LIVELY CAPITAL

EXPERIMENTAL FUTURES
TECHNOLOGICAL LIVES, SCIENTIFIC ARTS, ANTHROPOLOGICAL VOICES
A series edited by Michael M. J. Fischer and Joseph Dumit
 LIVELY CAPITAL
BIOTECHNOLOGIES, ETHICS, AND

GOVERNANCE IN GLOBAL MARKETS

Edited by Kaushik Sunder Rajan

DUKE UNIVERSITY PRESS DURHAM AND LONDON 2012

© 2012 Duke University Press
All rights reserved.
Printed in the United States of America on acid-free
paper
Designed by Nicole Hayward
Typeset in Scala and Scala Sans by Tseng Information
Systems, Inc.
Library of Congress Cataloging-in-Publication Data
appear on the last printed page of this book.
 CONTENTS

Acknowledgments!vii

Introduction: The Capitalization of Life and the

Liveliness of Capital!1
Kaushik Sunder Rajan

PART I. ENCOUNTERING VALUE

1. Prescription Maximization and the Accumulation

of Surplus Health in the Pharmaceutical Industry:
The_BioMarx_Experiment!45
Joseph Dumit

2. Value-Added Dogs and Lively Capital!93

Donna J. Haraway

3. Air’s Substantiations!121
Timothy Choy

PART II. PROPERTY AND DISPOSSESSION

4. Taking Life: Private Rights in Public Nature!155

Sheila Jasanoff

5. Rice Genomes: Making Hybrid Properties!184

Elta Smith

6. Marx in New Zealand!211

Travis Tanner
 7. AIDS Policies for Markets and Warriors: Dispossession,
Capital, and Pharmaceuticals in Nigeria!228
Kristin Peterson

PART III. GLOBAL KNOWLEDGE FORMATIONS

8. Diagnostic Liquidity: Mental Illness and the Global

Trade in DNA!251
Andrew Lakoff

9. Transforming States in the Era of Global Pharmaceuticals:

Visioning Clinical Research in Japan, Taiwan, and
Singapore!279
Wen-Hua Kuo

10. Biopolitics and the Informating of Environmentalism!306

Kim Fortun

PART IV. PROMISSORY EXPERIMENTS AND EMERGENT

FORMS OF LIFE

11. Genomics Scandals and Other Volatilities of Promising!329

Mike Fortun

12. Desperate and Rational: Of Love, Biomedicine, and

Experimental Community!354
Chloe Silverman

13. Lively Biotech and Translational Research!385

Michael M. J. Fischer

Epilogue: Threads and Articulations!437

Kaushik Sunder Rajan

Bibliography!453

About the Contributors!491

Index!495
 ACKNOWLEDGMENTS

This volume comes out of a workshop, also titled “Lively Capital: Biotech-
nology, Ethics and Governance in Global Markets,” held in November 2004
at the University of California, Irvine. I wish to thank the National Science
Foundation, the University of California’s Humanities Research Institute,
the Newkirk Center for Science and Society at UC Irvine, and UC Irvine’s
Division of Research and Graduate Studies for providing the funding that
was required to conduct the workshop.
I next wish to thank the participants in the workshop for their com-
mitment, friendship, and collegiality during the workshop; and for their
patience through the long process required to convert the workshop pro-
ceedings into this edited volume. For me, thinking with, and learning from,
other people is the most enjoyable aspect of being an academic, and I could
not wish for a better group of interlocutors than those who are a part of this
volume. In addition to the authors of the various chapters herein, I wish to
thank Geoffrey Bowker, Lawrence Cohen, and Cori Hayden, who also pre-
sented papers at the workshop, but were unable to contribute their pieces to
the volume.
My colleagues in the department of anthropology at UC Irvine deserve
special thanks. As I planned the workshop, I received tremendous encour-
agement from Jim Ferguson, who was at the time chair of the department,
and that support and encouragement was replicated by every one of my
other colleagues, many of whom served as discussants to papers at the work-
shop, and all of whom contributed in significant measure to making it a
success. Bill Maurer also provided a careful and critical reading of my intro-
duction to this volume, and I have benefited greatly from his comments. In
addition, people from other departments at UC Irvine and elsewhere served
as discussants and interlocutors at the workshop. I wish to thank them—
Bogi Andersen, Simon Cole, Jean Comaroff, Marianne de Laet, and Sharon
Traweek—for adding immeasurably to the conversations. Since the work-
shop, Elta Smith has read (too) many drafts of my introduction as they were
written, and I have benefited immensely from her patient, honest, and in-
valuable insight.
A few people deserve special thanks for the execution of the workshop.
Caroline Melly, Guillermo Narvaez, and Neha Vora were heroic in attending
to every organizational and logistical detail. Elta Smith transcribed the pro-
ceedings, while Esra Ozkan videotaped them, hence providing an invaluable
archive that I was able to draw on while compiling the edited volume and
writing my introduction.
Since 2002 Joe Dumit and Michael Fischer had been discussing with
me the importance of providing a venue where current work on the life sci-
ences and capital could be discussed. They both had a big role in inspiring
me to organize the workshop; in providing feedback on the various grant
applications that had to be written in order to get it funded; in helping me
outline and structure the workshop; and in being sounding boards at vari-
ous stages during the preparation of this volume. More generally, I recog-
nize now just how much my enjoyment in collaborative work and thinking
is due to having had them as my dissertation advisors. Very early in my
graduate career, Joe eagerly approached me with an article that had just been
written on the political economy of genomics, which is what I was planning
to study in my own research. He then stopped and asked, “Are you one of
those people who like it when other people are working on the same thing
that you are? Because I do. I think it’s so much more fun to think with other
people about my work.” I know that such an ethic—not just of collabora-
tion, but of friendship and of genuine engagement with and enjoyment in
the work of others—is not necessarily the norm in the academy, and is cer-
tainly not accounted for in the audit cultures that predominate in evaluating
research activities and outcomes. I am grateful that I was immersed in such
an ethic, because Joe and Mike taught me not just about anthropology, sci-
ence studies, or social theory, but showed me by their examples the sort of
academic that I wanted to be. I feel it is only appropriate that this volume is
appearing in the “Experimental Futures” series, which they coedit.
I wish to thank two anonymous reviewers for careful and detailed feed-
back that has helped greatly in the production of this volume, and especially
in the writing of my introduction. (One of them subsequently revealed him-
self to be Lawrence Cohen, who also, a few years previously, had the un-

viii ACKNOWLEDGMENTS
enviable task of reviewing the manuscript of my book Biocapital. So I have
much to thank him for, not just in terms of this volume, but in terms of my
intellectual development more generally. Much of my published work has
been marked, and improved, by his generous and rigorous readings.) Asya
Anderson has provided invaluable editorial assistance in compiling the vol-
ume. Ken Wissoker, Courtney Berger, and Leigh Barnwell at Duke Univer-
sity Press have been wonderfully supportive throughout the process, and
Patricia Mickelberry has been incredibly thorough and helpful in ironing
out wrinkles during the volume’s production. I am grateful to be working
with a press that has provided such a congenial and encouraging venue for
this work, for my work, and more generally, for work in the anthropology of
science.

ACKNOWLEDGMENTS ix
 KAUSHIK SUNDER RAJAN

INTRODUCTION

The Capitalization of Life and

the Liveliness of Capital

The objective of the workshop that resulted in this volume was to investigate
how new legal, social, cultural, and institutional mechanisms are emerg-
ing to regulate the global emergence of biotechnologies, and, building on
that, to consider the relationship of biotechnology to ethics, governance,
and markets.
The assumption underlying the workshop from the outset was that the
relationship between the science in question—the life sciences and biotech-
nologies—and “society”—as expressed in its laws, norms, cultures, insti-
tutions, discourses, and practices—is not unidirectional. Our contempo-
rary social realities are not simply adaptations to inexorable technological
advance, as suggested by popular media renderings of science and tech-
nology. Nor can science be regulated simply by submitting it to an assumed
social order, as if the latter were without history or preexisted the science.
Rather the emergence of technoscience and the emergence of “the social”
are simultaneous, historically constituted events.
This introduction engages some of the problem-spaces this volume in-
habits, outlines intellectual trajectories within which it can be situated, and
describes the particularities of individual contributions.
The Problem: Co-Production, Determination, and the
Conceptualization of Lively Capital

The title “Lively Capital” is meant to point in two distinct directions. As with
all workshops, this one purported to cover a topical area—broadly speaking,
that of the convergence of the life sciences with systems and regimes of capi-
tal. In that register, the title refers concretely to the ways in which the life
sciences are increasingly incorporated into market regimes. This is an insti-
tutional movement, away from the university and toward the market, which
has been particularly marked in the American context since the late 1970s
and early 1980s, and has, in the process, seen the university itself become a
more entrepreneurial institutional space, one that explicitly encourages the
commercialization of “basic” research conducted within its confines.
This corporatization of the life sciences can be traced back to the begin-
nings of the biotechnology industry, which was marked by the concomitant
emergence of new types of science and technology with changes in the legal,
regulatory, and market structures that shaped the conduct of that techno-
science. The “new” technoscience was recombinant DNA technology (RDT),
a set of techniques, developed in 1973 by Herbert Boyer and Stanley Cohen,
that allows the dissection and splicing of DNA molecules in laboratories. RDT
allows the life sciences to become “technological,” where the product is cel-
lular or molecular matter such as DNA or protein. Some of these proteins
could, in principle, have therapeutic effects (especially for diseases that are
caused by, or have as a central symptom, an abnormal amount of that pro-
tein) and be produced industrially.
While RDT was a necessary condition for the development of the biotech
industry, the emergence of a new technology could hardly in itself be con-
sidered sufficient cause for the emergence of an entirely new industrial seg-
ment, which can only be understood as a consequence of the conjuncture
of several events and factors. First, venture capitalists were willing to invest
in a technology that had little credibility at the time as a successful business
model. Second, the U.S. federal government spent an enormous amount of
money on basic biomedical research through funding of the National Insti-
tutes of Health (NIH) consequent to the declaration of a war on cancer in
the early 1970s.1 Third, the Bayh-Dole Act, a piece of legislation enacted in
1980, facilitated the transfer of technology between academe and industry
in the United States, and thereby enabled rapid commercialization of basic
research problems. Fourth, a supportive legal climate allowed the protec-
tion of intellectual property in biotechnologies, marked, for instance, by the

2 KAUSHIK SUNDER RAJAN

landmark U.S. Supreme Court ruling in Diamond v. Chakrabarty, in 1980,
which allowed patent rights on a genetically engineered microorganism that
could break down crude- oil spills. Since the 1990s, the increasingly natu-
ralized corporatization of the life sciences has become a more global phe-
nomenon, often explicitly or implicitly imitating events, models, or transfor-
mations that had occurred or been established in the United States, though
hardly ever in seamless or homogenous fashion.
The emergence of the entrepreneurial university; the corporatization of
the life sciences; the naturalization of this corporatization. Crudely speak-
ing, this is the historical trajectory of the last four decades or so, within
which this volume is located. This trajectory is neither predetermined nor
uncomplicated.
I wish to illustrate this through a brief account of Stanford University’s
technology-transfer office, which is implicated in transformations that, over
the past four decades, have helped set the stage for this volume. Stanford is
often regarded as the exemplary entrepreneurial university, especially in the
context of the life sciences. Its office of technology transfer was established
as early as 1970, and the university’s aggressive commercialization of its
technologies has been seen as a huge spur to the overall commercialization
of biotechnology, and specifically to the development of Silicon Valley. While
Stanford, like many other universities, had before that an office of sponsored
projects, which negotiated research contracts with sponsors, the develop-
ment of a full-fledged technology-licensing office that focused exclusively
on marketing university inventions was instigated by the entrepreneurial
spirit of a particular associate director of the sponsored-projects office, Niels
Reimers. Patenting university inventions was not a new phenomenon—
what was at stake was institutionalizing and streamlining this process in a
way that turned commercialization into an administrative priority for the
university; generating expertise on patenting, often by outsourcing patent
activities to patent law firms; and creating incentives for university scien-
tists to prioritize the commercialization of their research.2
Stanford was not the only university to adopt a more entrepreneurial ap-
proach in the 1970s (though most technology-transfer offices in the United
States were set up after the passage of the Bayh-Dole Act, in 1980). But the
history of its office of technology licensing (OTL) is intrinsically linked to
the history of biotechnology, and especially to the history of commercial
biotechnology. Stanford’s OTL was involved in getting a patent on Boyer’s
and Cohen’s recombinant DNA technology, the most lucrative technology
that Stanford licensed during that period.3 Crucially, there were two major

INTRODUCTION 3
consequences of models such as those adopted by Stanford. First, a greater
degree of collaborative research between university and industry was estab-
lished (since the university retained upstream patent rights, as opposed to a
“more open” or “less commercial” model, wherein patents were usually on
more downstream applications and tended to reside exclusively with indus-
tries that utilized technologies in the public domain for specific product de-
velopment). Second, a “spin- off ” culture ensued, whereby university profes-
sors commercialized their research by starting their own companies.
By providing this potted history of Stanford’s technology-transfer office,
I mean to suggest that the emergence of the entrepreneurial (American)
university, the corporatization of the life sciences, and the naturalization
of that corporatization are complex processes. It is not the case that life
sciences research before the 1970s was noncommercial, or that universi-
ties were uninterested in marketable technologies. Rather, what one sees is
the changing nature and locus of “commercialization” from that time, with
the university becoming a more explicit—and institutionally regulated—
stakeholder in the entire process.
The consequences of commercialization are also not self- evident, be-
cause commercialization does not imply a predetermined set of actions or
outcomes. Rather, the forms and modes of commercialization constitute a
terrain of deeply strategic maneuver and contestation. A patent in itself does
not determine the way university technologies are disseminated. All that it
allows is for the patent holder to negotiate the market terrain with a certain
set of exclusive rights that others in the marketplace do not possess.
The dissemination of RDT is itself instructive in this regard. Stanford de-
cided to issue nonexclusive licenses, an approach that allowed the univer-
sity simultaneously to reap enormous commercial benefit and to promote
wide distribution of the technology, the latter ensuring that Stanford ful-
filled the public-service function deemed appropriate for a public institu-
tion.4 At many points along the way, Stanford pursued strategies that were
in fact antithetical to a profit motive.5 For instance, in addition to the original
recombinant DNA patent that was granted in 1980, Stanford also acquired
two subsequent patents, in 1984 and 1988, which covered products gener-
ated by downstream application of RDT, in prokaryotic and eukaryotic cells,
respectively. In the normal course, these patents would have expired in 2001
and 2005, thereby effectively extending the length of time for which RDT
patents would generate revenue for the patent holders. However, Stanford
allowed the subsequent patents to expire along with the original RDT patent,

4 KAUSHIK SUNDER RAJAN

in 1997. Furthermore, Stanford decided not to charge royalties to nonprofit
organizations to which it licensed RDT.
The story of the RDT license suggests the potentially immense mallea-
bility of property regimes; hence, adopting a moralistic position on intel-
lectual property is often unhelpful in responding to the actual political
complexities that are enshrined within the idea and practice of commer-
cialization.6 But the story also points to a moment of deep ferment, wherein
granting a patent on a platform technology took six years. The legitimacy of
the patent was deeply debated, and the role of the university (including the
private university) as existing for the public good was largely deemed non-
negotiable. Thus, in referring to a certain historical trajectory that the value
system of the life sciences has traversed over the past four decades, I do
not mean to present a simplified narrative in which the private encroaches
on the public, nor do I intend to suggest that the outcomes of such an en-
croachment are inevitable or known in advance. But I do want to suggest
that questions about commercialization—which are, among other things,
about the legitimate extent of commodification, the role of the university,
and the value system of science—were deeply unsettled less than three de-
cades ago, yet seem largely beyond argument today, certainly in the United
States. What is crucial here is the changing investment in the market by
the value system of the life sciences—which, in spite of numerous contin-
gencies and open- ended, strategic negotiations, has nonetheless seen a tra-
jectory that is resolutely more embracing of market logics over time. Even
if historical trajectories are emergent and not predetermined, the fact that
they have consistently unfolded in certain institutional and ideological di-
rections over others—and not just in the United States, but in other parts of
the world as well—is important to note and assess.
Stanford’s RDT licensing is a useful point of departure for describing the
terrain of this volume for a number of reasons. The first, quite simply, is its
historical importance. RDT in many ways provided the technological condi-
tions of possibility for biotechnology, and the mechanisms of its dissemi-
nation (which had everything to do with Stanford’s strategy of nonexclusive
licensing) were consequential for the development of the biotech industry.
In addition, Stanford’s approach to licensing exemplifies both the frictioned
commercialization of the life sciences and, more broadly, the emergence of
new normative systems that are more open to such commercialization. On
the one hand, one sees the (at the time) contested question of the appro-
priate relationship of university science to commercialization, with Boyer

INTRODUCTION 5
and Cohen themselves being initially wary of the RDT patent application
and thus deploying the patent, once issued, in a manner that ensured the
public dissemination of the technology. On the other hand, Stanford’s move
toward patenting the technology in the first place, and the movement of
its technology-licensing office in a distinctly entrepreneurial direction, in-
dicates a moment of changing value systems in the sciences, away from a
Mertonian disinterestedness or communism.7
This direction was evident in at least three ways. First, the public dis-
semination of a technology, while it undeniably provided access to that tech-
nology in the public domain, was also a spur to private industry. Stanford’s
investment as a university in the life sciences, combined with its entrepre-
neurial strategies of technology licensing, was undoubtedly a factor in the
biotech boom in Silicon Valley. Second, self- questioning about the advis-
ability of patenting, evident in the RDT case, eventually dissipated, as com-
mercial enterprise came to seem like a natural course of action for univer-
sity scientists. And third, Stanford to some extent emerged as a model of
the entrepreneurial university, even though its mechanisms of technology
transfer, which favored public dissemination of the technology, were not
necessarily adopted. Over the past three decades, it has in fact become the
norm for American universities to have technology-transfer offices that ag-
gressively pursue intellectual property in the life sciences.
Stanford itself, in its actions in the RDT case, was adhering not just to the
public-service function of the university, but also to the spirit of the patent
regime, which is to promote the public disclosure of inventions by provid-
ing the inventor with a set of property rights. In other words, the idea (and
ideal) of the public is already enshrined in the very rationale of a patent, as
a particular form of intellectual property that acts in the interest of public
disclosure and dissemination. That this ideal so often manifests in ways
that instead protect institutional interests in the face of market competition,
making Stanford’s actions seem almost surprising or altruistic, is itself an
indication of the way in which the commercialization of the life sciences has
become naturalized. Exemplifying patent strategy as protectionist rather
disseminating is Hoffmann-La Roche’s patent on polymerase chain reaction
(PCR), a technology considered in many ways as seminal as RDT for the de-
velopment of biotechnology. Roche aggressively enforced the PCR patent,
thereby arguably creating value for themselves without the same consider-
ation for accessible downstream applicability that Stanford showed. Roche’s
approach to technology patents is perhaps by now seen as more normative

6 KAUSHIK SUNDER RAJAN

than Stanford’s. While both institutions engage in the commercialization of
technologies, they play out market logics in decidedly different ways.
The territory of this volume is hardly limited to the playing out of
intellectual-property regimes. It is more generally concerned with the nature
of value systems in the life sciences, how they are perceived and deployed.
What is crucial here is that, over time and more globally, the investment in
market logics has been seen as variously inevitable, nonnegotiable, desir-
able, or even virtuous, even as market logics may themselves be contradic-
tory. By situating the case of Stanford against that of Roche, one detects ad-
herence both to public dissemination and to private monopolization, based
on the same instruments of intellectual property. Nevertheless, whether
they be more liberal or more monopolistic in inclination, both logics oper-
ate under the sign of the market, of capitalist exchange and value. Histori-
cal contingency, therefore, arises at the level of particular strategies and tac-
tics adopted as the life sciences have been incorporated within systems and
regimes of capital. This historical contingency has occurred in the shadow of
an ideological embrace of the market that, while not seamless, has become
increasingly uncontested over time.8
In other words, the fundamental nature of the market, its value systems
and epistemologies, is itself shifting, in what might broadly be considered
a “neoliberal” direction. Neoliberalism is often used as a catch-all phrase,
simultaneously encompassing too much and describing too little. Yet there
are uncanny overlaps between the development of life-science epistemolo-
gies and the epistemologies of neoliberal economics since the early 1970s,
as Melinda Cooper (2008) has elegantly demonstrated. This is not a relation-
ship of cause and effect—the life sciences do not change because of neolib-
eralism, nor is neoliberalism a consequence of the biotechnology revolu-
tion. Rather, what one can trace is an emergent epistemic milieu in which
both economics/capitalism and the life sciences/biotechnology are under-
going radical transformation and dealing with apparently similar types of
problem-spaces (such as, for instance, the understanding and management
of complex systems of risk) at similar moments in time, and often draw-
ing on one another for metaphoric or epistemic sustenance. Even the ideol-
ogy of innovation, which gained enormous traction under Ronald Reagan’s
presidency, in the 1980s, under the influence of neoliberal thinkers such as
George Gilder (1981), suggests a value system of capitalism that is in some
ways quite distinct from that which Marx traced during the industrial revo-
lution, whereby the magic of capital lies not in the creation of the surplus

INTRODUCTION 7
through the apparent exchange of equivalents, but rather in the creation of
what Michael Lewis (1999) refers to as “the new new thing.” Innovation as a
driving force of capital draws to a large degree on technoscientific potential
for value generation; technoscientific potential for value generation is fun-
damentally enabled by a political-economic regime that provides incentives
to innovate. Rather than cause and effect, what one is confronted with are
mutually implicated and emergent epistemologies and systems concerning
life and value, what Sheila Jasanoff (2004, 2005a) has termed co-production.
While much is changing and emergent, what has remained constant, or
intensified, is a set of mutual investments—the investments of the market
in the life sciences, and the investments of the life sciences in the market.
The co-productionist sensibility of this volume is complicated by this deep
mutual investment, which does lead to the life sciences being increasingly
“driven” by market logics, so that even when actions are apparently taken
in the public good (as by Stanford with regard to RDT), the parameters of
those actions make sense in terms of the market and of capital. I wish here
to elaborate on this complication.
I do so, specifically, by reading Jasanoff against Marx, as an entry point
into a more general problem of theory and method that this volume wrestles
with. This reading, at one level, is not necessarily representative of all the
chapters in the volume, which explicitly draw on or engage with either or
both of these theorists to varying degrees, or not at all. But such a reading
situates a problem-space that I feel all the chapters do occupy, regardless of
their specific modality of engagement with it. These next reflections, there-
fore, are more authorial than representative, speaking to my own thinking
through of problems of theory and method. I will revert to a more editorial
role in a subsequent section.
On the one hand, by bringing in the notion of co-production, I want to
reform a certain kind of Marxian analytics that is economically determinist.
To reduce changes in the biosciences to economic causes would be inade-
quate. At the same time, I do not wish to suggest that co-production simply
implies complexity or contingency. I am wary of a certain current anthro-
pological move that seems to posit the establishment of contingency as the
methodological solution to doing anthropology of the contemporary. This is
not to deny the importance of staying attentive to contingency—Marx him-
self, after all, was a supremely careful theorist of the contingent. But contin-
gency alone, I suggest, cannot adequately serve as explanation for the sorts
of consistent historical unfoldings with which this volume is concerned.9
Both Jasanoff, with her idea of co-production, and Marx, with his histori-

8 KAUSHIK SUNDER RAJAN

cal dialectic method for studying the unfolding of systems and logics of capi-
tal, are theorists who take the contingent seriously, but refuse it as the point
at which (to use a Wittgensteinian phrase) explanations run out. This leads
to methodological and conceptual dilemmas though: how might we think
causally about the trajectory of capitalization of the life sciences? How might
co-production, or Marxian analytics, or indeed other kinds of conceptual
frameworks, help work through the problem with which I have introduced
this volume—concerning a particular political economic and epistemologi-
cal trajectory that, over space and time, indicates a process of capitalization,
but where the norms and forms of capitalization are complicated, and where
falling prey to economic determinism would be an impoverished analytic
move?
As an example of the dilemma that I am trying to elucidate, let me con-
sider Emily Martin’s work on the dual movement of capital and life toward
flexibility, Flexible Bodies (1995). Martin’s analysis is not simply diagnostic;
it forces us to ask a series of analytic questions. Why flexibility? Why at this
time (the 1980s and 1990s)? Martin shows that flexibility is geared toward
modalities of maximizing productivity, within certain, particular political-
economic conjunctures. Martin’s account of “flexible bodies” most certainly
shows a particular co-production of forms of life with forms of capital. But
this co-production occurs under the sign of certain value systems that struc-
ture the terrain within which it happens. Melinda Cooper paints a similar
canvas, showing a similar kind of dual structure, of co-production, but under
the sign of particular political-economic and epistemological structures, in
Life as Surplus (2008). This is entirely an analysis of the co-production of life
sciences with neoliberal economics, but at a moment in history (the 1970s
onward) wherein the appropriation of both by capital is a consistent, and in-
creasingly dominant, feature.
My interest in this volume, inspired by works such as those just cited, is
to understand the co-production of life and capital along with the consistent
unfolding whereby life is increasingly appropriated (or at least appropriable)
by capital. How one provides such an understanding is a fundamental meth-
odological question, and each chapter implicitly or explicitly deals with this
question in its own way and on its own terms. I myself have three sugges-
tions in this regard, all based on a fundamental provocation: that it is ana-
lytically important to not abandon the question of determination, but at the
same time, it is important to think of determination as not always already
implying pre-determination.
Rather, first, one can think about multiple determinations. Max Weber did

INTRODUCTION 9
so throughout his work. While he never abandoned the question of cau-
sality—in many ways, it was one of the central questions that structured his
work and method—he recognized that causes for social phenomena were
always multiple, and establishing that multiplicity had to be an empirical
task. There were a number of empirical strategies that Weber adopted: his-
toricist; comparativist; and, in his rendering, sociological, through the de-
vice of the ideal type.10
Second, one can think about overdetermination. Overdetermination is
originally a term of Freudian psychoanalysis, further developed and ana-
lyzed by Louis Althusser to suggest a subjectively mediated contextual re-
lationship, which, while not causal in any simple sense, might nonetheless
appear to be disproportionately important (Althusser 1969 [1965]). And so,
even if a particular set of political economic formations do not in any di-
rect and simplistic way lead to particular epistemic emergences, they could
still disproportionately set the stage within which the latter take shape in
particular ways and, further, appear to do so to various actors in ways that
naturalize complicated relationships into simple causal ones. Thus, even if
capitalism represents particular types of political-economic formations, in
this current moment in world history, as Slavoj Žižek argues, it “overdeter-
mines all alternative formations, as well as non- economic strata of social
life” (2004, 294). Therefore, even while emphasizing the historicity and
the far-from-natural emergence of capitalism as a set of political economic
forms and structures, it is important to acknowledge the importance of capi-
tal as being what Žižek calls the “‘concrete universal’ of our historical epoch”
(ibid.).
And third, one can think through Marx’s phrase of the economy as being
determining “in the last instance” (Marx 2009 [1858]). I wish to reflect on
this phrase at some length, as an opening into thinking about Marx’s method
and its relevance for studying the life sciences and capital. Marx’s phrase is
often understood to signify his economic determinism, but it can, in fact, be
read in a far more open-ended fashion. Indeed, I would argue that a proper,
conjunctural reading of Marx, which is attentive to the moment and context
of his writing, must read the phrase in a more open-ended fashion, especially
considering the fact that Marx, in attempting to develop a materialist basis
for understanding the economic, social, and political orders of his time,
was writing against idealists of various sorts (including Young Hegelians,
utopian socialists, and certain bourgeois thinkers). Frederich Engels makes
this point explicitly. Even without necessarily providing a clear alternative to
thinking about the problem of determination, Engels clarifies that neither

10 KAUSHIK SUNDER RAJAN

he nor Marx meant themselves to be read in terms that simply implied the
predetermination of the social by the economic. One can, indeed, see in
Engels a quite elaborate attentiveness to contingency, but it is contingency
that is operational under the sign of certain kinds of formations.

According to the materialist conception of history, the ultimately deter-

mining element in history is the production and reproduction of real life.
Other than this neither Marx nor I have ever asserted. Hence if some-
body twists this into saying that the economic element is the only deter-
mining one, he transforms that proposition into a meaningless, abstract,
senseless phrase. The economic situation is the basis, but the various
elements of the superstructure—political forms of the class struggle and
its results, to wit: constitutions established by the victorious class after a
successful battle, etc., juridical forms, and even the reflexes of all these
actual struggles in the brains of the participants, political, juristic, philo-
sophical theories, religious views and their further development into sys-
tems of dogmas—also exercise their influence upon the course of the
historical struggles and in many cases preponderate in determining their
form. There is an interaction of all these elements in which, amid all the
endless host of accidents (that is, of things and events whose inner inter-
connection is so remote or so impossible of proof that we can regard it
as non- existent, as negligible), the economic movement finally asserts
itself as necessary. . . . Marx and I are ourselves partly to blame for the
fact that the younger people sometimes lay more stress on the economic
side than is due to it. We had to emphasise the main principle vis-à-vis
our adversaries, who denied it, and we had not always the time, the place
or the opportunity to give their due to the other elements involved in the
interaction.11

What Engels is suggesting is that the economic is, to borrow a phrase

from Bruno Latour, an obligatory point of passage—it is impossible to
understand the social and the political in the conjuncture in which Marx
was writing, of industrial capitalism, without accounting for it. But to say
that something is necessary to understand is hardly the same as saying that
it predetermines the sociopolitical.
Each of these three strategies for thinking about determination as not
always already predetermination—owing themselves respectively to Weber,
Freud, and Marx, three of the great social theorists of the nineteenth cen-
tury and the early twentieth—deploys a different explanatory modality.
The first is historical and anthropological (and, relatedly, what Weber calls

INTRODUCTION 11
“sociological”); the second is ideological and subjective; and the third is, for
want of a better word, structural. But that “structure,” in Marx’s writings,
is in fact extremely complicated, and Marx is supple in his analysis of it. It
is not enough to say that the economic, in Marx, is necessary but not deter-
mining. It is also important to recognize that when Marx analyzes “the eco-
nomic,” he is analyzing multiple things.
One can see this quite clearly in volume 1 of Capital, which is perhaps
Marx’s most schematic rendering of the structure of capital (Marx 1976
[1867]). The structural elements of capital—concerning the production of
value in the relationship between the use and exchange of an object within
a particular political-economic formation—are outlined at great length
through most of the volume, which starts with an analysis of commodities,
moves on to an analysis of money, looks at the way in which the continuous
exchange of one for the other somehow leads to the generation of surplus
in spite of it being an apparent exchange of equivalents, analyzes the crucial
mediator (the labor of the worker) in this process, and concludes that in fact
it is because this labor is always already labor power, containing within it an
excess potential for work over and above that remunerated by wage, that one
has the ability to generate surplus value. This much is schematic, abstract,
and structural; and it is made “real,” within the parameters of the schema,
in the transition from analyzing absolute surplus value (which is the ab-
stract rendering of surplus value in the hypothetical interaction between a
capitalist and a worker) to relative surplus value (which is the real rendering
of surplus value generated in the collective interactions between capitalists
and workers, which are mediated, crucially, by machinery).
But even within this schematic rendering of the structure of capital, one
sees the inescapable presence of both the ideological/subjective and the his-
torical/anthropological. The ideological/subjective dimension is to be found
in the crucial section on commodity fetishism, which speaks to the abstrac-
tion that is at the heart of an apparently thoroughly materialist analysis. It
is, indeed, quite literally in the heart of the analysis, being placed carefully
between the sections on commodities and on money, and at the cusp of
the development of the analysis of surplus value. And it is about the com-
modity, on the face of it a simple material thing, being “full of metaphysical
subtleties and theological niceties,” and thereby appearing to individuals as
a mediator of social bonds. Marx is careful to call this abstraction “fetishism”
rather than “ideology,” an indication of the vexed place of the concept of ide-
ology in his writings.12 But even if commodity fetishism is not ideology, in

12 KAUSHIK SUNDER RAJAN

the specific manner in which Marx develops that concept in his early writ-
ings such as The German Ideology (Marx and Engels 1963 [1845]), it is still
ideological; that is, it refers to the masking of real social relations through
appearance, illusion, and naturalization of those illusions. Žižek, indeed,
suggests that the notion of commodity fetishism is central to Marx’s analy-
sis of capital, getting as it does not “to the secret of the content of the form,
but to the secret of the form itself ” (Žižek 1994, 296).
The historical/anthropological dimension is to be found at the end of
volume 1, in the section on “The So- Called Primitive Accumulation.” In
this, Marx shows the historical conditions of possibility that even make pos-
sible the establishment of the structure that is elucidated until that point.
This history is a violent one, involving the enforcement of property regimes
(in England, through the dispossession of peasants from the land during
the enclosure movement), followed by the forcible outlawing of vagrancy
that pushed these dispossessed peasants into the factories as workers for
industrial capitalism. On the one hand, this section is striking in its abso-
lute empirical specificity—the reading of particular laws that were enacted
over time in England, and the care with which Marx insists on that particu-
larity (Marx 1976 [1867], part 8). At the same time, in spite of this rigor-
ous specificity, there is a more general structural provocation, pertaining
to the constitutive relationship of violence to the history of capital, so that
“capital comes dripping from head to toe, from every pore, with blood and
dirt” (ibid. 926); a provocation that disputes the myth of “free” exchange of
labor for wage that is propagated by bourgeois political economists, and that
undergirds the entire preceding structural analysis.
In addition to these three dimensions—the structural, the ideological/
subjective, and the historical/anthropological—“the economic” in Marx has
a fourth dimension, in its guise as political economy, which is relevant for
the concerns of this volume: its epistemological dimension. In order to ex-
plore this, I must back up to reiterate what Marx is doing, especially in his
later works. In Capital (and also in the rough notes that represent his work
toward it, Grundrisse), Marx is engaged in a project of critique that is not criti-
cism or denunciation, but rather, in a Hegelian sense, a mode of analysis
that attempts to explore the limits of a concept or practice. What is the con-
cept or practice that Marx is critiquing? In his development of the concept
of surplus value, Marx is analyzing capitalist exchange. But what is capitalist
exchange? Is it concept, is it practice, or is it system? This is crucial, because
often in order to grasp the “stuff of the world,” as Marx is attempting to do,

INTRODUCTION 13
one has to constantly shift registers between looking at concepts, at prac-
tice, at systems, at objects. And how to do that remains a live methodological
challenge for contemporary analysis, as much as it was for Marx.
I would suggest that, in fact, Marx was not doing systemic analysis in
any simple sense; he was not trying to understand “capitalism,” because
capitalism as a singular is an absurdity—it did not exist in Marx’s time, nor
has it since. Systems of capitalist exchange certainly have existed, but they
have been always fluid and emergent, taking specific organizational, insti-
tutional, and political forms in particular times and places. What Marx was
trying to do, rather, was understand capital.
But what is capital, in material terms? Money and commodities. Yet
money and commodities by themselves do not constitute capital; they only
do so when operational in a system that is structurally geared toward the
generation of surplus. Here, one is potentially confronted with a tautology,
of a system that only makes sense in terms of the modalities of function-
ing of the objects that constitute that system, objects that themselves only
function as constituents of that system when already situated within those
systemic logics. After all, money and the things that circulate in exchange
relations with money both existed in precapitalist societies, and systems
of monetary exchange existed for centuries before capitalism. What is that
magical element that breaks this tautology and mediates the exchange of
money and commodity to turn them into capital? It is labor.
Who came up with this answer? Not Marx—he was playing off of this
fact, which was already well-known at the time of his writing. It was well-
known because political economy—an emergent but already powerful body
of knowledge that explained how capital works—said so. Indeed, Marx’s
crucial modification to this understanding was in insisting that it was not
labor—work that was materialized and remunerated adequately in wage—
but labor power—the constitutive potential for labor over and above that
remunerated in wage—that actually was the driving force of capital, by pro-
viding the conditions of possibility for surplus-value generation.
The analysis of labor power, crucially, comes not from an empirical ob-
servation of the accrual of value, but from the critique of political economy,
from the fact that political economy’s own analysis of capital failed to ac-
count for the fact that if labor was simply a mediator in a process of exchange
and that if that labor was “free” and remunerated, then it was capital that
kept growing, while labor was exploited and alienated. This is what politi-
cal economy failed to explain; this is what political economy failed to explain.
In other words, Marx’s critique of capital was not a critique of capitalism,

14 KAUSHIK SUNDER RAJAN

which would have been an absurdity; and it could not have been a critique of
exchange per se, because there was no way of empirically accessing exchange
per se except through the means available to know and understand that ex-
change.
In other words, Marx was—especially in his later writings—critiquing the
way in which we came to understand capitalist exchange—and that way was
through political economy, which was the foundational epistemology of the
time that explained these mechanisms. Capital is, after all, subtitled “a cri-
tique of political economy”—not “a critique of capitalism,” or even “a cri-
tique of capital.” Political economy failed to take into account the history of
capital, whose dynamics it claimed to explain; and it failed to be attentive to
the abstractions with which capital was able to hide its “true” nature. Yet it
functioned as authoritative knowledge.
With this elaborate exegesis on Marx’s method, I wish to return to the
problem of conceptualization and method that I started with. My entry point
into thinking about Marx’s method was to suggest that his statement that
the economic is determining “in the last instance” is in fact not a deter-
minist statement. But I have ended up by suggesting that not only is Marx
not determinist, but he is also, methodologically, an epistemologist—just
as he is, variously, a structuralist, a historian, an anthropologist, and a phi-
losopher of abstraction and naturalization. Indeed, Marx cannot understand
capital except through epistemology; but this not does mean, again, that po-
litical economy determines capitalism. What one sees, rather, is the develop-
ment of an analytic that, in fact, looks rather uncannily like co-production!
Marx is looking at systems and regimes of exchange and value that are made
intelligible, and naturalized, through epistemology, which in turn responds
to those forms of exchange and value in its own development as an authori-
tative form of knowledge. Value and epistemology, in this analytic, are co-
produced. Yet, at the same time, Marx claims it is the economic that is deter-
mining in the last instance.
Methodologically, Marx suggests the importance of shifting registers,
between the historical, anthropological, analytic, and epistemological. But
when it comes specifically to the question of determination, Marx presents
a challenge of method and conceptualization that is a dialectic between the
co-production of value and epistemology, and the determination “in the last
instance” by the economic, where “in the last instance” refers not to pre-
determination, but at the very least to multiple determinations and over-
determinations, and where “the economic” at least has structural, ideologi-
cal/subjective, historical/anthropological, and epistemological dimensions.

INTRODUCTION 15
 The question of the mutual investment of the life sciences and capital,
therefore, can open itself up to a number of different explanatory schema
that are attentive to contingency without reifying the contingent as itself the
ultimate form of explanation; and that is what this volume does in different
ways. The specification of particular relations of co-production to particu-
lar types of consistent unfoldings is, in part, the project of this book. Each
chapter develops this relationship, explicitly or implicitly, in its own way; but
I would suggest that all the chapters, even the ones that do not claim to be
Marxist, are caught within a problematic that is shaped by the Marxian in-
heritance of thinking of the relationships between the co-productions and
mutual determinations of the life sciences and capital.
Investment is one of those wonderful dual-edged words that points simul-
taneously in different directions. On the one hand, it suggests monetary
investment in and by the market, speaking to regimes of valuation that fall
within regimes of calculability (if not determinate, then at least probabilis-
tic). On the other hand, it speaks to an emotional commitment—questions
of obligation, passion, ethics, morality, hope, love, and pain are all at play in
various peoples’ investments in the life sciences and in capital.
In one register, then, Lively Capital is about the commercialization of the
life sciences—its institutional histories, epistemic formations, and systems
of valuation. In a second register, however, it refers to the lively affects—the
emotions and desires—at play when technologies and research impinge on
experiences of embodiment, kinship, identity, disability, citizenship, accu-
mulation, or dispossession. In this volume, the topic of capital is specifically
allowed interpretive range. The intention is not to discuss the “effects” of a
particular new technological development, or the adequate ethical response
to such new developments; it is, instead, to see if a potentially fresh set of
approaches to looking at the life sciences and biotechnologies and their re-
lationships to the social, to “life” as lived experience, can be facilitated.

Life Sciences and Capital as Objects of Inquiry

Three points about the objects of inquiry that this volume addresses need
to be emphasized. The first is that Lively Capital, in its broadest conception,
is about a set of interactions between science and society wherein “science”
and “society” cannot be analytically purified from one another or assumed
as given. The chapters in this volume examine neither the “social impacts”
of science nor the impacts of society on scientific progress. Rather, as has
been the method of recent work in science and technology studies (STS),

16 KAUSHIK SUNDER RAJAN

both the scientific and the social are up for grabs here—none of the au-
thors assume or believe positivist narratives that portray either the techno-
science they study, or the culture, politics, or ethics within which that
technoscience is completely situated, as a stable or linear process. Second,
technoscience goes beyond the boundaries of the laboratory, even though
the laboratory is an essential site for technoscientific production. Techno-
science is equally produced in the deliberations and actions of policymakers
(state and nonstate), market actors, activists (whether opposed to techno-
science or fighting for its acceleration or intensification), consumers of
various sorts, editors of scientific journals, and patients. One of the meth-
odological challenges of studying lively capital is that it is not self-evident
where one should look, for technoscience is always already many things—a
collection of institutions, normative structures, practices, ideologies, and
vocations. And third, we are not just concerned with the actions and effects
of humans here. Indeed, both the actors of technoscience and the constitu-
ent elements of capital transcend human agency. Information, commodi-
ties, money, filings with the Securities and Exchange Commission, dogs,
air, rice, genes, websites, and search engines, all make their appearance as
central actors in the same way that scientists, policymakers, venture capital-
ists, bioethicists, and anthropologists do.
What, then, is lively capital as an object of study? Rather than strictly
define the life sciences or capital at the outset, this volume is focused around
topics that speak to their confluence, such as the promissory grammars that
surround the search for therapies, the circuits of circulation of pharmaceuti-
cals or other biologicals, questions concerning the increased recourse to in-
formation sciences in fields such as genetics or environmentalism, and the
various legal techniques and political strategies deployed in order to moder-
ate debate and construct authoritative governance regimes. Nonetheless, it
is important to justify why the life sciences and capital are so central to this
volume, and what is so lively about either or about their confluence.
In an attempt to theorize the contemporary, we encounter the persis-
tence and intensification of the life sciences as one of the foundational epis-
temologies of our times, rather in the manner in which Michel Foucault
diagnosed biology, political economy, and philology to be the foundational
epistemologies upon which modernity was built in Enlightenment Europe.
There have indeed been profound shifts in the understanding of “life” over
the past half century. The life sciences are a shifting referent, and the bi-
ology of today often bears little apparent relation to the biology of the nine-
teenth century.

INTRODUCTION 17
 Simultaneously, we can see shifts in the locations of knowledge produc-
tion in the life sciences, such that research is increasingly performed in
corporate locales, with corporate agendas and practices. This is a corpora-
tization, as mentioned earlier, that has been particularly marked since the
1980s and that intensified through the 1990s and the early part of the new
millennium. An immediate challenge faced by work such as that contained
in this volume is to trace the contours of this institutional shift, all the while
situating it in the context of the epistemic and technological changes hap-
pening within the science, especially the trend in the last half century toward
understanding biology at the cellular and molecular level, rather than at the
level of the organism.13 This move toward the molecular is related to the
increased ease with which life gets conceived and represented in informa-
tional terms. Both commodities, such as therapeutic molecules, and “basic”
scientific knowledge, which can itself be more and more easily represented
as information, and packaged and commodified as, for instance, databases
or diagnostic kits, are being created in this increasingly corporate environ-
ment. If STS has always been concerned with the construction of scientific
facts, then what does a scientific fact mean, and how does it operate as a fact
in the world, when that world is increasingly that of the market? How are
these facts constituted differently in the market environment than the way
in which they were constituted in a “traditional” scientific ethos, and how
are objects and subjects in the world constituted in turn by these facts?14
What is the relationship of the scientific representations performed by these
facts to political representation? And how can we situate these changes in
the technoscience and in the institutional contexts of their conduct com-
paratively, in different parts of the world?
At stake in this co-production of new forms of knowledge about life with
new sites of such knowledge production are ways to intervene in and adju-
dicate on matters of health, life, and death, such as for instance through
resultant emergent practices of medicine or nutritional supplementation
of food crops. Therefore, the changes that this volume seeks to trace con-
cern the changing nature and relevance of the biopolitical, referring to Fou-
cault’s diagnosis that one of the markers of modernity is the way in which
its institutions and discourses seek to put life at the explicit center of politi-
cal calculation (Foucault 1990 [1978]). Biopolitics plays out or gets trans-
formed through questions of rights and ethics, such as privacy, informed
consent, ownership, and the fluid and contested boundaries that separate
the public domain from legitimate private property, and is, at least in part,
economic. The question of the economies, mechanisms, and multiple deter-

18 KAUSHIK SUNDER RAJAN

minations and overdeterminations of the co-production mentioned above,
where “economy” refers not just to the quantitative measures of productivity
or profit, but also to the regimes of value, both material and symbolic, that
form the theater of political articulation, is in many ways the central one for
Lively Capital.
Value is a central concept for this collection, and links questions of politi-
cal economy to those of ethics and governance. It is a double-jointed word
that implies not just material valuation by the market, but also a concern
with meanings and practices of ethics. This is particularly salient for indus-
tries such as biotech and pharmaceuticals, which generate significant sym-
bolic capital from being, as they are never averse to pointing out, in the
business of saving lives. Systems of valuation are animated by abstractions
that go beyond quantitative material indicators, and the ethical is often a
shorthand that black-boxes these abstractions. Among the tasks of this col-
lection is to open the black box—to posit ethics not as independent of po-
litical economy, but rather to see how the two are articulated, ethics being
an integral part of the political economies of the life sciences and biotech-
nologies. Equally, ethics contains its own political economies and capacities
for being institutionalized and made corporate. Therefore, parallel to emer-
gent regimes of technoscience and capital are emergent regimes of ethics,
with increasingly powerful voices in constructing discursive, normative, and
ideological terrains. The analyses of these cannot be compartmentalized or
kept easily separate from one another, which is why a number of the con-
cepts concerning value in this collection are those like promise, hope, hype,
obligation, and love—none of these evidently political-economic terms, yet,
as they operate through this volume, absolutely central to the analysis of the
liveliness of capital, of the life sciences and capital, of Lively Capital. Value
also operates at multiple scales, from the local to the global, and the his-
torical and geographic contexts from which the papers speak are essential
to resist a positivist rendering of value, whether market value or ethical or
symbolic value, as somehow unitary and universal. This volume, then, asks
how and in what ways it becomes possible to think about ethics and politics
in technocapital, and in our emergent worlds.

