Stuart Blume

Histories of cochlear implantation

The cochlear implant, an electronic device by means of which some totally deaf people can be provided with a form of hearing, has been increasingly used since the early 1980s. The mass media have typically presented it as an example of the remarkable success of modern technological medicine. In France and The Netherlands, the countries on which this paper focuses, as in many others, deaf communities have rejected the technology. They have protested at its use with deaf children in particular. Rather than locating it in a history of medical progress, they have located it within a history of their own oppression. Each historical rendering is used to try to influence policy. The contest, however, is an unequal one.

Land of Hope and Glory: Exploring Cochlear Implantation in the Netherlands:

This article deals with the author’s experiences in studying cochlear implantation over a period of some years. While no overt controversy surrounded the device or the practices associated with it in the Netherlands when this work started (as was the case elsewhere), studying its introduction became complex. Following others, the research strategy that was evolved might be termed one of mediation and intervention. It entailed treating the views and aspirations of research subjects, clinical and lay, with equal regard. It entailed promotion of dialogue. For reasons that are discussed in the article, the attempt was made to translate this dialogue to the political level. The challenge confronting the author was simultaneously methodological and political.

VACCINOLOGY: An Industrial Science?

j A ‘NEW PRODUCTION OF KNOWLEDGE’? In the last few years numerous authors have claimed that changes are occurring in the relations between science and its application. Such changes have been sought, and found, in various ways and in various places. For example, the relations between patent and scienti® c literatures have changed (Narin et al., 1997). So too have those between universities and industry (Leydesdorff and Etzkowitz, 1998). The implications of market orientation for universities, and the threat that this may or may not pose to their traditions and values, have been discussed for decades. Rather newer is the claim that the traditional disciplines of science may be declining in signi® cance. The authors of The New Production of Knowledge argue that, alongside traditional discipline-based forms of knowledge production (`Mode 1’), a quite different `socially distributed’ alternative (`Mode 2’) is emerging (Gibbons et al., 1994). Mode 2 knowledge production is no longer limited to traditional laboratories; it takes place in various types of organizations, exibly linked by modern communications media. It is oriented to solving practical problems, and was created by the adaptive behaviour of the more entrepreneurial `old style’ scientists seeking to integrate their own research agendas with those of other organizations. According to this analysis, Mode 2 science weakens traditional modes of quality control. Good research is no longer de® ned by established disciplinary standards and disciplinary elites, but rather is guided by practical and social concerns. Though they may or may not continue to identify themselves in disciplinary terms, scientists no longer make their careers as `physicists’ or `physiologists’ . Instead,

Early Warning in the Light of Theories of Technological Change

Current interest in early warning can be understood as a natural response to the regularity with which health service planners have been overwhelmed by new technology. Planning the rational introduction of a new technology should be facilitated by advance warning of its imminent arrival on the market. Current approaches to early warning tend to rely on the insights and expectations of scientific and clinical experts in the field in question. In this paper it is argued that such an approach fails to recognize important changes that have occurred both in the innovation process itself, and in theoretical understanding of it. With the more complex roles that governments now play, and with the increasingly articulate demands of consumers, the innovation process has become more complex. At the same time, it is now clear that the innovation process embodies a multitude of choices. Approaches to early warning must be compatible with these new perspectives.

Vaccine Innovation and Adoption: Polio Vaccines in the UK, the Netherlands and West Germany, 1955–1965

