Bronwyn Parry, Beth Greenhough, Tim Brown and Isabel Dyck (eds.) Bodies Across Borders: The Global Circulation of Body Parts, Medical Tourists and Professionals, 2015, 248 pp., Routledge, New York, paper $109.95 ISBN 978-1409457176.
There is a paradox in clinical uncertainty management. While contemporary medical education and training dismisses prognosis in favor of diagnostic and treatment skills, prognosis is ever present in daily medical life. In fact, physicians arguably engage in more prognostic behavior than most other professionals because, bound by their duty to heal, they are routinely called upon to concurrently navigate short-term and long-term care goals. With new accumulating evidence establishing prospection (i.e., the mental simulation of possible futures) as a central organizing principle of cognition and behavior, and with more clinicians warning about the central role of prognosis in clinical decision making, concerns about the relative neglect of prognostic training are becoming louder. Yet, although there is much writing and some fairly robust guidelines about how physicians should do prognosis, very little is currently known about what the process of medical prognosis actually looks like on the ground. I begin to fill this gap in my forthcoming book How Doctors Make Decisions, based on a three-year ethnographic study of hospital cardiology.
There is an odd combination of care and mockery with regard to infrastructure devoted entirely to sinkholes. Please, please go to thesinkhole.org and check them out. It is not a complex blog, but it is dead serious (for example, note that a number of the stories covered by the blog record casualties). A curious resource and one to keep your eye on.
… while the topics associated with infrastructure were plentiful this year, one of them sticks-out and consistently lingers in my mind’s eye. It is a topic implied in what I saw again just today while scrolling through my facebook and twitter feed.
It is called a number of things, although, apparently, “ruin porn” is term that has come to encapsulate the phenomenon. For example, I saw it today: an abandoned Wizard of Oz theme park that “will haunt you.”
I am pleased to announce that Dr. Phaedra Daipha, whose first book I wrote about and enjoyed, will be a guest blogger on Installing (Social) Order this month (October, 2016). She is going to be telling us about her recent work in a new post every week or so. Personally, I am excited to learn more about her work about forecasting (weather forecasting, in this case) and especially her re-thinking of decision-making that extends in new directions previous models of “decision science” from the business school crowd, organizational analysis, and organization studies.
Dr. Daipha a cultural sociologist working at the intersection of STS, organization studies, and social theory. Her research agenda centers on the nature, practice, and institutions of knowledge and technology production, with an eye toward understanding the development and transformation of systems of expertise and the emergence of new forms of coordinated action. She has employed a number of methods and data sources to examine such diverse fields of knowledge and technology production as academic sociology, weather forecasting operations, the commercial fishing industry, and medical care.
Despite the diversity of method and empirical focus, however, her work consistently pursues the following substantive themes: decision making in complex sociotechnical systems; visualization and expertise; object-centered sociality; and professional boundary work. She has pursued these topics in a series of papers, culminating with her recent book, Masters of Uncertainty: Weather Forecasters and the Quest for Ground Truth.
She is currently in the process of completing her forthcoming book, How Doctors Make Decisions: The Role of Prognosis in Cardiology Practice, based on two and a half years of comparative fieldwork. This book builds on her previously developed model of the process of decision making to highlight the practical, materialist, prospective, and situationist character of clinical judgment and care. But it also considerably extends her earlier conceptualization by applying it to a decision-making field that is interventionist (rather than consultative), that relies on cross-functional (rather than single-specialist) teamwork, and that operates within a significantly longer window of uncertainty.
If you find yourself teaching unintended consequences, consider this case “Radioactive wild boars rampaging around Fukushima nuclear site.” The animal population, which was previously hunted as a delicacy, has expanded dramatically (likely on account of nobody wanting to eat the radioactive meat); the hogs have pillaged the environment local to the Fukushima nuclear site, eating all manner of contaminated fruits and vegetables.
Self, who guides the walking tours, gets meta pretty quick; he “began with a brief introduction to the situationists – the Paris-based artists and thinkers of the 1960s who championed the concept of “psychogeography”, the unplanned drifting through an urban landscape to become more in tune with one’s surroundings.”
Contributors include AbdouMaliq Simone, Maria Kaika, Vyjayanthi Rao, Mariana Cavalcanti, Stephanie Terrani-Brown, Omar Jabary Salamanca, Rob Shaw, Harriet Bulkeley, Vanesa Caston-Broto, Simon Marvin, Mike Hodson, Renu Desai, Steve Graham, and myself. Arjun Appaduria kindly provided a thoughtful foreword for the book.