Intellectual Trajectories

I wish here to suggest four intellectual trajectories that operate at different

scales in the work represented here, without making any claims to providing
a review of the range of work done on the life sciences and society.15 The first

INTRODUCTION 19
two are the trajectories of science and technology studies (STS) and social
and cultural anthropology as separate fields; the third is their convergence;
and the fourth is the impact on social theory, more broadly construed, as in-
formed by the first three trajectories.
On the face of it, Lively Capital is conceived as an interdisciplinary ven-
ture that goes beyond the two disciplinary trajectories of STS and anthro-
pology, and the volume brings together contributors housed in disciplines
and areas of inquiry as broad and varied as African studies, anthropology,
comparative literature, history of consciousness, public policy, rhetoric, STS,
and sociology. A number of these fields of inquiry are themselves recently
constituted and continuously emergent interdisciplines. And yet, the pri-
mary concern of the chapters in this volume lies in tracing particularly rapid
contemporary emergence. This brings with it a set of methodological and
conceptual challenges, which speak most directly to the current disciplinary
concerns of anthropology perhaps more than any other. Without wishing to
claim a particular disciplinary imprint for this collection, I think it is fair to
say that the conjuncture in the humanities and social sciences that sets the
stage for a volume such as this is an emergent and still fluid conversation
between the amorphous methods of STS and the more entrenched (in insti-
tutional terms) discipline of cultural and social anthropology. This has re-
sulted, on the one hand, in an increased turn toward ethnographic method
by sociologists of science and technology, who in many ways dominated STS
in the 1980s, and, on the other hand, in a serious pedagogical and theoreti-
cal engagement with STS literature that has arisen from outside the canon
of disciplinary anthropology by anthropologists.
It should be noted that STS, while a small field, itself has multiple gene-
alogies. The foundational ones, in many ways, grew out of the Edinburgh
school of the sociology of scientific knowledge (SSK) and its subsequent de-
velopment in France through actor-network theory (ANT).16 But there were
also other genealogies of STS represented within the United States—such as
at MIT, where I received my doctorate—that grew out of other intellectual
trajectories. In the case of MIT’s STS program, such trajectories included,
crucially, both the history of technology and the American political context
of the late 1960s and early 1970s, which had seen science and technology
reconstituted as intensely political sites of civic engagement.17 Feminism
provided another crucial genealogy and introduced hitherto ignored dimen-
sions to the study of technoscience, such as by looking at the gendered and
racial nature of its discourse and practice, or by generating more embodied,
experiential accounts of technoscientific development, or simply by writing

20 KAUSHIK SUNDER RAJAN

about science and technology to an audience committed to feminist praxis.18
By the late 1980s, anthropology was also getting explicitly interested in sci-
ence and technology as an object of ethnographic study, a seminal marker of
which was Sharon Traweek’s ethnography of high-energy physicists, Beam-
times and Lifetimes (1988).19
A crucial marker of a certain anthropological turn that subsequently
opened the discipline up to something like STS was the “writing culture”
moment of the mid-1980s. The publication of Writing Culture (Clifford and
Marcus 1986) and Anthropology as Cultural Critique (Marcus and Fischer
1986) made tangible an “experimental moment” in the human sciences,
and in anthropology in particular, which had been brewing for the previous
two decades of the discipline’s encounter with political economy, psycho-
analysis, and poststructuralism. The books represented, simultaneously, a
certain (particular) coming to fruition of a Geertzian interpretive anthro-
pology and a promissory note for a modality of work yet-to- come. Calls for
multisited ethnography that developed over the subsequent decade (for in-
stance, Marcus 1995a) were elaborated out of this mid-1980s moment and
represented one programmatic idea for the development of ethnographic
research projects that were adequate to the contemporary intellectual and
political moment of globalizing (post)modernity.
The ambition here concerned an at the time unstated recognition of
the fact that ethnography had, in Douglas Holmes’s and George Marcus’s
formulation (2005), to be “refunctioned” in a fundamental way given the
changing objects of ethnographic inquiry. Writing Culture itself did not have
the words to articulate this refunctioning, which it was already calling for,
though scholarship in the subsequent two decades has argued for it in dif-
ferent ways.20 It is in the context of the decentering and refunctioning of
ethnography that STS comes to matter, because, regardless of whether the
dialogue with anthropology is explicit or not, recent ethnographies of sci-
ence and technology have contributed to methodological debates within an-
thropology.
What one sees, therefore, is the development of an amorphous and inter-
esting conversation between anthropology and STS over the past two de-
cades, though the trajectories and investments of that conversation are not
uniform. This has happened at a moment when STS has turned to ethnogra-
phy as a crucial modality through which to describe technoscience, supple-
menting and in some cases supplanting earlier foci that drew on sociology
or history of science and technology. And at a parallel moment when anthro-
pology has started engaging with a great variety of objects and processes

INTRODUCTION 21
as ethnographic objects and sites of study, especially engaging with glob-
ally dispersed, rapidly emergent processes that are centrally involved in the
constitution of the modern world, technoscience being exemplary in this
regard. It is this intellectual context—of anthropology turning to techno-
science as an object of study, over the same period of time that STS turns to
ethnography as a method with which to study its objects—that this volume
is situated within.
I wish to suggest that the confluence of STS and anthropology is not
simply a traversal of interests across distinct disciplinary spaces. STS indeed
never really was a disciplinary space with clearly constituted boundaries,
except in certain departments. Anthropology has been such a disciplinary
space, with all the credibility, gravitas, and constraint that comes with dis-
ciplinary projects; but it has been marked by practices of inquiry that have
constantly exceeded the boundaries of its own disciplinary regulation. In
this sense, both STS and anthropology have been marked by an excess or
surplus, which is the “stuff of the world” that has bled into their practices of
inquiry to torque them. The coming together of anthropology and STS rep-
resents the coming together of two fields of inquiry that have always found
it difficult to contain themselves. However, in this process, neither remains
unchanged. Anthropology plus STS is not merely technoscience meets cul-
ture. Rather, it is the beginning of a profoundly interdisciplinary conversa-
tion, the likes of which can be seen in a volume such as this.
I illustrate what I mean by “interdisciplinary” by turning to the object
of study here, the life sciences, which have been particularly open to being
shaped by multiple disciplinary influences. When the life sciences turned
“genomic,” the importance of elucidating life processes in informational
terms became evident. This has, indeed, been evident for at least half a
century, as cybernetic understandings of life-as- code became normative in
molecular biology in the 1950s and 1960s.21 What genomics has allowed
in the last decade or so is a radical change in information-generating ca-
pacity, so that the epistemic dilemma of having too little information to
decode life processes at the cellular and molecular level became, almost
overnight, a dilemma of having too much information to make sense of.
Challenges of data generation very quickly became challenges of data min-
ing and data management.22 What this meant was that computational capa-
bility and informatics became central to the everyday operation of genomics
research, and suddenly biologists who had not been trained in computer
science had to start talking to computer scientists who often had little do-
main knowledge of biology. Interdisciplinary work in such a situation was

22 KAUSHIK SUNDER RAJAN

not a choice—it was necessary in order to successfully keep pace with the
very possibilities opened up by the experimental systems that were being
studied. What changed was not just the approach to doing things, but rather
the very nature of the problem; no longer was the question “How do we gen-
erate enough information to create meaning?,” but rather “How do we sift
through the information we have to create meaning?” Even the meaning of
data came to be at stake through these interdisciplinary encounters.
For me, this has deep parallels to the challenges confronting ethno-
graphic projects that are theoretical in scope and ambition. The problem
of theory today is not simply to “make sense” of things we see as empirical
observers of the world through frameworks that are already given. It is, in-
stead, to make sense of a problem when the very nature of the problem is at
stake.23
I wish to suggest therefore that the theoretical problem of this volume
is not to come up with the “theory of ” life or capital or governance or glob-
alization or markets or neoliberalism, but is rather to come up with forms
of inquiry that are adequate to studying a contemporary conjuncture of the
life sciences and capital that contributors to the volume believe is of world-
historical significance. My own investment in Marx, for instance, has noth-
ing to do with whether he was “right” or “wrong” in a predictive sense, but
has everything to do with the fact that he developed a mode of inquiry that
allowed an investigation into capital in ways that political economy, because
of the ways in which it had framed the problem in advance, was unable to
do. Similarly, the theoretical work of this volume is to think through the
modes of inquiry that might be adequate to studying the life sciences in all
its historically, socially, and politically situated manifestations, at a moment
when, in Michael Fischer’s formulation, “life is outrunning the pedagogies
in which we were trained” (Fischer 2003, 37).
Broadly speaking, there are four distinct nodes of emphasis in this vol-
ume. First, the most Marxian chapters focus directly on theorizing capi-
tal, occasionally (though not consistently) through a close reading of Marx.
Second are chapters that consider questions of property, primarily through
a study of intellectual-property issues in the life sciences and the ways in
which these controversies have redrawn boundaries of the public and pri-
vate. Third are chapters concerned most directly with questioning the spa-
tiality of biocapital and engaging the question of what “the global” means.
And fourth are chapters that are concerned most directly with the affective
dimensions of lively capital—the “surplus” constituted by obligation, desire,
and love, which cannot be captured by quantifiable political economic mea-

INTRODUCTION 23
sures. Elements of all of these emphases—concerning capital, the global,
property, and affect—are to be found in varying degrees in a number of the
contributions.

Overview of Contributions

This volume is divided into four parts. Part I, “Encountering Value,” en-
gages biocapital through different readings of value, showing how these
forms of value are always already relational and implicated in the creation
of certain types of subjects. Part II, “Property and Dispossession,” focuses
on the constitutive place of property in the establishment of various forms
of biocapital, as well as the expropriation that forms the conditions of possi-
bility for these property regimes to be instantiated in the first place. Part III,
“Global Knowledge Formations,” focuses on the epistemic and institutional
rationalities within which the life sciences can be understood at transna-
tional and global scales. And Part IV, “Promissory Experiments and Emer-
gent Forms of Life,” focuses on the affective and ethical dimensions of hype
and hope that are constitutive to emergent and experimental forms of bio-
capital.
Part 1 begins with Joseph Dumit’s experimental reading of volume 1 of
Marx’s Capital, “Prescription Maximization and the Accumulation of Sur-
plus Health in the Pharmaceutical Industry: The_BioMarx_Experiment.”
Dumit attempts to understand logics of contemporary pharmaceutical capi-
tal through Marx’s Capital, in the process of which he discovers that the
latter’s analysis holds up surprisingly well in describing the risk logics that
the former operates through (Marx 1976 [1867]). The key issue for Dumit is
understanding surplus in pharmaceutical logic, given the fact that for Marx
it is surplus value that constitutes the moment of exploitation of the worker.
Dumit comes up with the notion of “surplus health,” which is his analogous
concept to surplus labor. He defines surplus health as “the capacity to add
medications to our life through lowering the level of risk required to be ‘at
risk,’” a lowering that occurs through the setting of biomedical risk thresh-
olds.
Dumit is tracing a particular logic, a logic that acquires its power through
the fact that it speaks in a series of potentialities—the potential for future ill-
ness, the potential for future market growth, the potential for greater thera-
peutic consumption among ever larger segments of the world population.
Like Jeremy Bentham’s panopticon (Foucault 1977), this logic does not have
to be realized in an actual visible structure for it to create its effects and af-

24 KAUSHIK SUNDER RAJAN

fects. The risk threshold is the key to the operation of this potentiality; it is
that which is set by biomedicine in order that its logic might unfold, in a
manner analogous to the way in which the setting of wage by capital is the
moment at which the conditions of possibility for the creation of surplus
labor are set up and calibrated. In this logic, market size does not matter
as much as market potential does, because the former is simply a retro-
active indicator of events already gone by and therefore not a true indica-
tor of value, which is always future oriented; just as in industrial capital,
the realization of value occurs not through profit (the actual, quantifiable
amount of money made over that expended), but through surplus labor (the
potential for labor productivity in excess of that remunerated by wage). The
logic of capital here is therefore thoroughly speculative.
The other chapters in part I locate Dumit’s analysis of pharmaceutical
logics of value generation next to other forms of value, thereby showing how
even the surplus value that Dumit traces in rigorously Marxian fashion is
animated in various ways by what Donna Haraway calls “encounter value.”
Haraway’s “Value-Added Dogs and Lively Capital” argues that Marxian cate-
gories of use and exchange value are relationally constituted and there-
fore mediated by encounters. In other words, the fundamental categories of
Marx’s labor theory of value are subjective.24 She develops this argument
through an account of dog-human interactions wherein dog worlds are in-
creasingly technocorporate.
Haraway focuses on dogs in part because of the constitutive history of
canine labor power in the story of capital, a history that is not a part of the
dominant narrative of capital as it gets told. But the insertion of dogs into
systems of capital is not just as labor, but is rather threefold: in contempo-
rary U.S. culture, dogs are also, themselves, commodities, as well as con-
sumers of commodities. In an uncanny link to Dumit’s chapter, Haraway
points out that the size of the pet-food market in the United States in 2003
was equal to the size of the statin market that year.
The larger conceptual argument about exchange that Haraway is making
here is one that has been made by a number of feminist science-studies
scholars, which is that questions of exchange are always underwritten by
those of kinship.25 Kinship, in this context, operates at two levels. The first
is at the level of the human-animal familial bond, while the second is in
the importance of tracing canine pedigrees. Haraway points to the “human-
animal companionate family” as a diagnostic marker of contemporary U.S.
capitalism, which sees a “productive embrace of kin and brand.” And so, sta-
tistical issues such as the size of the pet-food market have to be considered

INTRODUCTION 25
in relation to affective issues in particular biopolitical situations involving
dogs’ health and illness, their life and death, where these situations often
manifest as a consequence of the dogs’ subject-position as a kin member in
human households. For instance, Haraway’s question “How does a com-
panion animal’s human make judgments about the right time to let her
dog die?” speaks, on the one hand, to the increased salience of such ques-
tions when biomedical technologies of intervention allow canine lives to
be prolonged through the diagnosis and treatment of illness in ways not
possible before. But it also feels like a resoundingly familiar question to
those concerned with the human impacts of new biomedical technologies,
a question that (at the time of its writing, in November 2004) provided an
uncanny anticipation of such debates that took political center-stage in the
United States, through 2005, in media spectacles such as that surrounding
the death of Terri Schiavo.
Timothy Choy’s chapter, “Air’s Substantiations,” shows how the air in
Hong Kong is simultaneously felt experience, pollution, literary imagery,
and the substance of transnational capital negotiations. Choy therefore
locates how the environment simultaneously becomes a health problem and
an economic one. Air matters, and this mattering refers both to the materi-
ality of air and to the fact that it is an object of concern, care, and investment
among those who are affected by it. Choy’s attempt in his piece is to layer the
various ways in which it matters. He is concerned with “four forms of air . . .
(1) air as medical fact, (2) air as bodily engagement, (3) air as a constellation
of difference, and (4) air as an index for international comparison.”
This superimposition of different forms of air points to the “warp and
woof of the network being woven.” These are global networks of fact, capital,
affect, and lived experience. The manner in which Choy investigates air—as
simultaneously material and abstract, as object and signifier, as circulating
matter and as an object that we enter into constitutive lively relationships
with, and as something that, while often taken for granted, functions at mul-
tiple registers simultaneously—shows an uncanny resemblance to the way
in which Marx considers money, in Grundrisse, as, simultaneously, means of
exchange, measure of exchange, universal equivalent, and as world money
(Marx 1993 [1857]).
These interweaving registers produce Hong Kong as at once a global and
a local site. They are saturated with the particularities of Hong Kong’s his-
torical and cultural specificity, but are also entirely dependent on locating
Hong Kong’s air as part of the global environmental problem that tran-
scends boundaries and place. Choy therefore talks about air in Hong Kong

26 KAUSHIK SUNDER RAJAN

in terms of what he calls a “poetics of place,” where “place” does not signify
locality as much as it signifies the particularities that are located within, and
in turn both shape and defy, larger structures.
Property is the central analytic that structures part II of this volume. The
chapters by Sheila Jasanoff and Elta Smith focus on intellectual-property-
rights issues in biotechnology. Jasanoff ’s chapter, “Taking Life: Private
Rights in Public Nature,” looks at the way in which the law constructs the
boundaries between public and private by considering landed property
(through a reading of the U.S. law of takings) against intellectual-property
(IP) debates surrounding new biotechnologies. The takings clause considers
the contexts in which the state can appropriate land for “public” purposes.
Jasanoff argues that what constitutes a public purpose in fact involves a cal-
culus of a range of material against nonmaterial values, where the material
values often pertain to property, and the nonmaterial ones concern abstract
concerns of “public good” that by definition are hard to quantify. In this cal-
culus, property rights often function as the limit to taking land for public
use.
Intellectual property is a set of rights given to inventors, thereby signi-
fying “invention,” which is man-made, and has to be distinguished from
a “discovery,” which involves finding something that is deemed to occur
naturally. The process of granting IP rights involves, as Jasanoff puts it, “a
removal of the thing being patented from nature to culture.” A major way
in which nature is converted to culture by law is to convert nature into prop-
erty, which can subsequently be rendered liquid and made to circulate. The
diagnosis of these bounded categories—“invention” and “discovery,” which
map onto the boundary between “nature” and “culture,” where what is at
stake is “public” and “private”—as typical of modernity is central to Bruno
Latour’s analysis in We Have Never Been Modern (1993). Rather than leave it
at diagnosis, however, Jasanoff empirically investigates the steps that need
to be taken in order to shift an object through a particular legal materializa-
tion from a “natural” to a “cultural” domain.
A crucial incongruence, however, is set up between the form of law and
its content. There is a fundamental formal aspect to the functioning of IP
law in advanced liberal societies, one which sees it functioning consistently
in certain ways to demarcate nature from culture, public from private. And
yet, legal outcomes that follow the same logic of the law could vary radi-
cally, as seen in the different outcomes on the Harvard OncoMouse patent
(which was held to be valid in the United States and subsequently in most
advanced liberal countries, but denied by the Canadian Supreme Court).26

INTRODUCTION 27
Understanding these different interpretations of patent law in the Onco-
Mouse case, according to Jasanoff, involves understanding both the different
conceptions of life and liveliness that are stake in the two situations, and the
different imaginations of the public good that are at play—different abstrac-
tions that animate particular legal materializations.
Elta Smith’s chapter, “Rice Genomes: Making Hybrid Properties,” relates
property to health via nutrition through a study of rice-research endeavors.
The discourse of rice genomics is one of food security for the Third World
as well as one of commercial value. Indeed, Smith shows that much of the
primary value of rice as an object of genomic research comes from the fact
that it serves as such a good model organism for more profitable food crops
like maize, wheat, and soy. Hence, nutrition or food security is increasingly
articulated through and constrained by commercial viability or profitability.
In addition to this institutional movement is a movement within rice re-
search toward an emphasis on genomics, where information becomes a key
material object whose access and ownership becomes essential to regulate.
The corporatization of biology occurs simultaneously to biology becoming
more of an information science. The multiple material forms of rice—“as
scientific (genetic and genomic) information, as a model cereal, as a major
food staple, as a cultural icon”—are as crucial to trace as the multiple insti-
tutional forms that emerge to conduct research on rice.
Smith writes about four different rice-genome projects, of which two
were publicly funded and two privately funded. She shows that in fact it is
difficult to demarcate what constitutes private property from what consti-
tutes the public domain in each of the disclosure arrangements that sur-
round these efforts. Rather, a spectrum of property forms emerge, none of
which are purely “public” or “private,” but are a hybrid of the two.
As the environment of rice research becomes increasingly corporate, re-
search priorities shift toward where the markets are. Rice, being primarily a
Third World staple crop, is not particularly attractive in this regard. But this
profit-making imperative is in tension with a philanthropic imperative that
has become increasingly articulated out of corporate environments. Thus,
while rice is an object of corporate research interest because of its value as
a model organism, the corporate discourse surrounding rice research is one
that constantly emphasizes the social responsibility that is being fulfilled by
research that is geared toward meeting Third World nutritional needs. How-
ever, Smith shows that the public beneficiary of “public” research is never
clearly articulated. None of the intellectual-property debates around rice re-
search even touch on questions of the commodity status of new or better

28 KAUSHIK SUNDER RAJAN

rice strains, questions of seed availability, or distribution mechanisms, all of
which are essential to food security.
Jasanoff ’s and Smith’s chapters look at the workings of intellectual prop-
erty, in law and in practice. In the process, fundamental ontological ques-
tions—concerning nature, culture, value, the boundaries between com-
modities and objects in nature, or between the public domain and private
property—all come to be at stake. The next two chapters, by Travis Tanner
and Kristin Peterson, locate these ontological questions in terms of histori-
cal conditions of possibility; specifically, in relation to the forms of dispos-
session that the authors argue are necessary in order for regimes of contem-
porary biocapital to function. This section, therefore, sets up questions of
property, which are themselves unsettled and in formation, in relation to
forms of dispossession that provide the grounds upon which, as Marx also
argued, capital emerges and functions.
Tanner’s chapter, “Marx in New Zealand,” is concerned with accumu-
lation in the context of the genetic dispossession of indigenous peoples
through projects such as the Human Genome Diversity Project (HGDP). He
argues that such dispossession is not merely material (as in the extraction
of human genetic material and its subsequent commodification through
intellectual-property protection), but also cultural. The HGDP itself was a
failed project, but similar practices of genetic archiving continue under new
guises, and indigenous populations are often subject to them. These archiv-
ing practices, Tanner suggests, are not just about the production of value
(whether scientific or commercial), but also of meaning. Such projects lead
to the creation and reinscription of certain grand narratives—of capital and
of modernity—that indigenous populations are subsumed into through
their dispossession. What gets dispossessed, in part, is the possibility of
alternative narratives to the grand genomic narrative, which is always al-
ready inscribed within a grand narrative of capital.
The question of narrative is crucial for Tanner. Hence, he approaches his
argument not through an ethnographic study of technoscience, but rather
through the reading of native literature. He focuses on Patricia Grace’s novel
Baby No-Eyes (1998), which is about Maori genetic dispossession based on
a case of genetic theft that occurred in Wellington Public Hospital in 1991.
This novel, and hence Tanner’s argument, situates the question of biomedi-
cal ethics in the context of a larger and ongoing history, the struggle for
land rights by indigenous people in New Zealand. Questions of genomic
ethics, in Tanner’s argument, cannot be divorced from this larger histori-
cal contextualization concerning landed property; but they also cannot

INTRODUCTION 29
be divorced from questions of narrative representation about indigenous
peoples’ stories. Tanner attempts to address these questions of narrative rep-
resentation alongside those of legal and political representation.
The narratives of past and future get weaved together in the context of
native populations as targets of genomic sampling experiments in that these
experiments—seen by native populations as dispossession of something
that is theirs and that is sacred—mirror the earlier dispossessions of land
that were essential, in the first place, in making native populations frag-
ile, on the verge of “extinction,” and worthy of this kind of sampling effort.
Therefore, Tanner’s chapter has deep concerns with notions of property and
ownership—are genes something that “belong” to their bearer, or can they
become the intellectual property of scientists experimenting on them?
Kristin Peterson’s chapter, “AIDS Policies for Markets and Warriors: Dis-
possession, Capital, and Pharmaceuticals in Nigeria,” argues that Africa is
a site that gets “emptied out,” extracted of its resources, and understanding
this active dispossession is essential to understanding the nature of contem-
porary capital flows into Africa. Peterson’s chapter concerns the nature of
capital flows, but equally of Africa’s relationship to globalization. Her insis-
tence is that Africa is not simply a marginal entity that is outside the global,
or “left behind.” Rather, it is constantly articulated into the global through
trade, aid, development, and economic policy. In Peterson’s rendering, an
analysis of capital that focuses on wealth accumulation (whether through
speculation or manufacturing) is not enough, because that accumulation
is always undergirded by other logics—of wealth extraction and disposses-
sion—that are simultaneously at play. Further, Peterson shows that accu-
mulation by dispossession is not something that comes before “real” capi-
talism, but is an ongoing process that is a necessary condition of possibility
for global capital to function.27 This chapter provides an interesting contrast
to Dumit’s analysis, for what is at stake here is access to drugs, rather than
an excess of them. And yet, access becomes a problem for Africa at the same
time that excess becomes a problem in the United States through very simi-
lar neoliberal logics.
Access itself becomes a problem not just because of a constitutive lack of
capacity, as is often portrayed, but because of specific, historical moments
of dispossession that emptied out capacity. The implementation of World
Bank and International Monetary Fund (IMF) mandated Structural Adjust-
ment Programs (SAPs) in 1986 is a crucial moment in this regard. Peterson
argues that SAPs eviscerated Nigeria’s pharmacy industry, thereby destroy-
ing its drug- distribution infrastructure. This means that even when drugs

30 KAUSHIK SUNDER RAJAN

now flow into Nigeria through global aid schemes, there are no adequate
mechanisms for their distribution. The military must therefore be deployed
to distribute drugs, hence articulating pharmaceutical economies with mili-
tary ones.
Part III begins with Andrew Lakoff ’s piece, “Diagnostic Liquidity: Mental
Illness and the Global Trade in DNA,” which elaborates the theme of global
trade. Lakoff traces the French biotechnology company Genset’s attempts to
look for genes for psychiatric illness in Argentine mental patients, showing
the ways in which both institutional arrangements and epistemologies are at
stake in such efforts. The key here is establishing the “potential universality
of genomic knowledge about mental health,” speaking to the key themes
of potentiality and universality that emerge in other chapters in the volume.
Establishing such universality would “render liquid” the mental illness ex-
perienced by Argentine patients as “globally” valid scientific information
that can travel as a potential commodity. In the process, Lakoff shows that
the very question of what constitutes a psychiatric illness is at stake.
The key issue of universality or particularity however is also an episte-
mic question, which, as Lakoff puts it, is one of “how to know . . . whether
a case of bipolar disorder in the United States [is] the same ‘thing’ as a case
of bipolar disorder in Argentina.” These questions become constitutively
ingrained in the problem of making the Argentine DNA liquid. This prob-
lem of epistemology is, further, not just a scientific experimental problem
of how to identify or classify bipolar disorder: it is also linked to compara-
tive questions of the nature of medical practice in Argentina as compared to
Europe or North America, with the clinical diagnosis of bipolar disorder as
such being much less common in the Argentine context. Therefore, while
protocols for DNA sample collection or ethical regimes for informed consent
could be quite easily standardized in the Argentine context, ventures such
as Genset’s also require a prior standardization of medical information, a
much more difficult goal to achieve in practice.
A further complication arises from the fact that, as Lakoff shows, “bi-
polar disorder” is itself a biomedical category that has evolved along with
the rise of a pharmaceutical-centered approach to psychiatric treatment. The
purported universality of patients with bipolar disorder, therefore, hits up
against the particularity of “bipolar disorder” as a disease category in the
first place. And this particularity is highlighted by the Lacanian psychoana-
lysts who treat mentally ill patients in a ward adjacent to that in which, in
the same hospital, the medical geneticists are collecting DNA samples from
Genset. Complicating the epistemic difficulties faced by the medical geneti-

INTRODUCTION 31
cists in the story is the inherent subjectivity of psychoanalysis, which also
makes scientific claims, but in opposition to the objectivity and classificatory
impulses that lie at the heart of the epistemology of molecular genetics.
Wen-Hua Kuo investigates imperatives of standardization in his chapter,
“Transforming States in the Era of Global Pharmaceuticals: Visioning Clini-
cal Research in Japan, Taiwan, and Singapore.” Through a comparative study
of Japan’s, Taiwan’s, and Singapore’s responses to imported drug products,
Kuo looks at the moves toward regulatory standardization that occur when
clinical trials become global and travel to Asia. This analysis sees the articu-
lation of concerns with trade, with health, and with race.
Kuo’s empirical material is drawn from the International Conference on
Harmonization of Technical Requirements for Registration of Pharmaceu-
ticals for Human Use (ICH). The primary attempt here is to “create a univer-
sal standard for drugs by neglecting as much as possible bodily differences,”
wherein “one will finally fit all.” This is a logic that is deeply at odds with
the personalizing logics of pharmaceutical marketing that Dumit describes,
pointing to capital’s contradictory impulses to universalize target popula-
tions (a move that consolidates potential markets instead of segmenting
them) while individuating the subjects of therapeutic intervention (an indi-
viduation that is at the heart of neoliberal logics of self-governance).
Japan’s particularity was its insistence that clinical trials be reproduced
on Japanese populations in order for the results to be deemed applicable for
drug marketing in Japan. Underlying this insistence was an assumption of
fundamental racial or ethnic difference. In contrast to Japan, Kuo shows,
Taiwan embraced ICH guidelines. This was a strategic assertion of national
identity that showed Taiwan’s ability to set regulatory guidelines for itself in-
dependent of the People’s Republic of China. Meanwhile, Singapore’s incen-
tive for embracing harmonization is economic, with the burgeoning local
biotech industry likely to be a beneficiary.
Kuo shows that each of these national responses attempts to authorize
itself through science. Therefore, Japanese scientists are shown to embark
on research that points to stratification and population uniqueness, such as
population genomics. At the same time, Taiwanese researchers adopt, em-
phasize, and deploy other types of statistical data in order to justify their
inclusion in ICH regimes. Singapore’s case is tricky because of its highly
multiethnic population, and so the state and researchers “just ignore racial
difference” altogether. A comparison of these scientific strategies highlights
the arbitrariness with which race or population or biology get accounted for
or discounted in biomedical regimes. Yet it is precisely such arbitrary moves

32 KAUSHIK SUNDER RAJAN

that set the conditions of possibility for subsequent “scientific” experimen-
tation and the authority that stems from such science.
Environmentalism and scale-making are the subjects of analysis in Kim
Fortun’s chapter, “Biopolitics and the Informating of Environmentalism.”
Fortun looks at how informatics mediates political transitions at a number
of scales. She does so by looking at how environmental informatics takes
shape at a number of sites, such as environmental websites like scorecard.
org; the deployment of environmental “worst- case scenarios” in politics and
policymaking; or the ways in which informatics capacity leads to the eluci-
dation of environmental factors involved in increased risk of asthma. In all
of these sites, environmental informatics becomes a site of biopolitics. In
Fortun’s words, information technologies become “drivers of change at mul-
tiple scales.” In this sense, “informationalism” becomes the analog to the
industrialism that was at the heart of Marx’s analysis of nineteenth- century
capital.
The scalar dimension is key here, and is what distinguishes Fortun’s
analysis from linear-progress narratives of the glories of innovation. Indeed,
Fortun is precisely not interested in informatics as simply a site of innova-
tion, but rather in the ways in which it becomes one of “cultural production
and ethical action.” But the production of informatics deserves as much
ethnographic attention as its productivity. This is because there are mul-
tiple investments in informatics, by radically different institutional actors
(chemical companies as well as environmental activists, for instance), where
these investments are simultaneously material, ethical, and affective. The
production of informatics is “experimental,” in that it is a scientific activity
that is constantly being worked through and figured out, where the out-
comes are not known in advance or calibrated against a readily testable hy-
pothesis. But the production of knowledge through informatics is not just
determined by the scientific experimentation that goes into the creation of
websites or risk scenarios; it is also crucially dependent on how such infor-
mation can be made public.
Fortun, therefore, maps a relationship between environmental-risk in-
formation and the public domain that is intensely political and that is, as
much as anywhere else, shaped through policy initiatives and their inter-
actions with corporate interests and grassroots mobilization. Unlike Smith,
who shows the way in which informatics and public- domain issues get
politically contested around the question of property, Fortun is concerned
with the way in which security becomes the locus of this contestation.28 In-
formatics becomes the medium through which uncertainty (in this case,

INTRODUCTION 33
environmental risk) becomes engaged. Unlike in Dumit’s case of pharma-
ceutical marketing, however, this engagement is not yet overdetermined or
controlled by corporate interests. Instead, Fortun argues that informatics
leads to the creation of “discursive gaps” within environmentalism that pro-
vide the potential for various sorts of political action, including possibly
revolutionary ones. While the setting of clinical risk thresholds is an act of
scientific expertise in which the experts are exclusively those sanctioned by
the state or by corporations, the articulation of environmental risk is an ex-
pert discourse where “expertise” is constituted in a more polymorphic and
potentially democratic fashion.
Part IV begins with Michael Fortun’s chapter, “Genomics Scandals and
Other Volatilities of Promising.” Fortun concerns himself with the tem-
porality that is ingrained within promising, which is the temporality of “a
future still to come” (in opposition to a teleological future, a future that will
be).29 The empirical material that he draws on is the story of the controver-
sial Iceland-based genome company DeCode Genetics, which is archetypical
of speculative capital.
Fortun traces the grammar of hype. The hype of genomic corporate dis-
course is deeply entangled with the epistemology of genomics, which also,
constitutively, concerns itself with statements about the future. The promise
in terms of scientific potential that genomics carries is inseparable from the
promises that genome companies make about their potential as value gen-
erators in capital markets. The promises of genomics are therefore twofold,
concerning themselves both with technoscientific possibilities and with ex-
pressing promises that are inscribed within the genome itself. In Fortun’s
words, “Being promising . . . is a fundamental aspect of the being of that
favorite model organism of genomicists, a human.”
On the one hand, then, the promise is “ubiquitous and unavoidable,”
whether in language (as Fortun shows through reading Derrida), in the mar-
ket (as he shows by reading corporate filings with the U.S. Securities and
Exchange Commission [SEC]), or in the body (as he shows by reading geno-
mics). Indeed, that promising is not just a language game is evident in the
ways in which promising is made a material necessity, in both genomics
and in capital, by the law. Fortun traces how this process unfolded in high-
tech in the 1990s, especially the crucial role played by changes made by the
SEC in 1995 to the safe-harbor provisions of forward-looking statements.
These changes made it easier to protect forward-looking statements—which
are statements released by companies that speak directly or indirectly to
their revenue or growth potential in ways that could significantly influence

34 KAUSHIK SUNDER RAJAN

investors—from anti-fraud litigation. The materialization of hype through
changes in SEC provisions made hype both essential and legally mandated.
Far from being deemed an act of irrational excess or dishonesty, hype be-
came constitutive to the discourse of high-tech capital, in ways that were
nontrivial and had consequences—not least for ordinary Icelandic investors
in the stock market.
Situations of commitment and indebtedness within families are the ex-
plicit themes of Chloe Silverman’s chapter, “Desperate and Rational: Of
Love, Biomedicine, and Experimental Community.” Silverman writes about
the ways in which family, kinship, and commitment are all evident in autism
research. Autism constitutes a poorly understood, untreatable spectrum of
disorders; therefore, when parent-advocates of children with these disorders
call for treatment, their requests seem like desperation. In the process of
making such calls, parents of autism-afflicted children frame the disorder as
biomedical, thereby rendering it potentially treatable. This forcible render-
ing of a condition as biomedical has interestingly different resonances in the
case of autism than it does in the context of bipolar disorder as addressed in
Lakoff ’s chapter. While in the latter case, biomedicine constitutes the hege-
monic discourse of global capital and reductive, corporate- driven genome
science, in the setting of autism it is biomedicine that forms the “alterna-
tive” discourse.
Silverman’s chapter traces the way in which this biomedical knowledge is
produced in parent-practitioner communities. Empirically, it is an account
of a parent advocacy project, Defeat Autism Now! (DAN!). If Michael Fortun’s
chapter described a political economy of hype, then Silverman’s describes
what Carlos Novas and Nikolas Rose (2004) refer to as a “political economy
of hope.” What Silverman shows is the parents’ faith and investment in bio-
medicine, a particularly desperate and irrational kind of faith in reason and
rationality. They hold a belief that biomedical experimentation will provide
therapeutic outcomes for their suffering children, but this can only come
about if parents—many of whom are outside the circuits of expertise that
constitute the institutions of biomedicine—are involved in bringing about
such experimentation themselves (either through funding, or advocacy, or
collaborations with researchers, or in some cases, through getting involved
themselves in science). Their faith in science is entwined with the love that
animates this faith. Faith and love here are not opposed to objectivity, but
rather are involved in the creation of new forms of objectivity.
Such familial investment is hardly innocent or painless. Indeed, it in-
volves making the child an object of therapeutic experimentation, with all

INTRODUCTION 35
the risks that attend such subjection. Questions concerning such experi-
mentation are simultaneously epistemic and political. Choices are being
made and research agendas are being set, but by agents who do not fall into
the categories of actors—scientific or corporate—who normally are vested
with the authority to do so. One of the promissory terrains here therefore in-
volves the reconstitution of expertise, thereby potentially leading not just to
new therapies for autism, but also possibly reconstituting the very grounds
of biomedical knowledge production.30
Michael Fischer’s chapter, “Lively Biotech and Translational Research,”
concerns itself with experimental epistemology, institutional development,
and the “peopling” of technoscience. It is written as a memorial to the late
Harvard researcher Judah Folkman, one of the pioneers of angiogenesis re-
search, which came to have significant applications in the development of
anticancer therapies. Fischer begins by narrating Folkman’s “Decalogue,”
an account of the multiple challenges involved in translating experimental
research into the clinic.
But there are other sorts of translations, and translational challenges,
which are at play in the different tracks of Fischer’s narrative, for example,
interdisciplinary translations between experimental and informational sci-
ence; institutional translations between laboratory and market; the trans-
lation of skills between mentors and students, or between laboratories;
global circulations of knowledge through the mobility of graduate students
and postdoctoral researchers; and transnational translations that are occur-
ring through these circulations, as well as through institutional endeavors
(especially in Asia) to create new types of collaborative alliances that are not
necessarily centered on the traditionally powerful research centers of the
West. Hence, while earlier chapters in the volume (such as Tanner’s and
Peterson’s) focus on the dispossession that is constitutive to the operation
of technocapital, the Fortuns’s, Silverman’s, and Fischer’s chapters open up
the question of technocapital’s experimental nature and promissory poten-
tial. This promise is not simply articulated as a glorious narrative of inevi-
table innovation, but rather is worked through in terms of the constitutive
opportunities and challenges that are inherent in working within these
promissory arenas for its practitioners.
Fischer shows that the investments in emergent epistemic, institutional,
and “peopled” forms of the life sciences are not just financial or epistemic,
but also speak to individual biographical histories of migration, reflect dif-
ferent national sentiments and scientific priorities, and call not just on
structural constraints, but also on affect, aesthetics, and a whole range of

36 KAUSHIK SUNDER RAJAN

tacit skills—what might be considered, following Choy’s chapter, a “poet-
ics” of lively biotech and translational research. But these stories are not
merely contingent; they speak to larger structural and historical issues. For
instance, why are certain research initiatives privileged over others? When?
By whom? What are the implications, for instance, of Fischer’s account
(through a conversation with a Chinese postdoc based in the United States)
of agricultural biotechnology falling “out of the loop” in the United States,
such that cutting- edge work, where the fame and profit are to be found,
ends up being almost entirely in the domain of biomedicine? If the life sci-
ences, among other things, claim to provide us with knowledge about what
it means to be human, then who gets to decide what kinds of work end up
enabling or representing those claims? And how do these decisions operate
in the spaces and double-binds that exist between the structural and the im-
provisational, the expropriative and the promissory, between “what we have
been or what we will be” (Derrida 2002), the lively spaces of technocapital,
which are also the spaces for the emergence and contestation of the episte-
mological, the ethical, and the political?

Notes
1. According to Cynthia Robbins-Roth (2000), 11 percent of all federal research-
and- development money was allocated to basic biomedical research, and the Na-
tional Cancer Institute alone was spending nearly a billion dollars annually on basic
research by 1981.
2. For an account of the commercialization of the research university in the
1970s, with a specific focus on the Cohen-Boyer recombinant DNA patents and Stan-
ford’s licensing strategies, see Hughes 2001.
3. The RDT patent was jointly held by Stanford (where Cohen was employed) and
the University of California (where Boyer was employed), but Stanford handled the
licensing of the technology.
4. Maryann Feldman, Alessandra Colaianni, and Kang Liu document the actual
commercial value of the Cohen-Boyer patent. The value is measured not just in terms
of the market value of the technology itself, but also in terms of its function as a plat-
form for downstream product development. The patent generated $35 billion in sales
for 2,442 downstream products. The technology was licensed to 468 companies. By
the end of 2001, Stanford and the University of California had generated $255 million
in revenue from the patenting and licensing of the technology. The patent application
was filed in 1974, and the patent was granted in 1980, the year in which Diamond v.
Chakrabarty authorized the patenting of life-forms and in which the entrepreneurial
university received legislative sanction through the Bayh-Dole Act. The patent ex-
pired in 1997. See Feldman, Colaianni, and Liu 2007 for an elaboration of this case,

INTRODUCTION 37
which is regarded in many ways as a gold standard in strategic university technology
licensing.
5. I draw extensively on Feldman, Colaianni, and Liu 2007 in this account of Stan-
ford’s RDT licensing strategy.
6. In Biocapital, I have argued for the importance of staying attentive to what
Rosemary Coombe refers to as an “ethics of contingency with respect to commodi-
fied social texts” (Coombe 1998, 5; Sunder Rajan 2006). This was in response to the
unfolding politics around DNA patents, which were broadly condemned as the ulti-
mate signifier of the commercialization of the life sciences (reflecting, as it were,
the commercialization of “life itself ”). What did such a position signify, I wondered,
when major proponents for gene patenting included patient- advocacy groups for
rare genetic diseases, who argued that being about able to take out patents on gene
sequences expressed in such diseases was one of the few mechanisms to ensure that
they could have some control and direction over research into these diseases; and
when major opponents of gene patenting included big multinational pharmaceuti-
cal companies, who did not want their downstream product development fettered by
upstream property rights and licensing arrangements?
7. For Merton’s normative structure of science, consisting of the four norms of
universality, disinterestedness, communism, and organized skepticism, see Merton
1942.
8. Indeed, one can see this trajectory, wherein deep contestation regarding the
very grounds of capitalization gives way to a more naturalized acceptance of such
capitalization (even if the mechanisms and strategies of capitalization are varied),
in other parts of the world more recently. In the late 1990s and early 2000s, as the
Indian state pushed its scientific establishment to become more entrepreneurial in
its approach, I noted debates in India similar to those that had taken place in the
United States in the 1970s.
9. For Paul Rabinow’s development of an idea of method adequate to the an-
thropology of the contemporary, see, for instance, Rabinow 2003. Rabinow’s use of
the concept of assemblage, derived from Gilles Deleuze, is relevant here (Rabinow
1999). Rabinow defines assemblages as contingent articulations of heterogenous ele-
ments; and it is the mapping of these contingencies that Rabinow sees as important
for what he calls concept work. An elaboration of thinking with assemblages as a
methodological solution to what they call “anthropological problems” is provided
by Aihwa Ong and Stephen Collier in their introduction to Global Assemblages (Ong
and Collier 2005). Jasanoff ’s idea of co-production is something that forces us to go
beyond the contingent as explanation or solution; and Jasanoff herself, while deeply
attendant to the contingent and the particular, should not be misread in a manner
that simply allows one to substitute complex contingency for co-production.
10. The best-known example of Weber’s method in action as relevant to this argu-
ment is, of course, his analysis of the relationship between religion and capitalism
in The Protestant Ethic and the Spirit of Capitalism (2008). For Weber’s elucidation of
the ideal type and its role in sociological method, see Weber 1978.
11. Engels letter to Bloch, 1890 (Engels 1972 [1895]). I am grateful to Dominic

38 KAUSHIK SUNDER RAJAN

Boyer for conversations on the relationship of ideology to materialism, which have
helped me think through the question of determination “in the last instance.”
12. Indeed, the word ideology virtually drops out of Marx’s later writings. See Bali-
bar 1994 for a reflection on this fact.
13. The idea that life is information has been very much a part of the central
dogma of molecular biology since the 1950s, and sets the stage for more recent
emergences in the life sciences, such as recombinant DNA technology in the 1970s,
or genomics in the 1990s. For historical and philosophical reflections on the life
sciences becoming more molecular or informational, see Doyle 1997; Doyle 2003;
Jacob 1993 [1973]; Kay 2000; Keller 1995; Keller 2002b.
14. For the seminal essay that speaks to this “traditional” ethos, see again Merton
1942, which outlines the normative structure of science at that time—norms that dif-
fer radically from the corporate scientific ethos that prevails today in the life sciences.
15. Such a review would undoubtedly be a useful task, but it would be a different
task from introducing this volume, which is a particular reading, representation, in-
flection of such work writ large. Apologies, therefore, that crucial bodies of work in
the life sciences and society remain uncited. A useful resource to consult for such a
review would be Stefan Helmreich’s overview of what he calls “species of biocapital”
(2008).
16. On SSK see Bloor 1991 [1976]. On ANT see Latour and Woolgar 1986 [1979];
Latour 1987; Latour 1988; Callon 1986.
17. For work in this early MIT STS vein, see, for instance, Noble 1979; Weiner 1987;
Winner 1978; Winner 1988.
18. The list of relevant works in this genre is too extensive to cite here. But some
key works include Keller 1984, concerning women in science; Keller 1992, Martin
1991, and Cohn 1987, about the gendered nature of technoscientific discourse; Rapp
2000a, for an exemplary account of women’s experiences of new reproductive tech-
nologies; and Haraway 1991, for essays explicitly situating technoscience within
feminist praxis.
19. See Martin 1998 for an overview of the role of anthropology in the cultural
study of science and technology.
20. Particularly important in this regard is programmatic writing on anthro-
pology and ethnography by key contributors to Writing Culture, such as Michael
Fischer, George Marcus, and Paul Rabinow. See for instance Fischer 2003; Fischer
2007a; Fischer 2007b; Marcus 1995a; Marcus 2005; Marcus 2007; Rabinow 2003.
Over the past two decades Fischer and Rabinow have become central figures in STS,
not just through their own work, but through their mentoring of a generation of
graduate students doing ethnographic work on science and technology. Marcus has
been a curious, interested, and partisan onlooker of and interlocutor with the anthro-
pology of science.
21. See for instance Kay 1996; Kay 2000; Keller 2002a; Monod 1971.
22. I can illustrate this through personal experience of gene- expression studies.
Just a little more than a decade ago, I was engaged in a master’s research project
which involved studying gene expression in the slime mould Dictyostelium dis-

INTRODUCTION 39
coideum. Around the time I was finishing my degree, in 1996–97, the lab I worked
in adopted a new method called RNA differential display. What differential display al-
lowed was the ability to study gene expression in two different samples (say, between
a wild-type and mutant slime mould) in a single experiment. This study of differen-
tial gene expression could allow a comparison of the functioning of certain genes in
different states (for example, between different tissues, or between different stages
of development within a single cell type, or to look at whether a gene is turned on or
off in particular situations of stress or disease). However, one already had to know
which gene one was interested in to start with; and such a project could constitute an
entire doctoral dissertation. Within the next three years, however, high-throughput
technologies such as the Affymetrix DNA chip had been developed, which allowed
one to compare two entire genomes of interest for differential DNA expression in a
single experiment. For example, a major early publication that showed the utility of
the Affymetrix chip used it to differentiate acute myelogenous leukemia from acute
lymphocytic leukemia (Golub et al. 1999). This was a landmark paper because it en-
abled the classification of these two cancers based on the differential gene expression
patterns of fifty genes, without any prior biological knowledge. Normally, tumor clas-
sification would require clinical, pathological, and cytological analysis. Classifying
these cancers is of crucial importance in choosing the right treatment regimen, and
the regimens for these two types of leukemia vary considerably. Often cells that fol-
low different clinical courses look similar in biopsies, and traditional diagnosis of one
or the other form of leukemia requires a complicated battery of tests. The DNA chip
enabled this form of cancer diagnosis to move away from systems based on visual
analysis to molecular-based systems, and in this experiment, allowed the compara-
tive measurement of activities of nearly seven thousand genes expressed in bone
marrow samples from thirty-eight patients. In other words, one moved very quickly
from a stage of studying the expression of a single gene that was limited by how
much prior information one had about that gene, to a stage where one could study
the expression of seven thousand genes without any prior information about each
of them. This scaling up was entirely consequent to the development of informatics
capabilities that could generate and process large amounts of data very quickly.
23. See Rabinow 2003 and Rabinow 2004 on how problematization is the prob-
lem to be tackled. This is developed in conversations in Rabinow’s Anthropology of
the Contemporary Research Collaboratory (ARC), for which see www.anthropos-lab
.net. See also Aihwa Ong’s and Stephen Collier’s introduction to Global Assemblages,
for the development of the notion of “anthropological problems” (Ong and Collier
2005, 3–21).
24. Jason Read (2003) develops this argument for the constitutive place of subjec-
tivity in Marx’s political economy in a more philosophical vein.
25. For examples of such work, see for instance Franklin 1997; Franklin 2007;
Franklin and Ragone 1997; Franklin and MacKinnon 2002; Franklin and Lock 2003;
Ginsburg and Rapp 1995; Haraway 1997; Rapp 2000a; Strathern 1992a; Strathern
1992b; Strathern 2005.
26. This speaks to Jasanoff ’s crucial departure from Latour’s actor-network

40 KAUSHIK SUNDER RAJAN

methodology. While Latour’s diagnosis of the moves of purification that underlie the
modernist enterprise remain valid in both the U.S. and Canadian cases that Jasanoff
traces, the fact remains that the status of biotech patenting has emerged as signifi-
cantly different in the two locales. This reflects the importance of Jasanoff ’s insis-
tence on comparative methodology even within studies of advanced liberal societies,
which has threaded through all of her work but is clearly explicated in the context of
biotechnology policy in Designs on Nature (Jasanoff 2005a). See also Sperling 2006
for similar methodological moves in his comparative analysis of bioethics in the
American and German contexts.
27. “Accumulation by dispossession” is David Harvey’s term (2003).
28. Michel Foucault argues that security is one of the pillars of modern biopoliti-
cal governmental rationality, what he calls “governmentality.” See Burchell, Gordon,
and Miller 1991.
29. The distinction is by Derrida (1994).
30. See Epstein 1996 for a similar argument in the context of patient activism
around HIV- AIDS.

INTRODUCTION 41
 PART ONE

ENCOUNTERING VALUE
 1
JOSEPH DUMIT

PRESCRIPTION MAXIMIZATION AND THE

ACCUMULATION OF SURPLUS HEALTH IN

THE PHARMACEUTICAL INDUSTRY

The_BioMarx_Experiment

The late Roberto Goizueta transformed Coca-Cola in the early 1980s. He had
an insight—a simple but stunningly powerful one that he shared with his
senior executives. What, he asked almost casually, was the average per- capita
daily consumption of fluids by the world’s 4.4 billion people? The answer
was: 64 ounces. And what, he asked, is the daily per- capita consumption
of Coca- Cola? Answer: less than 2 ounces (Charan and Tichy 1998). “We
remain resolutely focused on going after the other 62,” Mr Goizueta said
(Coca- Cola Company 1996, 6). However absurd Goizueta’s redefinition of
the Coca- Cola Company’s market might seem, it has been taken as a key
transformative insight throughout the business world, demonstrating that
“every business is a growth business” (Charan and Tichy 1998, 435). And that
“virtually infinite growth” is a matter of finding the right formulation for the
virtual and then actualizing it. One pharmaceutical parallel to global human
liquid consumption is illness risk and the capacity to take drugs to ward it off.
The more I read about markets and talk with pharmaceutical marketers, the
more it seems as if this unbelievable growth in therapeutic consumption to
ward off the risk of illness is happening. In this chapter, I elaborate the logics
within the pharmaceutical industry that naturalize such growth.
Over the last twenty years, many scholars in medical anthropology and
allied fields, including myself, have studied pharmaceutical resistance—pill
diversion, strategic noncompliance, complementary and alternative medi-
cine, and organized antimedicalization movements—as positive, creative,
agentive challenges to the U.S. health system. While such resistance is wide-
spread, the scale of our analyses has been enveloped (though not eclipsed)
by the more general, macro scale of continued growth of pharmaceutical
prescriptions.
According to the data,1 which I have reviewed extensively with statisti-
cians and economists, the average insured American purchases ten to thir-
teen different prescriptions per year. Over 10 percent of all Americans,
and 50 percent of those over forty-five years of age, are buying cholesterol-
lowering drugs, a number comparable to that for antihypertensives. The
growth rate in users of chronic treatments has been and is conservatively
projected to be over 10 percent per year, and the total number of pills taken
grows 3 percent per year (Express Scripts 2007). Antidepressant use, despite
negative publicity on suicidal side effects, is projected to increase 5 percent a
year, and the rates of use remained steady in children even where such drugs
were more or less banned. Stimulants, especially attention- deficit drugs, are
growing 15 percent per year overall and 30 percent per year among those
under nineteen years old. The scale of the market in prescription drugs is
$500 billion per year. This does not include over-the- counter drugs, vita-
mins, nutraceuticals, alternative medicines, and so on.2 The challenge is
to account for the sheer amount of drugs being consumed and the mecha-
nisms of their continued growth.
The numbers arrest me, even if I don’t know how to believe them. What
has abducted my interest is the problem of accumulation—the state of bio-
chemical accumulation in the bodies of Americans continues at a rate that
seems unbelievable, absurd, and unsustainable. At the center of the pre-
scription growth in the United States are clinical trials as the key modality
for determining facts about health and treatment, and guidelines that use
those trials to redefine illness as a threshold. In this manner, health is re-
framed in the way that Goizueta reframed the potential consumability of
soft drinks as something that can be grown in a virtually unlimited manner.