“An effective AIDS vaccine could be found as early as 2012, saving 6 million lives if the world is willing to put £10 bn a year into a new programme, the chancellor, Gordon Brown, said in a speech last night in Tanzania”. Faith in biomedical science; the conviction that new vaccines will be translated into lives saved; belief in the necessity of globally concerted action: the British ministers statement reflects views of vaccine innovation that are widely held today. New and improved vaccines seem our best hope of coping with the scourge of AIDS, of arming ourselves against the unknown threats of emergent diseases and potential bioterrorism, and of tackling the resurgence of old diseases arising once more in Europe. Global coordination, pooling our resources, seems self-evidently necessary, given the international nature of a modern epidemic. Much current discussion of vaccine development and use thus has a global character. That is to say, it is conducted under the banner of global slogans or it seeks to establish globally integrated approaches to vaccine research and development (R&D). Over the past two decades the development and rapid introduction of new vaccines have come to dominate the vaccine agenda worldwide. Social scientists and health policy analysts have been set to work, examining barriers to the implementation of international priorities at the national level. Why, for example, are national responses to the availability of new vaccines often so lethargic? A recent study of the adoption of Hemophilus influenza b (Hib) conjugate vaccine is a good example. It shows policy makers in four countries rationally weighing the burden to public health of the diseases against which the vaccine offers protection (bacterial meningitis and pneumonia), against the high cost of the vaccine. Health policy analysts tend to explain the decision to introduce a new vaccine, or to replace an existing vaccine by a new alternative, in terms of the epidemiology and seriousness of the disease, and of scientific consensus regarding the efficacy and potential risks of the vaccine and (perhaps) their costs. The studies of vaccine diffusion and adoption that they conduct have little or nothing to say about political disagreements, or the influence of commercial interests, national traditions, international relations, or global agendas. Where any attention is paid to vaccine history, it is generally in the attempt to illustrate factors (such as resistance to vaccination) that might cause deviations from the rational deployment of vaccines.

Technology, Science, and Obstetric Practice: The Origins and Transformation of Cephalopelvimetry

The process of technological change in obstetrics must be understood as contingent on the exigencies of the professional project, rather than in terms simply of improvement or dehumanization of care. Transformation in the procedures by which the female pelvis and the fetal head have been measured illustrate this point. The development of new measurement techniques was profoundly influenced by the shifting locus of obstetric care and by changing professional concerns, including the initial demarcation of a professional practice and subsequent debates about preferred modes of intervention.

The Theoretical Significance of Co-operative Research

For those sociologists of science who admit some possible demarcation of science from non-science, and who seek some kind of “ordering principles” in the dynamics of science, the question of how we are to understand the influence of “external factors”, or society, on science is a central one. Methodologically, historical studies have provided considerable insight as well as a means by which the various theoretical positions have been exemplified. Theoretically, a number of recent formulations have achieved considerable influence and have stimulated considerable debate. These include the “finalization thesis” (Bohme et al. 1973), and the “strong programme in the sociology of knowledge” developed in Edinburgh. According to the first view, the openness of science to external influence, to external goal setting, is to be seen as a function of the theoretical maturity of the field in question. For the authors of the second view, which albeit in attenuated form has had a certain fascination for many “contextualist historians”, knowledge is always “constructed out of available cultural resources in ways which are specific to particular times and situations”, inspired by interests, and to be understood in terms of its “role in activity” (Barnes 1977). The knowledge constituted around these interests is what people then agree to call science.

In search of experiential knowledge

In recent years, the concept of “experiential knowledge” has increasingly been used to characterize the distinctive contribution patients make to decision-making in the health field. Even though it seems well-nigh impossible to characterize it precisely, there is no doubting its significance for decision-making contexts ranging from the individual to the political. Since individual experiences of any condition or treatment differ widely, whose experiences come to constitute “knowledge”? In this paper, I argue that, rhetoric notwithstanding, numerous constraints “filter” the experiences which come to function as “experiential knowledge”. Looking to the future of health care, likely to be marked by growing inequalities, I suggest that a reflection on the notion of experiential knowledge leads to two challenges for social scientists.

Social Process and the Assessment of a New Imaging Technique

Each group involved in the development of a new medical technology constantly assesses the value of the emergent technique in terms of the groups own specific goals and conventions. The history of infrared thermography demonstrates the social nature of this assessment process.

‘Su guagua no escucha nada’: Ecuadorian families confronting the deafness of a child

In accordance with the social model of disability, this study proceeded from the assumption that parents’ experiences of a child’s hearing impairment reflect the circumstances of their lives rather than anything innate in the impairment itself. Few studies have explored the influence both of culture and social structure and of families’ economic and social resources. We studied families’ experiences of the diagnosis of hearing loss in Ecuador, a multicultural country in which family ties are strong but where pronounced social and economic inequalities persist and where many people have no access to health care. The study shows how inequality – and in particular the experience of poverty – shapes families’ experiences of acquiring a diagnosis and of trying to accommodate a child with special needs.