Ayo Wahlberg

The governmentalization of living: calculating global health

Abstract The contemporary global health agenda has shifted emphasis from mapping disease patterns to calculating disease burden in efforts to gauge ‘the state of world health’. In this paper, we account for this shift by showing how a novel epidemiological style of thought emerged in the closing decades of the twentieth century. As is well known, the compilation and tabulation of vital statistics – death-rates, birth-rates, morbidity rates – contributed to the birth of the ‘population’ in the eighteenth and nineteenth centuries. The population is reformatted from the middle of the twentieth century by ‘modified life tables’ made up of disability weightings, health state valuations, quality of life scores, disease burden estimates, etc. The problem of morbid death gives way to that of morbid living, made calculable through a metrics of ‘severity’, ‘disability’ and ‘impairment’. A series of new indices and scales (e.g. the QALY and DALY) has contributed to a governmentalization of living, in the course of which the social and personal consequences of living with disease come to be an object of political concern, and made knowable, calculable and thereby amenable to various strategies of intervention. We conclude by showing how this style of epidemiological thought has generated a new global visibility for brain disorders as their impact on individuals, health care systems and nations are calculated in novel ways.

An Elusive Evidence Base: The Construction and Governance of Randomized Controlled Trials

In 1987, just a year before his death, the British epidemiologist Archie Cochrane gave one of his last public interviews. Cochrane had led an illustrious career, helping to establish the fields of epidemiology and public health in Britain and internationally.

Pathways to Plausibility: When Herbs Become Pills

Herbal medicine has long been contrasted to modern medicine in terms of a holistic approach to healing, vitalistic theories of health and illness, and an emphasis on the bodys innate self-healing capacities. At the same time, since the early twentieth century, the cultivation, preparation and mass production of herbal medicines have become increasingly industrialized, scientificized and commercialized. What is more, phytochemical efforts to identify and isolate particular ‘active ingredients’ from whole-plant extracts have intensified, often in response to increasing regulatory scrutiny of the safety and quality of herbal medicinal products. In this article, I examine whether describing these developments in terms of a biomedical ‘colonization’ of herbal medicine, as has been common, allows us to sufficiently account for the mundane collaborative efforts of herbalists, botanists, phytochemists, pharmacologists, toxicologists and clinicians to standardize and develop certain herbal remedies. By focusing on recent efforts to industrialize and scientifically develop a ‘Western’ (St Johns Wort) and a Vietnamese (Heantos) herbal remedy, I suggest that herbal medicine has come to be not so much colonized as normalized, with herbalists, phytochemists and pharmacologists working to develop standardized production procedures, as well as to identify ‘plausible’ explanations for the efficacy of these remedies.

The government of life: managing populations, health and scarcity

Abstract The concepts of governmentality and biopolitics were contemporaneous and interlinked in Michel Foucaults initial analyses. These foregrounded how in the eighteenth century the population emerged as a ‘natural-cultural reality’ resulting from an integration of biological and economic knowledge. Subsequent research on biopolitics and governmentality has tended to separate the concepts, differentiating into distinct research traditions each with different intellectual pathways. We propose to bring these conceptual innovations together to understand contemporary problems of the government of life, that is, of managing, controlling and optimizing a living population. In this domain, the natural/biological continues to intersect with the social/cultural in novel and unexpected ways. Straddling the specter of biopolitics, we examine four dimensions of the concept: vital threats and the resurrection of death power, the interplay of sovereignty, discipline and security, governmentalization through medical normalization, and ‘securitization’ of life as circulations and open series. The article also introduces this special feature on the government of life in which significant scholars explores issues of population management by drawing upon, debating, and developing the conceptual heritage of Foucault.

Above and beyond superstition — western herbal medicine and the decriminalizing of placebo

Does it work? This question lies at the very heart of the kinds of controversies that have surrounded complementary and alternative medicines (such as herbal medicine) in recent decades. In this ar...

Online Peer-to-Peer Communities in the Daily Lives of People With Chronic Illness: A Qualitative Systematic Review

This qualitative systematic review investigated how individuals with chronic illness experience online peer-to-peer support and how their experiences influence daily life with illness. Selected studies were appraised by quality criteria focused upon research questions and study design, participant selection, methods of data collection, and methods of analysis. Four themes were identified: (a) illness-associated identity work, (b) social support and connectivity, (c) experiential knowledge sharing, and (d) collective voice and mobilization. Findings indicate that online peer-to-peer communities provide a supportive space for daily self-care related to chronic illness. Online communities provided a valued space to strengthen social ties and exchange knowledge that supported offline ties and patient–doctor relationships. Individuals used online communities to exchange experiential knowledge about everyday life with illness. This type of knowledge was perceived as extending far beyond medical care. Online communities were also used to mobilize and raise collective awareness about illness-specific concerns.

The Problem of Complementary and Alternative Medicine Use Today Eyes Half Closed

Commentators such as Goldacre, Dawkins, and Singh and Ernst are worried that the rise in complementary and alternative medicine (CAM) represents a flight from science propagated by enemies of reason. We outline what kind of problem CAM use is for these commentators, and find that users of CAM have been constituted as duped, ignorant, irrational, or immoral in explaining CAM use. However, this form of problematization can be described as a flight from social science. We explore CAM use in light of a rigorous and robust social scientific body of knowledge about how individuals engage with CAM. By pointing to the push and pull factors, CAM user’s experiences of their body, and the problem of patient choice in CAM use, we summarize some of the key findings made by social scientists and show how they trouble many of the reasoned assumptions about CAM use.

Bodies and populations: life optimization in Vietnam

Vietnam has been described by many commentators as being about two decades “behind” many of its East Asian neighbors in terms of economic and social development, although a series of economic reforms initiated in 1986 under a banner of (renovation) are credited with closing the gap. At the same time, as has been the case in many other socialist countries, science and technology in Vietnam have been seen as central forces for national development, progress and health. Although molecular biology and genetics (especially in agricultural but also medical fields) have come to play an important role in successive government-sponsored science and technology programs since the mid-1990s, Vietnam is not considered to be one of Asias “emerging biotech giants”. By analyzing national efforts to revive traditional medicine in Vietnam, I propose in this paper empirically to restore the concept of biopolitics as one of the poles of a biopower that continues to administer, optimize and multiply human vitality. I will show how a national effort to revive traditional medicine has been both biopolitical (when contributing to the improvement of “population health”) and a case of bionationalism (when contributing to the “building of national culture”).

The birth and routinization of IVF in China

How can it be that China, with its history of restrictive family planning policies, is today home to some of the world’s largest IVF clinics, carrying out as many as 30,000 cycles annually? This article addresses how IVF was developed in China during the early 1980s, becoming routinized at the same time as one of the world’s most comprehensive family planning programmes aimed at preventing birth was being rolled out. IVF was not merely imported into China; rather it was experimentally developed within China into a form suitable for its restrictive family planning regulations. As a result, IVF and other procedures of assisted reproductive technology have settled alongside contraception, sterilization and abortion as yet another technology of birth control.

Reproductive medicine and the concept of ‘quality’

Selection in reproductive medicine today relies on normative assessments of what ‘good life’ consists of. This paper explores the terms under which such assessments are made by focusing on three particular concepts of ‘quality’: quality of life, biological quality and population quality. It is suggested that the apparently conflicting hypes, hopes and fears that surround reproductive medicine can co-circulate because of the different forms of normative assessment that these concepts allow. To ensure clarity in bioethical deliberations about selection, it is necessary to highlight how these differing forms of assessment are mobilized and invoked in practices of and debates about reproductive medicine.