“We want to recommend more aggressive treatment to people who are at

very high risk,” said Dr. James I. Cleeman, the coordinator of the group
that issued the guidelines, the “National Cholesterol Education Program”
of the National Heart, Lung and Blood Institute.
“And,” he added, paraphrasing Shakespeare, “there are more of them
out there than are dreamt of in your philosophy.” (Kolata 2001, 1)

46 JOSEPH DUMIT
 Cleeman’s suggestion is that clinical-trial implications exceed not only
what one thinks, but also one’s very imagination. To imply a failure of
imagination is to propose a need to reframe the problem. The people-at-risk
(patients-in-waiting), he intimates, are not visible, even to themselves.3 If
Americans want to be healthy in the future, they must necessarily trust clini-
cal trials and treat the numbers that they propose. Cleeman is talking about
guidelines, introduced in 2001, which lowered the recommended level of
bad cholesterol, thus tripling the number of people defined as high risk.
Within his declaration is an order of reality in which epistemology (where
clinical trials redefine high risk) determines that people who fall into the
newly identified category are now ontologically at high risk, and being at
high risk, they should (as in need to, ethically, imperatively) be put on treat-
ment. Even as Cleeman pronounced these words, though, new clinical trials
were under way that three years later, in 2004, would take the undreamed
of numbers of people he referred to in 2001 and triple them, to 200 million.
And in 2006 the thresholds were lowered even further.4
In a paragraph taken from an article in the Wall Street Journal published
in 2004, the author emphasizes a set of population statistics that intensify
an argument about the dangers of not listening to doctors and clinical-trial
data: “Only a fraction of people with high cholesterol are on statins, despite
a barrage of drug- company advertising backed up by guidance from public-
health officials. About 11 million Americans currently take one of the statins,
while some public-health experts say that at least 36 million should prob-
ably be on one. Globally, the discrepancy is even more dramatic: About 25
million are taking the pills while an estimated 200 million meet guidelines
for treatment” (Winslow 2004, 1). The new target number, of 200 million
people worldwide, represented one out of every thirty persons on the planet.
Universal screening programs and mass pharmaceutical regimes con-
tinue to regularly appear in the news, with the line between good use and
abuse being increasingly hard to draw. The twenty-first century has already
seen recommendations for mandatory cholesterol screening starting at age
twenty for all Americans and for prescribing standard pharmaceutical treat-
ments for the approximately 30 percent of the population expected to be
at high risk when tested. Children are subject to screening for obesity and
other risk factors for heart disease in similar ways. Each of these screens
works by setting a number, a threshold, which, when crossed, triggers a
diagnosis of risk or disease and a recommendation for treatment. Under-
lying the controversies surrounding mammograms, PSA prostate- cancer
tests, and other screens is a concern as to whether, in light of evidence sug-

THE_BIOMARX_EXPERIMENT 47
gesting that lower thresholds might help more people, there could be any
reason not to make the test more sensitive.
Looking at the growth rates and the projected rates of growth, I am con-
fused. How does “our” pill-taking continue to grow? My conversations with
colleagues, doctors, and economists invariably end with the interim con-
clusion that an ever-increasing prescription rate makes no sense. However,
despite actively looking for projections that prescription rates will taper off
in the future, I cannot find them. Instead, rates are predicted to grow 8–15
percent per year. While the number of prescriptions must surely, logically,
stop growing at some point, it seems there are other logics at work.
Rereading Marx, I heard echoes of this pharmaceutical logic, where in-
creases in productivity paradoxically create more work: “Hence, too, the eco-
nomic paradox, that [machinery,] the most powerful instrument for short-
ening labour-time, becomes the most unfailing means for placing every
moment of the labourer’s time and that of his family, at the disposal of the
capitalist for the purpose of expanding the value of his capital” (Marx 1976
[1867]). Could it be that health has become expandable? Doctors, govern-
ment health officials, pharma marketers, all pronounce the most mystical,
teleological sentences, as if they were channeling Marx about an infinite
imperative for accumulation, substituting pharmaceuticals in the body for
hours of labor: “We want to maximize the number of new prescriptions”;
“We want to identify people at risk at the earliest possible point.”
Marketers want to maximize the number of prescriptions in order to
maximize profits. They see clinical trials as investments whose purpose is
to increase sales of medicines: “Important clinical studies to conduct from
a scientific or medical perspective are sometimes not important studies to
conduct from a drug development perspective” (Spilker 1989, 372). Phar-
maceutical researchers openly express their unhealthy predicament: “One
of the significant problems for the Pharma industry is that of the 400 dis-
ease entities identified, only 40 are commercially attractive by today’s re-
quirements of return on investment” (Bartfai and Lees 2006, 14). They see
patients as points of resistance: “Pharma’s New Enemy: Clean Living” (title
on cover of Forbes, 29 November 2004).
Just substitute a few words and these marketers and researchers could be
quoting Capital. This is not surprising, for Marx was, after all, quoting the
industrialists of his day. What has shifted are the terms: it is Illness as Value
that is now being maximized, and the Health of Patients rather than their
Labor that is being exploited. There is a parallel in form: perhaps marketers

48 JOSEPH DUMIT
see unproductive health the ways capitalists saw unproductive labor. That
is, marketers may see clinical trials as investments that increase the extent
and intensity of prescriptions the way capitalists saw machinery as an invest-
ment that increased the extent and intensity of labor hours. The grammar
and logic of capitalists that Marx studied in Capital, in other words, seem to
be mirrored by strategies of pharmaceutical executives and marketers.
Step-by-step, the logic is impeccable. Everyone agrees with the basic
points and the underlying framework: first, since medicine is so expensive,
pharmaceutical companies are required to fund much of the research; sec-
ond, as companies, they must of course be able to earn a return on these
“investments.” This framework is not scandalous. If the analogy holds, then
it makes clear a strange dynamic: health as a growth field through treat-
ments; surplus health growth via clinical trials. Mickey Smith, the author of
a dozen classic works on pharmaceutical marketing, describes this indefi-
nite resource of health as growth. “For as long as everyone is destined to die
from some cause, a decline in one can only come at the expense of an in-
crease in another. This is an inescapable truth, yet there seems to be some
failure to recognize it. What society, and the pharmaceutical industry to
some degree, is doing is making conscious or unconscious decisions about
‘tolerable’ causes of death” (Smith, Kolassa, Perkins, and Siecker 2002, 32).
Smith is pointing out that if health is defined as reducing risk, then
health is an infinite phenomenon, since for every risk you reduce or elimi-
nate, you still have a 100 percent risk of dying from something else. The
limit to health research is not, then, a realizable healthy body, but a risk-
free body, which instigates a virtually infinite process. There is always room
for another study and another treatment, until patients can’t take any more
treatment due to side-effects, costs, or effort. To put this back in Coca- Cola
terms, where Goizueta took the prospective soft- drink market from a mea-
sure of people’s desires for Coke to the limit of their capacity to consume
liquid, pharmaceutical companies have redefined health from a measure
of symptom reduction to the limit of our body’s capacity to consume treat-
ments. How many drugs could we be mandated to take?
It looks therefore as if pharmaceutical companies have found a way to
grow health through clinical trials, redefining health as treatment, in part by
expropriating the means of diagnosing illness, through screening tests that
tell us and the doctor that we need treatment. Consequently, the interests of
the pharmaceutical industry lie not in reducing treatments, but in increas-
ing them. No matter how obvious this might seem now, I didn’t immediately

THE_BIOMARX_EXPERIMENT 49
see the connections, even when pharmaceutical researchers said it directly:
“No one is thinking about the patients, just market share” (Bartfai and Lees
2006, 73).
The dilemma might be summarized this way: clinical trials are by and
large conducted in order to test new treatments for healing a disease state
or reducing the risk of future disease. Clinical trials designed to reduce the
amount of medication people take and still save lives sounds like a win-win
solution—the company will have a better, more targeted drug to sell, and
people will get better faster—but in practice this kind of trial is remarkably
rare, even counterintuitive. If successful, such a trial would remove a large
number of people from a risk category, essentially assuring them that they
had less risk than they had thought, and the drugs they had been taking for
health would no longer be understood to provide such. As I have talked with
doctors as part of my fieldwork, they, too, have registered a sense of how
odd this dilemma is. Most trials are set up so that either they are successful
and a new, more intensive treatment regimen is indicated, or they fail and
the status quo prevails. Only the trials that backfire and find excessive side
effects result in reduced treatment. Doctors are particularly struck by how
easy it is to put people on medication because they meet guideline criteria
and how difficult it is to get them off. There are often no studies conducted
to determine when it would be better or safer to stop giving a medication
to a patient, while at the same time there are very few studies of the long-
term effectiveness or safety of those medications (Klein et al. 2002). Such
studies do not interest drug companies, because, again, they could conceiv-
ably shrink the market for treatments. The general trend, therefore, is for
the industry to conduct only trials that would grow the market by increasing
the amount of medication in our collective lives, and the empirical data for
U.S. pharmaceutical consumption bears this out.

run The_BioMarx_Experiment.prog in all [marx.works]:

replace [Capital] with [Biomedicine]

Marx’s categorical analysis seeks to explain some of the apparent anomalies of mod-
ern social life as intrinsic aspects of its structuring social forms: the continued pro-
duction of poverty in the midst of plenty, the apparently paradoxical effects of labor-
saving and time-saving technology on the organization of labor and social time, and
the degree to which social life is controlled by abstract and impersonal forces despite
the growing potential ability of people to control their social and natural environment.
MOISHE POSTONE, TIME, LABOR, AND SOCIAL DOMINATION

50 JOSEPH DUMIT
Rereading Capital, I found what I felt to be remarkable parallels between the
pharmaceutical growth process and especially the chapters on machinery.
Machinery both multiplied labor power and therefore seemed to be a reason
to labor less, and yet in the industrial system, it had the paradoxical effect of
increasing the amount of labor needed, in order to continue to produce sur-
plus labor. Theoretically this was worth pursuing. Thus, in order to better
understand the pharmaceutical industry and the logic and political econ-
omy of treatment maximization, I have conducted an experiment: I have at-
tempted to channel Marx, twenty-first century Marx, using twenty-first cen-
tury technology. Karl BioMarx is the author of a future automatic translation
of Capital into Biomedicine.5 I use biomedicine as the general term because I
think this analysis has relevance to the broad set of health industries that are
science, statistical, information-based, and for-profit.
Methodologically, Marx operates with a fascinating strategy: he reads
newspapers, government reports, factory guidelines, and economists. One
of the analytic tactics he deploys regularly is to point to how much of what
he would like to say as critique has already been said openly, in public and in
reports, by capitalists. That is, exposé alone is not critique; one must show
how the system reinforces its worst tendencies despite being conscious of
them. Furthermore, most of what Marx found scandalous had been publicly
scandalous at the time it was first being perpetrated. Yet critique and scandal
had been assimilated, naturalized, and their very scandalousness and sys-
tematicity had been forgotten. What makes it hard to keep the intolerable
nature of a particular phenomenon in focus is twofold: first, economists
cover it up with logical explanations; second, capitalists and workers may
perceive many aspects of it to be necessary and even desired, but still con-
sider it to be in need of tweaking. Indeed, Marx himself notes that he is not
claiming that the capitalist system, for all of its horrors, is worse than what
went on before—only that it needs considerable improvement.
For this chapter, I checked out a number of pharmaceutical-industry text-
books from the University of California libraries. Written by pharmaceutical
researchers and marketers, as well as by management consultants who work
for or have worked for pharmaceutical companies, these books are intended
to teach readers about the workings of the pharmaceutical industry. They
are practical, orienting books. They include Drug Discovery: From Bedside to
Wallstreet (2006), by Tamas Bartfai, a long-time pharmaceutical researcher
at Hoffman la Roche and now chair and professor of neuropharmacology at
Scripps Research Institute, and Graham V. Lees, a scientific editor and pub-
lisher; The New Medicines: How Drugs Are Created, Approved, Marketed, and

THE_BIOMARX_EXPERIMENT 51
Sold (2006), by the researcher Bernice Schacter; and A Healthy Business: A
Guide to the Global Pharmaceutical Industry (2001), by Mark Greener. They
are concerned, above all, with helping scientists and laypersons understand
how it matters that pharmaceutical research and sales is always a business.
With this in mind, I used an electronic copy of Capital (from the Marxists
Internet Archive, www.marxists.org) and began to systematically substitute
key words. The aim was to create a theoretical fission between contemporary
healthcare shifts and nineteenth- century industrial shifts. What became im-
mediately apparent was how careful a writer Marx was. Systematic substitu-
tion actually works. After many attempts to find an appropriate program of
substitutions, the result is a text in which many of the sentences seem un-
cannily prescient, and many more present surprising and challenging for-
mulations.
I treat this as an experiment. It is ongoing. The words I’ve come to select
are quite specific to the logic of surplus health and derived through inter-
action with the pharmaceutical marketing literature. In this substitution,
value becomes illness, machinery becomes clinical trial, employment becomes
treatment, and so on. What this produces is an experimental logic of medical
growth through increased diagnosis and the magic of symptom-fetishism.6
An examination of the passages that use the substitute terms helps one
think through possible articulations of how thresholds work in patients and
for biomedical growth, and how the system of biomedicine has logics that
easily outstrip local analysis of pharmaceutical action.7 This chapter is a pre-
liminary read through some of the consequences of Biomedicine alongside
some passages from my forthcoming book.8
My pocket origin story of this biomedical form of capital is as follows:
it could be said to start when medicine as an arm of capital (charged with
maintaining workers for work) became an industry itself, beginning in the
1930s and picking up steam after the Second World War. The healthcare in-
dustry has its own imperatives for growth that on the face of it are contra-
dictory to capital; that is, healthcare grows by treating more illnesses, yet it
should not remove workers from the workplace. The solution is to appropri-
ate that part of health that is not needed for work. This surplus health in-
cludes those persons who are too young or too old to work, and it includes
illnesses that can be treated “on-the-job,” so to speak, without keeping the
worker from working. The latter encompasses both illnesses of the everyday
(like mild depression) and illnesses of the future (like risk factors and symp-
tomless illnesses like cholesterol). Each of these areas of illness can easily be
shown to be major targets of diagnostic and therapeutic development, and

52 JOSEPH DUMIT
each has had phenomenal growth in the last fifty years, intensifying espe-
cially in the last decade.9
Comparing pharmaceutical textbooks with Biomedicine has allowed me
to explore the ways in which mass medicine functions as a regime of capital,
and hopefully to better understand why medicine continues to be developed
in such promising ways (more knowledge of health and illness, and more
treatments) that are nonetheless tragic (we are taking more medicines, and
not necessarily dying less). Working through BioMarx alongside contempo-
rary writings also helped me understand more about how Marx struggled to
make sense of the capitalists of his day. Moreover, the uncanny prescience
of BioMarx provides insight into the strange ways in which pharmaceutical
analysts talk about health. In the conclusion I will discuss more about my
relation to Marx and our relation to the logic of biomedicine. In the mean-
time, I will walk through this logic, learning how pharmaceutical companies
have come to see the population. Perhaps it will also become evident how
the public has come to accept a notion of quantitative health, as investment,
and how this might not lead to the best future.

replace all [commodit(y/ies)] with [Symptom(/s)]

Where Capital begins with a discussion of the commodity, Biomedicine be-

gins with the symptom, and this allows us to see how strange health and
illness have become.

The Healthy Life of those societies in which the Biomedical mode of

Medicalization prevails, presents itself as “an immense accumulation of
Symptoms,” its unit being a single Symptom. Our investigation must
therefore begin with the analysis of a Symptom.

Felt-Illness become a reality only by use or Healing: they also constitute

the substance of all Healthy Life, whatever may be the social form of that
Healthy Life. In the form of society we are about to consider, they are, in
addition, the material depositories of Measured-Illness.

As Felt-Illness, Symptoms are, above all, of different qualities, but as

Measured-Illnesss they are merely different quantities, and consequently
do not contain an atom of Felt-Illness. (C1: ch. 1)

The distinction described here is between, on the one hand, experienc-

ing Felt-Illness (feeling sick) and going to the doctor to change how you
feel, and, on the other hand, watching an advertisement or getting screened

THE_BIOMARX_EXPERIMENT 53
(measuring your illness) and being told you may be at risk and should talk
to your doctor about possible treatments. In this substitution, symptom is
shown to be two-sided in the way that Marx showed the commodity to be
two-sided. It had both a use value and an exchange value. The exchange
value renders the commodity quantitatively comparable to every other com-
modity. With biomedicine, we see a similar shiftiness. A symptom seems
to be both felt and measured. As measured, the symptom begins to take on
a life of its own. A screening test for high cholesterol tells us we have been
ill without knowing it, and we begin to experience ourselves as having high
cholesterol. Or a test suggests we have a high risk for prostate cancer and we
feel the need to do something. Even a question may suggest that though we
think we feel fine, we actually feel ill without knowing it. For example, here
is a transcript of an early unbranded commercial by Lilly to help promote
Prozac.

VOICE- OVER: Have you stopped doing things you used to enjoy? Are you
sleeping too much, are you sleeping too little? Have you noticed a change
in your appetite? Is it hard to concentrate? Do you feel sad almost every
day? Do you sometimes feel that life may not be worth living?
VOICE- OVER: These can be signs of clinical depression, a real illness, with
real causes.
SCREEN-TITLE: Depression strikes one in eight
VOICE- OVER: But there is hope, you can
SCREEN-TITLE: Get your life back
VOICE- OVER: Treatment that has worked for millions is available from
your doctor. This is the number to call for a free confidential information
kit, including a personal symptoms checklist, that can make it easier to
talk with a doctor about how you’re feeling. Make the call now, for your-
self or someone you care about.

This direct-to- consumer (DTC) television commercial begins as a checklist

in the form of an interrogation, with simple questions that are very general:
are you sleeping too much or too little? But the seriousness of the questions
is contained in the follow-up: “These can be signs of clinical depression.”
This conclusion converts the questions into a medical algorithm, a logical
process following a series of steps. The checklist of symptom questions mea-
sures your potential illness. But the grammar arrests: “These can be signs”
is a peculiar phrase. It is retroactively transformative, inscribing aspects of
one’s life as symptoms. What you had previously thought of—if at all—as
personal variations in mood and habit are brought into heightened aware-

54 JOSEPH DUMIT
ness; if you had not considered them to be symptoms, now you might. The
first implication is that you are, maybe, suffering from a serious disease and
do not know it. But this is not a presymptomatic form of awareness. Unlike
the situation in Nelkin’s and Tancredi’s Dangerous Diagnostics (1989), where
a brainscan or genetic test reveals a disease before it manifests symptoms,
here you find out that you have been suffering from symptoms without
knowing it.
The grammar of the phrase “These can be signs of X” or “You could be
suffering from X” are not simple performatives (see Austin 1962). They do
not assert that you have depression, nor do they diagnose. For legal, market-
ing, and health reasons, the grammar is explicitly modalized as possibility:
“These can be,” “You could be,” “You might be.” But such suggestions do give
you a new potential. You cannot, morally, ignore the possibilities they raise,
because your status has changed via this information. You really might be
suffering (see Sacks and Jefferson 1992). You are now at risk (for being at
risk), you now know that you have been at risk, you have to try to do some-
thing about it. And the commercial draws you out with “There is hope.” Why
is there hope? Because treatments are available.
The dynamic here shifts symptoms away from being felt toward being
measurements controlled by others. Even though you self- diagnose, you do
so via an algorithm, converting your embodiment into quantitative signs.
Where Marx described the odd situation of the worker who must be free to
choose to work, but nevertheless must work, BioMarx details the parallel re-
quirement that a person must both be free to accept a diagnosis and yet is
obliged to accept it.

The Patient instead of being in the position to Submit Symptoms in

which his Health is incorporated, must be obliged to offer for Submission
as a Symptom that very Healthiness, which exists only in his living self.

For the conversion of his Test-Scores into Biomedicine, therefore, the

Diagnoser of Test-Scores must meet in the market with the Fearful
Patient, Fearful in the double sense, that as a Fearful man he can dispose
of his Healthiness as his own Symptom, and that on the other hand he
has no other Symptom for Submission, is short of everything necessary
for the realisation of his Healthiness. (C1: ch. 6)

The dynamic goes as follows. A person watches a commercial and goes

to a doctor, or gets screened and finds out she has a risk factor. She is sup-
posed to take action to reduce it: change her lifestyle or take a pill. This is

THE_BIOMARX_EXPERIMENT 55
for her health, here defined not in terms of illnesses whose suffering she
feels, but in terms of a measure whose threshold she has crossed. By taking
the treatment she reduces her risk, and this generates health in herself.
This health, one should note, is based entirely on clinical trials whose facts
have set the guidelines that determine her risk. Felt illness still exists—
those times when her body drives her to see a doctor—but more and more
of her “illnesses” are detected only through measurements, checklists, and
biomarkers. These measures are her symptoms, which she fearfully and
proudly tries to reduce. As one patient shouts to the world in a commercial:
“I’ve lowered my cholesterol!”
From a marketer’s point of view, the question is how to get you to add de-
pression, breast cancer, cholesterol to your lived anxieties, to your personal
agenda, enough so that you attend to it, find more information, and talk to
your doctor about it.10 The problem marketers must solve is how to get their
particular facts into your head as facts that you come to depend on. For in-
stance, another commercial begins with a scene of middle-aged people on
exercise bikes in a gym, working out but looking tired. The only sound is of
a ball rolling around, and superimposed above the exercisers is a spinning
set of numbers. Finally the ball is heard dropping into place; the number is
265. The cholesterol roulette is over. The text on the screen: “Like your odds?
Get checked for cholesterol. Pfizer.”
The form of such commercials draws on a public-health logic of aware-
ness: the unaware consumer-at-risk must be made into a patient-in-waiting.
In order to achieve this, the consumer’s felt-sense of health must be attacked
as not simply mistaken, but dangerous. A campaign for colorectal cancer ex-
emplifies this, first asking, “Are you the picture of health?,” then warning,
“You may look and feel fine, but you need to get the inside story.”11

Once adopted into the Medicalization process of Biomedicine, the means

of Health passes through different metamorphoses, whose culmination
is the Threshold, or rather, an automatic system of the Clinical Trial . . .
so that the Patients themselves are cast merely as its conscious linkages.
In the Threshold, and even more in the Clinical Trial as an automatic sys-
tem, the Felt Illness, i.e., the Body quality of the means of Health, is trans-
formed into an existence adequate to fixed Biomedicine and to Biomedi-
cine as such; . . . it is the Threshold which possesses skill and strength
in place of the Patient, is itself the virtuoso, with a soul of its own in the
mechanical laws acting through it. . . . The Patient’s activity, reduced to a
mere abstraction of activity, is determined and regulated on all sides by

56 JOSEPH DUMIT
 the movement of the Clinical Trial, and not the opposite. The science . . .
does not exist in the Patient’s consciousness, but rather acts upon him
through the Threshold as an alien power, as the power of the Threshold
itself. The appropriation of living Health by objectified Health.12

The process described here is the turning over the state of your health-in-
general or healthiness to biomedicine so that it is something you must look
up; it is fully expropriated from your own experiences, since you can’t trust
your senses, even though “you may look and feel fine.” In turn, you come
to experience risk itself. “Lipitor caught everyone by surprise since it did
not have competitive outcomes data, but it shifted what counted as success
beyond long-term clinical trials (hope) to short-term biomarker reductions
(signal, as in lowered cholesterol numbers), which in turn became experi-
encible” (Moss 2007, 31).
Converting hope into a signal, a biomarker (cholesterol) that becomes
a type of felt-illness (experiencible) completes the transformation of mea-
sured illness into the two-sided symptom that takes on a life of its own. Bio-
Marx calls this symptom-fetishism, where the number becomes embodied.
Risk is more real than lived healthiness. The question is thus: how did mea-
sured illness and risk come to be the definition of health?

replace all [Cooperation] with [Preventive Health]

The shift to measured illness took place during the twentieth century, at the
intersection of public health and clinical studies, as preventive health. Pub-
lic health recognized that some illnesses needed to be treated collectively in
order to prevent repeated outbreaks. Vaccinations are the prototype. Large-
scale clinical studies, beginning in the 1950s, approached illnesses collec-
tively even if they were not spread like infectious diseases. The Framing-
ham Heart Study was foundational as a prospective (future- oriented) study
that examined the health of over five thousand people in Framingham, Mas-
sachusetts, over their lifetimes and eventually across three generations. It
aimed to discover connections between ongoing behaviors (like smoking) or
biomarkers (like cholesterol) and future events (like heart attacks).
Clinical studies like the large-scale Framingham Heart Study enabled
pioneers in epidemiological medicine like Geoffrey Rose to articulate the
need for a comprehensive notion of “preventive health.” In his now clas-
sic treatise, Strategies for Prevention (1993), Rose described how large-scale
studies slowly transformed our definition of health from the traditional,

THE_BIOMARX_EXPERIMENT 57
simple models of disease—in which the patient first suffers, then calls on the
doctor—to an epidemiological, measured model of diseases like hyperten-
sion and high cholesterol. These represented “a type of disease not hitherto
recognized in medicine in which the defect is quantitative not qualitative”
(Pickering 1968, in Rose, Khaw, and Marmot 2008, 7). Rose describes the
traditional model of diseases as one of felt-illness, whose treatment aims at
removing the felt-illness. The quantitative model, however, is one of mea-
sured deviance, whose treatment aims at reducing the risk of future adverse
events.
The most significant difference between these two models is in the form
of diagnosis as we move away from “Has he got it?” to “How much of it does
he have?” (Brayne and Calloway 1988, quoted in Rose, Khaw, and Marmot
2008, 9). Given a continuum of measurements (blood pressure tends to
be shaped like a bell curve in populations), Rose asks where the diagnostic
line should be drawn. Our current administrative medical system demands
clear decisions; “this decision taking underlies the process we choose to
call ‘diagnosis,’ but what it really means is that we are diagnosing ‘a case for
treatment,’ and not a disease entity” (Rose, Khaw, and Marmot 2008, 10).
In other words, given the continuum of scores where everyone has some
blood pressure, the only meaningful reason to draw a line is because that
line makes a difference in what we do about it. Rose’s public-health perspec-
tive allows him to see and state clearly consequence of quantitative disease
models, that diagnosis equals treatment.
Rose’s argument thus tracks that of chapter 13 of Capital, on “Co-
operation,” in which Marx examines how man’s collective labor is much
more productive than the sum of individual efforts—it becomes social labor.
Rose, in turn, offers the concept of population illness. Rose shows how im-
portant it is to consider many illnesses, like hypertension, as population
illnesses, requiring population-based treatments. To study population ill-
nesses though, for which the actual events (like heart attacks or deaths)
are rare, one needs to run very large clinical studies. In one kind of clini-
cal study, the clinical trial, the population being studied is randomized at
the beginning into often two groups, with one being given a specific treat-
ment, like a drug, and the other group being given a placebo or a competitor
treatment. Clinical trials study the effect of a treatment on a large group of
people over a period of time (two weeks to ten years), and it is the large scale
of the trial that allows a small treatment effect to be multiplied enough to
be visible. For example, it might require a trial of ten thousand people over
the age of thirty taking a beta-blocker for more than five years to determine

58 JOSEPH DUMIT
whether the risk of a heart attack has been reduced by that particular treat-
ment. If ten fewer fatal heart attacks are found (forty among the five thou-
sand taking the drug versus fifty among those not), then the study might
reach statistical significance and be used to get FDA approval for the drug.
If the trial is well- designed, its result then becomes a type of public-
health fact. If you are over thirty and take the pill every day for five years, you
reduce your chances of a heart attack by 20 percent (this is a big percentage,
as the original chance of having a heart attack was 1 percent, now reduced
to 0.8 percent). Of course, another way to look at it is that 500 people must
take pills every day for five years in order to prevent one heart attack; the
number needed to treat (NNT) is therefore 500. Of those people, 495 would
not have had heart attacks in any case, and four of them would have had
heart attacks despite taking the pill. Thus there is a lot of unnecessary treat-
ment (another way to think of that NNT). This kind of result is known as the
“prevention paradox” in which “many people must take precautions in order
to prevent illness in only a few” (G. A. Rose 1992, 12).
Rose’s analyses were hailed as critical insights that reformulated how to
treat coronary heart health and brought public health and clinical medicine
back together. Rose uses the word precautions because treatments for him
mean lifestyle, diet, and behavioral changes first, and he displays extreme
caution regarding prescriptions, since he points out that large NNTs greatly
amplify the number of long-term side-effects, many of which would be all
but impossible to detect without other massive, long-term, and prohibitively
expensive clinical trials.

replace all [value(s)] with [Illness(es)]

replace all [labor] with [Health]

Rose’s book is fascinating because it clearly demonstrates how preventive

logic based on clinical trials does not have to result in more medicine. Rose
is acutely aware, however, that it could. I have dwelled on Rose’s arguments
for preventive medicine not only because they’ve been persuasive in policy
and research, but also because they show the true power, insight, and inno-
vation of population (or mass) health. Since he literally marks off popula-
tion health from traditional felt-illness, he provides an image of measured,
quantitative disease that is not economically beneficial, but is plausible and
rational on humanitarian grounds. Rose in fact begins his book with a medi-
tation on the uneconomic consequences of preventive health, noting that it
does not save the state money, since it tends only to postpone, rather than

THE_BIOMARX_EXPERIMENT 59
truly prevent, health problems. He also points out that the longer one lives,
the more treatments one tends to require. In the end, Rose argues for pre-
ventive medicine solely on humanitarian grounds, that more life with less
illness is better.
Though he hints at the fact that preventive health has no inherent limit
and that thresholds of treatment must be carefully and socially debated, Rose
does not confront or even consider the use of clinical trials and preventive-
medicine logic by for-profit pharmaceutical companies. The shift from clini-
cal trials primarily for health to clinical trials for profit has been taking place
in pharmaceutical companies since the 1950s (Greene 2006). The historian
Steve Sturdy summarizes the process:

The scene was set for the rapid institutionalization of clinical trial proce-
dures in the postwar years. Drug companies, government agencies and
charitable organizations now realized that, by exerting strict controls over
the supply of new drugs, they could force clinicians to participate in stan-
dardized clinical trials. But at the same time, clinicians came to recognize
that they too could benefit from participating in such trials. The develop-
ment of dramatically effective new drugs, including the antibiotics and
subsequently such molecules as cortisone (Cantor 1992; Marks 1992),
did much to raise public expectations of the power of modern medicine.
By acting as gatekeepers to potentially beneficial new therapies, clini-
cians could do much to enhance their own professional prestige and au-
thority over patients. As a result, large scale clinical trials became one of
the defining features of the postwar medical landscape. Drug companies
and administrative bodies were now able to conduct large scale clinical
experiments to measure the therapeutic effects of a wide range of novel
substances. . . . Doctors had now ceded much of their clinical autonomy
to the administrative demand for standardized forms of medical practice.
(Sturdy 1998, 283)

The importance and centrality of prevention and clinical trials for ad-
vancing healthiness is disputed by no one. Current spending on clinical
trials exceeds $14 billion per year. According to governmental and nongov-
ernmental studies, in 2004 around 50,000 clinical trials took place in the
United States, involving 850,000 people in industry-funded preapproval
testing, and another 725,000 in postmarketing (Phase IV) trials. In addi-
tion, 750,000 more people participated in government-funded trials. While
these numbers may seem large, within the health industry they represent a
crisis of under-enrollment. Four out of every five clinical trials are delayed

60 JOSEPH DUMIT
due to recruitment problems. “The number of trials has doubled in the past
10 years, forcing companies to seek trial participants in emerging markets
outside of the saturated areas in the United States and Western Europe.
Emerging markets such as India, China, and Russia offer drug companies
a volume of potential subjects, and trials can often be executed at reduced
costs” (Ernst and Young 2006). The pressure to rapidly complete clinical
trials has led to doctors being paid to enroll their own patients, and in a
number of countries, people participating as experimental subjects in ex-
change for healthcare.13
At the same time, the ever-increasing scale of clinical trials, the sheer
number of them, and the size of each one has put them more or less out of
even government’s financial reach. Across the board, the pharmaceutical
industry, government officials, and even critics agree that only corporate
institutions have the resources to conduct most clinical trials. For example,
in examining the Celebrex and Vioxx discussions at the Food and Drug Ad-
ministration (FDA), the pharmaceutical researcher Bernice Schacter noted,
“Lengthy discussion about what kind of trial or trials are needed to clarify
the issue of the relative cardiovascular safety of the NSAIDs [nonsteroidal
anti-inflammatory drugs], triggered both by the FDA’s question and a sug-
gestion by Dr. Robert Temple, Director of CDER’s [Center for Drug Evalua-
tion and Research’s] Office of Medical Policy, that what he called an ALL-
HAT trial [Antihypertensive and Lipid-Lowering Treatment to Prevent Heart
Attack Trial] be done to compare the cardiovascular effects of NSAIDs using
naproxen and diclofenac as controls. Whether such a megatrial could be done
and who would fund it remained unclear, though the enthusiasm among
the members of the committee was high” (2006, 219). In other words, the
proper questions that needed to be asked with regard to the drugs probably
“could not” be investigated, since the clinical trial would be too expensive for
government funding and since the direct- comparison questions would be
too risky for a pharmaceutical company to ask, given that corporate research
funding is tied to investments.14
The problem is that biomedical companies are first and foremost compa-
nies; they exist to make profits, and therefore they must run clinical trials
as investments whose purpose is to grow returns. This fact is the key form
through which marketing takes over research design in pharmaceutical
companies. The insight we get from BioMarx is that the return on invest-
ment is calculated not solely on labor of workers or clinical-trial subjects,
but that value is seen to accrue from the patients via treatment numbers (even
speculative ones). Hence clinical trials become machinery for generating

THE_BIOMARX_EXPERIMENT 61
evidence for generating prescriptions. In other words, the flipside of an
evidence-based marketing strategy is that markets are made through evi-
dence, and potential marketable evidence (from a clinical trial) is the deter-
mining factor in running the clinical trial in the first place.
The mystery of value for Marx lies in the fact that value is not in fact
tied to material wealth; instead capitalists are fixated on labor as value. For
the capitalist, the machinery, factory, raw materials, and distribution are
all sunk costs, or “fixed capital.” The only “variable capital” is the worker,
whose full day of labor power the capitalist forces him to sell. If he could,
the worker would sell his labor only dearly, but since there is no better work
elsewhere and the worker is easily replaced, he must sell a whole day’s labor
in order to work at all. The wages the capitalist pays the worker is enough
to allow him to survive and reproduce. After the worker has put in enough
hours to cover his cost (and the cost of the fixed capital), everything else is
surplus labor resulting in surplus value. Capital brings this into being by striv-
ing (through competition) to bring necessary labor time to a minimum (so
as to maximize surplus labor time), and the result is science, but in a mis-
shapen form.

“Hence it posits the superfluous in growing measure as a condition—

question of life or death—for the necessary.”

1. capital “calls to life all the powers of science and of nature as of social
combination and of social intercourse, in order to make the creation
of wealth.”
2. “on the other hand it wants to use labor time as the measuring rod for
the giant social forces thereby created, and to confine them within the
limits required to maintain the already created value as value.” (1993
[1857]: 706)

Science and technology become tragedy because capital has a peculiar mea-
suring system. Marx is quite clear that capitalism brings this science into
being, but because it insists on labor as the measure of value, even when
labor isn’t necessary, it uses science and technology to produce more sur-
plus labor, rather than to produce material wealth.15
In working with marketers and working through BioMarx’s version of
surplus, I have come to understand the pharmaceutical development pro-
cess better. The pharmaceutical company sees the clinical trial, the pills,
and marketing as sunk costs; the only variable capital is the total number of
prescriptions (TRx) that are filled, which is the number of patients times the

62 JOSEPH DUMIT
number of prescriptions they purchase. Health research therefore is mea-
sured by the number of projected total treatments.
Biomedicine thus calls to life the powers of science (though cooperation
and social force) in order to create wellness, but

on the other hand it wants to use Treatments as the measuring rod for
those giant health forces, and confine them within the limits required to
maintain the already created Health as Health. (BioMarx)

In other words, a pharmaceutical company thinks of health directly in terms

of prescriptions, so that, as Rose concluded, treatments are the “meaning”—
that is, use of—Health. Therefore a patient is valuable to pharma to the ex-
tent she takes treatments and continues to take them. A “healthy” person
who is not on or does not like to be on medicine is, from the perspective of
this economy, not valuable. In other words, from the perspective of value,
healthiness is antithetical to biomedicine—only Health, abstracted and valo-
rized, is valuable.16
Each clinical trial is evaluated first by whether and by how much profit
it will generate for the company. Thus Bartfai and Lees take pains to spell
out to their readers: “The company’s order of priorities is extremely clear.
The major factors in selection of a clinical candidate in the company’s own
priority order are: (1) marketing . . . (2) internal economics . . . (3) scientific,
technical and legal issues . . . The regulatory and marketing groups, and
then the clinicians, can always override scientific considerations; they ‘call
the shots.’ . . . Under current circumstances this is unavoidable . . . Decisions
of this caliber are so expensive and so delicate for the companies’ future that
they cannot be left to scientists and clinicians alone” (2006, 71–72). Un-
avoidable priorities. Companies are only doing what they have to do in order
to survive. This is stated in the same manner as Marx: the executives, like
the capitalists, are possessed by the circumstances. The result is that each
clinical trial must be designed so that it increases the number of prescrip-
tions purchased. It might seem that a steady state—keeping the population
healthy and improving drug efficacy—would be enough to keep an industry
alive, but the pressures on biomedicine to grow are enormous, leading to the
need to accumulate prescriptions.
Marx described how “Capital as such has to grow” (G III:317). This accu-
mulative sentiment pervades pharmaceutical industry discussion. “In order
for Pharma and biotech companies to maintain double- digit growth rates
through 2005, they need to multiply their productivity by a factor of five”
(Perkins 2002, 148). Similarly, Mark Greener, a former research pharma-

THE_BIOMARX_EXPERIMENT 63
cologist and editor of Pharmaceutical Times, notes, “The stock market ex-
pects the pharmaceutical sector to grow at a healthy rate. A survey of 15
analysts in 2000 found that they expected the large pharmaceutical compa-
nies to grow between 12% and 15% per year between 2000 and 2005. They
also expected sales to increase by between 8% and 10% each year, with the
market increasing between 6% and 8% annually. However the U.S. mar-
ket—the last unfettered, free pharmaceutical market—accounts for some
75% of growth worldwide, reflecting in part the impact of pricing controls”
(Greener 2001, 36). Thus, not only is profit an unavoidable priority, but mas-
sive growth is too. The problem is precisely that pharmaceutical companies
are expected to run clinical trials, and even critics like Jerome Kassirer, the
former editor of the Journal of the American Medical Association (JAMA), con-
cede that they legitimately want profits (Kassirer 2005, 188)
For Kassirer and many critics, the answer is better regulation in order
to define ethical bounds for rule-binding the system to enable profitable
pharmaceutical health. The fight between regulators and profits often leads
to bizarre encounters, as described by Leonard Weber, healthcare consul-
tant and former director of the Ethics Institute at the University of Detroit
Mercy. “Drummond Rennie, a JAMA editor interviewed by Peter Jennings
on Bitter Medicine 2002 agreed that drug companies ‘are intent on keeping
consumers on drugs, which are not as good as older drugs, for the simple
requirement of profit.’ ‘Rennie responded yes, absolutely, and it would be
strange if they didn’t. “They’ve got to be prevented.” Rennie’s point was
that the pharma industry needs to be understood as part of the for-profit
business world” and “will do whatever they can in the pursuit of profits’
limited only by legal restraints” (Weber 2006, 13). Although Weber goes
on to suggest better business ethics, he leaves untouched the fundamental
transformation of health value as measured by treatments. Indeed, better
regulations would help curb the abuses, like withholding information on
side-effects, but it does not address a deeper, structural concern, which is
the dynamic shift that takes place when clinical trials are run by industry in
order to grow itself.

replace all [machinery] with [Clinical Trials]

Increasingly, large companies need the mature sales . . . generated by several block-
busters—drugs that achieve sales of more than $1b annually—to fund R&D pro-
grammes and meet shareholders’ expectations of growth.
MARK GREENER, A HEALTHY BUSINESS

64 JOSEPH DUMIT
A significant problem for the FDA is that there are too many me-too drugs submit-
ted. . . . The companies see it as a way of generating profits, through establishing a
new market share, and it is also seen as a safe way to introduce a new drug . . . [since
the competition] has already validated the target. . . . But no one is thinking about the
patients, just market share.
TAMAS BARTFAI AND GRAHAM V. LEES, DRUG DISCOVERY

The solution to growth is clinical trials. They alone can increase the pro-
ductivity of prescriptions, creating more drugs for more people for longer
periods of time. Their dynamic in healthcare parallels that of machinery in
capitalism. In Capital, machinery occupies a pivotal role, unleashing col-
lective productivity and thus allowing one man working one hour to pro-
duce more than what two or ten or a hundred were able to produce without
the machine. Machinery’s paradox is the most tragic for Marx. The tremen-
dous increase in productivity enabled by machinery would seem to liber-
ate man from endless toil; with more wealth produced from less effort, it
would seem to follow that less work would need to be done. But, historically,
the opposite happened: machinery led to longer working days and required
more workers, since capitalists came to see not using the machines as waste-
ful and therefore wanted them to be used at all possible times. Furthermore,
machinery’s relative ease of use meant that women and children could also
be employed, expanding the labor pool tremendously and cheaply.
The analog in biomedicine has a similar paradox: clinical trials are an
amazing way to increase the healthiness of the population. Although they
have promised to reduce the amount of time we spend attending to our
health, they have instead increased the time, energy, money, and treatments
we apply to our health, and have extended treatment to children and the
elderly in increasing numbers. This may seem overstated, but bear with
me. Machinery under capitalism did increase productivity (and successful
clinical trials do offer ways to increase healthiness), but capitalists employed
machines not for that purpose, but instead to increase their profits. If a ma-
chine could save labor but would not increase profits, for example, then the
capitalist would not use it. Marx discussed a case in England where women
were sometimes used instead of horses for hauling barges because the
women as “surplus population [were] beneath all calculation. Hence we no-
where find a more shameless squandering of human labor-power for despi-
cable purposes than in England, the land of machinery” (C1:517). Cases like
this, in which the decision to use a machine turns on whether it is “worth”
it to replace humans, speak to the core of the labor theory of value. Increase

THE_BIOMARX_EXPERIMENT 65
productivity—but only if it does not cost more than employing labor and in-
creases the surplus value of the remaining labor. Thus, only those machines
which increased profits (e.g., by making a product that could be sold at a
higher profit) would be installed.
The problem is eerily the same in biomedicine. “Today, 62% of the
sales of Pharma is in the United States. But how many know that there are
over 800 compounds that are sold in Europe, and which are highly effica-
cious, therapeutically wonderful, but which have not yet been registered
in America? And they won’t ever be. Because by now the patent life is so
short, and the FDA so slow, that they cannot be. . . . [T]he marketers in the
U.S. won’t be interested. And it is nonnegotiable; this is how it is” (Bartfai
and Lees 2006, 138). America as a pharmaceutical contradiction is all too
familiar. Many critics echo Ken Silverstein (1999) in decrying a world where
“millions [are spent] for Viagra, pennies for the poor.” It may seem straight-
forward to hold drug companies responsible for the choices they make re-
garding which diseases to research, but as Bartfai and Lees indicate, this
critique is internal to corporate logic. Almost every pharmaceutical indus-
try textbook I found narrates an ongoing debate over precisely this issue, of
whether a pharmaceutical company can afford to care about medicine and
people, rather than about profits. Passing along this debate to future indus-
try scientists is precisely the purpose of pharmaceutical industry textbooks
in bringing it up. “Should they develop for this specific use and that one, but
not the one unlikely to succeed or unlikely to generate a sufficiently large
market?” (Schacter 2006, 116).
Especially today, under the pressure to maintain growth, apparently vile
decisions are driven by a clear perception of “waste.” One is literally “throw-
ing money away” if one is not making “as much as one could” compared
with other investments. “One of the significant problems for the Pharma
industry is that of the 400 disease entities identified, only 40 are commer-
cially attractive by today’s requirements of return on investment. . . . Society
needs to find a way to make more diseases commercially attractive if it wants
Pharma investment in treating any of the other 350 diseases affecting hun-
dreds of millions of people” (Bartfai and Lees, 2006, 14). Here Bartfai and
Lees, a former pharma researcher and a publisher, seem to be calling for
regulation to save them from their own structural violence. This call echoes
an industrial practice, which Marx registers in a chilling footnote, wherein
even kidnapping raids of children, who were forced to work in factories for
more than twelve hours per day, were unstoppable as long as competition
with other capitalists existed. One group of factories actually submitted a

66 JOSEPH DUMIT
petition to the British government in 1863, pleading, “Much as we deplore
the evils before mentioned, it would not be possible to prevent them by
any scheme of agreement between the manufacturers. . . . Taking all these
points into consideration, we have come to the conviction that some legis-
lative enactment is wanted” (C1:297). Bartfai and Lees state that the ques-
tion is not one of choices, but of structural pressure. Their mode is one of
enlightened attack: it is society that needs to find ways to make thing better,
to make unprofitable diseases profitable.17 Similarly, Marx describes how
under the regime of machinery, “Capital takes no account of the health and
length of life of the worker, unless society forces it to do so” (C1:381).
Across the board, pharmaceutical-industry analysts are unabashed about
these constraints and presuppositions. “Pharmaceutical companies tend not
to invest in tropical medicines because they are unlikely to recoup their in-
vestments. . . . Given the pressure on pharmaceutical companies to maxi-
mize their return on investment, this attitude is unlikely to change without
a major change in shareholders’ attitudes” (Greener 2001, 122). This is what
Marx was striving to explain about the interactions of Capital, how once you
see it in process, then the entailments of that process have a type of force
to them—not a deterministic force, but influential nonetheless. From in-
side the pharmaceutical industry, one feels that one’s life is at stake, and
certainly one’s company is. The pressure from “other possible investments”
(such as other disease research at the same company) is key, since this
means that there does not even need to be competition from other compa-
nies for the process of value generation to exert its force. The very fact that
disease research is an investment establishes an equivalence between in-
vestments, such that they become comparable along one dimension: quan-
titative health, or treatments.

To the out- cry as to the physical and mental degradation, the premature
death, the torture of over-Treatment, it answers: Ought these to trouble
us since they increase our profits? But looking at things as a whole, all
this does not, indeed, depend on the good or ill will of the individual
Pharma. Free competition brings out the inherent laws of Pharma Ex-
perience, in the shape of external coercive laws having power over every
individual Pharma. [82] (Ch. 10)

The problem of comparing possible treatment research within pharmaceu-

tical companies is that saving one set of lives through research and devel-
opment, marketing, and sales must be compared on return- on-investment
profit grounds with saving other lives who may return more net profit.

THE_BIOMARX_EXPERIMENT 67
“Products that are not able to limp along must be eliminated. They are a
drain on a business unit’s financial and managerial resources, which can
be used more profitably elsewhere” (Perkins 2002, 122). Most critics do not
begrudge pharmaceutical companies this attitude, because they understand
and have naturalized corporate funding of research.
Here is the twist so peculiar in capitalism and biomedicine: the com-
pany that one loves because it makes healing medicines becomes secondary
(logically) to the money it returns. The disease one wants to cure becomes
secondary to its market size. It comes to appear that it has to be this way.
“Pharmacoeconomics plays a pivotal role. Drug development is very capi-
tal intensive and even big indications such as malaria and tuberculosis are
affected. The cost means that small indications suffer, regardless of how
good the science is. If drug discovery were a science- driven activity, one
would expect scientists to be running drug companies. However, since Roy
Vagelos of Merck retired [in 1995], no Big Pharma has been run by a scien-
tist; they are all run by people who were trained in economics” (Bartfai and
Lees 2006, 71). Bartfai and Lees suggest that because drug development is
capital intensive, economic value comes naturally to supplant scientific or
health value. The reason why this can be justified has its roots in Geoffrey
Rose’s insight that once disease comes to be defined as on a continuum with
health, the only meaningful diagnosis is that which indicates treatment.
Treatment therefore equates with diagnosis, and the market indicated by a
diagnostic threshold is both a measure of profit and the very definition of
“health.” As health is an a priori “good,” comparisons of two possible clinical
trials turn on their relative profitability.
Inside a pharmaceutical company, this comparison is a source of con-
tinual negotiation, where clinical research directed at healthiness can clash
with market research, leading to struggles over who should really be decid-
ing clinical directions. Bert Spilker, the head of project coordination at Bur-
roughs Wellcome and author of many pharmaceutical textbooks, writes of
this struggle in his six-hundred-page Multinational Drug Companies: Issues
in Drug Discovery and Development. Note how “medical value” retains only
a ghost of its apparent persuasiveness: “The cooperation of research and
development and marketing groups may be severely tested when an in-
vestigational drug has a high medical and low commercial value and the
project draws resources (or would draw resources) away from projects that
the marketing group believes have greater commercial value and are of high
or medium medical value” (Spilker 1989, 427–28). There is a defensiveness
in the qualifying phrase “of high or medium medical value,” as if a me-too

68 JOSEPH DUMIT
drug with low medical value would not be chosen no matter how commer-
cially valuable it was.
Hidden (and assumed) within these debates over medical and commer-
cial value is the fact that, like machinery, clinical trials seen from the point
of view of investments become a different sort of beast than those seen
from a medical point of view. The very innovative power of science and tech-
nology, productivity, and intensity comes to be transformed, mutated into
profit and growth monsters. As Marx puts it, “This process of separation
. . . is completed in large-scale industry, which makes science a potentiality
for production which is distinct from labor and presses it into the service of
capital” (C1:482). Similarly, Steve Morgan, Morris Barer, and Robert Evans,
writing in 2000, eerily repeat the same insight: “Science and objectivity are
of interest to a private, for-profit corporation only insofar as they further
the quest for profits” (660). Looking closer at how clinical trials are imple-
mented via BioMarx will let us see how surplus health continues to be ex-
panded.

replace all [productivity] with [Knowledge]

Using financial, contractual and legal means, drug manufacturers retain a degree of
control over clinical research that is far greater than most members of the public (and,
we suspect, many members of the research community) realize.
STEVE MORGAN, MORRIS BARER, AND ROBERT EVANS,

“HEALTH ECONOMISTS MEET THE FOURTH TEMPTER”

If growth is achieved through choosing to study those diseases that have

the biggest markets, those markets can be stretched wider through choos-
ing how to design clinical trials so they indicate more of the population for
treatments. This is possible because clinical trials were designed to compare
treatments for existing diagnoses that had known outcomes, such as cures.
When clinical trials are used to define a diagnosis along a continuum, they
turn out to be remarkably flexible. In Rose’s Strategy of Preventive Medicine
(2008), Geoffrey Rose uses as an example the potential benefits of serum-
cholesterol reduction on coronary-heart- disease deaths. In a table—which I
have reproduced here, since it makes clear just how open clinical trials can
be—he breaks down risk by age and sex.
Rose points out how a screening program for men 55–64 would require
230 men to be screened and 100 of those screened to be treated for five
years, and would prevent one death on average. And this, he says, “relative

THE_BIOMARX_EXPERIMENT 69
TABLE 1!Estimates of potential reduction in coronary heart disease deaths
from screening for raised serum cholesterol (> 6.5 mmol/l) in different age
and sex groups

Age in years 25–34 35–44 45–54 55–64

Percentage with raised level

Men 20 35 40 45
Women 15 20 50 70

5-year deaths per 1,000 in this group

Men 1.2 5.8 21.3 48.1
Women 0.2 1.1 4.5 15.9

Number screened to prevent 1 death in 5 years *

Men 21,100 2,500 600 230
Women 137,300 23,200 2,200 450

Number treated for 5 years to prevent 1 death

Men 4,200 860 230 100
Women 20,600 4,560 1,100 320

*Assuming 20% reduction in deaths among all eligibles.

