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Evidence, Ethos and Experiment

Evidence, Ethos and Experiment: The Anthropology and History of Medical Research in Africa

P. Wenzel Geissler
Catherine Molyneux
Copyright Date: 2011
Edition: 1
Published by: Berghahn Books
Pages: 452
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  • Book Info
    Evidence, Ethos and Experiment
    Book Description:

    Medical research has been central to biomedicine in Africa for over a century, and Africa, along with other tropical areas, has been crucial to the development of medical science. At present, study populations in Africa participate in an increasing number of medical research projects and clinical trials, run by both public institutions and private companies. Global debates about the politics and ethics of this research are growing and local concerns are prompting calls for social studies of the "trial communities" produced by this scientific work. Drawing on rich, ethnographic andhistoriographic­­­material, this volume represents the emergent field of anthropological inquiry that links Africanist ethnography to recent concerns with science, the state, and the culture of late capitalism in Africa.

    eISBN: 978-0-85745-093-7
    Subjects: Sociology, Anthropology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vii)
  3. List of Figures
    (pp. viii-x)
  4. Introduction Studying Trial Communities: Anthropological and Historical Inquiries into Ethos, Politics and Economy of Medical Research in Africa
    (pp. 1-28)
    P. Wenzel Geissler

    This book is about medical research carried out in Africa, by African institutions and their collaborators from Europe and the USA. It is thus about what used to be called ‘overseas’ medical research, a term which – unlike more recent terms such as ‘transnational’ or ‘collaborative’ – recalls its imperial origins as well as the assymetrical topography of power and resources it still involves. Overseas research is shaped by its geographical and political-economic frames, as well as by colonial history and by the process of nation building, and decay, that marked the postcolonial era (or, as Ombongi, below, distinguishes, the...

  5. Engagements

    • Chapter 1 Writing Knowledge and Acknowledgement: Possibilities in Medical Research
      (pp. 29-56)
      Susan Reynolds Whyte

      One of the central themes in the scarce ethnographic literature on medical research in Africa is the transaction of substances. Blood is usually seen as the mediating material par excellence, weighted with significance for the researchers who remove and test it, and for the people from whose bodies it is extracted. But there is another substance that is more universal in medical research. In fact it is such an integral part of the activity of gathering data that it is hardly ever remarked upon. That substance is paper. Paper and the activities of registering and writing to which it is...

    • Chapter 2 Can One Rely on Knowledge?
      (pp. 57-76)
      Marilyn Strathern

      How communications proceed between practitioners and subjects and leaders in medical research is necessarily the focus of much attention. Bad communication is as great a hindrance as good communication satisfies all kinds of ethical and social imperatives. Thus the Nuffield Council on Bioethics report on research relating to healthcare in developing countries states (NCOB 2002: 74) that methods must be devised for making sure that information will reach all members of a community. One obvious approach is to offer information as a fresh view on things, for out of the presentation of viewpoints some kind of compromise can be struck....

    • Chapter 3 Being ‘with the Medical Research Council’: Infant Care and the Social Meanings of Cohort Membership in Gambia’s Plural Therapeutic Landscapes
      (pp. 77-98)
      Melissa Leach and James Fairhead

      Contemporary discussions of medical research frequently frame it as something distinct from ‘normal’ healthcare practice. Its infrastructural and financial trappings, involving research stations, laboratories, international staff, vehicles and funding flows set apart from and contrasting with surrounding, impoverished African people-scapes, seem to reinforce the logic of such radical distinction. So, too, do many of the institutional rules and practices that surround medical research, with its bioethical codes and study-by-study protocols, information and consent procedures for participation. Yet in settings where medical research institutions are long-established, such radical distinctions may no longer hold, especially in the perspectives and experiences of the...

    • Chapter 4 Contextualizing Ethics: Or, the Morality of Knowledge Production in Ethnographic Fieldwork on ‘the Unspeakable’
      (pp. 99-124)
      Hansjörg Dilger

      Why are anthropologists doing fieldwork on HIV/AIDS in Africa? Why are they engaging in long-term research and academic debates when people are dying?

      In this chapter, I discuss some of the multiple challenges surrounding anthropological fieldwork on HIV/AIDS in eastern Africa with regard to its ethical and methodological implications. I argue that at a time when the boundaries between applied and basic anthropology have become less rigid,¹ questions about the ethicality of ethnographic fieldwork on HIV/AIDS-related issues should focus less onwhysuch research is being done and more on how it can be carried out in ethically, and therefore...

