across disciplines is rarely recognized or rewarded in ways that matter to the academy. So, I conclude this commentary with a modest invitation to readers to think with me on how we can foster dialogue between medical anthropologists, adjacent fields, such as STS and information studies, and technologists themselves.
Bio: Megh Marathe is a Presidential Postdoctoral Fellow at the University of California, Irvine and an incoming Assistant Professor of Media, Information, and Bioethics at Michigan State University. Their research examines the relationship between lived experience and professional expertise in healthcare and governance, bridging the fields of science & technology studies, disability studies, and information studies.
Image source: https://www.flickr.com/photos/fdaphotos/8249708093/
Articles from the MAQ archive
- Robbie Davis-Floyd. (1987). Obstetric Training as a Rite of Passage. Medical Anthropology Quarterly, 1(3), 288–318. https://doi.org/10.1525/maq.1987.1.3.02a00050
- Margaret Lock. (1996). Death in Technological Time: Locating the End of Meaningful Life. Medical Anthropology Quarterly, 10(4), 575–600. https://doi.org/10.1525/maq.1996.10.4.02a00110
- Forsythe, Diana E. 1996. “New Bottles, Old Wine: Hidden Cultural Assumptions in a Computerized Explanation System for Migraine Sufferers.” Medical Anthropology Quarterly, 10 (4): 551–74. https://doi.org/10.1525/maq.1996.10.4.02a00100
- Christian Simon. (1999). Images and Image: Technology and the Social Politics of Revealing Disorder in a North American Hospital. Medical Anthropology Quarterly, 13(2), 141–162. https://doi.org/10.1525/maq.19184.108.40.206
- Elaine Gerber. (2002). Deconstructing Pregnancy: RU486, Seeing “Eggs,” and the Ambiguity of Very Early Conceptions. Medical Anthropology Quarterly, 16(1), 92–108. https://doi.org/10.1525/maq.2002.16.1.92
- Sharon R. Kaufman and Lakshmi Fjord. (2011). Medicare, Ethics, and Reflexive Longevity: Governing Time and Treatment in an Aging Society. Medical Anthropology Quarterly, 25(2), 209–231. https://doi.org/10.1111/j.1548-1387.2011.01150.x
- Scott Stonington. (2020). “Making Moves” in a Cardiac ICU: An Epistemology of Rhythm, Data Richness, and Process Certainty. Medical Anthropology Quarterly, 34(3), 344–360. https://doi.org/10.1111/maq.12557
This section proposes questions for reflection and discussion by people who have already read some or all of the articles in this collection.
- For each article, what did you learn that you did not know in advance? Share your initial reactions, including things you found surprising, with a colleague or fellow participant.
- What are some frequent terms that came up in the articles in this issue? What can they tell us about the progression in thought on understandings and implications of medical technology over time?
Parsing medical anthropology
- Go to the Association for Computing Machinery’s digital repository of research articles at https://dl.acm.org. Search for ‘medical AND technology’ and read the titles and abstracts of articles on the first page of results (or more, if this activity piques your interest). For work that is a little closer to medical anthropology, select “CSCW: Computer Supported Cooperative Work” or “CHI: Conference on Human Factors in Computing Systems” under Proceedings Series. Reflect on similarities and differences between these articles and articles in this issue as well as the broader MAQ archives. Repeat this exercise and reflection for two flagship science and technology studies journals: Social Studies of Science and Science, Technology, and Human Values. What are some overlaps and tensions in the way these fields approach medical technology?
- Compare Diana Forsythe’s articles on building an intelligent information system for migraine in MAQ (this issue) and in the Proceedings of the Annual Symposium on Computer Applications in Medical Care (https://pubmed.ncbi.nlm.nih.gov/1482926/). What are some differences in the way Forsythe pitches the work, as well as the implications that are drawn from the ethnography? What does Forsythe’s work tell us about fostering dialogue between these bodies of literature?
- Think about a recent visit to a community clinic, university healthcare facility, hospital, or academic medical center. What were the various technologies you encountered, and by extension, how would you define medical technology? Outline 3-4 defining features of medical technology.
- Think about a medical technology that you are somewhat familiar with – examples include COVID-19 spit kits, stethoscopes, electrocardiograms, ultrasound scans, and electronic medical records. How would you go about studying the social context of this technology, including its implications for the social as well as how the social helped shape this particular instantiation of the technology? Who would your interlocutors be and what sources would you draw upon? What would you study in particular and why? What would you expect to find, and which anthropological debates would you be entering? Drawing on these insights, what would you want technologists, patients, and practitioners to take away?
Benjamin, Ruha. 2019. Race After Technology: Abolitionist Tools for the New Jim Code.
Braun, Lundy. 2014. Breathing Race into the Machine : The Surprising Career of the Spirometer from Plantation to Genetics. University of Minnesota Press.