SOURCE: Based on Rose, Khaw, and Marmot 2008.

to other preventive or therapeutic measures . . . would be reckoned a good

value” (Rose, Khaw, and Marmot 2008, 37). Among women 25–34, how-
ever, such a program would require screening 137,300 women and placing
20,600 of those screened on treatment for five years to prevent one death.
The number needed to treat (NNT) is so high in this instance because that
demographic has so few coronary deaths to begin with (only 0.2 per 1,000,
or 1 in 5,000, over five years). Rose’s response illuminates a crisis in health
prevention. Despite appearing objective, one must engage in a relative valu-
ing of lives: “Unless one takes the extreme and wholly unrealistic view that
the saving of a life is worth any price at all, then it is hard to justify” (ibid.).
Rose’s need to increase the hyperbole, saying “extreme and wholly unreal-
istic,” reveals the dilemma, since he is nonetheless talking about a program
that would save lives.
Empirically, a clinical trial could be designed to show a population goal
for putting everyone over twenty-five on cholesterol-lowering drugs, despite
the incredibly huge NNT. Which clinical trial to run, where to draw the line,
is thus a social and political dilemma. The dilemma becomes a full-blown
contradiction when one considers the structural economic constraints.
First, only a few of the many possible population and cholesterol groups can
be studied; and second, due to the large size of the groups and the expense of

70 JOSEPH DUMIT
clinical trials, it is pharmaceutical companies who are allowed to choose the
groups. Make no mistake, the clinical trial will generate legitimate and true
facts about health; it will indicate treatment for whatever population subset
it successfully studied. And since very few similar clinical trials are likely to
be conducted, the facts generated by the first trial may very well be the only
facts available about this kind of health.18
Now ask yourself: if you were running a pharmaceutical company and
had to choose between a study that could show a high treatment benefit for
men over forty-five, or one that would show a low benefit for (but still save
lives among) everyone over twenty-five, which would you fund?

As Pharma, he is only Biomedicine personified. His soul is the soul of

Biomedicine. But Biomedicine has one single life impulse, the tendency
to create Illness and surplus-Illness, to make its constant factor, the
means of Medicalization, absorb the greatest possible amount of surplus-
Health. (Ch. 10)

Since the problem for pharmaceutical companies is how to keep growing

despite the constant pressure of stockholders, competitors, and the time-
bombs of their own patents running out, clinical trials must be designed to
maximize their markets in order to maximize their investment return. The
point is that there is corporate awareness of the variety of possible clinical
trials, and conscious selection of those trials that meet the desired profile
(long-term, large population, etc.). Bernice Schacter’s book, The New Medi-
cines, written by a researcher to train future pharmaceutical researchers, ex-
plains the dilemma this way: “If the team elects to seek approval for a nar-
row subset of patients with a certain condition, then the market for the drug
may be too small to make financial sense for the company. If they seek the
widest use, for example, for everybody with arthritis, they are at a greater
risk of failing to demonstrate safety and efficacy and therefore failing to get
approval. This is based on biology” (115).
Here again one discerns the parallel to machinery in capitalism: machin-
ery can only be implemented when it increases surplus value. In this ad-
monition, Schacter makes clear why clinical trials cannot be designed with
healthiness as a priority, why companies must see health as a means to profit
through increasing treatments. And this is how clinical trials that result in
larger NNTs (i.e., less efficient drugs) come to be valued more than smaller
ones. The dynamic of surplus health is at work in the fact that the larger NNT
means that more people will be taking the drug without benefitting from it,
but since there aren’t more facts available about who will actually benefit, it

THE_BIOMARX_EXPERIMENT 71
appears as if everyone taking the pill is benefitting a little by reducing their
risk. “Ideally the study would look at the drug’s effects on the so-called ‘hard’
endpoints—death or a heart attack, for example. However such studies tend
to be large, expensive, and lengthy. So many studies rely on ‘surrogate’ end-
points. These predict the risk of suffering a hard endpoint either for each
patient or from a population perspective. . . . Taken across the whole popu-
lation these are associated with, for example, a risk of stroke asthma or heart
attack. However that does not show that any particular patient will develop
the disease” (Greener 2001, 61).

In one word, surplus-Illness is convertible into Biomedicine solely be-

cause the surplus-Risk Diagnosis, whose Illness it is, already comprises
the material elements of new Biomedicine. (BioMarx)

A recent article by D. G. Manuel et al. in the British Medical Journal com-

paring eight cholesterol treatment guidelines in four countries made this
dynamic visible (see 1). The researchers designed a graph that mapped the
population indicated by each of the guidelines and the lives that would be
saved, assuming that the clinical-trial evidence was correct and the guide-
lines were scrupulously followed. The first thing to note about the graph is
that different guideline committees in different countries and at different
times made very different choices about how to implement the facts at their
disposal. They came up with vastly different percentages of the population
indicated for treatment and numbers of lives potentially saved. The curve on
the graph is the researchers’ extrapolation of the ideal treatment-to-saving
rate. The fact that it is a curve and not a point shows something very im-
portant about the graph as a whole. Any point under the curve is a potential
guideline. And any point would save lives. The graph thus illustrates that
there are thousands of potential clinical trials that could be run and thou-
sands of consequent treatment indications.
In order to compare the different guidelines, the authors describe the
horizontal distance from the curve for each guideline as the efficiency gap,
which implies that the same number of lives could be saved while treat-
ing fewer patients. The vertical distance to the line they call the efficacy
gap: how many more lives could be saved with a different guideline target-
ing the same percentage of the population. They thus suggest that prudent
committees design clinical trials and guidelines to move the points up and
to the left. Yet such trials would be predicated on decreasing the numbers
of people on medication. Like Rose, these researchers fail to consider the
countervailing pressure of companies, for whom the value of a clinical trial

72 JOSEPH DUMIT
 1. Number of deaths from coronary heart disease (CHD) prevented
over five years by percentage of Canadian population aged 20–74
years treated with statins for different national guidelines for the
management of dyslipidaemia. From Manuel et al. 2006, used
by permission.

and of consequent guidelines would be based instead on how far to the right
they would appear on the graph, which translates into vastly more treat-
ments. Thus Schacter states clearly, “The challenge for the project team is to
design the most efficient development plan, within the regulatory and ethi-
cal constraints, that will provide the largest market, and the best return on
investment. The trials should be no larger, nor run longer, than required to
provide evidence for efficacy and safety” (2006, 117).
It comes as no surprise, perhaps, that the U.S. guidelines are the furthest
to the right and getting more so with each guideline revision. The medi-
cal historian Jeremy Greene notes that once Merck had started conducting
clinical trials for its drug Mevacor so that they reinforced the then contro-
versial cholesterol guidelines, subsequent trials by many companies “came
to exert a formative influence on the guidelines themselves” (2006, 197). At

THE_BIOMARX_EXPERIMENT 73
the same time, there is nothing inherently wrong with any of these guide-
lines. The revised U.S. guidelines are projected to save approximately 300
more lives per five years than New Zealand’s (15,000 versus 14,700), at the
mere cost of putting 12 percent more of the population on statins (24 per-
cent versus 12 percent).
Rose’s struggles with this entailment of his preventive-health proposal
reflects the inability of the logic of prevention to stop the biomedical ap-
propriation of clinical trials. Almost ironically, Rose notes the “folly” of
those health-service managers and policymakers who get so caught up in
mistaking “people treated” for improved health that they say things like,
“This has been a good year for the National Health Service. . . . [W]e have
treated more patients than ever before.” Rose’s assessment is that they are
managing health services “according to the principles of the market” (Rose,
Khaw, and Marmot 2008, 38). Precisely! Rose nowhere seems to recognize
that what he calls this “blinkered attitude” is the very goal of pharmaceutical
marketing.

Drug companies commonly control the research question (with what

products and what doses, and for what patients and conditions, is the new
drug compared?), they control the selection of patients for the trials, they
control how drop- outs and side- effects are reported and treated in the
analysis, and they control what information makes its way into scientific
presentations and peer-reviewed publications. Drug companies often use
surrogate endpoints to establish a product’s efficacy (and to establish a
market for the product), despite absence of evidence that the surrogate
outcome and health status are in fact correlated, and sometimes, in the
face of evidence that they are not. (Morgan, Barer, and Evans 2000, 661)

In this manner, biomarkers undergo a transformation from being additional

signs of an illness or risk of one into being the means of defining a new ill-
ness for treatment.19 Symptoms become commodities not because they are
paid for, or even because they involve biomarkers, but because that is the
only way to decide on illness. The person is dependent on the clinical-trial
evidence for knowing whether or not he is ill and needs treatment. And the
patient has no way of knowing whether or not a test finds a real thing, or
whether the treatment works. The switch to “preventive, population medi-
cine” makes it possible for the biomarker to become the “fact” that defines
an illness for treatment, with its attendant consequences.
Rose’s argument is cited by pharmaceutical companies in their explana-
tions of what they have been up to! “Defining illness is somewhat arbitrary.

74 JOSEPH DUMIT
Blood pressure and lipid levels, for example, have a normal ‘bell-shaped’ or
‘n-shaped’ distribution. In such cases, the abnormality is quantitative rather
than qualitative. As a result, the point at which clinicians decide that some-
thing is abnormal and therefore warrants treatment, is an arbitrary decision
usually based on population risk (Rose 2008, 6–8). This means that differ-
ent clinicians can—and sometimes do—draw different conclusions about
the point at which they will intervene. Clearly such factors can influence the
success of a particular medication” (Greener 2001, 47). It was in fact this
citation of Rose in Greener’s guide to the pharmaceutical industry that led
me to his Strategies for Prevention in the first place. Rose’s lack of understand-
ing of the political-economic context of clinical-trial operations causes him
to overlook the true function of clinical trials in biomedical capitalism in
the same way that economists missed the function of machinery in capital-
ism. It is Rose, then, who wears blinders, for marketing must insist that the
clinical trial be designed such that success will generate a bigger and more
profitable market in prescriptions, whereas Rose assumes that the point of
designing a clinical trial is to maximize healthiness in society and that this
requires careful discussion of the tradeoffs between the size of the popula-
tion indicated by the clinical trial and the costs of treating that population.
All of Rose’s assessment modes are moot in the context of pharmaceu-
tical companies, whose criteria of value is number of prescriptions. Those
companies are quite explicit in calling for the maximum market size that
can be reliably diagnosed. The pharmaceutical management consultant
Arthur Cook provides an example in his Forecasting for the Pharmaceutical
Industry.

For the patient-based forecaster success-stories revolve around diseases

such as benign prostatic hypertrophy and HIV. Benign prostatic hyper-
trophy (BPH) is a disease that affects men, usually in older age. Cadaveric
epidemiological studies suggested that the prevalence of BPH was as high
as 95 per cent in men over the age of 65. However, the number of men
treated for BPH was significantly lower. With the advent of new diagnos-
tic technologies, physicians were able to monitor for an enzyme asso-
ciated with BPH and were able to diagnose patients earlier in their dis-
ease. This led to market growth through an increase in diagnostic rates.
(Cook 2006, 41–42)

Cook here shows how since pharmaceutical companies have begun to oper-
ate the clinical trials that define the facts about illnesses and risks, patients
are quite literally forced to rely on those facts and to submit their healthiness

THE_BIOMARX_EXPERIMENT 75
to screening and diagnosis. The healing and actual risk reduction the patient
receives is the equivalent of wages in Capital. But what of the excess or sur-
plus? Say the NNT is 50, then for every 50 patients who are diagnosed and
treated, 49 are treated without needing that treatment. For BioMarx, their
treatments are surplus and the healthiness used (that is spent in screening,
purchasing prescriptions, and side-effects) is “surplus health.”
But isn’t this the public-health argument and the prevention paradox? Yes,
and no. What makes the difference in machinery is not in the machinery-
worker relation, but in the capital dynamic that makes it the means for profit
on investment.

Now in order to allow of these elements actually functioning as Biomedi-

cine, the Pharmaceutical Pharma requires additional Health. If the ex-
ploitation of the Patients already Treated do not increase, either exten-
sively or intensively, then additional Healthiness must be found. For
this the mechanism of Pharma Medicalization provides beforehand,
by converting the Patient Class into a class dependent on Risks, a class
whose ordinary Risks suffice, not only for its maintenance, but for its
increase. It is only necessary for Biomedicine to incorporate this addi-
tional Healthiness, annually supplied by the Patient Class in the shape of
Patients of all ages, with the surplus means of Medicalization comprised
in the annual Medicalize, and the conversion of surplus-Illness into Bio-
medicine is complete. From a concrete point of view, accumulation re-
solves itself into the Return to Healthiness of Biomedicine on a progres-
sively increasing scale. The circle in which simple Return to Healthiness
moves, alters its form, and, to use Sismondi’s expression, changes into a
spiral. (B- C1: ch. 24)

In biomedicine, the current market for a drug is the limited viewpoint, and
to reframe it we need to take into account everyone who might possibly be
able to take the drug. In this worldview, the first step is not to look at those
who already visit their doctors, but to take a potential threshold diagnosis
and calculate how many people would be part of that threshold and there-
fore should be consumers of the relevant drug. Interviewed in the indus-
try journal Pharmaceutical Executive, an Aventis executive, Thierry Soursac,
describes this process: “‘Up until now,’ he says, ‘when we were looking at
the size of the market, we tended to open this market data bible called IMS
and say, Okay, the market of proton pump inhibitors is that much, and the
market of hypertension is that much, and this is the size of the market we
have to tap into.’ The problem, Soursac explains, is that IMS data represent

76 JOSEPH DUMIT
a ‘rearmirror view’ of markets, a view of the past, not the potential” (Shalo
2004). Soursac’s reference to the problem of the rear-mirror view of mar-
kets is almost an exact quote from Every Business Is a Growth Business, this
time referring to Robert Nordelli, the chief executive officer of General Elec-
tric Power Systems. Pharmaceutical executives, in other words, have already
been translating capital into biomedicine, substituting health for value and
illness for labor.
The question thus arises: how big is the market for statins or other drugs?
One approach, used by most drug companies, has been to measure the num-
ber of diagnoses for the indication and use this as a benchmark for market
size. One company, IMS Health, is the acknowledged leader in this type
of information gathering. IMS tracks almost every prescription written by
every doctor, then sells this information to marketers and drug companies
so they can track exactly how well their campaigns are going. “[Soursac’s]
entire marketing strategy hinges on his belief that pharma companies need
to ‘look at how many human beings on the planet have specific diseases
that can be addressed by our drugs; this is the market. Whether this market
has translated into any sales of drugs in the past is irrelevant.’ Soursac cites
the possibility that a market with low sales may be suffering from under-
diagnosis of a condition or poor documentation of disease epidemiology in
certain geographic areas” (Shalo 2004). When Soursac suggests looking at
who on the planet “has the disease,” he means to estimate the number of
people who could be determined to be below a specified threshold. Arguing
then from this “potential,” he outlines a strategy for achieving it, beginning
with changing how the disease is diagnosed and how it is documented.
One way to grow a megamarket is to emphasize underdiagnosis by iden-
tifying a hidden epidemic. In one instance of market production in Japan,
for example, targeted epidemiological studies were designed specifically
to show undetected, even unimaginable levels of deep venous thrombosis
(DVT) and thus to literally create a market for its diagnosis and treatment.
“‘People in the company said there are too few patients in Japan,’ [Sour-
sac] says. ‘But I looked at the U.S. and Europe. . . . And thought this is sure
to be a big market’” (ibid.). This approach is a textbook business-growth
tactic, emulating Goizueta’s admonition that Southern California’s average
monthly Coke consumption could be tripled because Hungary’s consump-
tion was three times greater per month. Growth for Goizueta was premised
on the notion that ideals, and not averages, were appropriate target norms.
So Soursac commissioned a third-party epidemiology study that found rates
of disease in Japan to be identical to those in the United States. “‘Suddenly,

THE_BIOMARX_EXPERIMENT 77
by having that data in your hand and being able to share it with the health
authorities and medical institutions, you certainly create the market for
diagnosis and treatment of DVT which didn’t exist before’” (ibid.).
National populations and potential markets are made equivalent through
epidemiology and international-standards bodies. Factual humanitarian
claims of disease prevalence are mobilized to invoke nation- state ethical
responses, opening up markets. Health facts, in Soursac’s view, are highly
contestable. If epidemiological data suggests one conclusion, another study
might counter it. The result would seem to be a contradiction or even a con-
troversy. But when the data are properly shared, emphasized, and amplified,
a new patient-population-in-waiting can be created whole cloth, where “one
didn’t exist before.”

Pharma does not know that the normal Prevalence of Health also in-
cludes a definite quantity of Unneeded Health, and that this very Un-
needed Health is the normal source of his gain. The category of surplus
Health-time does not exist at all for him, since it is included in the nor-
mal Treatment-Time, which he thinks he has Needed for in the day’s
Healthiness. (Ch. 20)

Here we can return to the unimaginable and virtually infinite numbers of

people at high risk prophesied by Cleeman, and inflect these numbers with
the materialization of theory by Soursac. One reason why we cannot imag-
ine how many people are at risk and need treatment is because the popula-
tion does not exist until the questions are posed.
In this remarkable perspective shift, we see how pharmaceutical mar-
keters and executives envision health: as a growth opportunity and a virtu-
ally unlimited one. Could they be right? Could we be headed for a world in
which greater numbers of drugs are taken for life, such that it comes to be our
bodily intolerance to multiple drugs taken simultaneously, rather than our
lived health, which provides some sort of limit? Can the number of drugs that
Americans consume continue its double- digit growth for another century?

replace all [hour(s)] with [Treatment(s)]

Intensification: From Mass Patients to Chronic

Health care has changed dramatically in the past 35 years, as treatment has increas-
ingly migrated from the doctor who directed care in the hospital to patients who now
prevent illness through medication use in an unsupervised community setting. . . .

78 JOSEPH DUMIT
[M]edications [now] treat illnesses early in their natural history, long before painful or
disabling symptoms are apparent. . . . With [these] asymptomatic conditions, patients
are often unable to determine if they need treatment at all and/or whether the prod-
uct is working. . . . This difficulty is only likely to grow. As researchers unravel the mo-
lecular basis of an illness, manufacturers increasingly turn incurable diseases into merely
chronic ones.
WINDHOVER INFORMATION INC., “MOVING BEYOND

MARKET SHARE” (EMPHASIS ADDED)

Thus we see, that Clinical Trials, while augmenting the human material that forms the
principal object of Biomedicine’s exploiting power, at the same time raises the degree
of exploitation.
If Clinical Trials be the most powerful means for increasing the Knowledge of
Health—i.e., for shortening the Treatment-Time required in the Medicalization of
a Symptom, it becomes in the hands of Biomedicine the most powerful means, in
those industries first invaded by it, for lengthening the Treatment-Time beyond all
bounds set by human nature. It creates, on the one hand, new conditions by which
Biomedicine is enabled to give Fearful scope to this its constant tendency, and on the
other hand, new motives with which to whet Biomedicine’s appetite for the Health of
others.
BIOMARX, BIOMEDICINE

Soursac’s policy of finding the epidemiology to back up projections is an ex-

ample of efforts to increase the number of people on a treatment as much
as possible, but it still runs into limits. Maximizing markets by choosing
the most profitable diseases and maximizing the number of people indi-
cated by clinical trials are only the first steps; the next is to maximize the
length of time people stay on a treatment by increasing the number of pre-
scriptions per diagnosis. One way to achieve this is to study younger pools
of risk patients. Bartfai and Lees explain how biomarkers enable this exten-
sion: “Drug companies do not have the time to wait for the actual therapeu-
tic effect to manifest itself. . . . That is why the designers of clinical trials
are always looking for ‘surrogate endpoints’; that is you look for something
which indicates the therapeutic effect indirectly” (2006, 121).
They use the example of chronic slowly progressing diseases like osteo-
porosis, rheumatoid arthritis, and Alzheimer’s.

If you want to look at the disease progression of say a neurological dis-

ease such as alzheimers (AD), the length of the study becomes a major
financial and marketing issue. Since the disease can be detected much

THE_BIOMARX_EXPERIMENT 79
 earlier, one can elect to perform the trial on patients with mild to moder-
ate symptoms, as defined neuropsychologically, and try to show efficacy
against a slow decline, but that can take 24 to 36 months. The market
size will of course be much bigger; they are younger and there are more
of these patients who are less likely to die from other causes during the
trial. (Bartfai and Lees 2006, 156–57)

In this passage, Bartfai and Lees demonstrate how one can choose to study
the mild, earlier forms of a disease, which will vastly increase both the num-
ber of people in the market (as well as the NNT) and the length of time each
of those people are on the drug. Pharmaceutical companies face enormous
pressure to redefine diseases this way, by studying them with the purpose
of identifying a market that is as large as possible.

Hence that remarkable phenomenon in the history of Modern Pharma,

that the Clinical Trial sweeps away every moral and natural restriction
on the length of the Treatment-Time. Hence, too, the economic paradox,
that the most powerful Test for shortening Health-time, becomes the
most unfailing means for placing every moment of the Patient’s time and
that of his family, at the disposal of Pharma for the purpose of expanding
the Illness of his Biomedicine. (B- C1:532)

The source of this expansion possibility lies in the fact that treatment
value is counted via the total number of prescriptions. This was brought
home to me when, in talking with a group of marketers about chronic ill-
ness and poring over a large flowchart of patient decision points, I was di-
rected to a loop in one corner of the chart where repeated prescriptions
were encapsulated. “We would love to increase the number of prescriptions
a patient takes,” said the marketer, “because the profit is the same if one
patient takes a drug for four months, as it is for four patients taking the drug
for one month.” This interchangeability of patient numbers and prescription
consumption is reflected in the Express Scripts report under “utilization,”
which is prevalence (the number of people indicated for the drug) times in-
tensity (the average length of prescription per patient).
The effect of quantitatively extending risk in this way not only places
more people in the category of “at risk,” but essentially changes the quality
of the disease, rendering it chronic. This illustrates the fact that, from the
marketer’s perspective, “the economic driver in health care has shifted from
the physician to the patient. While physicians continue to control episodes
of short-term, acute illness, such as hospitalizations, patients increasingly

80 JOSEPH DUMIT
drive the financial and clinical outcomes for chronic diseases through the
simple daily act of taking a pill, often over a long period of time. In financial
terms, the shift from acute to chronic care medicine means that between
75–80% of a prescription’s value is now concentrated in the patient’s re-
turn to the pharmacy for refills” (Windhover Information Inc. 2002, 64).
The point being made here, in a pharmaceutical report published in 2002,
is that if one were to compare two clinical trials, one for a cure and one for a
chronic treatment approach to a disease, one would find the latter to have a
four to five times better chance of becoming a blockbuster.
Similarly, Michael Kremer and Christopher Snyder investigate why drugs
are more profitable than vaccines.

In a simple representative consumer model, vaccines and drug treat-

ments yield the same revenue for a pharmaceutical manufacturer, imply-
ing that the firm would have the same incentive to develop either ceteris
paribus. We provide more realistic models in which the revenue equiva-
lence breaks down. . . . The second reason for the breakdown of revenue
equivalence is that vaccines are more likely to interfere with the spread of the
disease than are drug treatments, thus reducing demand for the product. By
embedding an economic model within a standard dynamic epidemio-
logical model, we show that the steady-state flow of revenue is greater
for drug treatments than for vaccines. (Kremer and Snyder 2003, em-
phasis added)

Kremer and Snyder make explicit that in too much drug research, cures
get in the way of repeat revenue. The corollary of seeing clinical trials as in-
struments or means for maximizing prescriptions especially when used to
lengthen treatment time is that everything that gets in the way of those treat-
ments becomes a loss. Since the expected return- on-investment for a clinical
trial is the total possible prescriptions, everything which impedes their real-
ization is perceived as a barrier to overcome. BioMarx says something very
similar after stating that “the development of this objective Healthy Life is
in opposition to, and at the cost of, the human individual.”

The productivity of Health in general = the maximum of Risk Diagnosis

with the minimum of Health, hence the greatest possible cheapening of
Symptoms. This becomes a law in the Biomedical mode of Medicaliza-
tion, independently of the will of the individual Pharma.

A version of the flowchart the marketers showed me, with patients’ re-
turn for prescriptions, appears in almost every pharmaceutical textbook.

THE_BIOMARX_EXPERIMENT 81
What I didn’t understand at the time is that what the marketers call “utili-
zation” (Express Scripts) is, from the user’s point of view, “bioavailability,”
the overall availability of an individual’s metabolism for the maintenance of
pharmaceutical flows.20 The consequence of this formulation is that mar-
keters envision patients literally as points of resistance (rather than of con-
sumption). Their physiological rejection of many drugs, their desire to stop
taking different treatments, even their sense of their own wellness are all
obstacles to be overcome. “Applying such metrics to a variety of chronic dis-
ease states reveals that a marketer’s real enemy is less the share lost to com-
petitors than the cumulative effects of patient attrition over time” (Wind-
hover Information Inc. 2002, 69).
Note that this means that marketers are directly opposed to your decision
not to continue taking a prescription because you feel better or want to try
an alternate form of medicine. The business magazine Forbes reinforced this
battle image with a cover story on Pharma’s New Enemy: Clean Living. Recall-
ing Goizueta’s redefinition of the Coke market toward human liquid con-
sumption, which he declared as a war on coffee, tea, and tapwater, the point
here is that for good business reasons, Pharma has found a way to grow
through declaring war on living without drugs. Or as BioMarx puts it: “If the
Patient Heals his disposable time for himself, he robs Pharma” (B- C1: ch. 10).
What seems absurd here, that medical research could define healthiness
as its enemy rather than a goal is precisely the absurd paradox that con-
fronted Marx regarding the factory. Extending the analogy in which ma-
chinery is equivalent to clinical trials, we see that the logical counterpart to
hours is treatments or prescriptions. As investments, factories and machin-
ery come to be seen by capitalists as in need of maximization; any time those
machines are not in use comes to be experienced as a loss, no matter how
absurd that perception may be. Marx describes this transmogrification of
factories into entities that require laborers, which in turn requires laborers
to work as long as possible.

Furnaces and workshops that stand idle by night, and absorb no living
labour, are “a mere loss” to the capitalist. Hence, furnaces and workshops
constitute lawful claims upon the night labour of the work-people. The
simple transformation of money into the material factors of the process
of production, into means of production, transforms the latter into a title
and a right to the labour and surplus labour of others. An example will
show, in conclusion, how this sophistication, peculiar to and character-
istic of capitalist production, this complete inversion of the relation be-

82 JOSEPH DUMIT
 tween dead and living labour, between value and the force that creates
value, mirrors itself in the consciousness of capitalists. (C1: Ch11)

Marx goes on to quote a “grotesque” passage in which a mill owner considers

his “property damaged” when workers don’t work long enough to keep the
machines running at all times and thus fail to maximize the capitalist’s re-
turn on investment.21 The counterpart in biomedicine is that, from the per-
spective of pharma, a drug’s possible market becomes its expected market,
and every person for whom that drug could be indicated is seen as a loss of
revenue if he or she is not in fact taking the drug.
Mickey Smith’s Pharmaceutical Marketing includes a chart on the “Decom-
position of the Market,” which lists the math through which patients with
chronic condition X (1,000,000) translates eventually into only 7,350,000
prescriptions whereas there was an “original potential” of 12,000,000 pre-
scriptions (1 million patients × 12 prescriptions). The remainder is termed
“Prescriptions ‘Lost’” with “Lost” in quotation marks, as if Smith knows he
is treading on ethically suspect grounds; but in the summary chart, defined
in terms of the potential market, the remainder is simply listed as “Total
Prescription Loss.” Smith uses this chart to make the point that increasing
compliance may be cheaper than increasing market share.
This type of paradox arises, according to Marx, because capitalists do not
employ machines in order to produce things and generate material wealth for
society, but perceive material wealth merely as a means to make more money.

This contradiction comes to light, as soon as by the general employment

of machinery in a given industry, the value of the machine-produced
commodity regulates the value of all commodities of the same sort; and
it is this contradiction, that in its turn, drives the capitalist, without his
being conscious of the fact, to excessive lengthening of the working- day,
in order that he may compensate the decrease in the relative number
of labourers exploited, by an increase not only of the relative, but of the
absolute surplus-labour. (C1:531, ch. 15)

For BioMarx, it is no less tragic.

This contradiction comes to light, as soon as by the general employ-

ment of the Clinical Trial in a given Market, the Illness of the Threshold-
Medicalized Symptom regulates the Illness of all Symptoms of the same
sort; and it is this contradiction, that in its turn, drives Pharma, without
his being conscious of the fact, to excessive lengthening of the Treatment-
Time, in order that he may compensate the decrease in the relative num-

THE_BIOMARX_EXPERIMENT 83
 ber of Patients exploited, by an increase not only of the relative, but of the
absolute Surplus-Health. (B- C1:531)

The phrase “without his being conscious of the fact” is stunning, and in-
triguing. Marx does constantly attend to the psychology of the capitalist,
whom he sees as structurally produced (“this contradiction in turn drives
Pharma”). He points out, for instance, that what may appear at first glance
to be miserly greed, the impulse to accumulate, must in fact be understood
as a kind of possession: Capital possesses the capitalist, such that seeing
through Capital’s eyes—from Capital’s point of view—comes to be so deeply
embedded that it blinds the capitalist to all else. Thus, Marx says, Capital in-
habits the soul of the capitalist.
It is only the notion of possession by capital that prepares me to under-
stand the following claim, which is otherwise, to me, incomprehensibly
callous.

Looking at the business of mental disease objectively, but without cyni-

cism, a common denominator of these indications is that they share the
distinction of not being cured by these pharmacological treatments. This
makes the market even more attractive. The patients have to take the
drugs chronically. Not only are the diseases not cured, but there are few
treatments that give 100% relief to those who have a syndrome. All usual
response rates are 60 to 70% for a really good drug. . . . This gives a
double opportunity: (1) one can enter a partially saturated market with a
drug that works on patients unresponsive to existing treatments; and (2)
one can improve on the side effect profile or the efficacy in terms of the
time required for the onset. (Bartfai and Lees 2006, 221)

“Objectively, but without cynicism”: it is as if the authors dimly recognize

how outrageous the rest of the paragraph will seem, yet they cannot stop,
because the point they are making is objective. The world they live in, that
we live in, is a world in which medical research is a financial investment
demanding returns. In our world, it is objectively true that drugs that cure
people or stop the spread of a disease (like vaccines are supposed to do)
“reduce revenue.” Chronic treatments are more valuable to research, and
drugs that work only on a subset of people (i.e., those with a large NNT)
generate more prescriptions (by indicating a larger market) than those that
treat everyone they are indicated for (i.e., those with an NNT of 1). This is the
reality of biomedical capitalism within which we and the pharmaceutical
companies must operate and survive.

84 JOSEPH DUMIT
 Bartfai and Lees claim their view is “without cynicism.” That is, while it
might appear as if they are speaking in a scornful and bitterly mocking atti-
tude, as if they were motivated only by selfish interests, they are not. What
they are saying, in essence, then, is that unlike Marx’s capitalists they are
consciously possessed and understand clearly that they have no choice but to
“excessively lengthen treatment time . . . beyond all bounds set by human
nature,” to let BioMarx rephrase them. “Cynicism” would imply that they
had based their analysis on selfish motives and that they therefore believe it
to be the product of human nature. But they rest in the knowledge, instead,
that their conclusions simply reflect the objective contradictions of health-
care.

What is a Treatment-Time? What is the length of time during which Bio-

medicine may Heal the Illness whose daily Diagnosis it buys? . . . [I]n its
blind unrestrainable passion, its were-wolf hunger for surplus-Health,
Biomedicine oversteps not only the moral, but even the merely physical
maximum bounds of the Treatment-Time. . . . It reduces the sound sleep
needed for the restoration, reparation, refreshment of the bodily powers
to just so many Treatments of torpor as the revival of an organism, abso-
lutely exhausted, renders essential. It is not the normal maintenance of
the Illness which is to determine the limits of the Treatment-Time; it is
the greatest possible daily expenditure of Illness, no matter how diseased,
compulsory, and painful it may be, which is to determine the limits of
the Patients’ period of repose. Biomedicine cares nothing for the length
of life of Illness. All that concerns it is simply and solely the maximum
of Illness, that can be rendered fluent in a Treatment-Time. (B- C1: ch. 10)

A different sort of logic was proposed by two researchers in the British

Medical Journal in 2004. Based on a meta-analysis of existing risk, bio-
marker, and threshold trial data, the authors proposed a single multipill that
would save lives to such an extent, they argued, that everyone over fifty-five
should be mandated to take it. Their logic is an extension of Rose’s preven-
tion analysis. In a nod to cost, but not to consent, they suggest that a low-
cost version of this polypill, using generic components off patent, would
work, even if “10% of the users were intolerant” (Wald and Law 2003, 4).
“Intolerance” here is a formulation of the literal limit of the body’s resistance
to too many drugs, that is, when it throws them up. Their proposal thus in-
volves calibrating the drug to the maximum number of effects, side effects,
and cost that society will tolerate before rebelling (the NNT of the polypill
was estimated to be between 600 and 800).

THE_BIOMARX_EXPERIMENT 85
 With “bodily intolerance” we confront the same ultimate physiological
barrier that Marx’s capitalists found with labor, and that Goizueta found
with Coke: the surprisingly expandable but not unlimited elasticity of the
human body. Where Goizueta suggested that the target for Coke’s growth
was human liquid- consumption capacity, Marx locates it in the labor
humans can be pushed to do, and BioMarx in the body’s tolerance for pills.

And this law is only realized because it implies another one, namely that
the scale of Medicalization is not determined according to given needs,
but rather the reverse: the number of Risk Diagnoses is determined by
the constantly increasing scale of Medicalization, which is as much Un-
diagnosed health as possible, and this is only attained by engaging in
Medicalization for Medicalization’s sake. (B- PEM 1038)22

Their article concludes with a call for the end of thresholds altogether by
taking them to their natural limit: “It is time to discard the view that risk
factors need to be measured . . . everyone is at risk” (Law and Wald 2003, 4).
This is a naturalized form of the suggestion to “put statins in the water
supply,” no longer even a half-joke, but a policy proposal.

Conclusion
replace all [laborer(s)] with [Patient(s)]
replace all [wage] with [Risk]
replace all [wage-laborer(s)] with [Patient(s)-at-Risk]

We see then, that, apart from extremely elastic bounds, the nature of the Measure of
Symptoms itself imposes no limit to the Treatment-Time, no limit to surplus-Health.
Pharma maintains his rights as a purchaser when he tries to make the Treatment-Time
as long as possible, and to make, whenever possible, two Treatment-Times out of one.
On the other hand, the peculiar nature of the Symptom Submitted implies a limit to
its Healing by the purchaser, and the Patient maintains his right as Submitter when
he wishes to reduce the Treatment-Time to one of definite normal duration. There is
here, therefore, an antinomy, right against right, both equally bearing the seal of the
law of Measures. Between equal rights force decides. Hence is it that in the history
of Pharma Experience, the determination of what is a Treatment-Time, presents itself
as the result of a struggle, a struggle between collective Biomedicine, i.e., the class of
Pharma Companies, and collective Health, i.e., the Patient Class.
BIOMARX, BIOMEDICINE

86 JOSEPH DUMIT
In using Marx to construct BioMarx, I did not assume that he was correct
about the economy. Rather I attended carefully to the careful way in which
he read the capitalists and the economists of his day. He attempted to make
explicit the logic of their way of valuing the world, which was via labor.
He found this directly in their writings: in the way they kept their account
books, the way they complained about wasted labor, and the way they chose
to invest in machinery (or not). In this manner he executed a close reading
of their practices as they were enabled by their perspective—the material-
ization of their theories of value. By following the logic of the competing
demands of this perspective—the way in which growth, for instance, be-
comes critical for a company’s survival—he tried to show that apparently
contradictory results, like constant crises, were results of this logic. And in
turn he was able to show how the actions of capitalists made sense in light
of this logic.
I, too, have had to adopt this convoluted approach, as I have been con-
fronted with apparently absurd and sometimes vile practices by pharma-
ceutical companies, and with corporate statements that have, in a calm, ob-
jective, and at times defensively complaining voice, logically justified those
practices. I did not attend to the scandalous practices of cheating in a clinical
trial, suppressing research, or ghostwriting results, but rather to the need to
develop drugs for diseases that affect the insured middle class and to avoid
focusing on diseases that largely affect the poor, and to the need to define
illness as risk and increase as much as possible the number of treatments,
even if this means that most of the people being treated would not benefit
from the drug.
When I’ve assessed these latter practices without the context and logic
unearthed by BioMarx, it has been impossible to understand pharmaceu-
tical companies as anything but predatory. Using Marx in this way helps
clarify the logic that drives pharmaceutical companies as a logic that is not
exclusive to that particular corporate culture, but is shared by all of us—and
that it is a historically specific logic, a way of seeing health qua mass health
as risk reduction, that results in health being defined via treatments.
When I presented a talk on this material (without mentioning Marx) as
grand rounds to the psychiatry department at Alta Bates Medical Center,
the first question I got was “Is there any hope?” The second was “What do
you recommend we do?” BioMarx suggests we are only at the beginning of a
transformation of health. In analogy to the fight over the length of the work-
ing day, BioMarx suggests that there will be increasing struggles over how
much medicine we can be mandated to take. Perhaps the various debates

THE_BIOMARX_EXPERIMENT 87
regarding the new “vaccines”—like a human papilloma virus vaccine for all
girls ages nine to thirteen, and a meningitis vaccine for all children—are
signs of this. And will the same happen with the polypill? Will there be a
fight to determine the level of drug intake we are forced to tolerate?

One of the most important problems, therefore, which the Diagnoser of

a Health Market has to solve is to find out the maximum speed at which
he can run, with a due regard to the above conditions. It frequently hap-
pens that he finds he has gone too fast, that breakages and bad Treatment
more than counterbalance the increased speed, and that he is obliged to
slacken his pace. (B- C1: ch. 10)

Reading BioMarx this way, I have started having little out- of-body experi-
ences. The future is calling me. This nightmare future where, when we wake
up, we first check the latest clinical trials, then order our pack of pills for the
day. Some people—the “intolerants” we call them—have negative reactions
to the pills. This is not their fault, as they protest, but their insurance goes
up all the same.
In this future, there are still two parties: the More-Lifers rule on a plat-
form of immortality. Life extension is a reality, they say, as long as we all
do our part and participate in enough clinical trials. The opposition party—
More- Choicers—complain that health is not a formula, that we should not
be forced to take so many drugs with so many unknown interactions. Cur-
rent guidelines require monitoring of seventy-five biomarker measures like
cholesterol levels (six types), the body-mass index, a composite behavioral-
emotional score, and a steady-attention test. In order to receive health cover-
age, all of these must remain above the acceptable level or one must be
taking the appropriate preventative pharmaceutical therapy. There is grow-
ing unrest over the legal intolerance rate of 10 percent, meaning that 10
percent of the population has detrimental reactions to the required medica-
tions. If the rate isn’t lowered below 3 percent, many predict that the More-
Choice party may take back the house.
That is my objective paranoid self speaking. My analytic self and the phar-
maceutical analysts begin with the tragedy. The more “health” we gain, the
more medicine we consume. Key to this is the fact that most clinical trials
are designed by the pharmaceutical industry, and in the most mundane capi-
talist way, this means that they are designed such that if they are successful,
they will increase the market in drugs. The corollary is startling: almost all
of the facts that we have gathered about our mass health over the last twenty
years tell us to take more drugs. They are not bad facts, but they are limited.

88 JOSEPH DUMIT
We are not asking—and tragically, in our current system, we cannot afford
to ask—what sort of “health” we might have if we took fewer drugs. Those
facts have not been produced. Until we rethink the infrastructure for the
design of large-scale clinical trials and screening tests, this trend will con-
tinue—even if we clean up the abuses of clinical trials.
The disturbing analytic problem is that the pharmaceutical executives
and marketers seem to be shouting the same thing. Don’t blame us, they
say. We know the problems better than you do, but we are trapped within
them, too, even as we perpetuate them. Thus Mickey Smith explains, “So-
ciety has medicalized human problems, it appears. Medicine has perhaps
been an accessory, and the pharmaceutical industry, certainly, has provided
both with the means. To expect either of the latter parties to do, or have done,
otherwise bespeaks a considerable naïvete” (2002, 35).
Similarly, Bartfai and Lees blame two groups “as the real root causes of
all the problems the industry and society face” (2006, xvii), including why
there are not enough drugs for the people who need them. The groups are
“the lawyers who litigate and the venture capitalists who may want too much
return from too short an investment and can switch their investments and
allegiances on a whim” (ibid. xvii). To point to lawyers distracts from the real
insight: the structure of drug companies is that of a capital company whose
chief allegiance is to shareholder returns.23 Whether by venture capitalists
or mutual funds, drug companies must always increase returns, and that
means more treatments.
Thus it seems we are in a bind, even as we have an ever-increasing num-
ber of treatments available, which continually reduces our risk. We call for
more regulation, better surveillance of drug companies, and even structure
incentives better, like orphan drug laws and granting companies six addi-
tional months of patent protection if they study the effects of their drugs on
children. We get more information on relative safety, companies get more
money, and, predictably, children end up taking more and more drugs (re-
ducing their risks more).
But this use of we marks me as a medically insured U.S. citizen most
deeply. My suspicious ears hear another trend being traced by the ethnog-
raphies of clinical trials conducted globally. There is a much bigger, global
story to tell about clinical trials that is the object of ongoing research by Kau-
shik Sunder Rajan, Adriana Petryna, Kris Peterson, myself, and others.
The insidiously banal logic of modern- day pharmaceutical industry
growth drives clinical trials in ways that have become so naturalized that it
is hard to imagine health research in any other way. How is it that we live

THE_BIOMARX_EXPERIMENT 89
with, love, and ingest medicines produced through this same experimental
zone? How is it that our privileged consciousness sees this as all so natural,
our bodies willingly given over, and other bodies so easily made invisible?

replace all [materials] with [Bodies]

replace all [property] with [Life]
replace all [price] with [Prevalence]
replace all [profit] with [Market-Increase]

Notes
1. IMS Institute for Healthcare Informatics, The Use of Medicines in the United
States: Review of 2010 (Parsippany, N.J.: IMS Health Incorporated, 2011); Office of the
Actuary, Centers for Medicare and Medicaid Services, National Health Expenditures,
Forecast Summary and Selected Tables.
2. This scale allows for tremendous variation. Huge disparities exist in prescrip-
tion rates by state, and by counties in states, and within counties. Often a single pre-
scriber can increase the prescription consumption in an area five- to tenfold.
3. Formulation from Sunder Rajan 2006.
4. The old guidelines held that blood levels of low- density lipid (LDL) cholesterol,
the bad kind that clogs arteries, should stay below 100 milligrams per deciliter (mg/
dL) and, ideally, below 70 mg/dL for very high-risk patients. According to the new
advisory, issued in 2006, those guidelines are now recommended for all people with
established heart disease. See Edelson 2006.
5. See https://sites.google.com/site/biomarxexperiment/home. The original is at
http://www.marxists.org/archive/marx/works/1867- c1/index-l.htm.
6. See appendix A for a list of the substitutions. I have not thought through even
in passing the relations of biocapital in the sense that Kaushik Sunder Rajan (2006)
uses it; the capitalization of biology in the sense used by Hannah Landecker (2007);
the commodification of bodies in either Adriana Petryna’s take on health or clinical-
trial trafficking (2005) or in Lawrence Cohen’s take on organs (1999); or the pro-
posed rewriting of Capital, vol. 3, by Sarah Franklin and Margaret Lock (2003).
7. Other words may be more appropriate for other areas of analysis. If anyone has
terms they would like to experiment with, I can easily code them and produce a sub-
stituted Capital in less than a minute. Automation does save labor!
8. All quotes from Biomedicine I have left in the raw automatic-substitution for-
mat. Please see the websites for the full text of Biomedicine.
9. The inspiration for this origin story lies in the work of the Socialist Patients
Kollectiv (SPK) (Sozialistisches Patientenkollektiv 1993).
10. See Greene 2006 on the history of this since the 1960s.
11. “Are You the Picture of Health?” campaign for colorectal- cancer screening.
Available at the Centers for Disease Control and Prevention website, http://www.cdc
.gov.

90 JOSEPH DUMIT
 12. [Fixed Biomedicine and the Development of the Knowable Forces of Society]
NOTEBOOK VII, End of February, March. End of May–Beginning of June 1858, The
Chapter on Biomedicine (continuation).
13. Compare Petryna 2005, Sunder Rajan 2007, Fisher 2009, Petryna, Lakoff, and
Kleinman 2006, and Peterson, chapter 7 in this volume.
14. See for instance J. Urquhart, “Some Key Points Emerging from the COX-2 Con-
troversy.” Pharmacoepidemiology and Drug Safety 14, no. 3 (2005).
15. The work of Moishe Postone, in Time, Labor and Social Domination (1993), was
extremely useful in helping me to understand this dynamic.
16. Pastoral care or biopolitics in terms of care of the population, from this per-
spective, is only meaningful when such “care” involves an expanding and constant
domain of prophylaxis. Normalization in a Foucaultian sense is meaningless in this
regard—the only state of “normality” that generates value is one that expresses an
aggregate potentiality of future illness.
17. They continue: “A more profound ‘revelation’ [than the fact that drug compa-
nies deceive us] is that members especially of the U.S. society are prepared to take
too many drugs with little provocation” (Bartfai and Lees 2006, xv). This statement
speaks fundamentally to why citizens should in no way expect drug companies or any
other company to look out for the public interest or even to tell the truth. As Althus-
ser (2006) suggests, the bourgoisie lies easily because the lies are naturalized, con-
tinuous, “common-sense” discourses all by themselves.
18. Ironically, cholesterol-lowering drug trials are actually quite numerous be-
cause the market is so large that almost every company competes for it (Greene
2006).
19. See Linda Hogle (2001) and Jennifer Fosket (2002) on clinical-trial entry cri-
teria determining “high risk” as a result.
20. See Cohen on bioavailability (Cohen 1999, 2004), as well as the federal defi-
nition: “the rate and extent to which the active ingredient or therapeutic ingredient
becomes available at the site of drug action” (section 505[j] of the Food, Drug, and
Cosmetic Act as amended by Title XI of the Medicare Prescription Drug, Improve-
ment, and Modernization Act of 2003 [505(j)(8)(A)(ii)]).
21. During the revolt of the English factory lords between 1848 and 1850, “the
head of one of the oldest and most respectable houses in the West of Scotland,
Messrs. Carlile Sons & Co., of the linen and cotton thread factory at Paisley, a com-
pany which has now existed for about a century, which was in operation in 1752, and
four generations of the same family have conducted it,” this “very intelligent gentle-
man” wrote a letter in the Glasgow Daily Mail, on 25 April 1849, with the title “The
Relay System,” in which among other things the following grotesquely naïve passage
occurs: “Let us now . . . see what evils will attend the limiting to 10 hours the work-
ing of the factory. . . . They amount to the most serious damage to the millowner’s
prospects and property. If he (i.e., his “hands”) worked 12 hours before, and is lim-
ited to 10, then every 12 machines or spindles in his establishment shrink to 10, and
should the works be disposed of, they will be valued only as 10, so that a sixth part
would thus be deducted from the value of every factory in the country.”

THE_BIOMARX_EXPERIMENT 91
 22. From author’s “BioMarx” substitution of the Economic Works of Karl Marx
1861–1864 at chapter 6: http://www.marxists.org/archive/marx/works/1864/eco
nomic/ch02a.htm (at [450]).
23. Lawyers are problematic in that their litigation puts drug companies on the
defensive (Smith, Kolassa, Perkins, and Siecker 2002).

92 JOSEPH DUMIT
 2
DONNA J. HARAWAY

VALUE- ADDED DOGS AND LIVELY CAPITAL

Marx dissected the commodity form into the doublet of exchange value and
use value. But what happens when the undead but always generative com-
modity becomes the living, breathing, rights- endowed, doggish bit of prop-
erty sleeping on my bed—or giving cheek swabs for your genome project,
or getting a computer-readable ID chip injected under the neck skin before
the local dog shelter lets my neighbor adopt her new family member? Canis
lupus familiaris, indeed; the familiar is always where the uncanny lurks.
Further, the uncanny is where value becomes flesh again, in spite of all the
dematerializations and objectifications inherent in market valuation. Marx
always understood that use and exchange value were names for relation-
ships; that was precisely the insight that led beneath the layer of appear-
ances of market equivalences into the messy domain of extraction, accumu-
lation, and human exploitation. Turning all the world into commodities for
exchange is central to the process. Indeed, remaking the world so that new
opportunities for commodity production and circulation are ever generated
is the name of this game. This is the game that absorbs living human labor
power without mercy. In Marx’s own colorful, precise language, which still
gives capitalism’s apologists apoplexy, capital comes into the world “drip-
ping from head to toe, from every pore, with blood and dirt” (1976 [1867],
926).
 What, however, if human labor power turns out to be only part of the
story of lively capital? Of all philosophers, Marx understood relational sen-
suousness, and he thought deeply about the metabolism between human
beings and the rest of the world enacted in living labor. As I read him,
however, he was finally unable to escape from the humanist teleology of
that labor—the making of man himself. There are, finally, no companion
species, reciprocal inductions, or multispecies epigenetics in his story.1 But
what if the commodities of interest to those who live within the regime of
Lively Capital cannot be understood within the categories of the natural and
the social that Marx came so close to reworking, but could not finally do
under the goad of human exceptionalism? These are hardly new questions;
but I propose to approach them through relationships inherent in contem-
porary U.S. dog-human doings that raise issues not usually associated with
the term biocapital, if, nonetheless, crucial to it.
First, however, a caveat about the “specificity,” in many senses, of my
arguments: co- constitutive relatings between taxonomically recognizable
dogs and people are at least tens of thousands of years old and reach across
and through the earth (and the near reaches of outer space in U.S. and Soviet
space programs) to almost every habitat and lifeway, past and present, and,
with luck, to come. “Dog is my co-pilot” is more than a joke or a slogan to
put on one’s car along with the Darwin fish. Multispecies, trans-species be-
coming with each other in naturecultures is the name of the game of life on
earth; the partners do not precede their dynamic knottings. Critters, human
and not, make each other up in flesh and sign, literally and figuratively.
There is no such thing as the universal human or the universal dog. There-
fore, it makes no sense to talk of human- dog relating as a singularity of any
kind, including capitalist sorts. That does not mean that living with, think-
ing with, “one” complex tangle in its interlaced times and spaces does not
shape attachment sites for many other connections—not generalizations,
but possible connections to other muddy worlds that nonholistically extrude
and intrude in the fibrous slime of situated becomings with. Ahumanist
temporalities infuse all the tissues of all the critters; history is not a human
monopoly. In that sense, “we have never been human” is my motto. We are,
rather, “companion species”—that is, mortal mess mates at a terran repast.2
So, in this chapter, I explore value tangles of mainly late-twentieth- and
early-twenty-first- century, Euro-American-U.S. dog-human doings, some
of which shape consequential and quite specific kinds of “globals” in com-
modity networks, queer and normative kin-formations, and other sorts
of worlding familiar to analysts of biopower and biocapital. It would be a

94 DONNA J. HARAWAY
mistake to read my analyses as paradigmatic for other situated dog-human
doings, but also a mistake not to grasp attachment sites for analysis and
action.3 I may be telling a tale of a decadent late imperial power, where lively
capital runs on doggy investments, but it is a tale with many other storied
and lived times—past, present, and to come.
There is no shortage of proof that classic rabid commodification is alive
and well in consumer- crazy, technoscientifically exuberant dog worlds in
the United States. I will give my readers plenty of reassuring fact-packages
on this point, sufficient to create all the moral outrage that we lefties seem
to need for breakfast and all the judgment-resistant desires that we cultural
analysts seem to enjoy even more. However, if a Marx-equivalent were writ-
ing Biocapital, volume 1, today, insofar as dogs in the United States are com-
modities, as well as consumers of commodities, the analyst would have to
examine a tripartite structure: use value, exchange value, and encounter
value—without the problematic solace of human exceptionalism.4
Trans-species encounter value is about relationships among a motley ar-
ray of lively beings, where commerce and consciousness, evolution and bio-
engineering, and ethics and utilities are all in play. I am especially interested
here in “encounters” that involve, in a nontrivial but hard-to- characterize
way, subjects of different biological species. My goal is to make a little head-
way in characterizing these relationships in the historically specific context
of lively capital. I would like to tie my Marx- equivalent into the knots of
value for companion species, especially for dogs and people in capitalist
technoculture in the early twenty-first century, where the insight that to be
a situated human being is to be shaped by and with animal familiars might
deepen our abilities to understand value-added encounters.