    • Chapter 5 Testing a New Drug for Leprosy: Clofazimine and Its Precursors in Ireland and Nigeria, 1944–1966
      (pp. 125-144)
      John Manton

      In the increasingly laboratory-centred context of mid-twentieth century pharmaceutical research, the persistent difficulties in subjecting leprosy to laboratory investigation presented a paradox, thrusting conceptions of the field, field ethos and field research conditions centre-stage in assessing the efficacy of chemotherapy in leprosy. Until 1948, with the ratification of Dapsone at the International Leprosy Congress in Havana, there was no universally recognized effective drug therapy for leprosy, and continued problems in supervising the administration of Dapsone in the following years ran alongside an increasingly active search for alternative drugs. One group of compounds with evident potential for the treatment of leprosy...

    • Chapter 6 Elucidating Ethics in Practice: Focus on Accountability
      (pp. 145-170)
      George Ulrich

      The theme of accountability has not been well illuminated in the current debate about medical research ethics.² The predominant tendency has been to focus on the definition and enforcement of a relatively narrow range of rigidly defined standards, usually through coercive means. Ethical standards thus come to assume a quasi-legal character and the notion of accountability is implicitly modelled on a juridical paradigm. A related salient tendency is to assimilate ethical review and accountability procedures to models derived from the financial sphere, which, too, imply an external enforcement of compliance with established standards. This is often perceived negatively by practitioners....

  6. Evidence

    • Chapter 7 When Physicians Meet: Local Medical Knowledge and Global Public Goods
      (pp. 171-196)
      Steven Feierman

      In the US, as in Britain, as in the whole of the industrial world, medical researchers work to develop scientific evidence that can be applied systematically to clinical practice.¹ When must a patient be given a specific antibiotic, and for how long? What is the relative efficacy of different antibiotics for each particular disease-causing organism? Which of many potential screening tests is preferred? How long should the course of treatment continue, and at what dosage? How can the course of treatment be structured so as to decrease the probability that resistant bacteria will emerge? A body of careful research-based knowledge...

    • Chapter 8 The Plausibility Design, Quasi-experiments, and Real-world Research: A Case Study of Antimalarial Combination Treatment in Tanzania
      (pp. 197-228)
      S. Patrick Kachur

      Since the late 1980s, the concept of evidence-based medicine has increasingly shaped clinical practice and health policy – initially in northern countries (Sackett et al. 1996) – but eventually expanding globally along with related political and economic forces and the agendas that drive them. The evidence-based medicine movement was appealing to policy makers in the context of broader neoliberal reforms in the public health sector and beyond (Berguer 2004). Principles of evidence-based medicine were rapidly generalised from academic biomedical research settings to clinical practice with individual patients and onto more general recommendations for whole populations (Eriksson 2000; Macintyre et al....

    • Chapter 9 Remember Bambali: Evidence, Ethics and the Co-production of Truth
      (pp. 229-244)
      Ann Kelly

      ‘And remember this village was the most difficult to recruit’, Sheriff says with a grin. Arriving in Bambali, children surround the Medical Research Council (MRC) Landrover, making it almost impossible to open the doors. ‘Dr Vasee thought we would have to pull out entirely – and Bambali’s a big village. We would have had to take on at least two or three more villages to the west to get the numbers needed.’ Sheriff Jobe was the senior field worker on the Malaria Vaccine Trial (MVT) and cohort studies conducted from 2002 to 2005.² The MVT was the most intensive investigation...

    • Chapter 10 Foetuses, Facts and Frictions: Insights from Ultrasound Research in Tanzania
      (pp. 245-262)
      Babette Müller-Rockstroh

      Dating from 25 January 2004, the letter by the National Institute for Medical Research in Dar es Salaam provides ethical clearance for my study on ‘Ultrasound in Tanzania’ with the following words: ‘Here-with you are permitted to conduct the above named study. We expect sound insights into a good technology that has not been researched in our country. We are looking forward to your reports biannually’.

      Since US President Harry Truman’s inaugural address announcing a ‘fair deal’ that initiated the beginning of a flow of goods from high-income to low-income countries, medical experts in offices in Geneva, in New York,...

    • Chapter 11 Healers and Scientists: The Epistemological Politics of Research about Medicinal Plants in Tanzania or ‘Moving Away from Traditional Medicine’
      (pp. 263-296)
      Stacey A. Langwick

      One June morning in 2006, Edmund Kayombo regaled me with the claims of people who travel at inhuman speeds without vehicles, of medicinal oils that prevent a person from being photographed, and of people rising up from the dead. After each anecdote he would say: ‘It can’t be proven, yet it happens’. The only social scientist among a team of medical doctors, chemists, botanists and ethnopharmacolgists at the Institute of Traditional Medicine (Taasisi ya Dawa za Asilia) in the Muhimbili University College of Health Sciences in Dar es Salaam, Tanzania, Dr Kayombo’s career rests on his ability to contribute to...