In “Water Wars in Mumbai,” a book chapter in Infrastructural Lives, we learn an important lesson about infrastructure as a material-social entanglement, in particular, in relation to the poor: infrastructure — or the lack-thereof — can be used to subjugate the poor — thus, reproducing their impoverished state — but infrastructure also, with rare exception, binds the poor to the non-poor.
It would have been unthinkable before, but I have a circle of companions. We even have a jokey motto: “life is change.” A feeding doesn’t pass without one of the group uttering it, eliciting knowing smiles, the occasional laugh. Our children and theirs share in our humor, but the joke lies in our generation’s history.
Our earliest memories of life are pregnant with change. From egg to adulthood, we pass through five stages of growth. Our first eight weeks consist only of feeding and molting. Back then, life was change. But for me and many of my kind, change consisted only of that, only of the molt and eventually that glorious passage into adulthood. After that, the days passed in a constant dance of mating and egg laying.
In those days, I experienced my day-to-day transformations alone. They were, after all, personal. There were plenty of opportunities for mating, of course. But these were always the product of random encounters—a sudden awareness of another, anticipation and that sharp pain I’d come to enjoy as males would probe and then pierce my abdomen. But these mating partners and all who shared my harborage were strangers. I took pleasure in the routine transformations that my body would undergo: the wound management, the egg laying. But no sense of togetherness was required to ensure that life’s “changes” could proceed unchanging. Life was change and we all experienced it alone.
I was particularly privileged. I had never left the nest I hatched into. I never had to. Back then, the conditions of my life were blissfully constant. My feedings so routine I took them for granted. My life played out in the sheltered confines of a third floor wing in what I would later come to know as 664 West 46th Street. Continue reading →
“… many people have never experienced true darkness,”a report reads. The discussion is mainly about light pollution, and the body-burdens associated with 24 hour light exposure, which are on the rise:
It’s estimated that the amount of light in the night sky globally is increasing by around 6 per cent a year, but that statistic can be deceptive, according to Paul Bogard from James Madison University [author of The End of Night].
There is hope, however, from the marketplace:
The Amsterdam-based company Tvilight is one of those firms leading the way in the practical roll-out of smart lighting technology. Tvilight manufactures street-based lighting systems that automatically respond to traffic and pedestrians. The idea is to create urban lighting systems that limit light pollution in suburban areas, with lights dimming or illuminating depending on the level of human and vehicular traffic detected.
I get the feeling, however, that access to darkness is going to become another equality issue: the wealthy in wealthy areas will get access to the diminishing resource of darkness based on their access to other resources (which, quite ironically, may have been earned through the bright lights of some other company) while the less than wealthy suffer light pollution. The capitalist logic is breath-taking: Sell them light and then sell them darkness! (this would work as a case lesson for students about resources and access to those resources, especially something as “given” as access to darkness … no doubt, college students have low access to darkness many campus locations)
Worth seeing: The Ship Breakers. Ships, at the ends of their lives, are rammed into the beach, thusly beaching these “end of life” ships onto the shores of ship-breaking yards of Bangladesh, India, and a few other states. The work is dangerous and the environmental consequences are visually obvious. There are other examples here, here, and especially this piece in the Atlantichere.
Water, water, everywhere, but not a drop to drink …
Earlier this week, Jacob raised the provocative notion that “terrorism expert” was something of an oxymoron drawing attention to how supposed terrorism expert Steve Emerson made some irresponsible public remarks about the concentration of Muslim persons in a number of cities.
But Jacob also shed some light on how the very notion of terrorism does not lend itself to a clean/clear subject to be an expert in because terrorism, on the one hand, has a political dimension that can never really be excised to form a “pure” science (cough) and, on the other hand, terrorism is often in the eye of the beholder (or as Jacob said somewhere, one man’s terrorist is another man’s freedom fighter). It all reminded me of some readings in my Social Problems class about terrorism – during class discussion a student (perhaps unknowingly) raised a really important question: “Hey, Dr. Rowland, does it matter that the author of this piece is not at a University and instead works for the government military complex?” (not a perfect question, obviously, but it lead to a great discussion, and, at times, a heated one). Returning to the crisis of expertise in terrorism: my hunch was that some serious traction might be gained by thinking about how persons in this line of work get said expertise during training – given that, as Jacob noted, certificates in this line of work are a dime a dozen – or what sorts of activities a person can be involved in – journalistic work with terrorists inside prisons, for example – that justify their expert status. On Monday, we were questioning the very possibility of an expert of terror(ism); the supposed experts, whom get a good deal of public and political attention, seem not to be experts in the scientific context that the term typically is used (thus, science is used in name only).