Valuing Dogs: Markets and Commodities

Like a 1950s TV show, companion-animal worlds are all about family. If

European and American bourgeois families were among the products of
nineteenth-century capital accumulation, the human-animal companionate
family is a key indicator for today’s lively capital practices. That nineteenth-
century family may have invented middle- class pet keeping; but what a pale
shadow to today’s doings that was! Kin and brand are tied in productive em-
brace as never before. In 2006 about 69 million U.S. households (63 per-
cent of all households) had pets, giving homes to about 73.9 million dogs,
90.5 million cats, 16.6 million birds, and many other critters.5 As an online
report on the pet food and supplies market from MindBranch, Inc. for 2004

VALUE-ADDED DOGS AND LIVELY CAPITAL 95

stated, “In the past, people may have said their pet ‘is like a member of the
family,’ but during 1998–2003 this attitude has strengthened, at least in
terms of money spent on food with quality ingredients, toys, supplies, ser-
vices, and healthcare.”6 The consumer habits of families have long been the
locus for critical theory’s efforts to understand the category formations—
like gender, race, and class—that shape social beings. Companion-species
kin patterns of consumerism should be a rich place to get at the relations
that shape emergent subjects, not all of whom are people, in lively capital’s
naturecultures. Properly mutated, the classics like gender, race, and class
hardly disappear in this world—far from it—but the most interesting emer-
gent categories of relationality are going to have to get some new names, and
not just for the dogs and cats.
The global companion-animal industry is big, and the United States is a
major player. I know this because I have dogs and cats who live in the style
to which I and my whole post-Lassie generation have become indoctrinated.
Like any scholar, however, I tried to get some hard figures to go with the
coming examples. The Business Communications Company publishes an
annual analysis of market opportunities and segments, company fortunes,
rates of expansion or contraction, and other such data dear to the hearts of
investors. So for the first draft of this chapter, I tried to consult The Pet Indus-
try: Accessories, Products, and Services for 2004 online. Indeed, I could have
downloaded any of the alluring chapters, but all of them are proprietary,
and so to peek is to pay. To get access to the whole package would have cost
me over $5,000, a nice piece of evidence all by itself for my assertion in the
first sentence of this paragraph. An alternative data source, Global Informa-
tion Inc. (the self- described online “vertical markets research portal”), offers
twenty-four-hour, five- day-per-week updates for pet marketers on forecasts,
shares, research and development, sales and marketing, and competitive
analysis. Ignore these services at your peril.
In the end, I settled for training-sized statistical tidbits from Business
Communications and from the free summaries for the 2006 survey avail-
able on the website of the American Pet Products Manufacturing Asso-
ciation. In the United States alone in 2006, pet owners spent about $38.4
billion overall on companion animals, compared to $21 billion in 1996 (con-
stant dollars). The global market for pet food and pet- care products for 2002
was U.S. $46 billion, which is an inflation-adjusted increase of 8 percent
over the period 1998–2002. The inflation-adjusted growth rate for 2003
alone was 3.4 percent, driven, we are told, by pet owners’ demand for pre-
mium foods and supplies.

96 DONNA J. HARAWAY
 Consider just pet food. ICON Group International published a world mar-
ket report in February 2004. The report was written for “strategic planners,
international executives and import/export managers who are concerned
with the market for dog and cat food for retail sale.”7 The point was that
“with the globalization of the market, managers can no longer be contented
with a local view.” Thus, the report paid special attention to which countries
supply dog and cat food for retail sale, what the dollar value of the imports is,
how market shares are apportioned country to country, which countries are
the biggest buyers, how regional markets are evolving, and how managers
might prioritize their marketing strategies. Over 150 countries are analyzed,
and the report makes clear that its figures are estimates of potential that
can be drastically altered by such things as “‘mad cow’ disease, foot-and-
mouth disease, trade embargoes, labor disputes, military conflicts, acts of
terrorism, and other events that will certainly affect the actual trade flows.”
Indeed. Nonetheless, the report neglected to state the underlying obvious
fact: industrial pet food is a strong link in the multispecies chain of global
factory farming.8
The News York Times for Sunday, 30 November 2003, is my source for
the $12.5 billion for the size of the U.S. pet-food market in 2003 ($15 billion
in 2006) (Koerner 2003). I did not know how to think about how big that
was until I read another story in the New York Times (2 December 2003)
telling me that in 2003 the human cholesterol-lowering statin market was
worth $12.5 billion to the pharmaceutical industry (Kolata 2003). How much
human blood-lipid control is worth how many dog dinners? I’d throw away
my Lipitor before I shorted my dogs and cats. Marx told us how the purely
objective nature of exchange value evacuates the trouble springing from
such use-value comparisons. He also told us how such things as statins and
premium dog food become historically situated bodily needs. He didn’t pay
nearly enough attention for my taste to which bodies, in the multispecies
web linking slaughter labor, chicken cages, pet dinners, human medicine,
and much more.
I cannot now forget these things as I decide how to evaluate both the
latest niche-marketed dog food purported to maximize the sports perfor-
mance of my agility dog and also how her nutritional needs are different
from those of my older but still active pooch. A large and growing portion of
pet-food products addresses specific conditions, such as joint or urinary tract
health, tartar control, obesity, physiological demands, age-related needs,
and so on. I cannot go to an agility meet to run with my dog without trip-
ping over brochures and booths for natural foods, scientifically formulated

VALUE-ADDED DOGS AND LIVELY CAPITAL 97

foods, immune-function- enhancing foods, homemade-ingredients foods,
foods for doggy vegans, raw organic foods that would not please vegans at
all, freeze- dried- carrot fortified foods, food- delivery devices to help out dogs
who are alone too much, and on and on. Indeed, diets are like drugs in this
nutritional ecology, and creating demand for “treatment” is crucial to mar-
ket success. Besides diets, I feel obligated to investigate and buy all the ap-
propriate supplements that ride the wavering line between foods and drugs
(chondroitin sulfate and glucosamine sulfate or omega-3 fatty acids from
flax seed or fish oil, for example). Dogs in capitalist technoculture have ac-
quired the mixed blessing of the “right (obligation) to health,” and the eco-
nomic (as well as legal) implications are legion. Dog nutraceuticals also land
them as well as their humans in the midst of controversies over depleting
shark populations for chondroitin from their cartilage or hyping consumers
on the benefits of omega-3s from cheap plants when the fatty acids from
disappearing fish stocks are probably the ones needed for joint and heart
health.
Food is not the whole story. The Business Communications Company
stressed that there was growth in all segments of the companion- animal
industry, with rich opportunities for existing players and new entrants.
Health is a giant component of this diversifying doggy version of lively capi-
tal. Small-animal veterinarians are well aware of this fact, as they struggle to
incorporate the latest (very expensive) diagnostic and treatment equipment
into small practices in order to remain competitive. A special study done
in 1998 revealed that vets’ income was not growing at the rate of compa-
rable professionals because they did not know how to adjust their fees to the
rapidly expanding services they were routinely offering.9 My family’s credit-
card records tell me that at least one of the vet practices we frequent got the
point in spades. In 2006 U.S. citizens spent about $9.4 billion for vet care
for pets. As a reality check, I turned to the World Animal Health Markets of
2010, a report that profiled animal health markets in fifteen countries, ac-
counting for 80 percent of the world share.10 The conclusion: in the affluent
parts of the globe, the pet-health market is robust and growing.
Consider a few figures and stories. Mary Battiata wrote a feature article
for the Washington Post in August 2004 that followed her search for a diag-
nosis for her aging family member, her beloved mutt, Bear, who showed
troubling neurological symptoms. After the first sick visit to the vet cost
$900, she began to understand her situation. She was referred to the Iams
Pet Imaging Center in Washington for an MRI. Or rather, Bear was referred,
and his guardian/owner Mary wrestled with the ethical, political, affec-

98 DONNA J. HARAWAY
tional, and economic dilemmas. How does a companion animal’s human
make judgments about the right time to let her dog die—or, indeed, to kill
her dog? How much care is too much? Is the issue quality of life? Money?
Pain? Whose? Does paying $1,400 for Bear’s MRI add to the world’s injus-
tice, or is the comparison between what it costs to run decent public schools
or to repair wetlands and what it costs to get Bear diagnosed and treated the
wrong one? What about the comparison between people who love their pet
kin and can afford an MRI, and people who love their pet kin and can’t af-
ford annual vet exams, good training education, and the latest tick and flea
products, much less hospice care (now available in a few places for dogs and
cats)? What comparisons are the right ones in the regime of lively capital?
Other high-end treatments now available for pets include kidney trans-
plants, cancer chemotherapy, and titanium joint-replacement surgeries. The
University of California, Davis, recently opened an up-to-the-minute treat-
ment and research hospital for companion animals with the kind of cancer
care expected in the best human medical centers. New veterinary drugs—
and human drugs redirected to companion animals—emphasize pain re-
lief and behavior modification, matters that hardly appeared on Lassie’s
people’s radar screens, but involve serious money and serious ethical dilem-
mas today.11 In addition, vets-in-training today take courses in the human-
animal bond, and this diversifying region of the affectional family economy
is as richly commodified and socially stratified as is any other family-making
practice, say, for example, assisted reproduction for making human babies
and parents.12
Pet health insurance has become common, as is malpractice insurance
for vets, partly fueled by the success in court of arguments that compan-
ion animals cannot be valued like ordinary property. “Replacement value”
for a companion dog is not the market price of the animal. Neither is the
dog a child nor an aged parent. In case we missed the point in all the other
aspects of daily life, efforts both to establish money damages and to pay
the bills for our companions tell us that parent- child, guardian-ward, and
owner-property are all lousy terms for the sorts of multispecies relation-
ships emerging among us. The categories need a makeover.
Besides vets, other sorts of health professionals have also emerged to
meet companion-animal needs. I get regular professional adjustments for
my Australian Shepherd sports partner, Cayenne, from Ziji Scott, an animal-
chiropractic- certified practitioner with magic hands. No one could convince
me that this practice reflects bourgeois decadence at the expense of my other
obligations. Some relationships are zero-sum games, and some are not. But

VALUE-ADDED DOGS AND LIVELY CAPITAL 99

a central fact shapes the whole question: Rights to health and family-making
practices are heavily capitalized and stratified, for dogs as well as for their
humans.
Beyond the domains of dog medical services, nutrition, or pedagogical
offerings, canine consumer culture of another sort seems truly boundless.
Consider vacation packages, adventure trips, camp experiences, cruises,
holiday clothing, toys of all kinds, daycare services, designer beds and other
animal-adapted furniture, doggy sleeping bags and special tents and back-
packs, and published guides to all of the above. On 24 September 2004, the
New York Times ran ads for dog shopping that featured a $225 raincoat and
$114 designer collar. Toy dogs as fashion accessories to the wealthy and fa-
mous are a common newspaper topic and a serious worry for those who think
those dogs have doggish needs.13 The American Kennel and Boarding Asso-
ciation in 2006 reported that the significant industry growth is in the high-
end pet lodgings, such as the new San Francisco hotel, Wag, which charges
$85 per night and offers massage, facials, and swimming pools. Webcam
TV for traveling humans to watch their pets in real time in communal play
areas is standard at San Francisco’s middle- of-the-market $40-per-night Fog
City Dogs Lodge.14 For those whose commodity preferences are more book-
ish, look at the companion-animal print culture. Besides a huge companion-
species book market in categories from anthropology to zoology and the
whole alphabet in between, two new general-audience magazines make my
point. Bark is a Berkeley, California, dog literary, arts, and culture rag that
I read avidly, and not just because they favorably reviewed my Companion
Species Manifesto. The East Coast finally faced its responsibilities in this mar-
ket segment; and so, with articles on such matters as how to win a dog-
custody battle and where to find the best ten places to walk with your dog
in Manhattan, the New York Dog appeared in November–December 2004,
aiming to rival Vogue and Cosmopolitan for glossy values.15 And all of this
hardly touches the media markets crucial to hunting with dogs, playing dog-
human sports, working with dogs in volunteer search and rescue, and much
more. It seems to me that it is all too easy in dogland to forget that resistance
to human exceptionalism requires resistance to humanization of our part-
ners. Furry, market-weary, rights bearers deserve a break.
Enough, or rather, almost enough—after all, in lively capital markets
“value-added” dogs aren’t just familial co- consumers (or co-workers, for
which you must go to the next section of this chapter). In the flesh and in the
sign, dogs are commodities, and commodities of a type central to the history
of capitalism, especially of technoscientifically saturated agribusiness. Here

100 DONNA J. HARAWAY

I will consider only kennel- club registered “purebred” dogs, even though
those surely aren’t the canines that come first to mind in connection with
the term agribusiness, no matter how much pedigree-packing dogs return
us to crucial nineteenth- century economic and cultural innovations rooted
in the biosocial body. In Bred for Perfection (2003), Margaret Derry explains
that the public data keeping of lineage—the written, standardized, and guar-
anteed pedigree—is the innovation that fostered international trade in both
livestock like sheep and cattle and fancy stock like show dogs and chickens.
And, I might add, race- and family-making stock. Institutionally recorded
purity of descent, emphasizing both inbreeding and male lines that made
female reproductive labor all but invisible, was the issue. The state, private
corporations, research institutions, and clubs all played their roles in mov-
ing practices for controlling animal reproduction from pockets of memory
and in local endeavors of both elites and working people to rationalized na-
tional and international markets tied to registries. The breeding system that
evolved with the data-keeping system was called scientific breeding; and in
myriad ways this paper-plus-flesh system is behind the histories of eugenics
and genetics, as well as other sciences (and politics) of animal and human
reproduction.
Dog breeds, not variously differentiated and stabilized kinds, but breeds
with written pedigrees, were one result. Across continents, dogs with those
credentials could command very nice prices, as well as fuel amazing prac-
tices of heritage invention, standards writing and maintenance, sales-
contract development, germ-plasm trading, health surveillance and activ-
ism, reproductive-technology innovation, and the passionate commitment
of individuals, groups, and even whole nations.16
The proliferation of dog breeds, and their movement into every social
class and geographical region of the world, is part of the story. There are
many breeds specifically produced for the pet market, some quite new, like
the cross of Borzois and Longhaired Whippets to make the little sighthound
called Silken Windhounds. Witness today’s explosion in toy breeds and tea-
cup breeds as fashion accessories (and too often, medical disasters). Or the
popularity of the puppy-mill-produced dogs because they carry an Ameri-
can Kennel Club (AKC) purebred dog pedigree. Or, as I move away from
outrage to love affair, I am reminded both of the knowledgeable, talented,
self- critical dog people whom I have met in performance dog worlds, as well
as in conformation show dog scenes, and also of their accomplished, beau-
tiful dogs. And of my dogs, including Roland, the one with the fraudulent
(that Chow- Chow dad) AKC Australian Shepherd registration, gotten so that

VALUE-ADDED DOGS AND LIVELY CAPITAL 101

he can play with agility in the shepherds’ sandbox, as long as he is reproduc-
tively sterilized.
But is he necessarily reproductively silenced? What happens when pedi-
gree, or lack of it, meets petri dish? Consider the Dolly technique so in-
sightfully written about by Sarah Franklin in Dolly Mixtures (2007). Dolly
the pedigreed sheep might have been the first mammal who was the fruit of
somatic cell nuclear transfer cloning, but she was at the head of a growing
parade of critters. By tracing the many biosocial threads in Dolly’s geneal-
ogy across continents, markets, species, sciences, and narratives, Franklin
argues that emergent ways of fleshly becoming are at the heart of biocapital,
as both commodities and as mode of production.17 Franklin maintains that
breedwealth was the crucial new kind of reproductive wealth in the late
eighteenth and nineteenth centuries; and control over the reproduction (or
generation by other means) of plants and animals (and, to varying degrees,
people) is fundamental to contemporary biocapital’s promises and threats.
The traffic between industrialized agriculture and scientific medicine for
people and animals is especially thick in Dolly mixtures and spillovers. Cur-
rent innovations and controversies in stem- cell research and therapeutic
as well as reproductive cloning are at the heart of the transnational, trans-
specific action.
Stem cells and dogs take us inevitably to Hwang Woo-Suk and the Seoul
National University. The international scandal surrounding Hwang’s an-
nouncement in Science magazine, in 2004 and 2005, of achieving the
globalized biomedical grail of human-embryonic-stem- cell clones and the
subsequent revelation, in December 2005, of fabricated data, bioethics vio-
lations in egg donation, and possible embezzlement have a more authen-
tic canine backstory that only makes sense in light of Dolly Mixtures. In
the United States, the well-hyped dog- cloning Missyplicity Project was di-
rected to the affectional commodity pet market.18 Not so the biomedical
dog- cloning efforts of Hwang and his nine South Korean associates, plus
Gerald Schatten, a stem- cell researcher at the University of Pittsburgh, who
announced Snuppy, an Afghan Hound puppy cloned with the Dolly tech-
nique, in August 2005.19 A biotechnical splice to his core, Snuppy is fab-
ricated of S(eoul) N(ational) U(niversity) and (pu)ppy. Hwang’s research
career must be understood in the context of agribusiness animal research
moved to human biomedicine. His professorship is in the department of
theriogenology and biotechnology in the College of Veterinary Medicine at
Seoul National University. Before Snuppy, Hwang reported having cloned a
dairy cow in 1999, and he was widely regarded as a world leader in the field.

102 DONNA J. HARAWAY

There is a great deal about Hwang’s dramatic rise and fall that is not clear,
but what is clear is the thick cross-species travel between agribusiness re-
search and human biomedicine often obscured in the U.S. “ethical” debates
over human-stem- cell technologies and imagined therapies or reproductive
marvels.
Pricey U.S. dog cryopreservation services, university-private company
collaborations for canine cloning research geared to the pet market, and
Korean national efforts to become first in a major area of biomedical re-
search are not the only arias in this lively capital opera. However, even if
freezing my AKC mutt Roland’s cells in anticipation of making a nuclear
clone of him could only happen over the dead bodies of my whole poly-
specific and polysexual family, these Dolly spillovers, especially Snuppy, do
suggest just the right segue to the second part of this chapter.

Valuing Dogs: Technologies, Workers, Knowledges

Referring to advertisements for the sale of working sheepdogs, Donald Mc-

Caig, the Virginia sheep farmer and astute writer on the history and current
state of herding Border Collies in Britain and the United States, noted that
categorically the dogs fall somewhere between livestock and co-workers for
the human shepherds.20 These dogs are not pets or family members, al-
though they are still commodities. Working dogs are tools that are part of
the farm’s capital stock, and they are laborers who produce surplus value
by giving more than they get in a market- driven economic system. I think
that is more than an analogy, but it is not an identity. Working dogs produce
and they reproduce; and, in relation to lively capital, they are not their own
“self- directed” creatures in either process, even though enlisting their active
cooperation (self- direction) is essential to their productive and reproductive
jobs. But they are not human slaves or wage laborers, and it would be a seri-
ous mistake to theorize their labor within those frameworks. They are paws,
not hands. Let’s see if we can sort through the implications of the difference
even in the face of the evolutionary homology.
To do so, I turn to Edmund Russell’s arguments about the evolutionary
history of technology in his introduction to the collection Industrializing Or-
ganisms (2004). Far from keeping organic beings and artifactual technolo-
gies separate, putting one in nature and the other in society, Russell adopts
recent science and technology studies insistence on the co-production of
natures and cultures and the interpenetration of bodies and technologies.
He defines organisms shaped for functional performance in human worlds

VALUE-ADDED DOGS AND LIVELY CAPITAL 103

as biotechnologies, that is, “biological artifacts shaped by humans to serve
human ends” (2004, 1). He goes on to distinguish macrobiotechnologies,
such as whole organisms, from microbiotechnologies, such as the cells and
molecules that get all the press as biotechnology itself in the current science
and business press.
In that sense, dogs deliberately selected and enhanced for their working
capacities, for example as herders, are biotechnologies in a system of market
farming that became contemporary capital-intensive agribusiness through a
welter of nonlinear processes and assemblages. Russell is interested in how
the ways in which human beings have shaped evolution have changed both
human beings and other species. The tight boxes of nature and society do
not allow much serious investigation of this question. Russell’s major efforts
are directed at analyzing organisms as technologies; and he looks at biotech-
nologies as factories, as workers, and as products. In spite of the fact that
Russell gives almost all the agency to humans—who, I admit readily, make
the deliberate plans to change things—I find his framework rich for think-
ing about valuing dogs as biotechnologies, workers, and agents of techno-
scientific knowledge production in the regime of lively capital.
Leaving aside such critters of the past as spit-turning dogs or cart-hauling
dogs, whole dogs are simultaneously biotechnologies and workers in sev-
eral kinds of contemporary material-semiotic reality. Herding dogs are still
at work on profit-making (or more likely, money-losing) farms and ranches,
although job loss has been acute. Their work in sheep trials is robust, but
located in the zone between work and sport, as is the labor of most sled
dogs. Livestock guardian dogs have expanding job opportunities, in part be-
cause of the reintroduction of ecotourism-linked, heritage predators (wolves,
bears, and lynxes) in sheep-raising areas of the French Alps and Pyrenees,
as well as predator control on U.S. ranches no longer allowed to use poisons.
Dogs have state jobs and jobs franchised out to private providers as airport-
security laborers, drug and bomb sniffers, and pigeon- clearing officers on
runways.
The popular television show Dogs with Jobs, using newspaper-style clas-
sified ads for jobs as the visual icon for the show, is a good place to get a
grip on dogs as workers.21 Most of the dogs seem to be unpaid voluntary
labor, but not all of them are. Jobs include epilepsy warning, cancer de-
tection, hearing-aid work, guiding the blind, serving as psychotherapeutic
aides for traumatized children and adults, visiting the aged, serving as aides
for wheelchair-bound people, providing rescue services in extreme envi-
ronments, and more. Dogs can be and are studied and specifically bred to

104 DONNA J. HARAWAY

enhance their readiness to learn and perform these kinds of jobs. For all of
them, dogs and people have to learn to train together in subject- changing
ways. But more of that later.
Part dogs (or delegated dog wholes or parts in other material bases than
carbon, nitrogen, and water) might have more work in lively capital than
whole dogs. Consider, in addition to Snuppy’s stem- cell scene, dog-genome
projects. Canine archived genomes are repositories useful for research for
product development by veterinary pharmaceutical enterprises and by
human biomedical interests, as well as by—a gleam in researchers’ eyes—
behavioral genetic research. This is “normal” biotechnology. Sequencing
and data-basing the complete dog genome was made a priority of the U.S.
National Human Genome Research Institute (NHGRI) in June 2003. Based
on a Poodle, the first rough dog-genome sequence, about 75 percent com-
plete, was published that year. The first full draft of the dog genome was
published and deposited in a free public database for biomedical and vet
researchers in July 2004. In May 2005 a 99-percent- complete sequence of
the genome of a Boxer named Tasha, with comparisons to ten other kinds
of dogs, was released. Dogs belonging to researchers, members of breed
clubs, and colonies at vet schools provided DNA samples. The team that got
this draft, in the process developing procedures that might speed the depo-
sition of many more mammalian genomes, was headed by Kerstin Lindblad-
Toh of the Broad Institute of MIT and Harvard as well as the Agencourt Bio-
science Corporation. Part of the NHGRI’s Large-Scale Sequencing Research
Network, the Broad Institute got a $30 million grant for the work. These are
the kinds of public-private arrangements typical of microbiotechnology in
the United States and, with variations, internationally.22
Further, once the genome was published, the Center for Veterinary Ge-
netics at the University of California School of Veterinary Medicine called
for individual dog people and clubs to contribute to a full repository of many
of the different breeds of dogs in order to address the needs of different do-
mains of dogdom. The goal was to enlarge the DNA data bank from its then
current sampling of the genetic legacy of a hundred breeds to more than
four hundred international canine populations. Many research projects in-
volving dog genes, organs, diseases, and molecules could be used to illus-
trate these kinds of things. The part- dogs are reagents (workers), tools, and
products, just as whole dogs are in macrobiotechnological kinds of knowl-
edge and production projects.
There is also another sense in which dogs are valuable workers in techno-
culture. In laboratories, they labor as research models both for their own

VALUE-ADDED DOGS AND LIVELY CAPITAL 105

and for human conditions, especially for diseases that could be “enclosed”
for medical commodity production, including previously unknown sorts of
services, to address newly articulated needs. That, of course, is what their ar-
chived genomes are doing; but I want to look more closely at another mode
of this scientific medical canine labor in the context of lively capital. Stephen
Pemberton explores how dogs suffering from hemophilia became model
patients, as well as surrogates and technologies for studying a human dis-
ease, over the course of years, beginning in the late 1940s, in the laboratory
of Kenneth Brinkhous at the University of North Carolina, Chapel Hill. This
research is what made human hemophilia a manageable disease by the early
1970s, with the availability of standardized clotting factors.23
Bleeder dogs did not just appear at the lab doorstep as ready-made
models and machine tools for making things for humans. The canine hemo-
philiac was made through representational strategies, dog- care practices,
breeding and selection, biochemical characterization, development of novel
measurement devices, and semiotically and materially joining hemophilia
to other metabolic- deficiency disorders (especially diabetes and pernicious
anemia, both treatable by administering something functionally absent in
the patient, and both being diseases in which dogs played a large role in the
research, with crucial payoff in techniques and devices for working with
dog organs and tissues). The principal problem Brinkhous faced when he
brought into the lab male Irish Setter puppies who showed the stigmata of
bleeding into joints and body cavities was keeping them alive. The puppies
had to become patients if they were to become technologies and models.
The entire labor organization of the laboratory addressed the priority of
treating the dogs before anything else. A bleeding dog got transfusions and
supportive care. Lab staff could not function as researchers if they did not
function as caregivers. Dogs could not work as models if they did not work
as patients. Thus, the lab became a clinical microcosm for its research sub-
jects as an essential part of the last century’s revolution in experimental
biomedicine. As Pemberton put it, “We cannot understand how scientists
discipline their experimental organisms without understanding how these
organisms also discipline scientists, forcing them to care” (2004, 205).
In the late twentieth century, drugs developed for people (and surely
tested on rodents) came to be agents of relief for dogs, too, in a kind of
patient-to-patient cross-species transfusion. This kind of dogs-as-patients
scene is part of my own adult origin tale in dogland. My middle- class child-
hood tale had more to do with confining the multispecies civic commons
by leash laws in the 1950s than with biomedicine. Toward the end of her

106 DONNA J. HARAWAY

sixteenth, and last, year of life, in 1995, my half-Lab mutt, Sojourner—that
grace-giving whelp of an irresponsible backyard breeder whom we named
for a great human liberator—and I began to frequent her vet’s office in Santa
Cruz. I had read Michel Foucault, and I knew all about biopower and the
proliferative powers of biological discourses. I knew modern power was pro-
ductive above all else. I knew how important it was to have a body pumped
up, petted, and managed by the apparatuses of medicine, psychology, and
pedagogy. I knew modern subjects had such bodies, and that the rich got
them before the laboring classes. I was prepared for a modest extension of
my clinical privileges to any sentient being and some insentient ones. I had
read Birth of the Clinic and The History of Sexuality, and I had written about
the technobiopolitics of cyborgs. I felt I could not be surprised by anything.
But I was wrong. I had been fooled by Foucault’s own species chauvinism
into forgetting that dogs, too, might live in the domains of technobiopower.
Birth of the Kennel might be the book I needed to write, I imagined. When
Species Meet is the mutated spawn of that moment.
While Sojourner and I waited to be seen by her vet, a lovely pooch pranced
around at the checkout desk while his human discussed recommended
treatments. The dog had a difficult problem—obsessive self-wounding when
his human was off making a living, or engaging in less justifiable non- dog
activities, for several hours a day. The afflicted dog had a nasty open sore on
his hind leg. The vet recommended that the dog take Prozac. I had read Lis-
tening to Prozac (2003), so I knew this was the drug that promised, or threat-
ened, to give its recipient a new self in place of the drab, depressive, obses-
sive one that had proved so lucrative for the nonpharmaceutical branches of
the psychological professions. For years, I had insisted that dogs and people
were much alike, and that other animals had complex minds and social lives,
as well as physiologies and genomes largely shared with humans. Why did
hearing that a pooch should take Prozac warp my sense of reality in the
way that makes one see what was hidden before? Surely, Saul on the way to
Damascus had more to his turnaround than a Prozac prescription for his
neighbor’s ass!
The canine patient’s human was as nonplussed as I was. She chose in-
stead to put a large cone, called an Elizabethan collar, around her dog’s head
so that he couldn’t reach his favorite licking spot to suck out his unhappi-
ness. I was even more shocked by that choice—what, I fumed internally,
can’t you get more time to exercise and play with your dog and solve this
problem without chemicals or restraints? I remained deaf to the human’s
defensive explanation to the vet that her health policy covered her own Pro-

VALUE-ADDED DOGS AND LIVELY CAPITAL 107

zac, but that the pills were too expensive for her dog. In truth, I was hooked
into the mechanisms of proliferating discourse that Foucault should have
prepared me for. Drugs, restraints, exercise, retraining, altered schedules,
searching for improper puppy socialization, scrutinizing the genetic back-
ground of the dog for evidence of canine familial obsessions, wondering
about psychological or physical abuse, finding an unethical breeder who
turns out inbred dogs without regard to temperament, getting a good toy
that would occupy the dog’s attention when the human was gone, accusa-
tions about the workaholic and stress-filled human lives that are out of tune
with the more natural dog rhythms of ceaseless demands for human atten-
tion: all these moves and more filled my neo-enlightened mind.
I was on the road to the fully embodied, modern, value-added dog-human
relationship. There could be no end to the search for ways to relieve the
psychophysiological suffering of dogs and, more, to help them achieve their
full canine potential. Furthermore, I am convinced that is actually the ethi-
cal obligation of the human who lives with a companion animal in affluent,
so- called First World circumstances. I can no longer make myself feel sur-
prise that a dog might need Prozac and should get it—or its improved, still-
on-patent offshoots.
Caring for experimental dogs as patients has taken on intensified mean-
ing and ambiguities in twenty-first- century biopolitics. A leading cause of
death for older dogs and people is cancer. Enabled by comparative post-
genomics tying humans and dogs together as never before, in 2006 the
National Cancer Institute set up a consortium of over a dozen veterinary
teaching hospitals to conduct drug tests of possible benefit against human
cancers on pet dogs living at home who are subject to the same malignan-
cies. The proposal was for a parallel nonprofit group to collect tissue samples
and DNA from pet dogs to pinpoint genes associated with cancer in dogs
and people. Companion dogs would be clinic patients and not kenneled lab
pooches, who might then be relieved of some of their burden; and grants
and companies would pay for the experimental drugs. Dogs might benefit
from the drugs, but they would get them with lower standards of safety than
would be required in human testing. That’s the point, after all, for enlisting
dogs in National Cancer Institute state- of-the-art testing in the first place.
Pet owners may have to pay for things like biopsies and imaging, which
could be very expensive. Researchers would have neither the animal-rights
scrutiny nor the financial burden of caring for lab dogs, including paying
for those MRIs.24 Pet owners and guardians would have the power to call a
halt to further experimental treatment, based on their sense of the experi-

108 DONNA J. HARAWAY

ences of their dogs. This system of drug testing seems to me superior to the
current one, because it places the burden of suffering (and opportunity of
participating in scientific research) on those specific individuals, humans
and dogs, who might reap the benefit of relief. In addition, experimenta-
tion would take place much more in the open than can ever be possible or
desirable with lab animals, perhaps encouraging deeper thinking and feel-
ing by a diverse human population of pet owners, as well as clinicians and
scientists.25
What I find troubling here is a growing ethos that subjects pet dogs to
the same search for “cures” that human cancer patients endure, rather than
continuing to work within and improve current standards of care in vet
practice to reduce cancer burdens and provide supportive care guided by
quality- of-life criteria and not by maximum prolongation of life. Chemo-
therapy that dogs currently get rarely aims to eliminate the cancer, and dogs
consequently generally do not experience the terrible sickness from drug
toxicity that most people, in the United States at least, seem to feel obligated
to accept. How long can that moderate veterinary approach to dog illness,
and acceptance of death as profoundly sad and hard but also normal, endure
in the face of the power of comparative postgenomic medicine and its asso-
ciated affectional and commercial biopolitics?
So dogs became patients, workers, technologies, and family members
by their action, if not choice, in very large industries and exchange systems
in lively capital: pet foods, products, and services; agribusiness; and scien-
tific biomedicine. Dogs’ roles have been multifaceted, and they have not
been passive raw material to the action of others. Further, dogs have not
been unchangeable animals confined to the supposedly ahistorical order of
nature. Nor have people emerged unaltered from the interactions. Relations
are constitutive; dogs and people are emergent as historical beings, as sub-
jects and objects to each other, precisely through the verbs of their relating.
People and dogs emerge as mutually adapted partners in the naturecultures
of lively capital. It is time to think harder about encounter value.

Valuing Dogs: Encounters

Why not start with prisons, since we have been touring other large indus-
tries in lively capital and this one is immense? There are many places we
might go—dogs terrorizing detainees in Iraq, for example, where the en-
counters shaping enemies, torturers, and attack dogs made use of the social
meanings of all the “partners” to produce definite value in lively capital.

VALUE-ADDED DOGS AND LIVELY CAPITAL 109

International human-rights apparatuses (and where were the animal-rights
outcries on this one?); scrutiny of franchised- out interrogation functions;
and the moral, psychological, and financial economies of contemporary im-
perialist wars: who could deny that all these are at the heart of enterprise and
investment? Or we could travel to the high-security, high-technology, soul-
destroying prison in California’s Pelican Bay to track the attack- dog produc-
tion, dog-fighting culture, and Aryan gang operations run from the prison,
resulting in the dog-mauling death of a young woman in her apartment hall-
way in San Francisco and an outcry for exclusion of dogs from public space
in general (but not apartment hallways).26
All of these prison dog-human encounters depend on the face-to-face
meeting of living, meaning-generating beings across species; that is the en-
counters’ power to terrorize and to reach into the core of all the partners to
produce dogs condemned to euthanasia when their usefulness has ended
and people fit to carry on the profitable enterprise of the prison-industrial
complex, as inmates, lawyers, and guards. However, I want to think about
co-shaping dog-human encounters in another prison context, one that
makes me pay a different kind of attention to coming face-to-face across
species, and so to encounter value. Therefore, let’s go to Animal Planet
television again, this time to watch Cell Dogs.27 If dogs became technolo-
gies and patients in the world of hemophilia, they become therapists, com-
panions, students, and inmates in the world of cell dogs. It’s all in the job
description.28
Every Monday evening in 2004, Animal Planet turned its attention to a
different prison work project that had reforming prisoners teaching reform-
ing pooches their manners in order to place them in various occupations
outside the prison. The narrative and visual semiotics are fascinating. First,
the entering dogs have to be made into inmates in need of pedagogy if they
are to have productive lives outside. Fast frame cuts show cell doors clanging
behind the dogs, who then get assigned to one prisoner-apprentice teacher,
to live in the same cell with this individual human inmate for the duration of
their joint subject-transforming relating. Dog trainers teach the prisoners to
teach the dogs basic obedience and sometimes higher- order skills for place-
ment as assistance dogs or therapy dogs, or even just as household family
members as pets. The screen shows the incarcerated dogs preparing for
life outside by becoming willing, active, achieving obedience subjects. The
pooches are obviously surrogates and models for the prisoners in the very
act of becoming the prisoners’ students and cellmates.
The technologies of animal training are crucial to the cell- dog programs.

110 DONNA J. HARAWAY

These technologies include the postbehaviorist discourses and the equip-
ment of so- called positive training methods (not unlike many of the peda-
gogies in practice in contemporary schools and child- counseling centers);
some older technologies from the military-style, Koehler training methods
based on frank coercion and punishment; and the apparatuses and bodily
and mental habits crucial to making family members and happy roommates
in close quarters. There is another sense of technology operating here, too:
in their personal bodies themselves, the dogs and people are freedom-
making technologies for each other. They are each other’s machine tools for
making other selves. Face-to-face encounter is how those machines grind
souls to new tolerance limits.
The canines must be modern subjects in many senses for the cell- dog
program to work. The dogs require and model nonviolent, non- optional,
and finally self-rewarding discipline and obedience to legitimate authority.
That is the route to freedom and work outside—and to survival. That death
awaits the failed dog is a leitmotif in many of the programs, and the lesson
for their teachers is not subtle. The traffic between performing and model-
ing is thick for both the humans and the dogs, teachers and students, docile
bodies and open souls to each other. Life and death are the stakes in the
prison-industrial complex. Prison-reform discourse has never been more
transparent. Arbeit macht frei.
Leaving the prison through mutual self-transformation of dogs and
people is the nonstop theme. The humans must stay behind to finish their
sentences (some are lifers); nonetheless, when their dogs are successful ca-
nine citizen-workers outside, the human inmates leave jail in two senses.
First, through their dog students, the convicts give themselves to another
human person, to someone free, someone outside; and so they taste free-
dom and self-respect both by proxy and in the flesh. Second, they demon-
strate their own reformed status as obedient, working subjects who can be
trusted with freedom in a society divided into the outside and the inside.
Part of the proof of worthiness is the human prisoners’ act of surrendering,
for the benefit of another, the companion and cellmate with whom they have
lived for weeks or months in the only physically intimate, touching, face-to-
face relationship that they are allowed. The graduation scenes, where the
human inmates sacrifice themselves to give their intimate companions to
another to achieve a better life for both, are always intensely emotional. I
dare you to be cynical, even if all the knives of critical discourse are in your
hands. Maybe it’s not all “arbeit macht frei” here, but something more like
“touch makes possible.” Since I can’t be outside ideology, I’ll take that one,

VALUE-ADDED DOGS AND LIVELY CAPITAL 111

face-to-face and eyes open. The rhetoric that connects categories of the op-
pressed in these programs is not subtle (prisoners, animals, the disabled,
women in jail, black men, strays, etc.); all belong to categories that discur-
sively need much more than remedial training. However, there is potential
in these projects for much more promising entanglements that question the
terms of these tropes and the conditions of those who must live them.
Perhaps it would be possible to rethink and retool cell dogs to work their
magic to build subjects for a world not so fiercely divided into outside and
inside. Marx understood the analysis of the commodity form into exchange
value and use value to be a practice crucial to freedom projects. Maybe if
we take seriously encounter value as the under-analyzed axis of lively capi-
tal and its “biotechnologies in circulation”—in the form of commodities,
consumers, models, technologies, workers, kin, and knowledges—we can
see how something more than the reproduction of the same and its deadly
logics-in-the-flesh of exploitation might be going on in what I call “making
companions.”
In Making Parents: The Ontological Choreography of Reproductive Technolo-
gies, Charis Thompson compares and contrasts capitalist production to what
she calls a “biomedical mode of reproduction,” which I think of as core to
the regime of lively capital. Thompson is studying the making of parents and
children through the subject- and object-making technologies of biomedi-
cally assisted reproduction, a very lively area of contemporary investments
of bodily, narratival, desiring, moral, epistemological, institutional, and fi-
nancial kinds. She is acutely alert to the classical processes of production,
investment, commodification, and so on in contemporary human-assisted
reproduction practices in the United States. But she is adamant that the end
of the practices makes a difference; that is, the whole point is to make par-
ents by making living babies. Capital, volumes 1–3, did not cover that topic.
Biocapital, volume 1, must do so.
In two columns, Thompson sets out the following lists, which I borrow,
abbreviate, and abuse.29 In practice, parents-in-the-making selectively seek
out, endure, elaborate, and narrativize various objectifications and com-
modifications of their body parts. Women do this much more than men do
because of the fleshly realities of assisted conception and gestation. Many
sorts of social stratification and injustice are in play, but they are often
not of the kinds that those seeking their fix of outrage find whenever they
smell the commodification of humans or part humans. Living babies prop-
erly assigned make living parents content with their objectifications. Other
actors—technicians, doctors, janitors, friends, many more—in this mode of

112 DONNA J. HARAWAY

TABLE 1!Capitalist production and biomedical reproduction

Production Reproduction

Alienated from one’s labor Alienated from one’s body parts

Capital accumulated Capital promissory

Efficiency/productivity Success/reproductivity

Life course finite and descent linear Loss of finitude/linearity in life course
and descent

Essentialism of natural kinds, social Strategic naturalization, socialization of

construction of social kinds all kinds

SOURCE: Adapted from table 8.1 in Thompson 2005, 249.

reproduction may be made invisible to render them non-kin and reproduc-

tively impotent. The lure of kin-making is the name of this promissory game
of reproduction.
I am interested in these matters when the kin-making beings are not
all human and children or parents are not the issue, literally. Companion
species are the issue. They are the promise, the process, and the product.
These matters are mundane, and this chapter has been replete with ex-
amples. Add to those many more proliferations of naturalsocial relationali-
ties in companion-species worlds linking humans and animals in myriad
ways in the regime of lively capital. None of this is innocent, bloodless, or
unfit for serious critical investigation. But none of it can be approached if
the fleshly historical reality of face-to-face, body-to-body subject-making
across species is denied or forgotten in the humanist doctrine that holds
only humans to be true subjects with real histories. But what does “subject”
or “history” mean when the rules are changed like this? We do not get very
far with the categories generally used by animal-rights discourses, where
animals end up permanent dependents (“lesser humans”), utterly natural
(“nonhuman”), or exactly the same (“humans in fur suits”).
The categories for subjects are part of the problem. I have stressed kin-
making and family membership, but rejected all the names of human kin
for these dogs, especially the name of children. I have stressed dogs as
workers and commodities, but rejected the analogies of wage labor, slavery,
dependent ward, or nonliving property. I have insisted that dogs are made to
be models and technologies, patients and reformers, consumers and breed-
wealth; but I am in need of ways to specify these matters in nonhumanist

VALUE-ADDED DOGS AND LIVELY CAPITAL 113

terms, where specific differences are at least as crucial as continuities and
similarities across kinds. Parts do not add up into wholes, and inners do not
sort well from outers. Critters and companion species, not humans and ani-
mals, seem to be the ontological denizens of my terra.
Biocapital, volume 1, cannot be written just with dogs and people. I face
up to my disappointment in this sad fact by rejoicing in the work of my fel-
low animal (and other critters) studies and lively capital analysts across life-
worlds and disciplines.30 Most of all, I am convinced that actual encounters
are what make beings; this is the ontological choreography that tells me
about value-added dogs in the lifeworlds of biocapital. Dogs are not figures
to analyze nor resources to exploit; they are co-making partners in the multi-
species, naturalcultural tangles of living value.