Burri, Regula Valérie, and Joseph Dumit. 2008. “Social Studies of Scientific Imaging and Visualization.” In The Handbook of Science and Technology Studies, edited by Edward J Hackett, Olga Amsterdamska, Michael Lynch, and Judy Wajcman, 3rd ed., 297–317. MIT Press. http://hdl.handle.net/20.500.11850/158566.
Davis-Floyd, Robbie E. 1987. “Obstetric Training as a Rite of Passage.” Medical Anthropology Quarterly 1 (3): 288–318. https://doi.org/10.1525/maq.1987.1.3.02a00050.
Fausto-Sterling, Anne. 2012. “Bodies with Histories: The New Search for the Biology of Race.” Boston Review, May 2012.
Forsythe, Diana E. 1996. “New Bottles, Old Wine: Hidden Cultural Assumptions in a Computerized Explanation System for Migraine Sufferers.” Medical Anthropology Quarterly 10 (4): 551–74. https://doi.org/10.1525/maq.1996.10.4.02a00100.
Friedner, Michele Ilana. 2015. Valuing Deaf Worlds in Urban India. Rutgers University Press.
———. 2022. Sensory Futures: Deafness and Cochlear Implant Infrastructures in India. University of Minnesota Press.
Gerber, Elaine Gale. 2002. “Deconstructing Pregnancy: RU486, Seeing ‘Eggs,’ and the Ambiguity of Very Early Conceptions.” Medical Anthropology Quarterly 16 (1): 92–108. https://doi.org/10.1525/maq.2002.16.1.92.
Hailu, Ruth. 2019. “Fitbits and Other Wearables May Not Accurately Track Heart Rates in People of Color.” Stat, July 24, 2019.
Inhorn, Marcia Claire. 2015. Cosmopolitan Conceptions : IVF Sojourns in Global Dubai. Duke University Press.
Inhorn, Marcia Claire, and Soraya Tremayne. 2012. Islam and Assisted Reproductive Technologies: Sunni and Shia Perspectives. Berghahn Books.
Jordan, Brigitte. 1997. “Authoritative Knowledge and Its Construction.” In Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives.
Kaufman, Sharon R., and Lakshmi Fjord. 2011. “Medicare, Ethics, and Reflexive Longevity: Governing Time and Treatment in an Aging Society.” Medical Anthropology Quarterly 25 (2): 209–31. https://doi.org/10.1111/j.1548-1387.2011.01150.x.
Lock, Margaret. 1996. “Death in Technological Time: Locating the End of Meaningful Life.” Medical Anthropology Quarterly 10 (4): 575–600. https://doi.org/10.1525/maq.1996.10.4.02a00110.
Moran-Thomas, Amy. 2019. Traveling with Sugar: Chronicles of a Global Epidemic. University of California Press. https://doi.org/10.2307/j.ctvqr1bjf.
———. 2020. “How a Popular Medical Device Encodes Racial Bias.” Boston Review, August 2020.
Rapp, Rayna. 2001. “Gender, Body, Biomedicine: How Some Feminist Concerns Dragged Reproduction to the Center of Social Theory.” Medical Anthropology Quarterly 15 (4): 466–77. https://doi.org/10.1525/maq.2001.15.4.466.
Roberts, Dorothy. 2012. Fatal Invention : How Science, Politics, and Big Business Re-Create Race in the Twenty-First Century. New York, UNITED STATES: The New Press.
Scheper-Hughes, Nancy. 1990. “Three Propositions for a Critically Applied Medical Anthropology.” Social Science & Medicine 30 (2): 189–97. https://doi.org/10.1016/0277-9536(90)90079-8.
Simon, Christian M. 1999. “Images and Image: Technology and the Social Politics of Revealing Disorder in a North American Hospital.” Medical Anthropology Quarterly 13 (2): 141–62. https://doi.org/10.1525/maq.19220.127.116.11.
Singer, Merrill. 1990. “Reinventing Medical Anthropology: Toward a Critical Realignment.” Social Science & Medicine 30 (2): 179–87. https://doi.org/10.1016/0277-9536(90)90078-7.
Stonington, Scott D. 2020. “‘Making Moves’ in a Cardiac ICU: An Epistemology of Rhythm, Data Richness, and Process Certainty.” Medical Anthropology Quarterly 34 (3): 344–60. https://doi.org/10.1111/maq.12557.
Vyas, Darshali A, Leo G Eisenstein, and David S Jones. 2020. “Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms.” New England Journal of Medicine 383 (9): 874–82. https://doi.org/10.1056/NEJMms2004740.
Wendland, Claire L. 2007. “The Vanishing Mother: Cesarean Section and ‘Evidence-Based Obstetrics.’” Medical Anthropology Quarterly 21 (2): 218–33. https://doi.org/10.1525/maq.2007.21.2.218.
———. 2019. “Physician Anthropologists.” Annual Review of Anthropology 48 (1): 187–205. https://doi.org/10.1146/annurev-anthro-102218-011338.