So what makes Jacob’s experts – who reach ecstasy on a daily news show – legitimate experts and Stef’s experts – who cringe at the thought of a daily news show – illegitimate experts?
If Lyotard was right about one thing in “The Postmodern Condition” it was his commentary about scientific expertise, especially about how “old fashioned” scientific expertise was being gradually replaced a parallel somewhat pseudo-scientific enterprise that serviced capital interests (think business scholarship and that ilk) and the state (Jacob’s terrorism experts will do). The net result was a plurality of experts, but what Lyotard did not tease out (he was too busy indicating that this was undermining the grand narrative that Science worked so hard to erect over passing centuries) was that this gradual shift toward a plurality of expertises allowed for a whole new game to be played in public arenas: You could have your cake and eat it too, so to say, you could have your (essentially unquestioned) experts while simultaneously challenging the expert-status of some other expert on the grounds that they claim to be an expert. There is a split; a fissure. This crisis of science, as Jacob pointed out in a comment to Stef’s post anticipates my response: Mertonian norms have failed us under precisely the postmodern conditions we live in!
What do I mean by “water, water, everywhere, but not a drop to drink” as it applies to experts? My meaning is simple: The split in expertise means that experts are somehow all around us all the time, but none is to be trusted outright, unless of course there are other non-scientific reasons for doing so.
Consider the anti-vaccination controversy (or movement, though I shudder to call it a movement). Now, it is worth noting that this is nothing new – anti-vaxers have been around for nearly a century (as long as we’ve had vaccinations to be against, folks have been against them). While there is a lot of attention directed at the US these days – because of the thought link between vaccinations and autism (where “evidence doesn’t dispel doubts”) and the recent outbreak of measles at Disneyland – there have been similar international examples in recent history in Sweden, the Netherlands, England, Ireland, and so on. What is it that makes Jenny McCarthy expert enough for a documentary film about “The Vaccine War”?
My sense is that it is precisely the fissure between expertise in the name of science and other expertises in the employ of capital or politics that opens-up seemingly legitimate space to reroute a general sense of skepticism and then target it so that, on the one hand, we can make the calm, sober, and public claim that a climate scientist is biased on account of being an expert (i.e., those scientists can cook-up any data they want, or that they are in a staunch debate that will never be resolved showing that, in fact, they don’t “know” anything definitively anymore), and, on the other hand, we also make the calm, sober, and public claim that a terrorism expert is unbiased because all s/he wants it to protect the nation and “our way of life” (i.e., the terrorism expert is unbiased on principle account of being obviously biased toward his/her home country, a bias “I can get behind”). This compartmentalization of expetises in relation to how bias operates in public appears to be at play; a bold corruption of Mertonian norms.
The twin issues of policy battle and the introduction of national health insurance are further complicated by infrastructural concerns. They are two fold:
1. The race by tech companies and the government to use information technology infrastructure to support one of the bill’s primary objectives: offering citizens a platform for researching, selecting, and then purchasing health care insurance programs. The goal is to reduce cost and make program costs competitive, all of which will hypothetically benefit the citizen. However, support — in this case, the support of information technology infrastructure, not political support — has been slow to come into existence.
The Affordable Care Act has been contentious, confusing and abstract, but that might change on October 1 when states are required to launch websites where people can chose among different health plans.
2. The prototype for the online support of the health exchange network mentioned in 1 is not friendly to non-English speakers. Apparently, the government is so worried about rolling-out the website on-time that they have not been able to offer the service in Spanish.
On Thursday, the Obama administration announced two new delays in the implementation of the Affordable Care Act, saying small business and Spanish-language online enrollment services in federally run exchanges would not begin on Oct. 1 as planned, Reuters reports (Morgan, Reuters, 9/26).
Today, an op-ed from President Obama is running in major Spanish-language newspapers across the country. The op-ed discusses the benefits of the Affordable Care Act for Latinos and announces the release of a new Spanish-language version of HealthCare.gov – www.CuidadoDeSalud.gov.
The op-ed is running in ImpreMedia’s print publications (including La Opinión in Los Angeles and El Diario La Prensa in New York) and online properties, all of which have a monthly reach of 9.3 million adults and monthly distribution of nearly 11 million.
Obama’s op-ed is, in contrast, available en español.
These two issues remind students of infrastructure that Law and Latour were correct all those years ago in saying that technology is “politics by other means,” although in a slightly different light. Routinely, the implementation of political aims is contingent on technological infrastructure, its development, and maintenance over time.
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