Notes
Revised from chapter 2 in When Species Meet (University of Minnesota Press, 2008).
1. Marx came closest in his sometimes lyrical early work, “Theses on Feuerbach”
and “The Economic and Philosophic Manuscripts of 1844” (Tucker 1978). He is both
at his most “humanist” and at the edge of something else in these works, in which
mindful bodies in inter- and intra-action are everywhere. I follow Alexis Shotwell’s
subtle analysis of Marx’s near escape from human exceptionalism, implicit in his dis-
cussions on how labor power becomes a commodity, sensuousness, aesthetics, and
human species being (Shotwell 2006, 111–21).
2. For the argument that “companion species” might be a better way to charac-
terize the material-semiotic, historical, philosophic, and scientific knottings at stake
than posthumanism, see Haraway 2008. Companion species are all of us—not just
dogs and people, not just humans and animals, not just macrospecies and micro-
critters.
3. For example, consider the evidence for the dog-human affectional and ritual
ties in the archaeologist Darcy Morey’s analysis (2006) of earth-wide ancient and
recent dog burial sites. For complex semiotic and power tangles between people
and dogs crucial to understanding past and present colonial and state relations for
the upper Amazonian Runa of Peru and the nonhuman animals (dogs, panthers,
insects, etc.) they interact with, see Kohn 2007. For a multispecies, canine-human
“becoming with” (and dying with) approach in quite another idiom in contemporary
Aboriginal Australia’s Northern Territory, see Deborah Bird Rose 2006. Contempo-
rary dog-people affectional and economic pet relations outside Euro-America are also
multiple and exuberant, not to mention politically contentious. For example, the zeal
with which officials in the People’s Republic of China periodically repress pet dogs
in cities is only matched by the inventiveness of middle- class Chinese citizens to
conceal and keep their cherished dogs. Some estimates puts pet dogs in China today

114 DONNA J. HARAWAY

at 150 million—one for every nine citizens (“Pets Contribute to China’s Economy”
2005). That seems to push the bounds of the middle classes! None of that keeps dogs
off the menu (except around Olympic sites) any more than pet love keeps large num-
bers of dogs out of puppy mills in the United States. My point is that past and present
dog-human doings are ubiquitous, important, and not amenable to typological, ahis-
torical generalization.
4. An early interdisciplinary effort to write that missing Marxist volume is Franklin
and Lock 2003. Then came the following abbreviated but crucial list, which I take
from the graduate seminar I taught in the winter of 2007, “Bio[X]: Wealth, Power,
Materiality, and Sociality in the World of Biotechnology”: Sunder Rajan 2006; Man-
der and Tauli- Corpuz 2006; Strathern 2005; Waldby and Mitchell 2006; Mbembe
2001; Franklin 2007; Petryna, Lakoff, and Kleinman 2006. The course grew partly
from thinking about a “figure” in the sense introduced in chapter 1, “When Species
Meet: Introductions.”
Consider a fictional multiple integral equation that is a flawed trope and a serious
joke in an effort to picture what an “intersectional” theory might look like in Biopo-
lis. Think of this formalism as the mathematics of science fiction.
Ω
∫ Bio [X]n = ∫∫∫∫ . . . ∫∫Bio(X1, X2, X3, X4, . . . , Xn, t) dX1 dX2 dX3 dX 4 . . .
dXn dt = Biopolis
α
X1 = wealth, X 2 = power, X 3 = sociality, X 4 = materiality, X n = ??
α (alpha) = Aristotle’s & Agamben’s bios
Ω (omega) = Zoë (bare life)
t = time
Biopolis is an n- dimensional volume, a “niche space,” a private foundation com-
mitted to “global is local” biocracy (http://www.biopolis.org/), and an international
research and development center for biomedical sciences located in Singapore (see
http://en.wikipedia.org). How would one solve such an equation?
5. The figures, provided by the American Pet Products Manufacturers Associa-
tion (APPMA), are from a free online teaser for their “2005–2006 APPMA National
Pet Owners Survey,” available for purchase by non-APPMA members for $595. See
http://www.americanpetproducts.org. The APPMA annual Global Pet Expo, the in-
dustry’s largest trade show, is a real eye opener for any remaining sleeping roman-
tics about pet commodity culture. It is not open to the general public, but only to
retailers, distributors, mass-market buyers, and “other qualified professionals.” By
not shelling out $595 for the pet owners survey, I lost my chance to get the lowdown
on such things as details on where U.S. pet dogs are kept during the day and at night,
groomer visits and methods of grooming used, methods used to secure dogs in the
car, type of food and size of kibble purchased, number of treats given, types of leash
or harness used, type of food bowls used, information sources consulted and books
or videos owned, dog- care items purchased in the last twelve months, pet-themed
gifts purchased, holiday parties for dogs given, expressed feeling about benefits and

VALUE-ADDED DOGS AND LIVELY CAPITAL 115

drawbacks of dog ownership, and much more—all duplicated for every common
species of pet. Not much in the practice of capital accumulation through the lives of
companion animals is left to chance.
6. MindBranch, Inc., “U.S. Pet Food Market,” Market Research Report for June
2004, http://www.mindbranch.com/listing/product/R567-0062.html, accessed 22
June 2011.
7. A brief, free, PDF-format summary is available online from MindBranch, Inc.
To learn more, you have to pay. To get my limited commercial facts for this chapter
cost only my phone number inscribed on an online form, followed by an advertising
call or two—much more easily resisted than the new liver cookies at Trader Joe’s.
8. The links of pet food within the transnational capitalist food industry are so
elaborate and involve so many kinds of products that the supply chain gone awry
can threaten national economies and international public health across species. See
Nestle 2008.
9. Mary Battiata (2004) tells us that a four-year veterinary education in the United
States costs about $200,000. Setting up a small vet practice starts at about $500,000.
Battiata cites a study of vet fee structures and lagging salaries published in 1998 by
the consulting firm KPMG.
10. www.pjbpubs.com/cms.asp?pageid=1490, accessed May 2007.
11. In the mid-2000s the slogan “One Medicine” emerged to signal the conver-
gence of human and vet medicine across the globe in the context of bird flu, ter-
rorism, global agribusiness, comparative biomedical genomics, wildlife-human re-
lations, and much else. The military has not been slow to see the relevance of a
one-medicine approach to bioterrorism, biomedicine, and food supply. In 2008 the
Sixth Annual “One Medicine” Symposium featured a one-medicine approach to cli-
mate change (http://www.onemedicinenc.org, accessed 17 August 2008).
12. Thompson 2005. See also Haraway 2003b.
13. See, for example, La Feria 2006.
14. Berton 2006. The marketing in all of the examples discussed was entirely
directed to affluent human beings’ ideas and fantasies, and paid scant heed to any-
thing like biobehavioral assessments of how dogs and other boarded species would
do best in unfamiliar surroundings. Paying for a “training vacation” might go a long
way toward increasing civil peace, say, compared to paying for suites appointed with
color- coordinated humanesque furniture and Animal Planet TV shows.
15. Lavery 2004.
16. For their place in complex nationalisms and ethnic identity discourses, con-
sider the Karelian Bear Dog, the Suomen-pystyykorva (Finnish Spitz Dog), the Norsk
Elghund Grå (Norwegian Elkhound), the Kelef K’naani (Israeli Canaan Dog), the
Australian Dingo (an Eora Aboriginal word), the Islandsk Farehond (Iceland Sheep-
dog), the Korean Jindo Dog, and the Japanese Shiba inu, Hokkaido inu, Shikoku inu,
Kai inu, and Kishu inu—and I have hardly started. Comparing the fascinating his-
tories, discourses, and cultural politics in which Canaan Dogs and Dingoes figure
would require another book. Both kinds of dogs scavenge and hunt in the “pariah” or
“primitive” dog categories, made over for globalized breed club standardization. Re-

116 DONNA J. HARAWAY

constituted or reinvented dogs of the hunting elites of European feudalism also have
a fascinating contemporary story. Check out the Irish Wolfhound in this regard, com-
plete with the breed’s Celtic origin story, from the first century B.C., along with the
details of the dogs’ nineteenth- century “recovery,” enabled by a Scot: Captain George
Augustus Graham’s breeding of dogs called Irish Wolfhounds who still remained in
Ireland with Borzoi, Scottish Deerhounds, and Great Danes. The popularly recited
details of the Great Rescuer’s craft seem never to pollute the pure origin story of an-
cient nobility, or to disturb the keepers of the closed stud books in the breed clubs.
“Value-added” seems the right term for these breeding operations!
Probably the world’s most important collection of Southwest Indian art, including
weaving, pottery, Kachina figures, and much else, is housed at the School of Ameri-
can Research in Santa Fe, New Mexico, in exquisite adobe buildings commissioned
by two transplanted, wealthy, eccentric, New York women, Elizabeth and Martha
Root White. The sisters also raised many of the most famous Irish Wolfhounds of
that breed’s early period in the United States, between the 1920s and the Second
World War, on this rugged and beautiful property. The land and buildings now serve
as a major anthropological research and conference center. Rathmullan Kennel’s
Irish Wolfhounds are buried in a little graveyard on the grounds, marking the value-
added encounter of wealth, gender, aestheticized and reinvented tradition in dogs
and human beings, white people’s collection of indigenous artifacts on a grand scale,
philanthropy, activism in support of Pueblo Indian land rights and health, patronage
of the arts of Europe, the United States, and Indian nations, as well as scholarship
of a kind that reaches across generations, nurturing some of the best twentieth- and
twenty-first- century anthropology in all subfields. When I visited the dogs’ graves at
the School of American Research in 2000, after writing the first versions of “Cloning
Mutts, Saving Tigers” for Sarah Franklin’s and Margaret Lock’s workshop on “New
Ways of Living and Dying,” the bones of the Whites’ Irish Wolfhounds seemed like
fleshy, fantasy-laden, Euro-American ancestors in this complex colonial and national
tangle. See Stark and Rayne 1998. For photographs of people, grounds, and dogs—
including a re- creation, organized by the White sisters for a Santa Fe festival, of a
sixteenth- century hunting party with Irish Wolfhounds—and for a detailed descrip-
tion of the myriad practices that sustained these upper- class show dogs, see Jones
1934, online at www.irishwolfhounds.org. The interlaced constructions of Native
American arts and crafts and Irish Wolfhounds in Santa Fe is perceptively analyzed
in Mullin 2001.
17. Franklin 2007. See also Clarke 2007.
18. Haraway 2003a; Haraway 2008, chapter 5, “Cloning Mutts, Saving Tigers,”
133–57, 355–60. Genetic Savings and Clone, the private corporate labs where the
never-successful Missyplicity Project came to rest after the researchers at Texas A&M
lost heart, went out of business in October 2006, leaving its frozen companion-
animal tissue bank to the livestock- cloning firm, ViaGen. Genetic Savings and Clone
did announce the live birth of two cloned cats in 2004, and mounted its Nine Lives
Extravaganza, the world’s first commercial cloning service for cats, with an advertised
price, in February 2006, of $23,000 plus sales tax. CopyCat, one of the kittens born

VALUE-ADDED DOGS AND LIVELY CAPITAL 117

in 2004, cost $50,000. No sequel called “Cheaper by the Dozen” followed. The presi-
dent of the Humane Society of the United States could only have been called ecstatic
at hearing of Genetic Savings and Clone’s departure; he was quoted by Reuters news
service, on 13 October 2006, for calling the business failure a welcome “spectacular
flop,” given the need for spending resources on addressing pet overpopulation. That
was my reaction, too; I had just read the local newspaper’s list of shelter dogs and
cats needing homes in my small town that month. Nonetheless, predictably, in 2008,
a commercial spin- off of Hwang’s (successful) dog- cloning work, Seoul-based RNL
Bio, sold five cloned puppies to an American woman named Bernann McKinney for
$50,000 (Kim 2008). McKinney’s Pit bull Bsooger had died of cancer in 2006. That
the first commercial cloned pups were Pit bulls is at best ironic, given the widespread
hysteria (ideology) about dangerous breeds.
19. Hwang et al. 2005. Somatic- cell nuclear transfer—the Dolly method—was
the technology employed. In view of the faked data on human- embryonic-stem- cell
(hESC) clones, Snuppy’s authenticity was questioned; but in January 2006 an inde-
pendent investigator pronounced him to be a definite clone of Tel, the DNA donor,
and a major advance for stem- cell research. See the Wikipedia page for Snuppy for an
introduction to this story. Over 1,000 dog embryos were transferred into 123 bitches
to get three pregnancies and one living dog. The special difficulties involved in clon-
ing dogs compared to other animals are detailed in Kolata 2005. On the hESC contro-
versy, Hwang still has supporters in South Korea, and many scientists elsewhere ac-
knowledge the extraordinary international competitive pressures at play in the whole
field.
20. From McCaig’s posting on CANGEN- L, a Canine Genetics Internet discussion
list, around 2000. To understand the work of Border Collies and the way they are re-
garded by their people, see McCaig 1992 [1984]; McCaig 1998a; McCaig 1998b.
21. Track the show through http://www.dogswithjobs.com, accessed May 2007.
For the history of dogs as behavioral genetics research subjects, see Scott and Fuller
1965; Paul 1998; Haraway 2003c. The early hopes for the first U.S. Canine Genome
Project, which was led by Jasper Rine and Elaine Ostrander, included connecting dog
genes and behaviors, using crosses of purebred dogs identified for different behav-
ioral specializations, like Newfoundlands and Border Collies. Some of the talented
fruits of those odd crosses play agility at the same trials that Cayenne and I frequent.
The ideas about behavioral genetics in some of the early pronouncements of the
Canine Genome Project were the butt of jokes among dog people and also other
biologists for their simplistic formulations of what different kinds of dogs do and
how “genes” might “code for” “behaviors,” formulations that are rare in postgenomic
discourse. Check out Polly Matzinger “Finding the Genes that Determine Canine
Behavior,” http://www.bordercollie.org/health/k9genome.html, accessed 22 June
2011, for an explanation to dog people of what the Canine Genetic Project was about.
Research into behavioral genetics is not necessarily simplistic or unimportant for
people as well as other species. However, old-fashioned ideology dressed up as re-
search plays a big role in the history—and probably future—of this field. Ostrander

118 DONNA J. HARAWAY

mainly concentrated on comparative cancer genomics in dogs and humans at the
Fred Hutchinson Cancer Research Center in Seattle. In 2004, the National Human
Genome Research Institute (NHGRI) named her as the new chief of its Cancer Ge-
netics Branch, one of the seven research branches in the Division of Intramural Re-
search. Related to psychopharmacogenetics, comparative behavioral genetics re-
mains a long-term research commitment in the NHGRI.
22. Lindblad-Toh et al. 2005. Elaine Ostrander was one of many prominent (and
not so prominent) coauthors on this paper. Several international labs also had canine
genetic mapping projects of various kinds dating from the 1990s. Comparative mam-
malian genomics, including ever better drafts of whole- genome canine sequence
data, is a rich interdisciplinary field of current research. With the guidance of Mark
Diekhans, a software engineer and fellow member of the University of California,
Santa Cruz, Science and Justice group, I spent a wonderful afternoon browsing dog
sequence data. See http://genome.ucsc.edu, accessed 17 August 2008.
23. Pemberton 2004.
24. See Pollack 2006.
25. Comparative oncology is the name of the very active research and clinical work
that tracks similar cancers across biological species, including dogs and people. To fol-
low progress in the alliance of pet dogs and their people in undertanding and treating
cancers that affect both, see Melissa Paoloni and Chand Khana, “Translation of new
cancer treatments from pet dogs to humans,” http://www.nature.com/nrc/journal/
v8/n2/abs/nrc2273.html, accessed 22 June 2011; for current open trials studying the
feasibility of personalized medicine approaches to similar pet dog and human can-
cers, see https://ccrod.cancer.gov/confluence/display/CCRCOPWeb/Clinical+Trials,
accessed 22 June 2011. Recent dog-focused publications from the Comparative On-
cology Program of the National Cancer Institute include: “A Compendium of Canine
Normal Tissue Gene Expression,” PLoS One, May 2011 (http://www.plosone.org/
article/info%3Adoi%2F10.1371%2Fjournal.pone.0017107); “Guiding the Optimal
Translation of New Cancer Treatments from Canine to Human Cancer Patients,”
Clinical Cancer Research 15:5671–77, 15 September 2009. Osteosarcoma has been
an early focus in this research; see M. C. Paoloni, C. Mazcko, E. Fox, T. Fan, S. Lana,
et al., “Rapamycin Pharmacokinetic and Pharmacodynamic Relationships in Osteo-
sarcoma: A Comparative Oncology Study in Dogs,” PLoS ONE 5, no. 6 (2010): e11013,
doi: 10.1371/journal.pone.0011013. My dog Cayenne’s best friend Willem, a Great
Pyrenees dog, died of metastatic osteosarcoma at seven years of age; maybe that is
why I notice all of this with love and rage, the only affects that seem up to the task of
staying with the trouble of both cancer and its research apparatuses.
26. This awful story can be tracked in Southern Poverty Law Center 2001. In
the year in which two large mastiff-type dogs mauled Diane Whipple to death in a
San Francisco apartment building, the incidence and severity of dog bites in San
Francisco in all public places was significantly lower as a result of effective public-
education programs. That did not stop the public demand to remove dogs from pub-
lic areas or greatly restrict their freedom in the wake of the mauling. About twenty

VALUE-ADDED DOGS AND LIVELY CAPITAL 119

dog-bite-related human deaths occur in the United States per year in a dog popula-
tion of over seventy million. That does not justify any of the deaths, but it does give
a sense of the size of the problem. See Bradley 2006.
27. For details on the series, which aired in 2004, see the Internet Movie Data-
base, http://www.imdb.com.
28. See also Neal 2005. Go to the Pathways to Hope website, http://www.path
waystohope.org, for more on the Prison Dog Project. Canine Support Teams is the
project at the California Institute for Women. The Pocahontas Correctional Unit
in Chesterfield, Virginia, is a women’s facility that trains inmates in dog groom-
ing. Gender assumptions seem well groomed here. The Second Chance Prison
Canine Program, in Tucson, is “a group of advocates for people with disabilities,
prison inmates, and animal welfare in Arizona [who] coordinate a prison pet part-
nership program to address issues common to these three groups” (http://www
.secondchanceprisoncanine.org). Go to the Jayne Cravens and Coyote Communi-
cations website, http://www.coyotecommunications.com, for a partial list of active
prison dog-training programs, which include institutions with projects for training
stray dogs and cats as well as dogs for people with disabilities. Websites accessed
14 May 2007. Also see Harbolt and Ward 2001. Canada and Australia also have pro-
grams.
29. Thompson 2005, 8.1.
30. For example, besides the texts already cited in note 4, see Hayden 2003;
Helmreich 2003; TallBear 2005; Hirsch and Strathern 2005.

120 DONNA J. HARAWAY

 3
TIMOTHY CHOY

AIR’S SUBSTANTIATIONS

The writer Xi Xi, from Hong Kong, opens her experimental short story
“Marvels of a Floating City,” a mixed-media piece that intersperses brief
narratives with reproductions of paintings by René Magritte, with a fantastic
image of a metropolis—a thinly veiled Hong Kong—emerging from the sky.

Many, many years ago, on a fine, clear day, the floating city appeared in
the air in full public gaze, hanging like a hydrogen balloon. Above it were
the fluctuating layers of clouds, below it the turbulent sea. The floating
city hung there, neither sinking nor rising. When a breeze came by, it
moved ever so slightly, and then it became absolutely still again.
How did it happen? The only witnesses were the grandparents of our
grandparents. It was an incredible and terrifying experience, and they re-
called the event with dread; layers of clouds collided overhead, and the
sky was filled with lightning and the roar of thunder. On the sea, myriad
pirate ships hoisted their skull and crossbones; the sound of cannon fire
went on unremittingly. Suddenly, the floating city dropped down from
the clouds above and hung in mid air. (Xi 1997, 106)

I love this image. It transforms a city that can at times feel dense and
overwhelming into a thing of quiet and delicacy. Xi Xi shows Hong Kong as
a place moved by the slightest touch of a breeze, as a place that can become
absolutely still. It reminds me of the Hong Kong I sometimes encountered
on late-night walks past Hong Kong’s government buildings, while taking
the slow ferry between Hong Kong and Lantau Island, and at times while
sitting on MTR subway trains when, following the example of many others
around me, I would listen to music through headphones and take a nap.
Xi Xi’s conceit also turns Hong Kong into something like a natural object,
something nearly elemental. Hong Kong’s mercantile and military origins
become almost atmospheric—a storm depicted by layers of clouds and a sky
filled with flashes and roars. The pirates themselves—the British Lord Palm-
erston and the others—are absent in this picture (their presence is marked
only by the crossed flag which is raised into the sky), but the meteorological
impact they had in birthing the floating city is made clear.
Xi Xi’s pairing of city and sky is fanciful and metaphoric—the images of
dangling and floating recall the questions about an uncertain future that
preoccupied Hong Kongers in the late 1990s—but for me, Xi Xi’s image of
the floating city is particularly compelling because it also invokes something
profoundly literal. Air is central to the understanding and experiencing of
Hong Kong.
To explain what I mean by this I need to tell you another story of city and
sky, this one just slightly less fantastic. In April 1999 Tung Chee-hwa visited
the headquarters of the Walt Disney Corporation in Los Angeles, California.
The visit was perhaps intended as a triumphant exercise of social capital,
meant to perform and to buttress a relationship forged through a controver-
sial agreement Tung had signed earlier that year, between the Walt Disney
Corporation and the Hong Kong government.
The agreement amounted to a joint business venture. Disney would build
a theme park in the Special Administrative Region, a park which not only
would serve as a draw for international tourists, but also (Tung hoped) pro-
vide service-sector jobs to the increasing—and increasingly vocal—ranks of
unemployed people in Hong Kong. In return, the Hong Kong government
would be the primary investor. The agreement was criticized roundly, for
its environmental oversights as well as for the economically vulnerable posi-
tion it forced on Hong Kong. At least in the Disney Corporation, though,
Tung had a supportive ally. They were in agreement: a world- class park for
a world- class city was exactly what Hong Kong needed.
Unfortunately, Tung’s visit to Los Angeles was marred by another voicing
of doubt and criticism, this time from within the Disney Corporation itself.
During the visit, Michael Eisner, Disney’s chief executive officer, took the
opportunity to express concern about the poor air quality in Hong Kong,

122 TIMOTHY CHOY

adding that the smog did not mesh particularly well with the family image
that Disney so prided itself on cultivating. Eisner never said explicitly that
Disney’s continued participation in the theme park hinged on an improve-
ment of Hong Kong’s air. But people with whom I later spoke—shopkeepers,
environmental activists, and taxi drivers alike—nevertheless interpreted the
event as something of a threat, as though Eisner had taken Tung aside and
whispered in his ear that Disney would pull out if Hong Kong’s air quality
did not improve.
One could have remarked on the irony inherent in this moment, when a
corporation based in—and associated so strongly with—the smoggy city of
Los Angeles faulted another city for its poor air, but Tung made no attempt
to do so. Instead, he returned to Hong Kong and sheepishly reported the
exchange to his advisors and to the Hong Kong public through the news
media.
The newspapers had a field day. Hong Kong had just coughed its way
through the worst winter of air pollution in its recorded history. Many Hong
Kong residents had checked themselves into hospitals citing respiratory
problems. The winter of poor air had also forced my partner, Zamira, and
me to relocate from our apartment in Sai Ying Pun, an aging urban district
in Western Hong Kong where we had been living since arriving in the city,
to a flat in a village house in Mui Wo, a rural town on the coast of Lantau
Island. Zamira had suffered three sinus infections in six months while we
lived in the city—it was time to move.
I remember feeling a guilty sense of relief when I read the news. The ex-
tremity of the air pollution—the worst in history, remember!—made my
partner’s illness, and our move from city to village, count now as a mo-
ment of participation in a genuinely Hong Kong experience. Until then, I
had sought to cultivate indifference toward air and air pollution. Although
we, like our friends, routinely avoided waiting or walking on busy streets
because the air stung our eyes and throats, and though we often charted
a course for rural areas on weekends to get away from the city pollution, I
consistently refused to comment on or even to notice the air. My justifica-
tion was simple, if not simple-minded: the people I met in my first months
in Hong Kong who were most vocally critical of the air quality were almost
without exception expatriate businesspeople from the United States. I did
not want to be associated with them. The air pressed upon me, for instance,
at a cocktail party celebrating the publication of a book by the renowned
Hong Kong landscape photographer Edward Stokes. I was chatting with
a representative from the American Chamber of Commerce and his wife

AIR’S SUBSTANTIATIONS 123

when the air pressed upon me. Hong Kong has to see, she told me, that
the environment is an economic problem. Hong Kong wanted to build this
Cyberport, for instance, but who would want to come to Hong Kong to work
if the air was bad? If you could not even see? This was the first time, but cer-
tainly not the last, that I heard Hong Kong’s air coupled with the future of
its economy.
At the same time, many of my Cantonese-speaking, Hong Kong–born
friends often vocalized their suspicions that politicians who built campaign
platforms on the topic of air pollution were motivated by selfish and middle-
class interests. Such politicians were only trying to preserve real- estate
values for the properties of elites, they said. So, in what I then considered an
ethnographer’s effort to become immersed in an ethics more grounded in
Hong Kong’s particularity, I tried hard to act as if the air stinging my throat
were a commonplace, not worthy of notice.
But the air persisted. Zamira’s illness, the record-breaking winter pollu-
tion, and the Disney debacle together forced me to take notice of the air that
had been swirling everywhere around, above, and through me and every-
body else the entire time I had been in Hong Kong. I remembered then that
during my first field visit to Hong Kong, in 1996, when I had asked various
environmental officials about the pressing environmental issues, one of the
first issues mentioned had always been air quality. Not only that, but air had
mediated ruminations about Hong Kong’s impending political handover to
Chinese sovereignty. The real concern is transborder pollution, the official at the
EPD tells me during an interview months before the 1997 handover. How will we
deal with the air and water pollution that comes down from the Mainland? The
air is framed as a threat from the north in these pre-post- colonial months. What
remained to be seen, they said, was how the Chinese government would re-
spond to Hong Kong’s attempts to reduce air and water pollution in Main-
land China. We will soon see, they seemed to be telling me, what the im-
plications of the political handover will be. One activist told me explicitly
that they were trying to lie low, and that rather than making any political
demands, they would concentrate on building relationships with Mainland
bureaucrats before the transfer of power.
This account of my gradual awakening to the significance of air mimes a
standard trope in ethnography, that of the epiphany-in-and- of-the-field. But
it is also something else, or it can be if you shift your attention away from
my eventual ethnographic realization and look more closely at my initial at-
tempts to disavow my difficulties with the air. That disavowal was plainly
an endeavor to distance myself from expatriates; it was a localizing and na-

124 TIMOTHY CHOY

tivizing enterprise, one whose motivations were analytically untenable but
nonetheless impossible for me to resist. If I avow that at stake in my ini-
tial disavowals was a naïve dream of being a Chinese American anthropolo-
gist more able to stomach an everyday, everyman’s Hong Kong life than
my imagined doppelgängers, the well-paid expatriates—including those of
Chinese descent—it is only to point out that whatever lines of distinction I
imagined—and whatever means I saw available to identify with some people
and to distance myself from others—themselves point to the key issue. Air
mattered powerfully in Hong Kong. It mattered in deeply felt, variegated,
and variegating ways.

All That Is Air

Air matters too little in social theory. Marx famously described the constant
change that he saw characterizing a “bourgeois epoch” as a state in which
“all that is solid melts into air,” and that provocative phrasing served in
turn as a motif for Marshall Berman’s diagnosis of “modernity” as a shared
condition in which all grand narratives were subject to skeptical scrutiny.
Yet, aside from signifying a loss of grounding, air is as taken for granted
in theory as it is in most of our daily breaths. This is unfortunate, because
thinking harder about air, that is, not taking it simply as solidity’s oppo-
site, might offer some means of thinking about relations and movements—
between places, people, things, scales—means that obviate the usual traps
of particularity and universality. These traps themselves, it turns out, are
generated through an unremarked attachment to solidity.
To understand this attachment, it is helpful to revisit the context and
afterlife of Marx’s commonly cited line “All that is solid melts into air.” The
passage where it appears is about a sweeping change.

The bourgeoisie cannot exist without constantly revolutionising the in-

struments of production, and thereby the relations of production, and
with them the whole relations of society. Conservation of the old modes
of production in unaltered form, was, on the contrary, the first condition
of existence for all earlier industrial classes. Constant revolutionising of
production, uninterrupted disturbance of all social conditions, everlast-
ing uncertainty and agitation distinguish the bourgeois epoch from all
earlier ones. All fixed, fast-frozen relations, with their train of ancient and
venerable prejudices and opinions, are swept away, all new-formed ones
become antiquated before they can ossify. All that is solid melts into air,

AIR’S SUBSTANTIATIONS 125

 all that is holy is profaned, and man is at last compelled to face with sober
senses his real conditions of life, and his relations with his kind. (Marx
1978a [1867], 475–76)

Marx argues here that with capital as such comes a constant revolutioniz-
ing of society. This is one of the livelinesses of capital. When surplus value
is a motivating abstraction, what once were means to generate differential
value—the instruments of production—can become a fetter to that project
once those instruments are fixed and ubiquitous. A technology might at one
time lower the costs of production or enable new forms of goods and mar-
kets, but if that technology becomes ubiquitous in a given market through
others securing similar means, the advantage it offered disappears. One
might try to revive dead capital through new markets, as many of the other
chapters in this volume illustrate, but if it cannot be resuscitated, some-
thing livelier must take its place.
Marx’s rendering of this process of endless dynamism hinges on a remark-
able figuration of solidity. On the one hand, solidity stands for fixity and re-
liability. The phrase “all that is solid” renders firm industrial society and the
long-standing nature of relations among people and between people and
land. On the other hand, this very fixity is itself historical. Solidity, in other
words, is not fixed at all. Marx materializes this paradox of fixity-nonfixity in
his language, through his images of relations being “fast-frozen” or “ossified,”
for these images beg the question of what existed before the freezing and ossi-
fication. His images of solidification as a process imply a prehistory, one of
presolidity.
There are typically two responses to an image of the world wherein so-
lidities dissolve. A philosopher might strive for some contingent conceptual
fixities to make sense of this swirling about. In fact, Marx does precisely this
at this moment in his analysis, and it requires an unavoidable universality.
We hear in the passage a mantric, assonant, repetition of “all.” “All social
conditions,” “all fixed, fast-frozen relations,” “all new-formed [relations]”—
together they aggregate, yielding an image of a whole that in turn gives way
to the epochal atmospheric world of capital. Similarly, social theorists since
Marx have sought to develop general terms like flexible capital, postmodern
condition, and neoliberalism to grasp and contain a world of dynamism and
change.
Meanwhile, another response, one common among cultural anthro-
pologists today, is to refuse the universalizing gesture, and perhaps even to
refuse the very project of the concept. This might take the form of repudi-

126 TIMOTHY CHOY

ating either the claim that “everything” is melting or the idea that there can
be “whole relations” in the first place. Such abstractions kill, this response
goes, doing violence to particular human lives and practices that lie outside
the terms of the analysis, and such lives are accessible only through empiri-
cal work.
The first response is the one usually charged with being up in the air,
with not being concerned with concrete details, particular conditions, spe-
cific lives on the ground; but in fact, both responses are of a piece. Both
responses, whether universalizing or particularizing, seek solid analytic
ground, and both find their ground through resort to a “one.” This is so
whether the one is the unifying one of the “all” or the irreducible particular
one refusing subsumption into the general. The conceptual one and the em-
pirical one are a conjoined pair, and both suffer vertigo without firm footing.
Air is left to drift, meanwhile, neither theorized nor examined, taken
simply as solidity’s lack. And there seems at first to be no reason not to
let it. When solidity is unconsciously conflated with substance, when only
grounding counts for analysis, air can only be insubstantial. And we are
stuck with the twinned ones—universal and particular—grounded, fixed,
and afraid.
Environmentalists in Hong Kong, however, would press us on this at-
tachment to the ground, as would Marx himself. The environmentalists
would ask, “Is not this stuff floating above and around us itself deeply sub-
stantial?” As for Marx, we should remember that his claim is ultimately
about a dialectics of solidity. Solidities all have a presolid past, and air lies
in solidity’s future. As he declares in a speech during the anniversary of the
People’s Paper, “The atmosphere in which we live weighs upon everyone with
a 20,000 pound force. But do you feel it?” (Marx 1978b [1867], 577–78).1 It
would be a mistake, in other words, to search only for ground when above
and around us is substance aplenty. Our living with this substance, further-
more, is neither universal nor particular. Air is not a one; it does not offer
fixity or community; but it is no less substantial. The question is whether we
can feel it.
Hong Kong might help us feel it. From a certain point of view, there is
no “air” in itself. Still, in the following pages I follow the lead of people in
Hong Kong in attributing (imposing?) a loose category, air, to encompass a
number of things, among them dust, oxygen, dioxin, smell, particulate mat-
ter, visibility, humidity, heat, and various gases. There is no air in itself; air
functions instead as a heuristic with which to encompass many atmospheric
experiences. The abstraction of air does not derive from asserting a unit for

AIR’S SUBSTANTIATIONS 127

comparison or a common field within which to arrange specificities, but
through an aggregation of materialities irreducible to one another (includ-
ing breath, humidity, SARS, particulates, and so on). Thinking about the ma-
teriality of air and the densities of our many human entanglements in airy
matters also means attending to the solidifying and melting edges between
people, regions, and events.
This might help us to imagine a collective condition that is neither par-
ticular, nor universal—one governed neither by the “all,” nor through the
“one nation, one government, one code of laws, one national class-interest,
one frontier, and one customs-tariff ” that Marx envisioned, nor even the
“one planet” of mainstream environmental discourse. Instead, it orients us
to the many means, practices, experiences, weather events, and economic
relations that co-implicate us at different points as “breathers.” I like this
term, breathers, which I borrow from environmental economics; it refers to
those who accrue the unaccounted-for costs that attend the production and
consumption of goods and services, such as the injuries, medical expenses,
and changes in climate and ecosystems. I like the term because its very vacu-
ousness constantly begs two crucial questions that are both conceptual and
empirical: what are the means of counting costs? And who is not a breather?

THE STORY OF AIR’S substantiation in Hong Kong hinges on acts of conden-

sation, and this chapter engages in parallel acts to condense that story. Con-
sider how the air pollution monitoring stations dotting Hong Kong yield a
measurement for RSP, or respirable suspended particulate. Enclosed ma-
chines on rooftops and streets ingest millions of mouthfuls of wind a day,
calming it so that what it holds can fall out and so that enough of those par-
ticles can be collected for counting—to accumulate enough of the particular
for it to register as weight, as substance worth talking about. Miming this
method, this chapter collects the details in a diffuse set of contexts: the pro-
duction of air pollution as a local and global medical concern, the material
poetics of honghei (ambient air) in daily discourse and practice, the acts of
large- and small-scale comparison signaled by air, and the transformations
that condense Hong Kong’s air into measurable particles and then further
into a particular, yet internationally recognized, metric for risk.
In short, four forms of air concern me: (1) air as medical fact, (2) air as
bodily engagement, (3) air as a constellation of difference, and (4) air as an
index for international comparison. Ultimately, my aim is to gain a deep
understanding of all of them and to move seamlessly between their meth-

128 TIMOTHY CHOY

ods and registers. Rather than focus on just one, I make a start in each of
them because conveying the dispersal of air’s effects and its substantiations
is one of my chief aims. This has produced a text that can seem diffuse; its
argument requires some work to condense. But that is exactly what people
concerned with air must do: turn the diffuse into something substantive.

Air and Dying

Climatologically, there are two Hong Kongs. Beginning in May and June,
the air in Hong Kong swells as winds blow in from the tropical south, bring-
ing heat and humidity. The air temperatures will range from the mid-80s to
the high 90s Fahrenheit, while the humidity hovers around 95 percent. The
air sticks to you as you walk, forms a sheen on your skin as you move from
an air- conditioned bus, taxi, or building to the outside. In the late summer,
there are the typhoons, great oceanic whirlwinds that occasionally batter the
small island with wind and rain as they spin through the Pacific. In collo-
quial Cantonese, typhoons are called da fung, the beating wind.
Then, around late September, the winds begin to shift. Cooler and drier
air gradually blows in from the north, across Mainland China and Asia. The
temperatures can drop into the mid-40s Fahrenheit—as they did in the win-
ter of 2000, when the streets filled with puffy North Face jackets—while
the humidity drops to 70 percent. In these drier months, Hong Kong can
feel temperate. In the summer, the air in Hong Kong is heavy with heat
and water, but in winter months its weight comes from a different kind of
load, as the cool, dry winds sweep the smoke and soot from the skies above
China’s industrial factory zones into Hong Kong.
It is these sooty, winter, months that most likely motivated Michael
Eisner to pull Tung Chee-hwa aside during Tung’s visit to Los Angeles. If
Eisner’s criticism of Hong Kong’s air was indirect and vague, the critiques
voiced a few years later by Hong Kong doctors were specific and direct. In
2001 and 2002, faculty from the departments of community medicine at
the University of Hong Kong (HKU) and the Chinese University of Hong
Kong (CUHK) published separate articles in internationally known scien-
tific journals linking Hong Kong’s air pollution and declining health. The
first of the two, published by Chit-Ming Wong, Stefan Ma, A. J. Hedley,
and T. H. Lam in the journal Environmental Health Perspectives, was entitled
“Effect of Air Pollution on Daily Mortality in Hong Kong” (2001). The sec-
ond, published in Occupational and Environmental Medicine by T. W. Wong,
W. S. Tam, T. S. Yu, and A. H. S. Wong of CUHK’s department of community

AIR’S SUBSTANTIATIONS 129

and family medicine, was entitled “Associations between Daily Mortalities
from Respiratory and Cardiovascular Diseases and Air Pollution in Hong
Kong, China” (2002). The articles’ findings were chilling. Both studies con-
cluded that there were significant short-term health effects of acute air pol-
lution. More people died of cardiovascular or respiratory illness on days with
bad air quality than they did on days with good air quality. The HKU study
also compared warm and cool weather data and found that the chance of
pollution- correlated mortality was statistically higher in the cool season.
Both articles take pains to locate themselves in a citational network. I
mention this not to argue that citational networks are invoked to confer
authority on the articles; that point about scientific articles has been well-
argued by others already, and though certainly applicable in this case, it is
not what interests me most.2 Instead, I am interested in the warp and woof
of the network being woven, for it lends a specific character to the objects
and political substances emergent in it. One way to see how is through the
titles of some of the citations which form the network:

“Particulate Air Pollution and Daily Mortality in Detroit” (Schwartz 1991)

“Air Pollution and Mortality in Barcelona” (Sunyer, Castellsague, and
Saez 1996)
“Particulate Air Pollution and Daily Mortality in Steubenville, Ohio”
(Schwartz and Dockery 1992)
“Air Pollution and Daily Mortality in London: 1987–92” (Anderson et al.
1996)
“Air Pollution and Daily Mortality in Philadelphia” (Moolgavkar et al.
1995)
“PM₁₀ Exposure, Gaseous Pollutants, and Daily Mortality in Inchon,
South Korea” (Hong, Leem, and Ha 1999)
“Daily Mortality and ‘Winter Type’ Air Pollution in Athens, Greece: A
Time Series Analysis within the APHEA Project” (Touloumi, Samoli,
and Katsouyanni 1996)
“Air Pollution and Daily Mortality in Residential Areas of Beijing” (Xu,
Dockery, and Gao 1994)

There is a remarkable, almost numbing uniformity to the titles. They share

a syntactic structure, differing from one another through a paradigmatic
substitution of terms within that structure. In each, a compound subject is
first offered through a conjunction of air pollution with mortality, later to
be positioned through a locating “in.” Though there are minor variations in
the first half of the titles—“air pollution” might be modified as “particulate

130 TIMOTHY CHOY

air pollution” or “winter type air pollution”—the most significant transfor-
mations are take place in the second half, the prepositional phrase naming
a particularity of place.
In this structure, we discern something about the workings of exem-
plarity as political method. Through the mustering of a network of almost
identical examples, and by naming Hong Kong’s air through a similarly al-
most identical name, the doctors make Hong Kong an example in a much
larger problem. At the same time as that example draws power from the
network, though, it also lends stability to that network. The co-examples as
a whole, as a network, substantiate a conjunction of objects—air pollution
and death—differentiated only by place.
One thing to notice here is the play of particularity in the formation of po-
litical substance. Rather than jeopardizing its stability, the proliferation and
accumulation of particulars is key to the citational network’s existence. The
production of Hong Kong air is both a localizing and a globalizing project.
It is localizing because it carves out the uniqueness of Hong Kong. It lends
it specificity—the hallmark of that last phrase is place-based specificity. At
the same time, it is globalizing because it performs membership in an inter-
national community of atmospheric and medical science, and in an interna-
tional, global problem.
Equally important, the common form of the titles signals common
method. Both articles were “retrospective ecological studies” employing
“time-series analysis,” a method which amounts to statistically correlating
the “number of people dying on a particular day” (or a day or two later)
with meteorological data and air-pollutant concentrations over a long-term
period.3 The statistical method used was a Poisson regression model “con-
structed in accordance with the air pollution and health: the European ap-
proach (APHEA) protocol” (Wong, Tam, Yu, and Wong 2002, 2). The near-
identity of the titles in this particular citational network, in other words, is
premised on a near-identity of technique. Hong Kong’s air cannot be simply
asserted to be one example among many of deadly airs in the world; co-
exemplarity is actualized through the standardization of technique.4
This generation simultaneously of general problem and specificity is
resonant with dynamics analyzed in other chapters in this volume. It bears
comparing, for instance, with the collecting, formatting, and iterating of
data in environmental informatics, as Kim Fortun explores in this volume
(chapter 10), in that it generates a general problem precisely by arraying
and juxtaposing particularities, though as Fortun observes, environmental
informatics enable this process to be iterated across sites and types of infor-

AIR’S SUBSTANTIATIONS 131

mation not possible in the space of one study. In fact, the Hong Kong daily-
mortality studies discussed here would be but two among a vast library of
data sets for information engineers like those Fortun describes, raising the
question of the extent to which such studies might be produced in antici-
pation of themselves being informatted and networked. The carving out of
specificity through geographic location also underscores Sheila Jasanoff ’s
observation, in this volume (chapter 4), that specificity plays a vital role
today in legitimating claims of intellectual innovation and ownership. What
becomes clear looking across these topoi is that while specificity is at play
in all these moments, one cannot take for granted what specificity means.
There is no specificity in general, and the real work of specificity must be
gleaned from the pragmatics of the specific knowledge practices in which
specificity as a concept is figured.
To understand this, let us examine the specific conditions in which the
citations appear in the Hong Kong articles. Consider this excerpt from the
HKU study’s conclusion.

In setting air pollution control policy from a public-health viewpoint, it is

important to identify the health effects of air pollutants from local data.
Because of the lack of data, there are few studies based on daily hospital
admissions and mortality in the Asian Pacific region. For hospital admis-
sions there has been only one study in Australia (36) and two in Hong
Kong (30, 37). For mortality studies, there have been one in Beijing,
China (38) based on 1-year daily data, two in Australia (36, 39), and two
in Korea (40, 41). Our report should contribute to the understanding of
the effects of air pollutants in this region and may clarify the differences
in effects and mechanisms between Western and Eastern populations.
Local data on health effects of air pollution are required for setting
standards and objectives for air pollution controls. When local data are
not available, foreign data may be helpful, but they may not be relevant
or applicable because of a difference in climate or other conditions. Our
findings in this study provide information to support a review of air
quality objectives with consideration of their effects on health. (Wong,
Ma, Hedley, and Lam 2001, 339)

Here, the network (plotted by the integers corresponding with the citations
at the end of the article) is invoked through a naming of its holes, “the lack
of data.” The naming of the general problem is indistinguishable from the
claim for the primacy of the specific.
The explicit value of the Hong Kong study is marked as clarifying dif-

132 TIMOTHY CHOY

ferences in effects “between Western and Eastern populations.” By identi-
fying Hong Kong’s warm, humid summer and cool, dry winter, the Hong
Kong University study reminds us that we are in the subtropics; and the
specific ways in which it cites its network of relevant citations give that re-
minder a certain freight. It identifies and locates the work of Hong Kong
doctors within the terms of a center and periphery of scientific practice. As
scientists in the periphery, the researchers must negotiate a double bind not
unlike the one Lawrence Cohen describes facing gerontological organiza-
tions and authors in India in the 1970s, who, in appending “India” to their
names and publication titles, “claim[ed] local autonomy from internation-
alist [gerontological] discourse, but [did] so through a reassertion of episte-
mological subordination” (Cohen 1998, 90).
The Hong Kong doctors navigate this bind through an appeal to local ap-
propriateness: “When local data are not available, foreign data may be help-
ful, but they may not be relevant or applicable because of a difference in cli-
mate or other conditions.” Note, they do not say that the category does not
apply “here” or that air pollution is a Western problem; they simply maintain
that better, more local data is needed. This is a supplementary strategy, one
that has the potential to disturb, even while leaning on, the centrality of tem-
perate studies: “This study provides additional information for our previous
study on hospital admissions (21), and the many time series studies on air
pollution and mortality in temperate countries (1–11, 13, 15, 17–19, 28, 29,
33, 35, 38, 39)” (Wong, Tam, Yu, and Wong 2002).
The Hong Kong studies “contribute to” and provide “additional informa-
tion for” the networked assemblage of other conjunctions of air and mor-
tality “in temperate countries,” and in doing so, they help it to grow. Yet at
the same time, their very act of “adding to” articulates through implication
an inadequacy in the apparently whole original to which they contribute.5
The Hong Kong doctors’ exemplification of Hong Kong names geographic
unevenness in—even while extending the reach of—an emerging coales-
cence of scientific and political substance.
This emergent substance is fragile stuff. Daily-mortality studies face
criticisms that they establish no causal link or proof of impact in the long
term. Some epidemiologists, for instance, argue that even if one can show
that the number of people dying on a day with high air pollution is sig-
nificantly greater than on a comparable day with lower pollution, the early
deaths might be of people who had little time left to live anyway.6 Those
most vulnerable on high-pollution days are those in fragile health or in ad-
vanced stages of terminal illness, the argument goes. This is termed a “har-

AIR’S SUBSTANTIATIONS 133

vesting effect.” Those who died were going to die soon; they were simply
harvested early. Long-term cohort studies are needed to determine precisely
how many, if any, person-years have been lost. Only with such data, this
argument concludes, can the extent to which air pollution decreases life be
understood.
Such a refusal to recognize air’s daily effects by scaling time out seems
absurd at first, but we should recognize it as a logical side-effect of rendering
illness and health into prognosis. As Sarah Lochlann Jain illuminates in her
analysis of “living in prognosis,” a prognosis, which assigns people a certain
percent chance of being alive in the next number of years based on how long
others considered to be in comparable medical and demographic categories
have lived, puts one in the mind-wrenching position of living counterfactu-
ally, always juxtaposing one’s living against aggregated odds of dying.7 The
analytic of harvesting simply takes this head-wrench to the extreme—by
deeming your death today unworthy of note simply because most others
in your position, whether good air day or bad, did not survive much longer
than you.
Substantiating Hong Kong air as a dangerous substance will require
crunching not only numbers. It will require grappling with how to think
about a cause of death when causes are multiple and overlapping, and how,
when lives and causes are complex, to say when it matters that a person dies
today—and not tomorrow or next year. These efforts are crucial if air pollu-
tion’s effects on health are to be grasped.
At the same time, they run a risk of narrowing our sense of what mat-
ters in human-atmospheric relations. When we ask how many more people
die on particularly polluted days than would have died if the air were clear,
death becomes a proxy for air’s effects, and death itself is rendered a prob-
lem of lost time—which in turn prompts the demand for more accuracy
in counting the time in person-years lost. (How many person-years will be
spent counting person-years?) But it bears remembering that air’s human
traces are found not only in those who die, their times of death, or total
person-years lost, but in the fabric of living.

Air and Living

One day I collapsed when I got home, my stomach somersaulting like it

had at the Tung Chung Citiplaza, where I had needed to stop at the public
washroom instead of catching my connecting bus. A fever hit me that night,

134 TIMOTHY CHOY

leaving me weak and useless. The next morning, I called Wong Wai King,
my collaborator and informant in Tai O village, with chagrin to cancel our
appointment.
“You’re sick, eh? Yeah, the honghei these days has been really bad.”
I found this strange. The air hadn’t seemed that bad. But I spoke to
others, who nodded knowingly and recalled that the air had been particu-
larly wet on that hot, muggy day.

THE LINK FORGED by the doctors between air and health was not novel or iso-
lated. Nor, as Wong Wai King and others helped me to see, was air’s impact
on health in Hong Kong limited to its particulate load. Already circulating
was an existing discourse of honghei (Cantonese: ambient air) and health.
Reviewing my notes back in San Francisco, I noticed this entry from August
2000: “Ah Chiu has been sick. She got a cold or something. It’s a common
thing to get colds out here in the summer. Nobody thinks it’s strange, be-
cause they all know that when going in and out of air conditioning, you can
get really cold and then sick.” My notes and memories are dotted with such
commentaries. Sometimes, I was told, it was too hot. Other times, it was
cold, dry, or wet. Intrigued, I consulted Traditional Chinese Medicine texts
and doctors for mention of honghei, but I was unable to find any. There was
plenty, however, about feng (Mandarin for “wind”; fung in Cantonese).
In Traditional Chinese Medicine texts, honghei (Mandarin: kōngqì) de-
notes one of two sources of acquired hei. The other source is food. Hei,
widely recognized in its Mandarin pronunciation, qi, is the fundamental
life force in TCM, often translated as breath. Honghei is thus a breath in two
senses; it is a source of vital breath, and it is breathed. In everyday use, hong-
hei refers to the air in one’s surroundings.
Though breath is vital, wind is dangerous. “Wind is the first evil,” my acu-
puncturist back in California, Marliese, explained to me. “It opens the body
to secondary ills.”
The historian of science Shigehisa Kuriyama offers a beautiful account
of the central role played by wind in the history of Chinese medical con-
ceptions of the body. He highlights the tension that existed between, on
the one hand, feelings of an ultimate resonance between the body’s breath
and the surrounding winds, and, on the other, anxieties about human sub-
jection to chaos, where humans were opened to irregular and volatile winds
by their skin and pores. Through close study of medical and philosophical

AIR’S SUBSTANTIATIONS 135

texts, Kuriyama shows clearly that “meditations on human life were once in-
separable from meditations on wind” in both Chinese and Greek medicine
(1999, 236).
What most strikes me in Kuriyama’s account is his attention to language,
both in the ancient texts he studies, and his own. Winds and air whistle
through his writing as much as they do through the texts he analyzes. Lis-
ten, for instance, to his discussion of the connection that the philosopher
Zhuangzi drew between earthly winds and human breath.

The winds of moral suasion, the airs that rectify the heart, and now the
heavenly music of gaiety and sadness. All these bespeak a fluid, ethereal
existence in a fluid, ethereal world. A living being is but a temporary
concentration of breath (qi), death merely the scattering of this breath.
There is an I, Zhuangzi assures us, a self. But this self is neither a shin-
ing Orphic soul imprisoned in the darkness of matter, nor an immaterial
mind set against a material body. Anchored in neither reason nor will,
it is self without essence, the site of moods and impulses whose origins
are beyond reckoning, a self in which thoughts and feelings arise sponta-
neously, of themselves, like the winds whistling through the earth’s hol-
lows. (Kuriyama 1999, 245)

By allowing the airs to permeate his own account’s figurations and similes,
Kuriyama conveys to his readers Zhaungzi’s theorization of human perme-
ability and impermanence more vividly and viscerally than a less writerly
account could. Later, Kuriyama will show how much more dangerously the
winds are figured in subsequent texts, and it is this later sense of wind’s dan-
ger that my acupuncturist in California inherits through her study of TCM.
Air’s meanings in Hong Kong seem to exceed this classical medical gene-
alogy. Among people I have known in rural and urban Hong Kong, good
fung characterizes good places. Wind’s ubiquity, however, and the way it
wends its way into everyday talk recall the inseparability of wind and life
that Kuriyama describes and the lyrical trace of an imminently atmospheric
sense of the self and health. Meditations on life through wind are as present
as ever.8

IN TAI O, the air is on the tips of people’s tongues. “Hello, good day. Nice feng
today, isn’t it?” The old men sit on the benches by the Lung Tin Housing
Estate, Dragon Field, facing the road that connects Tai O to the rest of Lan-
tau Island, watching the hourly bus come in with visitors. Their shirts are

136 TIMOTHY CHOY

loose. The breeze curls through Lung Tin, finds Wong Wai King sitting on
the concrete steps outside her bottom-floor apartment. She sips some sweet
water, closes her eyes, and plays her guzheng. “Wah, hou shufuhk,” she tells
me. “Ah, it’s so very shufuhk.”
The word shufuhk means “comfortable,” but also much more. When
people say they’re not shufuhk, they mean they’re not well. Conversely,
when Wong Wai King and others tell me that they’re shufuhk, they mean to
tell me that they are experiencing a crisp, pure pleasure that saturates their
being. Like a cool breeze on a hot sticky day. Clean sheets on a bed. Or the
way a cup of tea might warm you from the inside when you’re cold. The word
is ubiquitous.
Places are made into living things through a blend of landmark and lan-
guage, as anthropologists of place have taught us to see, and the air in Hong
Kong is undeniably part of the rhetoric of its place.9 But air, polluted and
otherwise, is a daily materiality as well as symbolic field. To explore a ma-
terial poetics of place, and air’s function within it, we need to ask after the
material and meaningful ways in which air enters into human and geo-
graphic life as such. For the notion of a poetics of place to have any teeth,
for it to do more than simply legitimate linguistic study as a study of some-
thing linked to the material world, we must also go after the nonverbal ways
that air operates poetically. How does air serve as a meaningful and material
unit in the building of Hong Kong? Let us take an atmospheropoetic tour.
Some of the neighborhoods I choose for this tour are among Hong Kong’s
most famous. Central is the financial center of Hong Kong and the heart of
its government. Central’s illuminated towers, set against a foreground of
the green waters of Victoria Harbor, adorn most of the stereotypical tourist
images of Hong Kong. Less celebrated internationally but well-known both
in Hong Kong and in Hong Kong tourist literature is Mong Kok, a district
on the Kowloon Peninsula. To many, Mong Kok is the antithesis of Central.
Mong Kok is commonly held to be more Chinese than Central. While the
English language appears on shop signs and restaurant menus in Central
and sometimes comes out of shopkeepers’ mouths, it is rare in Mong Kok.
Whereas Central offers at least some Western comforts, Mong Kok caters
to Hong Kong Chinese and to tourists seeking a flavor of Chinese alterity
within Hong Kong.10
Tai O, described just a few pages ago, should be considered a part of this
tour, along with Lung Kwu Tan and Ha Pak Nai. Tai O is a popular destina-
tion for domestic and foreign tourists, though not long ago it was consid-
ered a dirty backwater. Lung Kwu Tan and Ha Pak Nai, meanwhile, are rela-

AIR’S SUBSTANTIATIONS 137

tively less well-known villages in Hong Kong’s New Territories, hemmed
in by a power station and a landfill and facing the impending construction
of a municipal-waste incinerator.11 With their inclusion, another axis of dif-
ference becomes clear. Central and Mong Kok might in isolation evoke an
imagined opposition between Western and Chinese in Hong Kong, but
when Tai O, Lung Kwu Tan, and Ha Pak Nai become stops on our tour, Cen-
tral and Mong Kok find themselves partners in urbanity set against the rural
New Territories.

