Casper Bruun Jensen

Editorial Introduction: Unpacking ‘Intervention’ in Science and Technology Studies

In science and technology studies (STS) as elsewhere, continuous appeals are appearing, urging research to ‘get real’ (Bal et al., 2004) by which is meant to demonstrate usefulness, not just academically, but also in ‘practical’ environments such as policy and business.

Sociology, systems and (patient) safety: knowledge translations in healthcare policy

In 2000 the American Institute of Medicine, adviser to the federal government on policy matters relating to the health of the public, published the report To Err is Human: Building a Safer Health System, which was to become a call to arms for improving patient safety across the Western world. By re-conceiving healthcare as a system, it was argued that it was possible to transform the current culture of blame, which made individuals take defensive precautions against being assigned responsibility for error - notably by not reporting adverse events, into a culture of safety. The IOM report draws on several prominent social scientists in accomplishing this re-conceptualisation. But the analyses of these authors are not immediately relevant for health policy. It requires knowledge translation to make them so. This paper analyses the process of translation. The discussion is especially pertinent due to a certain looping effect between social science research and policy concerns. The case here presented is thus doubly illustrative: exemplifying first how social science is translated into health policy and secondly how the transformation required for this to function is taken as an analytical improvement that can in turn be redeployed in social research.

Sorting Attachments: Usefulness of STS in Healthcare Practice and Policy

Calls for normative and action-oriented research have been on the increase in recent years, but arguments for the benefits of ‘normative’ vis-à-vis ‘purely descriptive’ or ‘theoretical’ research have a longer history. Indeed, the latter ‘kinds’ of research, particularly of constructivist bent, have been persistently accused of being both practically useless and politically conservative as compared with approaches more active in identifying their stances and affiliations (Winner, 1993; Radder, 1998). Constructivists, in turn, have refused the terms of this argument, since, from their vantage point, no clear-cut dichotomy between the ‘normative’ and ‘descriptive’ or the ‘practical’ and ‘theoretical’ appears (Berg, 1998; Jensen, 2004). Instead all actors are seen as engaged in ‘performing’ the world in specific situated ways: just as a doctor performs a version of the patient and his/her disease and a health policy maker enacts a version of the healthcare system, so the researcher performs specific versions of the phenomena that are being researched. Such a view transforms the playing field on which ‘useful interventions’ take place, since it emphasizes that normativity is not an attribute of specific theories or methods but instead something which emerges in the course of doing research, through engagement with other actors. A performative disposition has serious implications for the ways in which one might answer questions relating to intervention and normativity in social science, such as: How does one assess, evaluate or intervene in studied practices? Why would one want Science as Culture Vol. 16, No. 3, 237–251, September 2007

An Experiment in Performative History: Electronic Patient Records as a Future-Generating Device

The aim of this paper is to describe parts of the history and development in Denmark of the interdisciplinary field of study known as medical informatics, which has been crucially involved in the current high-profile development of a national Danish electronic care record. This turn of events has enabled an increasing naturalization of the history of the discipline, but in this paper I suggest that this understanding is highly selective and limiting for coming to terms with the heterogeneity and contingency of events, which lead to the current situation. Both science and technology studies (STS) and deconstruction have tried to take such a contingency into account in their historiographic efforts. My experiment is to ‘diffract’ STS (as instanced here by cyborg history) and deconstruction through each other, in order to try to answer the following question: how does one tell the history of medical informatics in a subtle way, which does not lean upon a teleological belief in the development of better technologies and the concurrent need of medical informatics to put such developments to their proper use? The challenge is to tell it instead as formed by a multiplicity of actors, none of whom have been fully in control of themselves or other participants. In other words, it is to write an experimental history of medical informatics, which is not burdened with the idea that the electronic care record necessarily will be the crown jewel of the discipline and that this future was inherent in the discipline’s development from the outset.

Infrastructural Fractals: Revisiting the Micro—Macro Distinction in Social Theory

The relationship between the supposedly small—the micro—and the supposedly large—the macro—has been a long-standing concern in social theory. However, although many attempts have been made to link these two seemingly disjoint dimensions, in the present paper I argue against such an endeavour. Instead, I outline a fractal approach to the study of space, society, and infrastructure. A fractal orientation requires a number of related conceptual reorientations. It has implications for thinking about scale and perspective, and (sociotechnical) relations, and for considering the role of the social theorist in analyzing such relations. I find empirical illustration in the case of the development of electronic patient records in Danish health care. The role of the social theorist is explored through a comparison of the political and normative stance enabled, respectively, by a critical social theory and a fractal social theory.

Power, Technology and Social Studies of Health Care: An Infrastructural Inversion

Power, dominance, and hierarchy are prevalent analytical terms in social studies of health care. Power is often seen as residing in medical structures, institutions, discourses, or ideologies. While studies of medical power often draw on Michel Foucault, this understanding is quite different from his proposal to study in detail the “strategies, the networks, the mechanisms, all those techniques by which a decision is accepted” [Foucault, M. (1988). In Politics, philosophy, culture: Interviews and other writings 1977–84 (pp. 96–109). New York: Routledge]. This suggestion turns power into a topic worth investigating in its own right rather than a basic analytical resource. It also suggests that technologies form an integral part of the networks and mechanisms, which produce and redistribute power in medical practice. The paper first engages critically with a number of recent discussions of technology and power in health care analysis. It then formulates an alternative conception of this relationship by drawing on Foucault and historian of science and technology Geoffrey C. Bowker’s notions of infrastructural inversion and information mythology. Illustration is provided through a case study of a wireless nursing call system in a Canadian hospital.

Review: Beyond the Two Cultures with Scandalous Knowledge: Relativism and Constructivism Revisited

Barbara Herrnstein Smith has had a remarkable and prolific career. Originally trained in psychology, she moved into literature, wrote on poetic closure (1968) and edited a volume of Shakespeare’s sonnets. She went on to analyse the relation between literature and language in On the Margins of Discourse (1978) and to examine aesthetic and moral theory in Contingencies of Value: Alternative Perspectives for Critical Theory (1988), a work cited repeatedly in Andrew Pickering’s The Mangle of Practice (1995). Subsequently she edited a volume on The Politics of Liberal Education (1992) with Darryl J. Gless and one on Mathematics, Science and Postclassical Theory (1992) with Arkady Plotnitsky. The former was an intervention in the so-called culture wars, which, as we know in STS, were followed by (and related to) the science wars. In 1997, Smith provided what is still the subtlest diagnosis of the dynamics of these intellectual–political–practical engagements (and nonengagements) in Belief and Resistance: Dynamics of Contemporary Intellectual Controversy. In this book she engaged the field of STS for the first time, analyzing, among other things, principles of symmetry (Bloor) and generalized symmetry (Callon and Latour), and clarifying several of the confusions and misrepresentations these have given rise to in the hands of science warriors. The trajectory shows a continual broadening of interests and a voracious intellectual appetite by an author who is distinctly not worried about crossing traditional disciplinary boundaries. Luckily for the field of STS, that curiosity has increasingly brought Smith into contact with our domain,