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Biomedical Ambiguity

Biomedical Ambiguity: Race, Asthma, and the Contested Meaning of Genetic Research in the Caribbean

Ian Whitmarsh
Copyright Date: 2008
Edition: 1
Published by: Cornell University Press
Pages: 240
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  • Book Info
    Biomedical Ambiguity
    Book Description:

    Steadily increasing numbers of Americans have been diagnosed with asthma in recent years, attracting the attention of biomedical researchers, including those searching for a genetic link to the disease. The high rate of asthma among African American children has made race significant to this search for genetic predisposition. One of the primary sites for this research today is Barbados. The Caribbean nation is considered optimal because of its predominantly black population. At the same time, the government of Barbados has promoted the country for such research in an attempt to take part in the biomedical future.

    In Biomedical Ambiguity, Ian Whitmarsh describes how he followed a team of genetic researchers to Barbados, where he did fieldwork among not only the researchers but also government officials, medical professionals, and the families being tested. Whitmarsh reveals how state officials and medical professionals make the international biomedical research part of state care, bundling together categories of disease populations, biological race, and asthma. He points to state and industry perceptions of mothers as medical caretakers in genetic research that proves to be inextricable from contested practices around nation, race, and family.

    The reader's attention is drawn to the ambiguity in these practices, as researchers turn the plurality of ethnic identities and illness meanings into a science of asthma and race at the same time that medical practitioners and families make the opaque science significant to patient experience. Whitmarsh shows that the contradictions introduced by this "misunderstanding" paradoxically enable the research to move forward.

    eISBN: 978-0-8014-5993-1
    Subjects: Anthropology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Acknowledgments
    (pp. vii-x)
  4. Introduction: Vernaculars in Race and Disease Science
    (pp. 1-14)

    The current search for a genetic basis for common illnesses—for example, diabetes, asthma, cancers, depression—is a focus on hereditary susceptibilities. The concept of “biological predispositions” competes with, and draws on, other ways of explaining disease, some more closely related (e.g., characteristics of the blood, “family history,” fate) than others (e.g., melancholia, pollution, nutrition, sin). This mix of old and new nosologies is becoming increasingly visible today, as medical geneticists employ racial categories—for example, African American, Hispanic, Caucasian—to make biological links between particular populations and diseases. The terms for these racial categories carry multiple meanings, as do...

  5. Chapter 1 Contestations of Race
    (pp. 15-32)

    Race is a thorny topic in American biomedicine today. As Morris Foster and Richard Sharp (2002) have argued, the Human Genome Project created interest in new applications of the relationship between genetic predispositions and race. A growing body of research attempts to link racial disparities in the prevalence and severity of diseases—for example, cancer, heart disease, asthma—with genetic propensities. The genetic basis for response to medication—including genes involved in drug-metabolizing enzymes and chemotherapeutics—has been similarly differentiated by racial categories. The Food and Drug Administration (FDA) has recently approved a heart medication, BiDil, that is the first...

  6. Chapter 2 The Nation as Biomedical Site
    (pp. 33-55)

    Barbados is a center of international genetics-of-disease research. The various studies have been conducted by academic and industry research teams based in the United Kingdom and United States, including, in particular, teams from Johns Hopkins University and State University of New York (SUNY) Stony Brook. The current research includes searching for genetic propensity for cancers, asthma, acute lung injury, obstructive sleep apnea, asthma severity, and dengue fever (two studies, one American, one British). Previous genetic research in Barbados examined glaucoma. All of this research is premised on race. Biomedical research categorizes Caribbean populations as Afro-Caribbean, biologically equivalent to African American,...

  7. Chapter 3 Asthma Variations
    (pp. 56-68)

    Asthma in Barbados has only recently taken shape as a diagnostic category through the focused attention of the pharmaceutical industry, biomedical research, and the state. This (re)categorization has drawn on the multiple techniques and deep disagreements that have characterized American and British medical meanings of “asthma.” Before turning to the ways Barbados reflects and enhances this contestation, I here pause to explore this history of variation.