CENTRAL. In the winter the air in Central sweeps in dark swirls through
Connaught Road, blowing under squealing double-decker trolley cars before
whirling up Pedder Street toward Lan Kwai Fong, Central’s famed restau-
rant and bar area. It chases the heels of trundling buses and racing taxis, and
flings gusts of soot at the ankles of the pedestrians waiting at the crosswalk,
who, almost in unison, lower their heads and cover their mouths and noses
with a hand or handkerchief—a loosely synchronized nod and an almost in-
stinctive gulp of held breath—as the wake of air washes over them.
Lung Kwu Tan. In Lung Kwu Tan and Ha Pak Nai, two villages in Hong
Kong’s northwestern New Territories, the air smells cleaner at first—that is,
it doesn’t smell of diesel. There are fewer buses out here. Fewer taxis. But
it does smell of garbage, of the garbage water that leaks from refuse trucks.
People talk about the dust that settles on their vegetables from the cement
factory’s smokestack. And then there are the flies that fill the air, making it
so that you might want to keep your mouth more tightly closed while you’re
breathing. Now people are worried about what else might come from the
air, as the government plans to build their incinerator here. Dioxins, says
Rupert Yu, a Greenpeace campaigner working to halt the incinerator’s con-
struction, the most poisonous substance humans have ever created.
Still, the air is on the water, and this yields cool breezes. On weekends,
it fills the sails of windsurfers, and it carries the scent of visitors’ barbecue,
even if the occasional atmospheric shift wafts reminders of the cement fac-
tory, power station, and landfill nearby.
Mong Kok. In Mong Kok, a neighorhood on the Kowloon Peninsula that
has been called the most densely populated area in the world, the winter
winds are as sooty as those in Central. Dust expelled from the backs of abun-
dant buses, trucks, and taxis barely settles before it is stirred up once again.
Pedestrians cross the street with the same nodding gestures. Off the street,

138 TIMOTHY CHOY

though, the winter wind might find itself broken by a crowd, trapped and
thawed by the press of people gathered to shop and play.
The same is true a bit farther north, in Yau Ma Tei, where there is also
the night opera. There are two women performing, one middle-aged with
glasses, wearing a skirt, leaning deliberately toward her microphone under
bright incandescent lights. The musicians sit to the left, one smoking a ciga-
rette while he plays his erhu. The music, the voice, they quaver. They sound
like old radio. The air is full, too, with shells, with black beans, the slightly
sticky smell of cow parts being stewed, durian, skewers of pork, oyster
omelets. The smell of diesel fades into memory, and the cold air, defeated,
rises to the overlooking skyscrapers in warm ripples.

WE HAVE TAKEN a slight detour from the issues of health that first brought
us to consider the air. But we have retained the issues of the body, the ques-
tion of immediacy—the coughs, instinctive intakes of breath. Part of air’s
substantiability in Hong Kong comes from the fact that it is always breathed.
The poetic mattering of Hong Kong’s atmosphere encompasses not only
Wong Wai King’s rhapsodic “Wah hou shufuhk,” but also her sip of sweet
water, the placement of her chair, and the coughs and nods of the pedes-
trians aiming to cross the street in Central. Air’s poesis, the co-productive
engagements between people and air, range from commentary, to breath,
to avoidance, to the flip of an air- conditioner switch. Put another way, air is
not only an object of cultural commentary, and not only a nonhuman ma-
teriality always already enmeshed in webs of social and cultural practice.
It is something embodied that engages with humans through bodily prac-
tices. The smell, breath, wind, weather, typhoon, air conditioning, air pollu-
tion, height, verticality, science, sound, oxygen, smoking. The tactility of the
atmosphere.
The anthropologist and musician Steven Feld (1996) has argued that
sound and voice provide a useful entry for the anthropological study of re-
lations between person and place. He identifies the sonic resonance of the
human chest cavity as a central feature of the links and feedback loops be-
tween people and their environments. How similarly fruitful might an an-
thropology of air be, an anthropology of this stuff sensed in and through
the moment of bringing breath into the interiority of the body, or at the mo-
ment when wind opens the body to ailments? Air muddies the distinction
between subjects and environments, and between subjects. This thickness

AIR’S SUBSTANTIATIONS 139

and porosity rendered by air is part of what makes the air and the airborne
such deeply felt elements. Bodies may be, as the geographer David Harvey
(1996) argues, intersections of large- and small-scale spatial practices; but
if bodies are an intimate location of effects and agencies, air is the sub-
stance that bathes and ties the scales of body, region, and globe together, and
that subsequently enables personal and political claims to be scaled up—to
global environmental politics—and down—to the politics of health.

Air’s Comparisons

In August 2000 a feature entitled “A Breath of Fresh Poison” was published

in the South China Morning Post. In the article, readers are introduced to a
sympathetic character, Fred Chan Man-hin, who had recently returned to
Hong Kong from Canada to start a company. Although he initially “planned
on being here forever,” he tells the Post, “the pollution has affected my de-
cision. I can’t work and be sick all the time.” Today, Chan “avoids his office
in the Central business district because the pollution gives him dizzy spells
and migraine headaches. He has spent tens of thousands of dollars on doc-
tors and tests to find a cure for the allergies, viruses, and exhaustion that he
cannot seem to shake” (Ehrlich 2000, 13).
The article throws into relief a signature feature of air’s substantiation
as a problem in Hong Kong. It does not merely recount Chan’s unshakeable
health woes; it makes a pointed comparison. Chan had initially left Hong
Kong for Canada, we are told, and had later returned to make his fortune,
but now the pollution might affect his decision to “be here forever.” If air
constitutes a danger in Hong Kong, part of its threat derives from its ca-
pacity to serve as an index for comparing Hong Kong with Canada and other
places.
This capacity of air as a point of comparison first became evident to
me through my family, particularly through jokes about how predictably
those who do not live in Hong Kong get sick when they visit. My mother’s
cousin, Ling, playfully chided her when she fell ill, for instance, when my
parents visited Hong Kong near the end of my fieldwork. “You, your cousin
Maggie, and your brother To—you all get sick whenever you come back to
Hong Kong.” My mother falls ill almost every time she visits Hong Kong, as
do I. Ling knows this well, as we usually go to her or her husband for antibi-
otics. “You’re not jaahppgwaan, not accustomed, to the air,” Ling says. “Will
you still visit?”

140 TIMOTHY CHOY

 Will we still visit? This simple question draws us back to the landscape
photographer’s cocktail party, to my conversation with the American Cham-
ber of Commerce representative and his wife, who wondered aloud how in-
vestors could be expected to come to Hong Kong if the air quality continued
to deteriorate. It echoes Disney’s admonishment to the chief executive. Air
is not only an index of health. It is an index for comparing livability, well-
being, global attractiveness.12
I cannot leave the matter of air’s comparability at this level of global com-
parison, for it misses some of the subtle comparisons and distinctions that
operate within the city-state. We are now acquainted with the air of some of
Hong Kong’s neighborhoods, its qualities, and its dangers; now questions
of justice and equity beg to be asked. How are Hong Kong’s air spaces dis-
tributed? Who gets to occupy those with the cleanest air? Who breathes the
street? Who breathes mountains? Who breathes the sea? Who breathes flies?

A FEW WEEKS after moving to Mui Wo, I returned to Sai Ying Pun to visit
with the fruit vendor, Mrs. Chau. Ah, you’ve come back, Mrs. Chau said,
loudly enough for passers-by to hear. I smiled, a bit embarrassed, and re-
plied that the oranges looked good. I asked her to pick some for me, and for
a glass of juice, and we chatted for a while there on Mui Fong Street.
I missed Sai Ying Pun, I told her. Mui Wo was nice, but it wasn’t as con-
venient. There were also all the mosquitoes, I continued. Expecting some
sympathy, I offered my arms to show her my mosquito bites, but Mrs. Chau
dismissed them with a wave and a laugh.
Sure, there are mosquitoes, she said. But I’m sure the honghei is much
better there.
Of course. Of course honghei mattered to Mrs. Chau, who worked every
day on the busy corner of Mui Fong Street and Des Voeux Road, just down
the street from one busy bus stop, where diesel buses pulled in nearly every
minute, and across the street from another. Hillary, the stationer down the
street, at least had a door between the street and his shop, and his shop was
air- conditioned.

FAR FROM BEING UNIFORM, Hong Kong consists of pockets. Studies in the
loosely Marxist or critical geographic tradition take as a premise that there
are social inequities, mapped and realized through spatial distinction.

AIR’S SUBSTANTIATIONS 141

Through their lenses, we discern a geographically uneven distribution of
environmental harm, where the rich have access to good air, while the poor
are relegated to the dregs, to the smog and dust under flyovers or on the
streets.13 One can, in other words, discern a political- economic geography of
air. The poorest air quality was initially in the urban areas, in the industrial
zones. Now, the bad air is being exported, as Hong Kong companies relocate
their factories in the Guangdong Province, where labor costs are lower and
environmental standards are more lax. But then the pollution comes back
in those notorious winter winds.
These arguments help to ground the air in a solid sociological critique of
social and geographic stratification; for this reason they are politically vital.
At the same time, such fixings need less rigid company. When mapping the
spatial distribution of social inequity, an account of air must at some point
leave land-based maps, for they can divert us from the movements of air
and breathers alike—not to mention mobile pollution sources, such as the
taxis, buses, airplanes, and cargo ships crucial to the circulations of Hong
Kong’s industries. To the geography of air and the dialectics of air and capi-
tal, I simply add three corollaries: (1) air is made not only in emissions, but
also in the respiration and movements of breathers; (2) neither those who
emit particulate, the winds that carry it, nor those who breathe it sit still in
places; and (3) as Kuriyama reminds us, there has always been more to air
than particles.

THE STRATIFICATION OF AIR SPACES in Hong Kong has been loosely tied to in-
come, and incomes and occupations have also been racially marked. White-
collar expatriates, with their generous compensation packages, have to a
greater extent than most people in Hong Kong been able to choose to live
somewhere clean and central. Air spaces have been constituted in part by
the racialized and classed bodies that live, work, and play in them.
The Peak and the Mid-Levels have long served Hong Kong’s elite as airy
refuges. Almost from the moment British colonists occupied the small
island off China’s southern coast, they turned toward the peaks that formed
the dramatic backdrop for the small harbor they so desired, looking up-
ward for some respite from Hong Kong’s summer heat and humidity. If
for mountaineers the staggering heights of snowcapped peaks presented a
dream of sublimity and transformation, the Peak in Hong Kong offered to
colonists a more mundane, more everyday, yet perhaps equally treasured

142 TIMOTHY CHOY

transcendence of place, time, and air.14 Even relatively recently, civil servants
have had privileged access to apartment buildings high up.
In colonial times, people cared mostly about the heat and humidity. The
winter winds, whose passage through the landmass of greater Asia lent
them coolness and dryness, were greeted with great pleasure. Today, that
dryness and that passage through China have made winter less popular than
it used to be. Real estate up high continues to be prized, but now it is valued
not only for respite from summer heat and humidity, but also because it
promises at least some relief from roadside pollution and congestion, as well
as convenient access to work and play.
The Mid-Levels, known in Cantonese as zhong saan kui, or the “mid-
mountain area,” are found a bit downhill from the Peak, and they, too, serve
as something of a refuge from the soot below. The apartment towers are
spaced farther apart than in the neighborhoods at lower altitudes, and there
are fewer cars. Commercial skyscrapers are less prevalent up here, and the
common mode of commuting here is the escalator, the longest covered out-
door escalator in the world—the same one that stars in Wong Kar Wai’s film,
Chungking Express. The escalator descends into Central from the top of the
Mid-Levels in the morning, carrying not only local and expatriate profes-
sionals on their way to the office, but also domestic helpers heading down
to the markets to buy the day’s groceries. Later, at 10:00 a.m., the escalator
will reverse itself so that the domestic helpers won’t have to climb the many
flights of stairs back to their employers’ homes. Scores of restaurants and
bars have sprung up around the escalator. The escalator and the easy com-
mute it offers into Central have made the terraced streets of the Mid-Levels
a pocket of real estate that is even more highly valued today than it was in
colonial times.
Much of Hong Kong seems designed to get off the ground—into the air,
and out of it. In colonial times, the English built their mansions in the Mid-
Levels and the Peak. Today, when I walk with Hemen, a representative of
the Tsing Tao Beer Company, he wends his way expertly through Wanchai, a
government and nightlife district on Hong Kong Island, without ever touch-
ing the ground. We spend the day on the walkways that link this hotel to that
shopping center. Some walkways are covered, others enclosed. Up here, we
avoid the cars and the exhaust. My grandmother and I got lost once in these
walkways. I remember how she pointed down to the street. There, she said,
that’s where I want to go. How do we get there? We never made it—we were
lost in the flyovers.

AIR’S SUBSTANTIATIONS 143

AIR IS LIKE FOOD, essential to human life. Any anthropology worth its salt,
however, asks after the meanings of the essential and its manifestation in
material and semiotic constellations of power. Writing of food and eating,
Judith Farquhar observes that “[a] political economy of eating emphasizes
the uneven distribution of nutritional resources, while a political phenome-
nology of eating attends to the social practices that make an experience of
eating” (2002, 46). For an adequate account, both ends of the analytic pole
are necessary, as is everything in between. Air similarly calls simultaneously
for an understanding of its distribution and an emic analysis of its presence
and distinction in acts of living. Like foods and tastes, air is enrolled into
projects of social, racial, ethnic, cultural distinction. When diasporic Chi-
nese find the air in Hong Kong or China unbearable, their coughs, com-
ments, and airplane tickets distinguish person and region. Consider also
how atmospheric qualities figured in colonial poetics of difference. The Chi-
nese “do not suffer from the oppressive heat of the lower levels during the
summer months as Europeans do,” theorized the signatories to a petition
in 1904 to create a “Hill District” for Europeans.15 Air marked the moments
when colonists grasped for something concrete to say to concretize their
deep unease—a sense that all around them, permeating everything, was
difference.

Air’s Index

We have seen that people in Hong Kong have a number of techniques for
reading the air—dirtiness, wetness, heat, breeze, height. And we have seen
how threats and health are substantiated through air’s breezing and breath-
ing. In this section, I want to look at one of the state’s measures. Air’s sub-
stantiations, as we have seen them thus far, present a mess for a planner
or politician. To facilitate communication and policy, they need something
easier to evaluate—a measure that can be translated back into coughs and
particles, if need be, but that is simpler and more encapsulating. Little won-
der that air, an index of so much, should have an index of its own.
The Air Pollution Index (API) in Hong Kong is calculated in a manner
similar to that of other countries, such as the United States, Australia, and
Mexico. Air pollution monitoring stations throughout Hong Kong collect
data on several target pollutants: sulfur dioxide (SO₂), carbon monoxide (CO),
nitrogen dioxide (NO₂), and respirable suspended particulate (RSP). The raw
data for each pollutant, usually measured in micrograms per cubic meter
within a given period of time (1 hour, 8 hours, 24 hours), is turned into a

144 TIMOTHY CHOY

sub-index calibrated so that an index of 100 will correspond with a density
of pollutant that is dangerous to health. That reading of 100 corresponds to
different densities for different pollutants. For instance, for SO₂, an index of
100 is calibrated to 800 micrograms per cubic meter of air (800 µg/m3) in a
1-hour period, while for NO2, the 100 is calibrated to 300 µg/m3. For the gen-
eral Hong Kong API, the highest of the 5 sub-indices (measured in different
locations) for a given hour or day is taken as the API for that hour or day.
The clarity of the number 100—so metric!—in the index is what grabbed
my attention; it brought to mind the history of the kilogram.16 In 1799, in
an effort to standardize measurements in France, the French National As-
sembly decreed that a “kilogram” would be defined as the mass of a deci-
meter of water at 4 degrees Celsius. Brass and platinum weights were
made with equivalent mass, and the platinum one, the “kilogramme des
archives,” would eventually become the standard mass for twenty other
countries in Europe through a treaty known as the Convention du Mètre. A
more durable copy of the kilogramme des archives, made of platinum and
iridium, was later fashioned as the international standard and called “K.”
Twenty copies of K were then apportioned to each of the signatories of the
Convention du Mètre. Was this 100 of the API a universal measure—like
the kilogram—calibrated across national and cultural difference through an
ultimate standard?
It seems so at first. Common methods and machines internationally
unite those who seek to measure air’s load. These methods and machines
serve as paths of translation—along them, air can be turned into vials of
dust, which can in turn be transformed into indices. These are “circulating
references,” organizations and transformations of matter that allow material
to assume more mobile forms.17 The reversibility of these translations en-
sures the indices’ stability and rigor, assuring their users and proponents of
a pathway back to the dust. It takes an apparatus of techniques and meth-
ods—not simply the calibration of danger to the integer 100, but also the
replicability and reversibility of the translations between air and number—
to qualify Hong Kong’s API as an index among others. There is a standard-
ization, then, to the techniques for measurement, as well as to the form of
the API.
When I reviewed the Air Pollution indices of several other countries,
however, I was surprised to find that an API of 100 is calibrated to different
amounts of dust in different places. For instance, for carbon monoxide, the
one-hour objective in Hong Kong is 30,000 µg/m3, while in California the
equivalent objective is 23,000.18 If the air in California had 24,000 µg/m3

AIR’S SUBSTANTIATIONS 145

of carbon monoxide in it during a one-hour period, the API would read over
100 and be considered unhealthy, while in Hong Kong the API might hover
only around 80 and be considered acceptable.19 Between the final API form
and the standard methods for measurements lies a space for governing what
will register as risk or danger.
Most striking is the difference in objectives for RSPs (PM₁₀). The twenty-
four-hour target in Hong Kong is 180 µg/m3, while the federal standard in
the United States is 150. The California standard is lower still, at 50 µg/m3,
which is the same as levels deemed acceptable by the World Health Orga-
nization.20 That is, the Hong Kong threshold at which the air is considered
to contain an unhealthy level of RSPs is almost four times as great as the
threshold in California, exemplifying the fact that standards for danger are
different in different places.
Calibrating the API is a technique for managing the public perception of
risk—for a public that includes vendors like Mrs. Chau, sick entrepreneurs
like Fred Chan, corporations like Disney, and residents weighing arguments
that a more democratic government could care better for its people.21 The
API can be read alongside the adjustment of risk thresholds that Joe Dumit
analyzes, in this volume (chapter 1), in the context of pharmaceutical mar-
keting, where marketers aim to lower the published thresholds so that more
people will feel and be deemed unwell and, therefore, fit for medication. It
also has resonances with the novel iterations of data in environmental infor-
matics explicated by Kim Fortun, also in this volume (chapter 10). Together
these examples illuminate a common situation, where the ongoing tuning,
tweaking, and reiterating of numbers, graphs, and maps becomes central
to affective and aesthetic work—the making visible and experienceable (or
invisible and unexperienceable) of risks that are difficult to articulate.22 A
symptomless biomarker becomes felt as disease; an intuited tie between so-
cial difference and health verges on presence. Through the API’s calibration,
the smell of diesel drifts in, then out; a breath feels alternately thick and
thin, clean and dirty, invigorating and debilitating. It is not simply that the
API is deployed for persuasive ends, but that the very technical practice of
its generation—as much as commentaries on the breeze, held breaths, and
treatises on the effect of southerly versus northerly winds—brings air into
sense and sensibility. This is an aesthetic technology with serious stakes.

146 TIMOTHY CHOY

Air’s Poetics

First of all the enveloping hot air, ungiving, with not a flicker of movement, a still
thermal from which there is no relief. You are surrounded by hot air, buoyed up by
hot air, weighed down by hot air. You inhale hot air, you swallow hot air, you feel hot
air behind the ears, between the legs, between the toes, under the feet.

Many hours later, a very slight stir, followed by the suggestion of a breeze. The
thermal remains.

Yet more hours later, a sudden tearing gust of wind, and the storm has arrived.

LOUISE HO, “STORM”

What kind of substance is Hong Kong’s air at the end of the day? One
shared, particular, and comparable, one realized in bodily, sensory, practi-
cal engagements of breath and movement, as well as through the material
and mathematical transformations of medical method. One fixed in the
whorls between buildings, mobile as it blows across town, across borders,
across disciplines—one that signals a global political economy, postcolonial
anxiety, as well as concerns about health and well-being.
Air’s qualities are coupled with Hong Kong’s industries. Think of the
smokestacks of industrial factories making goods and the cargo ships
moving freight; the carbon footprints of the jets and taxis moving finance
workers; the mark on the air from the coal- and gas-burning power plants
that send electricity to Hong Kong’s skyline and to the electronics shops,
bursting with gleaming toys to be bought and powered with leisure money
or credit. Think of the combustion at the end of consumption’s lifecycle,
where discarded things are incinerated. Air pollution is both condition and
effect of capital. We burn in making, we burn in consuming, we burn in dis-
carding, and the smoke has nowhere to go but up. Once up, this smoke con-
stitutes its own threat to Hong Kong’s place in financial circuits.
Meanwhile, Hong Kong doctors work to locate their concerns about the
atmospheric load in Hong Kong within broader concerns about health,
as well as within international science. Pedestrians and environmental-
ists worry about the winter shift in the wind that brings China’s air into
Hong Kong. Air’s capacity to hold many forms of substance helped solidify
a village-NGO collaboration mobilized to halt construction of an incinerator
in Hong Kong’s New Territories.
Air disrespects borders, yet at the same time is constituted through dif-
ference. Neighborhoods have different atmospheres; nations generate and

AIR’S SUBSTANTIATIONS 147

apply different pollution standards; leaders worry about the state of their
air compared to that of other nations. The winds themselves derive from
differences in air pressure between regions, and similar relativities allow
our lungs to inhale and exhale. Gradients, whose foundations are the con-
tact and bleeding of difference, move air through the spaces we live in and
through our bodies.

HOW DO WE THEORIZE this shifting substance bound up in processes of pro-

duction and consumption that also holds and touches much more? What
manners of thinking about scales, distinctions, and connections does it
open to us? My answers to these questions remain preliminary, but let me
outline for now an argument for air’s potential to reorient discussions of
political universalism.
Recent efforts in post-Marxist political philosophy to retheorize univer-
salism can be brought fruitfully to bear in air’s analysis, but they also meet
a limit.23 As exemplars of such efforts, consider the interventions made in
Contingency, Hegemony, Universality, a series of provocations and exchanges
between Judith Butler, Ernesto Laclau, and Slavoj Žižek. The authors in this
exchange agree that there are no self- obvious political or ethical universals
unstained by particularity, and that the concepts of the universal and the
particular are best understood in relation with each other and with their de-
ployment in historically specific political acts. On the question of how pre-
cisely to understand the relation of the universal and the particular, how-
ever, the authors differ strongly.
For Laclau, the universal is an “impossible and necessary object” in the
constitution of any political articulation, in both theoretical and political
terms. “From a theoretical point of view,” he argues, “the very notion of par-
ticularity presupposes that of totality. . . . And, politically speaking, the right
of particular groups of agents—ethnic, national or sexual minorities, for in-
stance—can be formulated only as universal rights” (Laclau 2000, 58). The
particular is thus for Laclau never outside of, or prior to, a field of relative
and necessary universality within which particulars come to be known as
such. The universal, in its very impossibility and necessity, grounds politics
(and analytics) of particularity.
Butler, meanwhile, argues almost the reverse point. “If the ‘particular’ is
actually studied in its particularity,” she writes, “it may be that a certain com-
peting version of universality is intrinsic to the particular movement itself ”

148 TIMOTHY CHOY

(Judith Butler 2000a, 166). That is, a close study of particular political move-
ments might reveal that they actually are the universals that they seemed to
rely on. Universality, for Butler, rather than simply preceding the particular,
is in fact generated and iterated through particular visions of the universal.
Žižek, following Hegel and Marx, invokes the concepts of oppositional
determination and the concrete universal to solve the paradox of the uni-
versal’s and the particular’s simultaneity. Of all species within a genus, he
argues, there is always one that is both member of the genus and determiner
of the terms defining that genus. Furthermore, the historically specific con-
dition of global capital structures the situation of political particularisms;
and class politics, he maintains, while one among multiple forms of politics,
serves as the model for politics in general.
Any of these positions could ground air’s analysis to good effect. We
might lean on Butler’s concept of “competing universalities” to argue that
the daily mortalities substantiated by Hong Kong’s doctors not only buttress
a universalizing claim of air pollution’s link with dying, but also instantiate
a particular, competing, version of this universality that questions the pe-
ripheralization of Hong Kong scientists and Hong Kong health in interna-
tional science. We could borrow a page from Žižek to argue that in air’s en-
tanglement with capital we encounter the air relation determining all other
air relations. Or, twisting somewhat Laclau’s characterization of the relation
between universalism and contingently articulated political blocs, we could
see air emerging as an empty, yet always necessary, universal—to be filled
in with honghei, RSP, typhoons, buses, breezes, science, flies—making en-
vironmental politics, rather than class politics, a primary field for political
claims.
Before long, however, air would push back. Each approach offers a theory
of politics through a solution to the universal-particular paradox; but to do
so each leans on an initial opposition between the universal and the particu-
lar to render their coexistence paradoxical in the first place, in need of a solu-
tion. As I hope to have conveyed, however, air’s encompassment of universal
and particular does not present itself as a paradox. It is a banality. Rather
than a solution to a paradox of scale, then, air asks for a theoretical language
that does not find its movement through multiple scales and political forms
remarkable in the first place.
Can we, following Kuriyama, learn to hear air whistling through the
hollows of theory? Doing so means making permeable the grounding dis-
tinction drawn between the unruly manifold of matter and putatively prior

AIR’S SUBSTANTIATIONS 149

conceptual forms.24 For ethnography, it also means adopting a different re-
lationship than usual with the concrete. Listening to air, thinking through
this diffuse stuff in the thick of becoming, requires less literal materialism.
The poet and critic Charles Bernstein remarks on the relation between
poetry and philosophy: “Poetry is the trump; that is to say, in my philoso-
phy, poetry has the power to absorb these other forms of writing, but these
other forms do not have that power over poetry. . . . When I think of the
relation of poetry to philosophy, I’m always thinking of the poeticizing of
philosophy, or making the poetic thinking that is involved in philosophy
more explicit” (1992, 150–51). Thinking, for Bernstein, is always a poetic
act. Poetry is always thinking. This figuring of always poeticized philosophy
pushes me to make explicit the poetic thinking involved in theorizing prob-
lems of universality and scale.25 What are the “universal” and “particular”
but conventionalized figures for theory’s poetics? Their ossification should
be clear when those most ardently debating their definition declare the in-
adequacy of their terms, and then return to rest on them again and again.
Some tropic invigoration might help—a poetic revival through the activation
of examples, where details yield not simply particularity, but the potential
for mobile metaphors. Might the material poetics of Hong Kong’s air—with
its whirlings, its blowing through scales and borders, its condensations, its
physical engagements, its freight of colonial, economic, and bodily worries
about health and well-being, its capacity to link and to divide, its harnessing
for simultaneously local and cosmopolitan projects—provide that reviving
breath theory needs?

Notes
1. Cited in Berman 1988, 19.
2. On citational networks, see Latour and Woolgar 1986 [1979].
3. The CUHK group’s study spanned the four-year period from 1995 to 1998. The
HKU study used data for the period 1995–97. Meteorological data was obtained from
the Hong Kong observatory, and air-pollutant concentrations were obtained from the
Environmental Protection Department.
4. On the work of standards and standardization, see Bowker and Star 1999. Also
see Andrew Lakoff ’s contribution to this volume (chapter 8). Lakoff insightfully
shows the ways in which the specific freights of psychiatry and Lacanian psychoanaly-
sis in an Argentine hospital bear on the possible substantiation of bipolar disorder as
a viable diagnosis and thus on the liquidity or potential flow of genetic information
about Argentine patients as information—globally liquid information—about a glob-
ally common mental disorder.

150 TIMOTHY CHOY

 5. Homi Bhabha, following Derrida, elaborates the disturbing power of “being
additional” in a postcolonial situation. “Coming ‘after’ the original, or in ‘addition to’
it, gives the supplementary question the advantage of introducing a sense of ‘secon-
dariness’ or belatedness into the structure of the original demand. The supplemen-
tary strategy suggests that adding ‘to’ need not ‘add up’ but may disturb the calcula-
tion” (Bhabha 1994, 155).
6. For an example of this form of argument, see McMichael, Anderson, Brune-
kreef, and Cohen 1998.
7. Jain 2007.
8. My thanks to an anonymous reviewer and to Rachel Prentice for helping me
draw this connection.
9. See, for instance, Feld and Basso 1996; Rodman 1992; and Raffles 2002.
10. Mong Kok’s role in imaginations of Hong Kong can be illuminated by Mong
Kok’s selection as a challenge in an American reality-television show. Contestants
were asked in other parts of Hong Kong to complete tasks such as lowering a ship-
ping container with a crane or finding the tallest building in Central. In Mong Kok,
however, their task was simply to find a certain tea shop where they would be asked
to drink a bitter tea. Mong Kok’s tightly packed and sporadically marked streets drove
at least one contestant to tears.
11. For a discussion of an attempt by village residents and Greenpeace activists to
halt the construction of the incinerator, see Choy 2005.
12. For an analysis of state efforts in East and Southeast Asia to craft exceptional
spaces attractive to foreign- capital investment, see Ong 2006. Ong adopts the term
ecologies metaphorically to refer to the desired labor and financial conditions that are
predicted to be conducive to a city’s insertion in global trade circuits. I would merely
add that in the pursuit of such desires, the ecologies of landscapes, airscapes, and
waterscapes can be equally subject to concern and government.
13. For a strong and crucial argument for the recognition of air pollution as a
social class issue in Hong Kong, see Stern 2003. Stern points out that, despite the
fact that Hong Kong’s lower classes suffer greater exposure to air pollution—in their
occupations and in their homes—Hong Kong elites have generally set the anti-air-
pollution political agenda.
14. For a discussion of the historical racialization of urban space in colonial Hong
Kong, see Bremner and Lung 2003.
15. Quoted in Bremner and Lung 2003, p. 244.
16. The following draws heavily on material presented in “What Is the History
of Weighing (FAQ—Mass and Density),” 8 October 2007, available on the National
Physical Laboratory website, http://www.npl.co.uk, accessed 23 December 2007.
17. See Latour 1999.
18. Air Pollution Index, available at the website for Hong Kong’s Environmental
Protection Department, http://www.epd-asg.gov.hk/english/backgd/backgd.html,
accessed 27 June 2011. The objective was 30,000 µg/m3 both in 2002, when the first
version of this chapter was drafted, and again in 2007, when it was revised.

AIR’S SUBSTANTIATIONS 151

 19. The World Health Organizations’s acceptable NO₂ annual mean is 40 µg/m3;
Hong Kong’s target is 80 µg/m3.
20. The World Health Organization’s target for PM₁₀ is 50 µg/m3 and for PM₂.₅ is
25µg/m3.
21. For instance, the former Hong Kong legislative council member Christine
Loh made air quality and the state of Victoria Harbor central issues of her tenure in
the Hong Kong Legislative Council (LegCo). During her work in LegCo, as well as
in Civic Exchange, a think tank she founded after leaving government, she has con-
sistently figured environmental issues as examples of how important it is for Hong
Kong’s government to heed the needs and voices of its public.
22. Also relevant to this point is the account by Adriana Petryna (2002) of Ukra-
nians’ struggles after the Chernobyl accident to substantiate their debilitations as
radiation- caused ailments in order to receive state aid, while confronted with narrow
and fluctuating definitions of radiation sickness.
23. For instance, see Butler, Laclau, and Žižek 2000. Also see Balibar 1995a;
Badiou 2003.
24. On the distinction between the a priori and a posteriori, Judith Butler remarks,
“We might read the state of debate in which the a priori is consistently counterposed
to the a posteriori as a symptom to be read, one that suggests something about the
foreclosure of the conceptual field, its restriction to tired binary oppositions, one that
is ready for a new opening” (2000, 274). With this, Butler argues that strict distinc-
tions between the a priori and a posteriori signal a devolution of discussion rather
than an elevated state, an argument that such oppositions indicate a foreclosed and
unfruitful practice of theorizing. In the context of the exchanges with Laclau and
Žižek in which Butler makes this argument, this can be read as a claim that theory
would benefit from an infusion of historical materiality. One should not mistake But-
ler’s argument, however, for a call for empiricism against theory. This would repeat
the same mistake of strict distinction. I take her statement, instead, as an invitation
to think about theory’s poetics.
25. Poetry is an act of creation for Bernstein, a hopeful writing with ambition to
forge something new. “Poetry is aversion of conformity in the pursuit of new forms,
or can be. By form I mean ways of putting things together, or stripping them apart, I
mean ways of accounting for what weighs on any one of us, or that poetry tosses up
into an imaginary air like so many swans flying out of a magician’s depthless black
hat so that suddenly, like when the sky all at once turns white or purple or day-glo
blue, we breathe more deeply” (Bernstein 1992, 1).
The pursuit of new forms and the quest for new arrangements of things so that
the skies change color around us and so we all may breathe more deeply—such poet-
ics are in tune with the most critical and ambitious of theoretico-political projects.
I see the critical creativity of such poetics as kin with the serious play of Joseph Du-
mit’s BioMarx substitutions and Kim Fortun’s iterative informatics (chapters 1 and
10, this volume).

152 TIMOTHY CHOY

 PART TWO

PROPERTY AND DISPOSSESSION

 4
SHEILA JASANOFF

TAKING LIFE

Private Rights in Public Nature

Once out of nature, I shall never take

My bodily form from any natural thing . . .
W. B. YEATS, “BYZANTIUM”

When does something in nature become property? When may it be owned,

exchanged, manipulated, given away, entirely used up, or even destroyed?
Does it matter if that thing is alive? I will show in this chapter that the an-
swers given by the law depend not on the nature of the thing in question
but on the culture that conditions our understandings of what it means for
something to be natural.

Takings: Public and Private

Let us begin with land, the bedrock from which the juncture of nature and
property springs. The Fifth Amendment to the U.S. Constitution provides
in its “takings clause” that no private property “shall be taken for public use,
without just compensation.” That clause circumscribes the state’s power of
eminent domain, which allows governments to claim land for public pur-
poses such as building highways and railroads, protecting environmental
amenities, and fostering neighborhood renewal. Private ownership of land
is not in itself a barrier to takings. The law focuses instead on interpreting
the key terms of the constitutional guarantee, that is, on defining what is a
legitimate “public use,” entitling appropriation by the state, and what consti-
tutes “just compensation.” For instance, a controversial Supreme Court de-
cision of 2005, Kelo v. City of New London, held that a local authority may take
private property for economic redevelopment, even though the proposed
use would benefit some private parties, and even though the condemned
property included private homes that were neither derelict nor abandoned.
All that the municipality needed to show was that it had formulated a care-
fully considered plan to benefit the entire community. In a sternly utilitarian
calculus, it was enough justification that many would gain from a decision
that disadvantaged only a few.
That logic can undermine public takings that fail to meet a mathematical
test. Protecting the environment, for example, was at one time unquestion-
ably a valid public purpose under the takings clause; indeed, the public value
of environmental protection was so taken for granted that it hardly called
for explicit justification. Governments imposed restrictions on land use, and
even blocked development altogether, in order to prevent environmental
degradation or improve the quality of urban life. Measures such as reducing
traffic congestion or creating green spaces still are seen as legitimate public
purposes, but recent case law makes it clear that the state’s power to man-
date such measures is not unlimited.
Beginning in the 1980s, property owners gained increasing political in-
fluence and the federal courts began restricting the power of eminent do-
main in environmental cases. In a decision signaling that the tide was turn-
ing, the Supreme Court held that a law depriving property of all its economic
value would always count as a taking, triggering a right to compensation
(Lucas v. South Carolina Coastal Council 1992, 505 U.S. 1003). In other land-
mark cases, the court instructed communities that they had to demonstrate
an “essential nexus” between imposed conditions and legitimate regulatory
objectives (Nollan v. California Coastal Commission 1987, 483 U.S. 825), as
well as a “rough proportionality” between those conditions and the scope of
the planned development (Dolan v. City of Tigard 1994, 512 U.S. 374). Most
controversially, the court ruled that a city wishing to protect a designated
wetland had to pay a property owner for any resulting losses, even though
the owner had acquired his property knowing that it included a legally pro-
tected wetland.1
The logic in all these cases favors uses of real property that generate
greater economic value over uses that promote only nonmaterial values,

156 SHEILA JASANOFF

such as the integrity or aesthetic quality of nature. The relative value of alter-
native uses is measured, in part, by their capacity to circulate.2 Economic
development overflows the territorial limits of land; it converts place, which
sits still, into money, which moves. A mall generates more wealth than a
park. Aesthetic or other intrinsic value by definition does not circulate, or
so we imagine; it stays bound up in the land, permitting at best private en-
joyment by those who own or have access to it. The inverse principle is
that removing land from imagined, or even imaginable, economic produc-
tivity—making it sit still, lie fallow, or be seen by only a few—requires com-
pensation, even if the taking serves a recognized public good. Not surpris-
ingly, the first rule has tended to benefit mainly private property developers,
although in Kelo it was a city (to be sure, acting in concert with a private de-
veloper) that put forward the more gainful land-use plan, and thus overrode
the interests of private dwellers who could not so readily translate land into
money.
Inanimate land, then, can be owned, developed, mined for private gain,
or be otherwise made to circulate in commerce; and it can be “taken” out
of circulation for noneconomic public purposes only on adequate compen-
sation. Undeveloped land offends U.S. law’s predisposition toward use and
commerce. It is as if in the eye of the law the right of ownership naturally be-
longs to the party who can do most to render land fluid, enabling a bounded,
immovable territory to overcome its inert condition. Land becomes lively
through the commerce it enables or sustains. That logic explains why seek-
ing to maintain spaces in static or undeveloped form, whether for preser-
vation or for individual use as in Kelo, has fared less well in recent legal
conflicts than efforts to open up those spaces to the presumptively greater
mobility of commerce. In the hierarchy of utility, the user who does most
to overcome land’s earthbound limits gains priority, though it may be at the
cost of compensating a less entrepreneurial prior owner.
A very different imagination regulates the ownership of living things and
of nature’s laws. Here, the assumption in Western legal systems has been
that lively nature belongs to all: it is the taking of nature for private pur-
poses that should be banned or strictly regulated. Nature is considered to
be the common property of humankind. Private claims would corral a part
of universal nature, secreting it away from open access or enjoyment. In
particular, one may not stake an intellectual-property claim based on the
mere discovery of a natural object or law. Einstein could no more copyright
the equation “e = mc2” than Edmund Hillary or Tensing Norgay could own
Mount Everest, or Neil Armstrong, the Apollo astronaut who in 1969 took

TAKING LIFE 157

the famed “giant step for mankind,” could lay claim to the moon whose sur-
face he first set foot on. The logic again is utilitarian: no private use, the
law imagines, could possibly outweigh the public benefit of a nature whose
works and workings remain available, in equal measure, to everyone. In
order to claim an intellectual-property right in natural objects, the claimant
has to do more than merely find it, picture it, publicize it, or celebrate it.
The would-be patent holder has to change the quality of the thing itself, so
that it no longer partakes of the character of the “commons” that we see in
nature. The object of the patent claim has to be clearly marked, indeed set
apart from nature, as a creation of human ingenuity and enterprise. It has
to be a result of invention, not discovery. It has to remove the thing being
patented from nature to culture.
How have these understandings of inanimate land versus living na-
ture, and of public versus private benefit, intersected with, disrupted, and
to some degree refashioned intellectual-property rights in the products of
modern biotechnology? What steps, specifically, are required to move some-
thing from the domain of nature to the domain of culture? “Taking life” by
asserting private-property rights in natural objects or phenomena involves
two kinds of moves that are tacitly, though not explicitly, granted controlling
status in the law: specificity and circulation. Put differently, the property
claim has to involve both taking a specific, characterizable, and reproducible
bite (and, today, perhaps as much byte as bite) out of nature and a capacity
to make the excised element circulate widely in commerce. In this way,
patentable, human-made, “natural” objects escape the conditions of unruli-
ness, complexity, and nongovernability that environmental historians have
associated with American visions of wild nature (Nash 1982).
I elaborate this argument in five parts. I first look at varied treatments
of the nature- culture boundary to illuminate how that divide is constructed
and maintained while things move back and forth across it. I then offer the
historical example of slave ownership to illustrate the importance of onto-
logical stability and circulation in legal constructions of life as capital. I next
provide a brief account of U.S. patent law and the framework it lays out for
asserting intellectual-property claims in biological materials. Turning then
to case law, I compare the strategies for culturing nature, or failing to do so,
in two leading North American patent decisions: the judgments on patent-
ing life forms by the Supreme Courts of the United States and Canada in
1980 and 2002, respectively. I conclude with reflections on the law’s role in
constructing the metaphysics, the value, and the moral economy of nature
in the era of biotech patenting.

158 SHEILA JASANOFF

Nature/Culture: Intertwinings

It hardly needs stating that ideas of nature stem from culture. Neverthe-
less, the intensity of engagement between scientific and other imagina-
tions—literary, artistic, and legal, for example—in crafting biological cate-
gories deserves comment. Modern biotechnology builds on long histories
of human preoccupation with the natural. Can art emulate nature? Explora-
tions abound, from Galatea, the marble image of perfect womanhood awak-
ened to life by Pygmalion’s prayers, to Oscar Wilde’s happy prince, who
gave away his precious apparel to the poor and hungry until his leaden heart
was revealed to be worthy of god’s grace (Wilde 1990). How unnatural is
nature? Collectors such as Rudolf Virchow in Berlin and Peter the Great in
St. Petersburg sought answers to that question by amassing biological mal-
formations and monstrosities in their cabinets of curiosities. Where does
the human end and the nonhuman begin? Hybrids that cross that categori-
cal line are both revered and feared. The potbellied, elephant-headed god
Ganesha is one of India’s favorite deities, whereas in Western legends part-
human creatures were seen as slippery, treacherous beings—mermaids and
centaurs, vampires and werewolves.
Long predating the genetic turn, the possibility of tampering with
human nature presented forbidding possibilities. In the Gothic tales of the
nineteenth century, attempts to compete with nature usually led to disas-
ter. Mary Shelley’s Frankenstein became the iconic cautionary tale of human
overreaching. H. G. Wells and Robert Louis Stevenson offered in The Invisible
Man and Dr. Jekyll and Mr. Hyde, respectively, their own, near mythic glosses
on the hazards of tinkering with human nature. Leon Kass, the first chair of
the President’s Council on Bioethics, established by George W. Bush, asked
his fellow committee members to read Nathaniel Hawthorne’s short story
“The Birthmark” (1843), in which an overzealous scientist attempts to rid
his beautiful wife of a hand-shaped mark on her cheek. He cures the defect
but kills the beneficiary.
Biomedicine today uses material technologies to reinscribe the nature-
culture boundary yet again. These developments challenge our intuitions
about when human life begins and ends, which states of being are worth
preserving, and who should decide. The case of Karen Ann Quinlan in New
Jersey spotlighted the uncertain legal and ethical status of persons in a per-
sistent vegetative condition, kept “alive” through technological devices sup-
porting nutrition and respiration (Matter of Quinlan 1976, 70 N.J. 10). In
2004 the fate of Terri Schiavo, a brain- dead woman in Florida, plunged

TAKING LIFE 159

America into a media-saturated controversy about who should have power,
in disputed cases, to bring an end to liminal states of existence. While the
family fought bitterly over the removal of Schiavo’s feeding tube, the U.S.
president and members of Congress took up the cudgels in support of con-
tinued treatment in a misguided attempt to placate America’s pro-life reli-
gious Right. Disrupting kinship categories, new reproductive technologies,
beginning with the first use of in vitro fertilization, in England in 1978, have
allowed childless couples to conceive, postmenopausal women to bear chil-
dren, same-sex couples to become parents, procreation to occur between
dead and living spouses, and babies to be preselected to donate healing tis-
sue to diseased siblings (Thompson 2005). By introducing new biological
entities into the world—frozen gametes, cell lines, induced pluripotent
cells—these techniques have also tested the limits of our understanding of
the human community.
Curiously, it was the birth in Edinburgh’s Roslin Institute of a sheep
named Dolly, cloned from a mammary-gland cell of an adult ewe, that pro-
voked some of the deepest reflections on human nature. The announcement
of Dolly’s birth in an issue of Nature in February 1997 sparked intense de-
bate about the ethics of human cloning. At the epicenter of controversy was
the legal and moral status of human embryonic stem cells. Pregnant with
possibility, these biologically undifferentiated entities excited biomedical re-
searchers as much as they disturbed Christian fundamentalists and others
who believe that human life begins with the fusion of egg and sperm. In
their moral universe, the extraction of stem cells so as to prevent an embryo
from developing into a full human being was equivalent to murder. Presi-
dent George W. Bush, explaining why he would restrict federal funds for
working with embryonic stem cells, ratified this reading with characteristic
bluntness. His administration would not, he pronounced, promote research
“which destroys life in order to save life” (Stolberg 2005).
In all of these stories, nature manifests itself through disagreements
about what should be seen as natural. As Bruno Latour famously observed,
“The settlement of a controversy is the cause of Nature’s representation, not
the consequence” (1987, 99). What we see as belonging to nature is, in other
words, the result of all kinds of prior commitments to ways of seeing, study-
ing, and classifying life. Natural settlements are contingent on established
ways of knowing.3 If nature appears devoid of social influences, then that,
too, is the result of concentrated labor, which Latour (1993) in a bow to bio-
technological processes labeled “purification.”
We accept that traditional or premodern societies did not see nature as

160 SHEILA JASANOFF

cleanly bounded off from society. The Achuar of the Amazon, for example,
up until the late twentieth century, still conceived of plants and animals
as persons because they possess the ability to communicate with people
(Descola 1996, 224). But our own nature- culture divisions are no less the
products of cultural predispositions and institutional histories. They are ex-
perience congealed into material-semiotic systems and actors.4 The new
technologies of life naturalize new self- definitions and forms of sociality
(Rabinow 1992). For instance, reproductive technologies reinscribe stereo-
typical gender relations by constructing technologically mediated concep-
tion as “natural,” and hence desirable (Hartouni 1997). Not using the avail-
able technologies—by choosing to remain childless, for example—then
becomes the marked, or unnatural, behavior.
Nonhuman entities in some sense actively participate in technological
innovation. Blurring hard distinctions between agents and things acted on,
technological systems come into being as products of complex enrollments
and translations among their heterogeneous components, both animate
and inanimate.5 Recognizing this interplay, the proponents of actor-network
theory (ANT) have ascribed a kind of agency to the “actants” (nonhuman
agents) in such systems, denying any a prioristic divide between nature and
culture. The inanimate components are capable of resisting, and so redirect-
ing, human agency; as Latour pointed out with his famous example of the
traffic bump, or “sleeping policeman,” inanimate technological artifacts can
take over human functions, with varying normative and social, as well as
physical, consequences (Latour 1992).
Even in modern societies, then, distinctions between person and prop-
erty, actor and object, human and nonhuman should not be seen as given
in advance. Our definitions of things as they are and things as we would
like them to be are not independent but are frequently established together
through processes of co-production (Jasanoff 2004). It follows that ontologi-
cal settlements reached in one social or cultural context, with its particular
normative commitments, need not be universal, though they may become
so through concerted attempts to harmonize differences. As I have shown
elsewhere, Britain’s epistemic respect for empiricism and common sense
logic, coupled with a political history of deferring to elite public servants,
produced a legal regime that treated pre-fourteen- day- old embryos (some-
times called pre- embryos) as not yet human (Jasanoff 2005a). Parliament
and, by extension, the British public, accepted the view that the formation
of the primitive streak, precursor to the central nervous system, in embryos
around the fourteenth day marks a meaningful rupture in human biologi-

TAKING LIFE 161

cal development. There was no scientific consensus that the embryo under
fourteen days is any less human than after that date. The fourteen- day limit
was not, to start with, universally accepted. In Germany and the United
States, for example, dominant cultures of public knowledge, or civic epis-
temologies, kept alive questions about the embryo’s moral status and could
not produce a pragmatic bright line for research comparable to Britain’s.
Only gradually has the fourteen- day rule been smuggled into U.S. policy,
largely through the voluntary, self-regulatory activities of scientific bodies
interested in furthering research with stem cells.
Many controversies about the right way to draw the line between na-
ture and culture illustrate the centrality of the law as a device for perform-
ing what I call “ontological surgery” in modern political systems. Courts,
legislatures, and regulatory agencies routinely grapple with conflicts about
the nature and meaning of natural objects. How we define and characterize
boundary- crossing objects, and how we choose to interact with the resulting
things, are worked out as much through law as through scientific research
and development. Such concepts as the environment, clean air, brain death,
DNA fingerprint, or even “natural mother” are located in webs of meaning
crucially shaped by the law. The law constructs both life and capital and,
more specifically, demarcates those aspects of life that can be owned from
those that cannot.

Ontological Border-Crossing:
Naturalization, and the Law

A key function of the law is to produce inevitability. A legal decision takes a

social issue that is uncertain, disordered, or contested and reorders it within
a system of preordained rules and norms. Questions and ambiguities are
temporarily eliminated, and the fuzzy boundary between lawful and law-
less conduct is constituted once again as sharp and discernible—in a word,
natural. In today’s text-based legal systems, judicial opinions naturalize the
restored order, so that, in the ideal case, no one challenges the rightness of
the winning argument. Before a definitive judgment is handed down, there
are many possible ways to think about the rights and wrongs of the case, as
well as many reasons for choosing between possible outcomes; the law itself
appears unsettled. Afterward, only one reading prevails. When a court suc-
ceeds, its reading looks like the only one that could have been reached under
the circumstances. As if naturally all other rules and reasons fall away, and

162 SHEILA JASANOFF

the law appears to dictate the outcome rather than the outcome rewriting the
law. Like scientific writing, legal text-making produces its own authority by
erasing the contingencies from which the dominant ruling emerges.
Of course, such erasures can never be complete, and some of the moves
by which contingency is backgrounded can be easily recovered within the
textual practices of the law. American law writing, for example, offers space
for dissenting opinions, so that, in highly contested cases, any reader can
follow the debates behind the ultimate legal ruling.6 Dissenting opinions,
however, are consigned to history, like discarded scientific theories. It is the
holding in the case, and the arguments justifying it, that circulate as law.
All else is considered dicta, mere sayings without the force of law. The most
authoritative decisions are those that provoke no dissent, but even powerful
dissenting voices in the law go underground unless, in the rarest of cases,
they colonize the imagination of succeeding generations and ultimately get
resurrected as what should have been the law all along.
A noted example of such a shift in U.S. law occurred around the infamous
Dred Scott v. Sandford decision (1857), which is especially interesting here
because it sheds historical light on the law’s ability (or lack of it) to produce
definitive ontological settlements. The case tested at its most basic level the
stability of the legal compromise that had allowed slave states and nonslave
states to coexist within the Union before the Civil War. Technically, it raised
questions about whether Scott, a black man, had the right to sue in federal
courts; whether his years of residence in free northern states had made him
a free man; and whether Congress had the right to ban slavery in the north-
ern territories acquired through the Louisiana Purchase. Chief Justice Roger
Taney, an eighty-year- old, patriotic son of the South and a former slave-
owner, ruled on all three questions in a 7–2 decision that has reverberated
through time as a moment of shame in American constitutional jurispru-
dence.7 The dissenting voices of Justices John McLean and Benjamin Curtis
won the day morally, but legally it was the seven-member coalition of pro-
slavery Democrats who prevailed.
Taney devoted nearly twenty-four pages of his fifty-five-page opinion to
the first legal issue, which he phrased in this way: “The question is simply
this: can a negro whose ancestors were imported into this country and sold
as slaves become a member of the political community formed and brought
into existence by the Constitution of the United States, and as such become
entitled to all the rights, and privileges, and immunities, guarantied by that
instrument to the citizen, one of which rights is the privilege of suing in a

TAKING LIFE 163

court of the United States in the cases specified in the Constitution?” (Dred
Scott v. Sandford 1857, at 403). He concluded, in what historians have re-
jected as a perversion of facts and logic, that blacks were not entitled to be
regarded as citizens of the United States (McPherson 1990, 174).
There is little doubt that Taney’s was a deeply felt, “visceral” opinion,
written by an aging, bereaved man who saw a whole way of life that he valued
threatening to disappear before his eyes, and was determined to fight that
outcome with the most powerful instrument at his command: his nation’s
constitutional law. But was there no logic to Taney’s position? At stake in
the case was not only the political composition of the United States but the
ontology of a group of persons who constituted a sizeable part of its popula-
tion. Could American blacks claim rights of citizenship (and thus of person-
hood) by suing in federal courts, and yet be treated as property, not persons,
in some parts of the country? For Taney, this specter presented an intoler-
able contradiction. An early and ardent defender of Jacksonian free enter-
prise, Taney was perhaps especially troubled by the notion of a person who
could act as a free agent and fully autonomous citizen in some contexts, but
elsewhere would function only as useful chattel, devoid of agency. Logic, for
him, demanded a resolution of this ambivalent, boundary- disrupting iden-
tity, and he opted for a characterization of Dred Scott that would remain
unalterably on the side of chattel, regardless of where in the country his
masters chose to transport him. As chattel, Scott and others like him could
circulate smoothly across state borders, an integral and ontologically stable
component of the economic and cultural system that Taney had given his
life to defending.
Dred Scott proved to be a pyrrhic victory for the South. In less than five
years the slave states and the free states were at war, in a conflagration that
put paid to the notion of dual ontologies—as goods and as persons—for
human beings of any color living within the United States. Abraham Lin-
coln, who presided over the Union’s victory, bought into Taney’s logic of
singular ontologies, but famously not into his normative settlement. For
Lincoln, the confusion over where to place black humanity within the frame-
work of the U.S. Constitution could be resolved in only one way. All men,
as the Declaration of Independence stated, were created equal. In a famous
speech, just a year after Dred Scott, Lincoln said, “I believe this government
cannot endure, permanently half slave and half free.”8 A question for mod-
ern biotechnology, and particularly for intellectual-property law as it relates
to living things, is whether the time has come for similar ontological clarifi-
cation with respect to manipulated biological entities.