    • Chapter 12 Parasite Lost: Remembering Modern Times with Kenyan Government Medical Scientists
      (pp. 297-332)
      P. Wenzel Geissler

      Visiting Kisumu in western Kenya, I pass by the station of the Ministry of Health’s Division of Vector Borne Diseases (DVBD) where 15 years ago I conducted research on worm infections with a group of Kenyan and European scientists.¹ The offices and laboratories, situated adjacent to the District hospital in the centre of Kenya’s third largest city, were built between the 1930s and 1970s. In the early 1990s, we were still able to conduct simple scientific research on body parasites here, and the laboratory staff wer6e busy. In the early years of the twenty-first century, the place is quiet. The...

    • Chapter 13 Is the Sharia of the Doctors Killing the People? A Local Debate on Ethics and the Control of HIV/AIDS in a Rural Area in Kenya
      (pp. 333-352)
      Suzette Heald

      The implementation of HIV/AIDS testing and therapy programmes is rapidly turning Africa into an arena not only for medical research but for medical experimentation. The urgency of providing ART on a population-wide scale in countries such as Kenya inevitably raises questions about infrastructure in rural areas with few facilities to monitor patient tolerance and treatment. Further, practice slides into research as medical staff routinely collect and report data on their patients and, with drugs and funding in many cases coming from trial programmes sited elsewhere, ‘interesting’ cases are referred onwards to research centres. It is not the intention in this...

  7. Politics

    • Chapter 14 The Historical Interface between the State and Medical Science in Africa: Kenya’s Case
      (pp. 353-372)
      Kenneth S. Ombongi

      By the 1980s the abundant optimism that had accompanied the birth of modern African nations in the 1960s, and belied imperial pessimism about the viability of the African state, had waned. What had seemed as the African ‘golden age’ transited into institutional decay, policy failures and civil strife in many postcolonial states. The subsequent state weakness undermined the hegemonic colonial legacy which had earned the post-independence state the lexical label of ‘postcolonial’, which referred to the colonial origins and characteristics of the African state (Young 2004). Scholars have explained the diminished dominance of the African state by its incapacity to...

    • Chapter 15 The Intimate Rules of the French Coopération: Morality, Race and the Postcolonial Division of Scientific Work at the Pasteur Institute of Cameroon
      (pp. 373-402)
      Guillaume Lachenal

      This article aims to observe the ethics of medical research through the lens of historical ethnography. It focuses on the most important institution of biomedical research in Cameroon, the Pasteur Institute of Cameroon, created in Yaoundé in the late 1950s. The Pasteur Institutes of Dakar, Bangui, Abidjan, Brazzaville and Yaoundé have been the emblems of the French scientific presence in Africa. Between 1960 and 1990, French expatriates ran these prestigious laboratories and maintained close relations with the Pasteur Institute of Paris. The African Pasteur Institutes embodied and symbolised a certain idea of French grandeur, in line with the ambitions of...

    • Chapter 16 The Mosquito Taken at the Beerhall: Malaria Research and Control on Zambia’s Copperbelt
      (pp. 403-428)
      Lyn Schumaker

      This article describes a historical case of medical research and its application – the study of mosquitoes that made malaria control possible on colonial Zambia’s Copperbelt. Scholars have pointed to the ways that colonial doctors and sanitarians labelled Africans as ‘wild’ vectors or reservoirs of infection dangerous to ‘civilised’ European settlers. While not banishing racial divisions, the Copperbelt malaria control programme made an important step away from such medically justified segregationist visions, replacing them with new metaphors of health and risk, and new geographies of human/mosquito movement, consumption and reproduction. In addition to these European medical and industrial views, I...

    • Chapter 17 Trial Communities: HIV and Therapeutic Citizenship in West Africa
      (pp. 429-444)
      Vinh-Kim Nguyen

      Today, from many African vantage points it is possible to glean the contours of a truly postmodern future littered with failed states, humanitarian interzones and acephalous conflict. Nonetheless, among these ruins a troubled social order can be found camped around the gleaming engines of extraction that plug Africa’s oil and minerals into the global economy – and the growing humanitarian and NGO biomedical infrastructure that embraces Africa in a global moral economy (Ferguson 2006). Africa is still the global hub of modern medical humanitarianism, from Médecins Sans Frontières and the Biafran war to ‘Brand Aid’ for HIVToday(Richey and...

    • Chapter 18 Differences in Medicine, Differences in Ethics: Or, When is It Research and When is It Kidnapping or is That Even the Right Question?
      (pp. 445-462)
      Luise White

      In 1899 a smallpox epidemic broke out in Kampala, Uganda. The founders of the medical mission Church Missionary Society vaccinated two young men with all that was left of the vaccine they had brought from England. When the youths did not come back as instructed, the missionaries proceeded to protect the local population with all the violence of modern science and a reinscription of local methods of cure, particularly variolation against smallpox. One missionary saw a young boy in a market ‘with an obvious vaccination mark …. So she collared him and brought him into the dispensary and, with somewhat...

  8. Notes on Contributors
    (pp. 463-472)
  9. Index
    (pp. 473-498)