    At the end of the seventeenth century, asthma took shape as particular to a group, the asthmatics, as opposed to a generalized condition, in the work of Sir John Floyer (1698).¹ To Floyer, blood...

  8. Chapter 4 (Re)Categorizing Asthma and the Rational Pharmaceutical
    (pp. 69-97)

    Barbados has one of the highest levels of asthma of any country in the world, at 18–20 percent of the population, a number thought to be increasing sharply.¹ The following is a story about what these numbers mean. Asthma diagnosis, treatment, and prevalence estimates all vary widely as different criteria—some traditional, some more recent as a result of pharmaceutical and biomedical outreach—are employed in an expanding diagnostic approach to the condition. Biomedical and pharmaceutical practices discussed in the previous chapter are used in unexpected ways, creating new medical categories and techniques.

    According to a Barbadian researcher at...

  9. Chapter 5 Biomedical Partnerships: Making Genetics Significant
    (pp. 98-117)

    The asthma genetics study is now one of several genetics projects in preparation or being conducted in Barbados by teams from Johns Hopkins University. The genetics of acute lung injury is being researched by a multisited U.S. collaborative effort that now involves a Barbadian researcher. A project on the genetics of obstructive sleep apnea is being conducted by a Johns Hopkins researcher and Barbadian doctors involved in the genetics-of-asthma study. Research on the genetics of dengue fever and on the genetics of asthma severity are extensions of the asthma study, involving several of the same facilitators. These studies involve exchanges...

  10. Chapter 6 Misgivings in Medical Participation
    (pp. 118-144)

    Participation in the asthma genetics study involves allowing the genetics team or facilitators into the home to draw blood from all family members, collect dust samples, and conduct questionnaires, allergen skin prick tests, and a spirometry test. Because the study is longitudinal and extends into other areas (e.g., asthma severity), this process is repeated over the course of years. The families that comprise the participant population in the study thereby accept a host of technologies and medical practices into their domestic space. In the next few chapters, I explore why, and what participation generates for the families.

    What brings the...

  11. Chapter 7 Participant Mothers
    (pp. 145-156)

    Women are effectively the focal point for the genetics study: when children have an attack, the mother is usually the family member who takes them to the Accident and Emergency Department at the hospital for care, where recruitment into the study occurs. During subsequent enrollment, these women are also the primary source of getting extended family involved. In addition, during data collection, mothers are the ones who gather the family together for the home visits. I explore here how this gendered participation is significant for the mothers involved.

    Bajan participant families I talked with spoke often about fear as a...

  12. Chapter 8 Home Visit Translations
    (pp. 157-182)

    The following is a home visit experience reproduced from my field notes:

    We walk up to a house made of wood and concrete, resting on cement blocks, with sheets draped over the windows as window shades. As we enter the home, a woman in her mid-thirties greets us kindly but with watchful eyes—“Good morning,” she says. There are four of us: two Barbadian nurses who facilitate the genetics study, a student employee from Johns Hopkins University, and myself. As we enter, there are two mothers sitting at a table, and three children stop their playing to watch us. One...

  13. Chapter 9 Biomedical and Anthropological Excesses
    (pp. 183-190)

    In the extensive conversations I had with families about dust, the category had a particularly vague valence. Early in my fieldwork, I continually tried to reduce this ambiguity by asking people to tell me the one or several components that make up this dust. I failed, and only belatedly came to realize that this vagueness was integral to the concept. Asthma specialists and researchers in Barbados offered several competing definitions: the sands and allergens brought from the Sahara by the winds; the exhaust from the increased automobile use; the airborne debris produced by roadwork; finally, there was brief mention made...

  14. Notes
    (pp. 191-204)
  15. References
    (pp. 205-220)
  16. Index
    (pp. 221-226)