164 SHEILA JASANOFF

Invention and Its Rewards

In contemporary industrial societies, an inventor, author, or artist is entitled

to retain exclusive rights for a period of time in the products of intellectual
or artistic creativity, through patents or copyright. For the founders of the
American republic, the importance of scientific and technological innova-
tion was important enough to deserve constitutional support. It was not in-
quiry in and of itself that the founders prized, but useful inquiry, promoting
economic and social well-being. Accordingly, the word science explicitly ap-
pears in the U.S. Constitution only in the clause governing intellectual prop-
erty. Article 1, section 8 provides that Congress shall have the power “to pro-
mote the progress of science and useful arts, by securing for limited times
to authors and inventors the exclusive right to their respective writings and
discoveries.”
The U.S. Patent Act, originally drafted in 1790 by Thomas Jefferson,
among others, implements that constitutional grant of authority, and it still
remains, with minor revisions, the governing text for assigning intellectual-
property rights in the United States. Canada, too, regulates intellectual prop-
erty under an almost identically worded statute. The operative provisions
in both nations specify what sorts of things can be patented (“patentable
subject matter”) and under what conditions. Thus, patents can be issued
for “any new and useful process, machine, manufacture, or composition
of matter, or any new and useful improvement thereof.”9 As the words new
and useful make clear, the most important objective of patents is to reward
novelty and utility. Things already discovered and things that contribute
nothing to human welfare deserve no acknowledgment. The inventive step,
moreover, must be a real advance and not “obvious” to persons “skilled in
the art.”10 If a discovery lies too close to what knowledgeable inventors deem
to be “prior art,” then the claim to exclusivity is unfounded and deserves no
special legal protection.
Part of the justification for granting patents is that they encourage in-
ventors to put into the public domain knowledge and know-how that would
otherwise be held in confidence and would not circulate for the benefit of
would-be inventors and the public. In order for useful inventions to circu-
late, they must be exactly reproducible, and this requirement is secured by
the law’s demand for specification. To this end, the law calls for “a written
description of the invention, and of the manner and process of making and
using it, in such full, clear, concise, and exact terms as to enable any person
skilled in the art to which it pertains, or with which it is most nearly con-

TAKING LIFE 165

nected, to make and use the same, and shall set forth the best mode contem-
plated by the inventor of carrying out his invention.”11 Biological materials
that are too complex to be specified through written description can meet
the patent law’s specificity requirement in a more physical way: through de-
posit in a storage service like the American Type Culture Collection located
in Virginia.
Patents confer a temporary monopoly on the holder, contrary to the spirit
of free circulation that is central to a market economy. The conventional
rationale for nevertheless granting such a monopoly is that the inventor
compensates society by placing the know-how and the invention itself in the
public domain. Any subsequent person wishing to make the same product
or use the same process must acquire a license from the patentee; but any-
one with sufficient resources can in principle obtain a license, just as any-
one with sufficient ingenuity can alter a patented process to make it more
efficient and productive, or combine it in novel ways with other processes to
produce new entities that can in their turn be patented. The key to making
productive use possible is that the patent system must be capable of pre-
cisely describing what the inventor did to stake out a claim. Just as owned
land has to be precisely surveyed or described, so a patented invention must
be described in ways that render it reliably, consistently reproducible. Acci-
dental inventions, those for which there is no surefire recipe for others to
follow, cannot be patented.
Intellectual-property laws were not written with modern biotechnology
in mind, but a concern for protecting property rights in biological materi-
als dates back at least to the U.S. Plant Patent Act of 1930. The Plant Variety
Protection Act of 1970 extended similar rights to nonsexually propagated
plant life. Behind these laws was a growing consensus that breeding new
plants satisfies the patent regime’s desire for the new, the useful, and the
reliably reproducible. Utility, as noted, is firmly tied to the notion of repli-
cation: to circulate, a patented product or process has to move about as a
formula, package, or set of characteristics that can be accurately described,
recognized, and exchanged. Even an organism has to be reproducible in
predictable ways in order to merit a patent. Thus, Golden Rice, the first
and most vigorously debated product of agricultural biotechnology’s turn
to high-value-added staple commodities, is a highly specific modification
of one of the world’s most widely consumed grains.12 It results from incor-
porating into rice a new trait that no rice ever had before: genetically engi-
neered beta- carotene that confers on the resulting “golden” rice the power

166 SHEILA JASANOFF

to spur vitamin A production in the consumer’s body. It is novel in that it
crosses the line between food and pharmaceuticals, and builds into ordi-
nary rice a new characteristic that makes this rice nutritionally richer than
the natural grain. It is useful in that it caters to a new and presumably needy
market—people suffering blindness through malnutrition in impoverished
regions of the developing world. It is non- obvious in that many ingenious
extensions of existing knowledge and craft were needed to imagine, create,
and standardize this product for widespread cultivation. Indeed, so com-
plex was the translation process that moved Golden Rice from idea to object
that it required, according to Ingo Potrykis, of the Swiss Federal Institute of
Technology, who is widely regarded as the “father of Golden Rice,” seventy
separate patents to acknowledge all the inventions that he and his colleagues
drew on in producing their new product (Potrykis 2001).
In its landmark 1980 decision, Diamond v. Chakrabarty, the U.S. Supreme
Court laid out a very broad interpretation of the patent law as it applies to
biological products. At issue in the case was whether Ananda Chakrabarty, a
research scientist working for General Electric, could patent a new form of
the pseudomonas bacterium that he had created. The bacterium was capable
of breaking down the components of crude oil and thus was considered
potentially useful for cleaning up oil spills. Up to that time, patents had not
been granted for living organisms other than plants, and some observers
feared that extending patent rights to manufactured life would start society
down the slippery slope to commodifying and thus reducing the integrity
of life itself. By a 5–4 majority, however, the Supreme Court rejected these
fears as irrelevant. Quoting a congressional committee report, the court con-
cluded that the legislature had intended patentable subject matter to “in-
clude anything under the sun that is made by man.” Chakrabarty’s bacte-
rium clearly met that test since it was a product of laboratory manipulation
and had never previously existed in nature. Though the decision concerned
a bacterium, Chakrabarty’s authority was soon used to underwrite patents
on many higher animals, including mice, pigs, cats, and cattle.
As the center of biotechnological research and development moved
toward drug discovery and the search for genetic links to diseases in the
1990s, scientists and drug companies saw increased value in owning prop-
erty rights in genes and even gene fragments. Two questions immediately
arose. Are genes, entities that (unlike Chakrabarty’s bacterium) do occur in
nature, encompassed within the law’s definition of patentable subject mat-
ter? And do they meet the law’s additional constraints of novelty, utility,

TAKING LIFE 167

and non- obviousness? Despite some controversy, the courts and the United
States Patent and Trademark Office (PTO), in its 2005 guidelines, ruled posi-
tively on both issues.
The decision to allow patenting of genes illustrates again the inclina-
tion of property law to favor moves that put otherwise unproductive inani-
mate matter into circulation, creating economic value. Rejecting arguments
that genes are natural objects, and therefore unpatentable, the patent office
stated: “An isolated and purified DNA molecule that has the same sequence
as a naturally occurring gene is eligible for a patent because (1) an excised
gene is eligible for a patent as a composition of matter or as an article of
manufacture because that DNA molecule does not occur in that isolated
form in nature, or (2) synthetic DNA preparations are eligible for patents
because their purified state is different from the naturally occurring com-
pound” (U.S. Patent and Trademark Office 2005, 1093). The patent office
cited by way of historical precedent a patent in 1873 to Louis Pasteur for
purified yeast, free from disease germs, as a composition of matter. In both
cases, purified yeast and purified genes, the inventive step consisted of re-
moving a biologically occurring “composition” from any constraining ma-
terial matrix. Purification, in effect, was a process of denaturing, of taking
something out of its natural context. In pure and isolated form, genes are
no longer nature’s instruments, subject to the vagaries of natural law, but
are amenable instead to human intentions and purposes. They are ripe for
entering the cultural worlds of sociality and commerce. Indeed, as the PTO
guidelines stipulate, a gene patent may be granted only if the claimant pro-
vides a description of how the gene will be used.
A number of U.S. biotech patent decisions begin to make sense if re-
examined within the specificity- circulation framework. Most instructive,
perhaps, is the much- discussed 1990 decision of the California Supreme
Court in the dispute between a patient named John Moore and his doctors
at the University of California, Los Angeles (UCLA), over who owned the
cells excised from Moore’s spleen during his treatment for hairy cell leu-
kemia (Moore v. Regents of the University of California 1990, 793 P.2d 479).
The court held that Moore could sue for lack of informed consent, but that
he was not the proprietor of his own cells and tissues, and hence could not
pursue a claim of “conversion” or, colloquially, theft. The case has been ana-
lyzed by a number of scholars who stress its internal contradictions from
the standpoint of legal reasoning.13 For example, Moore’s cells were deemed
to be present in all human beings, thereby ruling out his claim to unique-
ness; but they were at the same time held to be novel enough as generators

168 SHEILA JASANOFF

of lymphokines to justify the researchers’ patent claim. Equally, the court
concluded that granting Moore ownership rights in his own tissues might
hamper research, but that granting patent rights to the UCLA researchers
would not create a similar impediment.
These apparent contradictions fall away when one views the actions of
the UCLA medical researchers as a project in mining nature for extractable
entities that can freely circulate. Lodged in Moore’s body, the leukemia cells
were part of a complex organism and were rendering no value to society at
large—indeed, they were producing a potentially incurable disease in the
host’s own body. Cut loose from context and allowed to exist in their own
right, they became the raw material for an “immortal” cell line of possible
therapeutic value, which could be instrumentally used to cure other people.
Structurally and functionally, the spleen cells were the same, whether in or
out of Moore’s body. But by excising them from their unruly context, the
UCLA researchers rendered this specific piece of nature more tractable to
human ends. Though not guilty of legal conversion (theft), they in this way
effected an ontological conversion, turning nature into property.
Instructive, too, is the outcome of the lawsuit brought by the prostate-
cancer specialist William Catalona against his employer, Washington Uni-
versity, to acquire ownership of a biorepository containing some thirty thou-
sand patient samples that the physician had collected during his research.
Catalona wished to take the samples with him when he joined the medical
faculty of Northwestern University. He argued that the samples were origi-
nally the property of his patients, who had donated them for research, so
that he now had exclusive control of them. In a unanimous opinion, the
Eighth Circuit Court of Appeals upheld the rights of the university, deny-
ing the claims of both Catalona and his patient- donors (Washington Univer-
sity v. Catalona 2007, 490 F.3d 667). Superficially, the judgment appears to
line up against circulation, since the court did not allow the repository to
move with Catalona. Consistency reappears, however, when we look below
the surfaces, to the deep structures of capital accumulation. Faced with a
choice between the individual researcher’s abstract claims of public ben-
efit—“a publication enriches the scientific community, is consistent with
the wishes and consent of the patients, contributes to the progress of medi-
cine by furthering research, and in some cases may bring grant money into
the university” (Lori Andrews 2006, 399)—and the university’s superior
wealth-generating and circulation-enabling power, the court opted for the
latter.
Another instructive case involved the attempt by a Mississippi farmer

TAKING LIFE 169

named Homan McFarling to circumvent a licensing agreement with Mon-
santo, the manufacturer of a genetically modified soybean crop that McFar-
ling had cultivated. In order to boost sales of its popular herbicide Roundup,
Monsanto had produced a variety of so- called Roundup Ready crop plants,
with growth enzymes resistant to glyphosate, the herbicide’s active ingre-
dient. The modified crops would grow in fields treated with Roundup, thus
prompting more farmers to use the two products together as a unified tech-
nological package. As part of its marketing strategy, the company required
all farmers to sign an agreement with their seed distributor, promising
not to store or replant Roundup Ready seeds from one growing season to
another. Bridging the turn of the century, from 1999 to 2000, McFarling
decided to test this new move in patent law by breaking the terms of the
agreement and replanting seed that he had saved from his first planting. He
alleged that Monsanto’s patent did not cover the second-generation prod-
uct. His legal argument consisted of two parts: first, by restricting use of the
second-generation seed, Monsanto had impermissibly broadened the scope
of its patent, constituting “patent misuse”; second, by making it impossible
to separate the patent on the genetically modified trait from the seed that
contained it, Monsanto was performing an impermissible act of “tying” the
two products, in violation of antitrust law.
McFarling lost, but not until he had pursued his claim up to the Supreme
Court, which refused to hear his appeal on 27 June 2005. That decision let
stand the adverse judgment of the Court of Appeals for the Federal Circuit
(CAFC), the specialized tribunal that hears all first-round patent appeals. The
CAFC ruling, together with the amicus curiae (friends of the court) brief filed
by the U.S. government in support of Monsanto, against McFarling, sheds
light on the metaphysics of the transition from nature to property in the
American legal imagination (Supreme Court of the United States 2005).
With respect to McFarling’s claim of patent misuse, the Federal Circuit
held that extending Monsanto’s patent to the second-generation seed, which
also contained the patented anti-glyphosate growth gene, did not constitute
an illegal broadening of the patent’s scope. This was because the seed in the
next generation was, in effect, a nearly identical copy of the original seed, be-
cause the plant was “self-replicating” (ibid. 14). This was not, in other words,
a case of a manufacturer attempting to keep a subsequent inventor from
using the original invention to produce a newly useful product. It was, as the
government’s brief also argued, a case of a downstream user illegitimately
trying to undermine an inventor’s lawful right to restrict how its patented
product, and all more or less identical products, should be used.

170 SHEILA JASANOFF

 The term self-replicating smoothly elided any distinction between one
generation and the next of a genetically altered seed. It foregrounded the
patented gene and rendered pragmatically immaterial the seed that con-
tained it. It also, incidentally and without fanfare, elided the farmer’s labor
in cultivating a generation of crops capable of bearing new seeds. McFarling,
by this reckoning, was not and could not be party to Monsanto’s inventive
step; his work of propagation needed no special acknowledgment from the
standpoint of patent law. To recognize him in any respect as a party to the in-
vention would only have muddied the waters and gotten in the way of those
with more power to make the product circulate. In advocating this result,
the government’s position bore a striking conceptual resemblance to John-
son v. Calvert (1993), the gestational-surrogacy case in which the California
Supreme Court decided that the genetic mother of a child should be seen as
its natural mother. The surrogate mother, who had provided nine months of
labor to bring a genetically unrelated child to life, was held to have no rights
to the being she had nurtured, but whose identity she could not legally claim
to have shaped.
With respect to the tying issue, the government again argued that no law
had been broken. McFarling had claimed that he was, in effect, being forced
to buy unwanted new seed as a result of having invested in Monsanto’s ge-
netically altered trait. The Federal Circuit considered this claim invalid.
McFarling, the court held and the government agreed, was not “entitled to
purchase respondent’s patented invention without also honoring limits im-
posed on the use of the product in which that invention finds its useful, tan-
gible expression” (Supreme Court of the United States 2005, 16). The inven-
tion (the modified trait) and the product in which it found expression (the
seed) became in this way a single, indissoluble package, part of culture not
nature. Therefore, as the government counterargued, keeping McFarling
and other farmers from storing and reusing seed from earlier plantings was
simply within Monsanto’s broad legal right to refuse to license its product
(Roundup Ready seed of any generation)—a right enjoyed by all patentees.
Further, illustrating the potency of economic arguments, the government
claimed that the restriction on reuse was not, in any case, likely to be anti-
competitive. Monsanto could, after all, have charged an additional fee for
reuse, and this plus the cost of monitoring and enforcing any such relicens-
ing system would arguably have driven up costs to a degree that would not
have benefited consumers.
As these U.S. cases illustrate, the history of granting patents on biologi-
cal inventions has tended toward expansion of property rights, though occa-

TAKING LIFE 171

sionally a case sends a reminder that limits still exist. Such a point was
reached in a case involving a diagnostic test for deficiency in B vitamins. An
American company named Metabolite Laboratories held patents on both
the correlation between elevated levels of the amino acid homocysteine and
the vitamin deficiency, and a blood test based on that fact; and it sued a
licensee, LabCorp, when it stopped paying royalties because it had switched
to using other tests (Laboratory Corp. of America v. Metabolite Laboratories
2006, 548 U.S. 2006). Metabolite claimed that LabCorp was infringing its
patent simply by permitting physicians to see the homocysteine–vitamin
deficiency correlation without paying licensing fees. The suit attracted con-
siderable media attention. In an op- ed column in the New York Times, the
science fiction writer Michael Crichton attacked Metabolite’s claim: “Basic
truths of nature can’t be owned” (2006, WK 13). Perhaps Crichton was de-
fending his own right to speak of such discoveries in his writing without
incurring possible charges of infringement. The case reminds us, in any
event, that specificity (as in the statement of a natural law) is not in itself
enough to establish a patentable claim. To circulate effectively—usefully—
in society, the claim still has to be materialized in some way (in a seed or a
blood test), just as money historically achieved circulation through embodi-
ment in shells, feathers, precious metals, and other products of nature.

Legal Metaphysics: Nature or Composition of Matter?

Diamond v. Chakrabarty marked in its way the first day of creation for the
U.S. biotechnology industry. With that decision, the Supreme Court threw
open the door to patenting any living things that were the creation of human
hands and human ingenuity. In effect, nature became a mine for those who
could satisfy the authorities that they had extracted or synthesized some-
thing that no longer properly belonged in the realm of the natural, and that
was at the same time new, non- obvious, and useful. Although the case con-
cerned only the microorganisms produced by Ananda Chakrabarty, most ob-
servers believed that the court’s logic extended equally well to higher organ-
isms, including mammals. In fact, the PTO waited until 1987 to apply the
ruling in this fashion, stating in its guidelines of that year that patents could
be granted for any “non-naturally occurring, non-human multicellular living
organisms, including animals.”14 The first patent granted for a transgenic
mammal in the United States was for the so- called Harvard OncoMouse, a
mouse strain that had been modified with a gene to increase its suscepti-
bility to cancer. The resulting construct was useful for cancer research, since

172 SHEILA JASANOFF

the genetic alteration made the OncoMouse more suitable as a model for
studying the development of the disease.
Environmental, religious, and animal-rights groups protested the exten-
sion of patents to higher organisms, but the PTO’s broad reading of Chakra-
barty remained intact. That human intervention had produced an entity not
otherwise occurring in nature was sufficient to define the altered thing as a
patentable “composition of matter.” Other possible readings of the nature-
culture boundary were accordingly ruled out. Over time, though with some
hiccups along the way, patent offices in Europe, Japan, and other countries
mostly fell in line behind the American decision. But in 2002, in President
and Fellows of Harvard College v. Canada, the Canadian Supreme Court be-
came the first judicial body to rule that higher animals could not be viewed
as compositions of matter under the Canadian Patent Act, whose wording
is almost identical to that of the corresponding U.S. law.15
In neither the U.S. nor the Canadian case was there a monolithic posi-
tion to which we unproblematically attach the label of “legal culture.” In-
deed, each was a 5–4 decision, with a vigorous, almost winning dissent.
The significant point is that the opinions split along very different intel-
lectual lines. The U.S. debate centered on an imaginary of progress: in sci-
ence, in law, and in national life. The Canadian decision, by contrast, occu-
pied itself with the difference between life and matter, even in the case of
such a lowly creature as a mouse. The differences of opinion in the United
States mapped roughly onto the liberal- conservative divide on the court, a
divide historically associated with opposing views of the free market and the
utility of centralized regulation. All five of the majority justices in this case
were Republican appointees, hence presumably more in sympathy with eco-
nomic interests; the dissenters included the only two Democratic appoint-
ees (Thurgood Marshall, Byron White) and two moderate-to-left Republi-
cans (William Brennan, Lewis Powell).
In Canada, the court’s make-up reflected the fault line of national iden-
tity, which runs along linguistic and religious divisions between Anglo-
phone and Francophone, and between Protestant and Catholic. The judges’
names may tell a part of the story. On the side of the cautious majority
were Michel Bastarache (the lead author), Claire l’Heureux-Dubé, Charles
Doherty Gonthier, Frank Iacobucci, and Louis LeBel. On the side of the acer-
bic minority were all three judges with identifiably English names, includ-
ing the lead author William Binnie, together with Louise Arbour, John C.
Major, and Beverly McLachlin. Some (l’Heureux-Dubé, LeBel, Arbour) had
received a part of their education in Canadian Catholic institutions or in

TAKING LIFE 173

France (Bastarache, Gonthier). Bastarache himself was an authority on lan-
guage rights, a federalist by political inclination, and, perhaps most impor-
tant, a man who had experienced genetic tragedy in his own life: both of
his children suffered from a congenital convulsive disorder, and both had
died before he was appointed to the court, one at three and a half and one at
seventeen (Corelli and Bergman 1997).
In comparing the two decisions, it is helpful to read the Chakrabarty opin-
ion together with two contrasting amicus curiae briefs. Routinely submit-
ted in important Supreme Court cases, such briefs supplement the argu-
ments advanced by the parties and often provide conceptual and rhetorical
resources that the justices use in crafting their written opinions. Key amicus
briefs were submitted in Chakrabarty by the biotechnology company Genen-
tech and the People’s Business Commission (PBC), an antibiotechnology
group founded by the author and political activist Jeremy Rifkin. Genentech
devoted a considerable part of its argument to debunking the claims put
forward by PBC, dismissing its opponent as having an “essentially Luddite
philosophy” (Supreme Court of the United States 1979a, 11). Appealing to
an American myth of self-fashioning through technology, the strategy suc-
ceeded. The majority opinion relied substantially on the Genentech brief
and, except for a few dismissive words, almost entirely ignored the PBC’s.

On Liveliness

The most revealing points of comparison between the two decisions, as

well as between the two Chakrabarty briefs, have to do, first, with the char-
acterization of life and liveliness and, second, the definition of the public
good. Genentech’s intention was to diminish as far as possible the distance
between Chakrabarty’s microorganism and the kinds of objects for which
patents had been granted in the past. To this end, the brief stressed the simi-
larity between the novel bacterium and inanimate matter, such as chemicals
and even carburetors. There could be no legal dispute worth commenting
on, Genentech argued, if the question before the court were the patent-
ing of a plasmid, for plasmids are “absolutely inanimate” structures, each
building block of which “is an absolutely dead bench chemical” (Supreme
Court of the United States 1979a, 15). Curiously, however, these very “dead
chemicals” (a term used several times in Genentech’s text) are endowed
with the capacity to “cough the bacterial engine [that contains them] into
useful life”—a rhetorical move that at once converts the dead chemical into
an agent of life, and its living container into a mere machine, like a car en-

174 SHEILA JASANOFF

gine (ibid. 16,17). Such admixtures of living and dead substances, Genen-
tech suggested, should be treated in effect as utilitarian objects whose com-
position should not in any way bear on their patentability: “Can it be said
that Congress intended patents on living organisms inside inanimate bits
of straw but prohibited them in the case of inanimate bits of chemical in-
side microorganisms, or are we beginning to draw distinctions that border
on the silly?” (ibid. 16).
To PBC these questions seemed anything but silly. For this intervenor, the
very attempt to equate a living organism with a mere inanimate composi-
tion of matter raised profound ethical issues. After all, the PBC argued, “the
thing which sets living organisms apart from nonliving entities is their very
‘aliveness’” (Supreme Court of the United States 1979b, 5). Granting patents
on life, they suggested, was the first step down an all too predictable slip-
pery slope toward turning human beings into objects of manipulation and
design, in violation of the human spirit. In support, they quoted the Ameri-
can physician and ethicist Leon Kass, later head of George W. Bush’s ethics
commission, and the French philosopher of technology, Jacques Ellul. Over
and over, the PBC brief insisted that once the line between life and nonlife
was breached, there would be no way to hold on to the most meaningful dis-
tinctions, between natural and artificial reproduction, between human and
machine, and between higher and lower organisms. Neither law nor science
would be in a position to stop the slide, for “if patents are granted on micro-
organisms there is no scientific or legally viable definition of ‘life’ that will
preclude extending patents to higher forms of life” (ibid.). Notably, the brief
did little to unpack the difference between nature and artifice. It was funda-
mentalist in its assertion that human life should be held apart from manipu-
lation and ownership. It raised no serious metaphysical questions.
In advocating for Chakrabarty’s patent, Genentech, too, bought into
PBC’s humanist concerns, but not into their implications for patenting life.
Its brief repeatedly sought to distance the chemical-like microorganism
from any connection with forms of life that could give rise to deeper ethi-
cal concerns. Thus, the company noted that “animal cloning, test tube in-
semination and other extravagances have nothing to do with the minute
concerns of Chakrabarty, and those in turn have nothing to do with gene-
splicing, which alone has generated all the controversy” (Supreme Court of
the United States 1979a, 10). It would be perverse, the brief went on, to im-
pede potentially life-giving research by showing altruism toward “invisible
bacteria that can be freeze- dried to a powder having no semblance of living-
ness” (ibid. 12). The question before the court, accordingly, was not, as PBC

TAKING LIFE 175

had argued, “the rapid proliferation of genetic technologies in the areas of
energy, agriculture, medicine, industrial processes and many other aspects
of the nation’s economic life” (Supreme Court of the United States 1979b, 3).
Rather, the court’s obligation was simply “one of statutory interpretation,
of grammar leavened with reason” (Supreme Court of the United States
1979a, 11). The majority went along with this narrow construction of its role,
announcing in the opinion’s first line that its task was only “to determine
whether a live, human-made micro- organism is patentable subject matter
under 35 U.S.C. §e101” (Diamond v. Chakrabarty 1980, 447 U.S. 305).
PBC’s fears turned out to be partly justified. In spite of its focus on one
of the most minute and micro forms of life (a bacterium), Chakrabarty
was read within a few years to authorize the expansion of patent protec-
tion across the full domain of genetically altered life forms, including all
nonhuman animals. In Genentech’s conceptually groundbreaking brief, the
living container for a patentable “composition of matter” (a gene, a plasmid)
came to be seen as mere matter—analogous to an automobile engine need-
ing to be coughed into life, or even to straw. Once that sleight of mind was
accomplished, the same reasoning was smoothly extended by administra-
tive decree to genetically altered higher animals, oysters, mice, and eventu-
ally larger mammals. All these met the test, in Genentech’s words, that they
were “called into being solely by the hands of man” (Supreme Court of the
United States 1979a, 4), and in the Supreme Court’s echoing language, were
“not nature’s handiwork,” but the inventor’s own (Diamond v. Chakrabarty
1980, 447 U.S. 310).
This was precisely the move that the five-member majority of the Cana-
dian Supreme Court refused to make twenty-two years after Chakrabarty.
That court’s leavening of grammar with reason led to a very different meta-
physical resolution than did the U.S. Supreme Court’s seemingly unprob-
lematic construction of the law.16 The situation confronting the Canadian
justices was, of course, crucially different from that in Chakrabarty. Canada
had extended patent rights to microorganisms and fungi without debate or
litigation. In the Harvard College case, however, the Canadian court had be-
fore it a mammal that could by no stretch of the imagination be likened to a
mere composite of inert chemicals.
History mattered. By 2002, after Dolly and the cloning wars, some of the
Canadian jurists clearly felt that the specter of the slippery slope was more
real than it had seemed in 1980. In particular, the PBC’s warnings about the
march toward depersonalizing and commodifying human nature seemed
to have more substance than it had two decades earlier. Allowing patents on

176 SHEILA JASANOFF

higher organisms, the majority concluded, would create problems in a time
when the boundary between animals and humans was becoming blurred
through biomedical advances such as xenotransplantation. As Justice Basta-
rache wrote for the majority: “The pig receives human genes. The human
receives pig organs. Where does the pig end and the human begin?” In such
an environment, it was imperative for metaphysical lines to be redrawn and
clarified through legislative action. “In my view,” Bastarache observed, “it
is not an appropriate function for the courts to create an exception from
patentability for human life given that such an exception requires one to
consider both what is human and which aspects of human life should be
excluded” (President and Fellows of Harvard College v. Canada 2002, SCC 76,
para. 181).
It was, however, in what the dissent dismissed as “murine metaphysics”
that Bastarache’s opinion most strikingly parted company from Chakra-
barty (ibid. para. 45). For the Canadian dissenters, who in essence followed
Chakrabarty’s logic, classifying the OncoMouse as a composition of mat-
ter was thoroughly unproblematic because every cell in its body had been
changed through the addition of an oncogene: “The oncogene is everywhere
in the genetically modified oncomouse, and it is this important modification
that is said to give the oncomouse its commercial value” (ibid. paras. 68, 69,
96). By contrast, the majority was substantially less impressed by the inven-
tor’s degree of control over the whole mouse. To them, it was almost com-
mon sense that altering one small bit of a complex organism’s genetic code
does not produce an altogether different entity, a human invention that is
no longer part of nature.

Although some in society may hold the view that higher life forms are
mere “composition[s] of matter,” the phrase does not fit well with com-
mon understandings of human and animal life. Higher life forms are
generally regarded as possessing qualities and characteristics that tran-
scend the particular genetic material of which they are composed. A per-
son whose genetic make-up is modified by radiation does not cease to
be him or herself. Likewise, the same mouse would exist absent the in-
jection of the oncogene into the fertilized egg cell; it simply would not
be predisposed to cancer. The fact that it has this predisposition to cancer
that makes it valuable to humans does not mean that the mouse, along with
other animal life forms, can be defined solely with reference to the genetic mat-
ter of which it is composed. The fact that animal life forms have numerous
unique qualities that transcend the particular matter of which they are

TAKING LIFE 177

 composed makes it difficult to conceptualize higher life forms as mere
“composition[s] of matter.” It is a phrase that seems inadequate as a de-
scription of a higher life form. (ibid. para. 163, emphasis added)

In this way, the Canadian court repudiated the logic that had, in the United
States, so smoothly subordinated and made immaterial the container of the
patentable genetic trait, regardless of whether that container was a mouse or
a microorganism. Specificity and circulation were not enough, in the Cana-
dian jurists’ minds, to confer property rights over the mammalian matrix
within which the inserted oncogene found expression.

The Public Interest

The two North American patent decisions also differed in their understand-
ings of the public interest and the respective roles of legislatures and courts.
Chief Justice Warren Burger, writing for the Chakrabarty majority, picked up
on two themes that Genentech had highlighted and that resonated well with
America’s founding myth of progress through discovery. First, the court
sustained the company’s view that the patent law, as an instrument for fur-
thering invention, should be given an expansive reading. Genentech had
played on the theme of exploration and advancement—“The system seeks
not to catalogue the past, but rather to compass the future” (Supreme Court
of the United States 1979a, 4)—which it backed up with evidence from legis-
lative history. Quoting congressional committee reports accompanying the
law’s 1952 reenactment, Genentech observed that “patent laws are written in
large and prospective terms, so as to include ‘anything under the sun that is
made by man’” (ibid. 6). This formulation proved influential with the court.
Burger in turn sustained the widest possible application of the law with a
quotation from Thomas Jefferson—“Ingenuity should receive a liberal en-
couragement” (Diamond v. Chakrabarty 1980, 447 U.S. 308)—and he incor-
porated into his opinion the same bit of 1952 legislative history that Genen-
tech had cited. From 1980 onward, the rubric “anything under the sun that
is made by man” became identified with the subject-matter provision of the
Patent Act, now ratified by the highest law of the land (ibid. 309).
The court’s second theme, again echoing Genentech, was judicial defer-
ence to the will of Congress. The company’s brief had asserted that it was
up to the legislature, not the courts, to decide what to include in or exclude
from “the broad compass of patentability” (Supreme Court of the United
States 1979a, 7). The field was too complex for judicial evaluation, and the

178 SHEILA JASANOFF

“surgical precision” of legislative policy discriminations was to be preferred
to the “meat ax” approach of the petitioner, who was advocating the curtail-
ment of advances across a vast field of technological development (ibid. 8).
The Supreme Court agreed that restrictions on patenting, if there were to
be any, had to come from Congress. Courts were institutionally incapable of
making the right sorts of judgments. On the one hand, fears such as those
voiced by the PBC (referred to only obliquely as “the [petitioner’s] amicus”)
could be resolved only “after the kind of investigation, examination, and
study that legislative bodies can provide and courts cannot” (Diamond v.
Chakrabarty 1980, 447 U.S. 317). On the other hand, any attempt to put
brakes on innovation would be fruitless anyway, because “legislative or judi-
cial fiat will not deter the scientific mind from probing the unknown any
more than Canute could command the tides” (ibid.). Even this shopworn
metaphor of helplessness was not the Court’s own. In its brief, Genentech
had written that it was not for the Court “to attempt, like King Canute, to
command the tide of technological development” (Supreme Court of the
United States 1979a, 12).
For the Chakrabarty majority, then, all the relevant lines—legal, meta-
physical, institutional—were bright lines, admitting no ambiguity. In par-
ticular, there was and could be no question whether an object for which a
patent was sought existed in nature or was the work of human hands. Any-
thing on the nonhuman side of the boundary deserved a patent in accor-
dance with the broad purposes of the law. Limiting patentability—hence
limiting the circulation of inventions—was the step that required justifi-
cation, and courts moreover lacked the institutional capacity to carve out
exceptions. If there were slippery slopes and special dangers inherent in
patenting life, those were matters that only lawmakers could competently
address.
The Canadian Supreme Court, too, decided that it was not in a position
to make the sorts of policy judgments that the OncoMouse case called for,
but the starting point for invoking judicial restraint was the reverse of that
adopted in the United States. Unlike the U.S. court, which took the ontologi-
cal line between natural and manmade as clearcut, the Canadian justices
saw scientific and technological practices as blurring important boundary
lines: between human invention and nature’s handiwork, especially with
regard to gene-altered complex organisms; between human and nonhuman
organisms and entities; and between permissible innovation and protection
of a valued status quo. Accordingly, the court viewed the patenting of higher
life forms as “a highly contentious and complex matter that raises serious

TAKING LIFE 179

practical, ethical and environmental concerns that the Act does not contem-
plate” (President and Fellows of Harvard College v. Canada 2002, SCC 76, para.
155). The justices refused to undertake such a “dramatic expansion of the
traditional patent regime” (ibid.); instead, they held that higher life forms
did not constitute a “manufacture” or “composition of matter” within the
meaning of the term invention in the Patent Act.
The principles of judicial construction and deference were essentially the
same for both courts: it was their application that differed. In both common
law cultures, it was concededly the legislature’s job to make policy through
law. Courts could determine whether or not a particular question fell within
the law’s intended purview, but they could not redraw the legislated lines to
fit new facts in the world. The point of divergence between Chakrabarty and
Harvard College lay in their treatment of the ontological challenges posed by
biotechnology. The U.S. court saw life patents as unproblematic in the light
of an analysis that stressed the manufactured character of bioengineered
entities and the inevitability of technological advances. Applying the clas-
sic “but for” test, the Supreme Court concluded that the bacterium would
not have existed but for Chakrabarty’s ingenuity. The Canadian court, faced
with a mouse rather than a microorganism, trained its analytic sights on
an altogether different question. That human agency had endowed a com-
mercially valueless animal with high economic value did not, in that court’s
judgment, turn a mouse into a “composition of matter.” It merely raised dif-
ficult questions about where this entity, and others like it, stood in relation
to the objectives of the Patent Act, and to human values more broadly. In the
public’s interest, that complexity had to be resolved by Parliament, not the
judiciary.

Conclusion

Patent law is often described as a highly technical area of legal practice,

mainly oriented to resolving questions of priority (who is the first mover),
as well as whether the claimed invention meets the tests of novelty, non-
obviousness, and utility. It is seen as a site of technical assessment and nar-
row legal construction, not for high matters of ethics, politics, or philoso-
phy. For U.S. patent law in particular, as the rhetoric of litigants and of
courts constantly reminds us, the most important policy choice was that
written into the Constitution and the first Patent Act: “Ingenuity should re-
ceive a liberal encouragement.” Patenting is only a means to an end, namely,

180 SHEILA JASANOFF

that the nation should continue to renew itself through invention, and so
remain true to its founding imaginary.
That reading, when applied to claims relating to novel biological con-
structs, has led to a systematic favoring in U.S. law of moves that isolate spe-
cific bits of nature and put them into economic circulation. In this respect
the law of life patents is logically consistent with the law of “takings” as it re-
lates to real property. Whether nature resides in inanimate land or in living
things, what the law rewards is the act of economic agency that takes some-
thing that was fixed, embedded, and immovable and makes it specific, dy-
namic, and commercially value-laden. In short, lively. Like precious metals
mined from a mother lode, genes and other biological constructs extracted
from living nature can be patented by anyone ingenious enough to detach
them from their physical surroundings and make them useful in commerce
or industry. That logic of the market, grounded in Lockean notions of value
creation through labor, helps to explain why John Moore, whose diseased
body produced cells of potential therapeutic value, could not patent his own
tissues, but why such a patent was granted to the physicians and the com-
pany that manufactured from his spleen a cell line for use in biomedical
research and development. It explains why William Catalona could not act
as an agent on behalf of his sample- donating patients. It also explains why
Homan McFarling, the farmer who wanted the right to replant Monsanto’s
genetically altered soybean, failed in his bid to restrict the company’s rights
in the second-generation seed that contained the manipulated genetic trait.
Backtracking a century, it may also help explain why Chief Justice Roger
Taney, confronted by the ambiguous ontology of the slave body, opted for
the legal reading that would allow it to circulate freely without losing value.
Even market logic, however, has metaphysical ramifications when it is
applied to “private takings”—taking things out of public nature for private
gain. As Chakrabarty and Harvard College dramatically illustrate, granting
patents on living things involved decisions about where to draw the line
between life and matter. Silently and with little fanfare, the U.S. Supreme
Court decided in Chakrabarty that any circulating commodity containing
within it a part altered by human invention is eligible for a patent. The
court’s interpretation of invention seamlessly carried over to the patenting
of higher animals, blurring the line between living genetically engineered
cows or soybean seeds and mechanical contraptions such as cars with newly
designed engines.
The Canadian Supreme Court’s refusal to classify the OncoMouse as a

TAKING LIFE 181

“composition of matter,” and hence to treat it as patentable, drew a line that
U.S. patent law does not recognize between patentable microorganisms and
nonpatentable higher life forms. But it also put back on the agenda of pub-
lic debate previously glossed- over questions about the degree of interven-
tion, innovation, and control that must be shown in order to move some-
thing across the boundary from nature to culture, or from life to capital.
That question is unlikely to recede as life and capital come to be bonded
together in ever more intricate assemblages. In the lively, global landscape
of intellectual-property law, it remains to be seen whether the division be-
tween the aggressively materialist commodity culture of the United States
and Canada’s more cautious respect for the ungovernable complexity of life
can long endure.

Notes
1. Palazzolo v. Rhode Island et al. 2001, ruling that acquisition of land after an en-
vironmental regulation’s effective date does not bar a takings claim, since otherwise
future generations could not assert a right that the present generation was unable to
assert through lack of will or resources (533 U.S. 606).
2. On theories of valuation, see Graeber 2001; Singer 2000. Singer argues, consis-
tently with the broad argument of this chapter, that the ownership model of property
rights is deficient because it includes no element of obligation.
3. Even philosophers of science who do not embrace a radical skepticism about
the reality of nature accept the contingency of specific representations. See Kitcher
2001; Hacking 1999.
4. See particularly Haraway 1991, “A Cyborg Manifesto: Science, Technology, and
Socialist-Feminism in the Late Twentieth Century,” 149–81. Also see Latour 1993.
Unlike Haraway, Latour has not written specifically about the socially constitutive
properties of the life sciences and technologies, but much of his work on hybridiza-
tion and purification of material objects bears importantly on our understanding of
the contemporary metaphysics of living things.
5. For a classic exposition of actor-network theory, including a definition of the
concept of translation, see Callon 1986.
6. One can see this practice as similar in some ways to the German ideal of Nach-
vollziehbarkeit (follow-through-ability) that Stefan Sperling describes in “Science and
Conscience: Bioethics, Stem Cells and Citizenship in Germany” (2006). Only in the
U.S. case what seems to matter is the fact of a debate and not the transparency of the
reasoned argument itself.
7. For a detailed account of the contorted politics of the Dred Scott decision, see
McPherson 1990, 170–81.
8. Abraham Lincoln, speech before the Republican State Convention, Springfield,
Illinois, 16 June 1858.

182 SHEILA JASANOFF

 9. 35 USC Sec. 101.
10. 45 USC Sec.103.
11. 35 USC 112.
12. On the concerns expressed about Golden Rice in relation to food security and
public health, see Jasanoff 2005b.
13. See Boyle 1996, 97–107; Jasanoff 2005a, 213–24.
14. Donald J. Quigg, Assistant Secretary and Commissioner of Patents and Trade-
marks, “Animals—Patentability,” 7 April 1987, available at U.S. PTO, Consolidated No-
tices, 3 December 2008, 1337 CNOG 487, http://www.uspto.gov/web/patents/patog/
week53/OG/TOCCN/item-115.htm#cli115, accessed 23 June 2011.
15. Patent Act, R.S., c. P-4, s. 1.
16. Of course, the Canadian court too saw its task as a matter of statutory con-
struction rather than policymaking. Both the majority and the dissent agreed that the
words of the Patent Act should be read “in their grammatical and ordinary sense”
(President and Fellows of Harvard College v. Canada 2002, SCC 76, paras. 8, 11, 154, 155).

TAKING LIFE 183

 5
ELTA SMITH

RICE GENOMES

Making Hybrid Properties

The field of genomics is one of the busiest sites of research and debate at the
nexus of technoscience and policy, and also the most upstream. The work of
genomics involves developing scientific knowledge and technologies to pro-
duce new information about organisms, the implications of which stretch
from basic research to improved pharmaceuticals and agricultural products.
In this emerging arena, intellectual-property rights in genes and genome-
related information are highly contested. For example, in early 2000 two
world leaders, President Bill Clinton and Prime Minister Tony Blair, an-
nounced the completion of genome maps for the human species. Compared
in importance with the moon landing, and called the scientific breakthrough
of the twentieth century, the sequenced genomes became the focus of in-
tense media attention and public speculation. At the heart of the announce-
ment by Clinton and Blair was a call to private genomics companies to make
their information public, leading many to speculate whether they intended
to change the policy landscape for gene patents (Abate 2000). The Clinton-
Blair announcement, following similar announcements by the French and
Japanese governments, also incited the sell- off of biotech stocks and initi-
ated debates among business, legal, and political leaders around the world
over the direction in which this breakthrough would take humankind.
When two draft rice genomes, one generated by a public sequencing con-
sortium and the second by the private biotechnology firm Syngenta, were
published in the journal Science, in April 2002, they were hailed as the
most exciting genomic efforts since the completion of the Human Genome
Project, announced only two years earlier.1 The rice-genome projects were
described as a solution to food-security concerns in the Third World and as
key to mapping more commercially valuable but more genetically complex
cereal grains. The publication of the genomes was a controversial move for
Science. The editorial on 5 April answered charges that Science was violating
the norms of scientific publication and potentially threatening prospects
for humanitarian aid by allowing Syngenta to publish its sequence without
releasing its genome information to the public domain, as the journal typi-
cally requires. The Science publication followed five years of mapping and
sequencing efforts by four different groups, two publicly and two privately
funded. While publication made the property debates surrounding these
projects public for the first time, these debates were simply the culmina-
tion of long-standing and ongoing negotiations over the property rights that
would emerge with the new scientific information. From the time an inter-
national consortium of scientists began the first mapping effort, in 1997—
followed in these efforts by a private biotechnology firm, in 1998—new con-
ceptions of property rights arose alongside the generation of genomic data.
In articles and websites discussing the four projects, genome maps were
debated and described by many actors as necessarily public. These argu-
ments contrast with the private patent claims that could be and were made
on individual genes and with the trade-secret status of private biotechnology
firms’ genome projects. In genome research, intellectual-property protec-
tion takes the form of trade secrets and patents. Trade-secret laws protect
commercially valuable knowledge so long as that knowledge remains secret.
Trade-secret status is both more and less protective than a patent: it is more
restrictive than a patent for information that remains completely confiden-
tial, but information that becomes available either legally or through guess-
work is no longer protected. Patents allocate de facto monopoly power to
a group or individual “creator” to prevent unauthorized use of their inven-
tions for a limited period of twenty years. This includes sale, distribution,
and use without license or other agreement. In exchange, inventors must
release information that would allow others to replicate their creation. To
obtain patent rights, the invention must meet three requirements: novelty,
inventiveness, and utility in the United States or industrial applicability in
the United Kingdom.
Debates over property rights permeate every discussion of the scope and

RICE GENOMES 185

import of new biotechnologies. The imagined benefits include drug devel-
opment, therapeutics, increased agricultural production, and nutritional
improvement. But genomics is a set of upstream technoscientific practices,
producing large volumes of information with as yet little practical signifi-
cance, and with marketable products in most cases at least several years
down the road. As can be inferred from the human- and rice-genome ex-
amples, this is a highly contested terrain for property rights at all of the
levels of science and technology policymaking. Central to these debates are
the expansion of markets—biotechnology companies in particular—into
spaces previously occupied largely by state-sponsored or nonprofit research
alone, and a shift toward increased property claims that has led many to
question to what extent it has become possible to own “life itself ” (Jasanoff,
chapter 4, this volume; Juma 1989).
The mapping and sequencing of rice genomes provides an interesting
set of cases for exploring the development of global governance through
intellectual-property rights. The recent effort to map and sequence the rice
genome not only illustrates the production of new scientific information,
but also the simultaneous constitution of new intellectual-property regimes
that do not (always) reflect current legal notions of property rights. I ana-
lyze these debates through interviews with genome scientists, news-media
accounts, scientific-journal articles, and online exchanges among the differ-
ent groups working on the genome projects. These debates make visible not
only the dynamics of property debates and the emergence of new forms of
property rights, but also the fact that such rights are negotiated all the way
from upstream science to downstream agricultural development, raising
questions of ownership and accountability across the entire spectrum.

Hybrid Properties

Debates concerning the usefulness and viability of intellectual-property

rights usually center on an all- or-nothing proposition: either private rights
can be claimed, in which case a specific owner, usually one person or entity,
is designated, or ownership accrues to the public at large, in which case the
information becomes a good inheritable by everyone—though who exactly
that “everyone” is remains an open question. But classifications that rest on
only two possibilities are of little use when the property rights in question
are not clearly all of one kind or the other. The binary does not “logically ex-
haust all the possible solutions” (Carol Rose 1986; also Aoki 1998). Instead,

186 ELTA SMITH

aspects of information can be both public and private, free and owned, and
thus are too complex to be fitted into the simple binary of private or public.
The emergence of intermediate or hybrid categories that do not conform
to the well- established binaries of scientific objects (nature- culture) and
legal reasoning (public-private) has become a focus in the fields of anthro-
pology, critical legal theory, and science and technology studies.2 The prop-
erties that emerge in the rice-genome projects do not easily fall into the pri-
vate or public domain (also often called a commons) as traditionally defined
by law. Rather, they are a mixture of properties, multilayered in conception,
availability, control, and reach. These “bundles of rights” that range between
fully protected private property and a completely accessible public domain,
I term hybrid properties. At one end of the spectrum sit purely private prop-
erty rights, as produced and defined in the legal system; at the other end is
the public domain, where there are no owners and no formal protections.
In the middle lies a range of hybrid properties: sets of freedoms and restric-
tions that are constructed in an ad hoc fashion in rice-genome research, in
conjunction with the production of genome data.
The critical legal theorist Carol Rose (1986) argues that there are par-
ticular types of property—“inherently public property,” in her term—that
are neither individually owned nor controlled by the state. Rose focuses on
landed property such as waterways and roads, but her more relevant point
for the genomics case is that some types of property arise and become stabi-
lized through custom instead of through law. And, as the science and tech-
nology studies scholar Stephen Hilgartner (2004) importantly reminds us,
we do not have to look to national or international governmental institu-
tions to see the emergence of property regimes.
“Hybrid properties” in genomic information represent a set of social
classifications that have developed alongside the production of new scien-
tific knowledge. In sharp contrast to traditional conceptions of the relations
between science and law, where knowledge generation is seen as separate
from rule making, my account suggests that representations of the genome
come into being with tacit property regimes attached to them. Thus, prop-
erty rights for biotechnology are emerging, not only in formal, top- down in-
stitutional processes, such as patent suits, regulatory frameworks, or multi-
lateral treaties and trade agreements, but also at diverse sites in the everyday
practices of genome research.

RICE GENOMES 187

Creative Commons

A simple way to illustrate hybrid properties is through an example from

copyright law and practice. In 2001 the intellectual-property lawyer, pro-
fessor, and activist Lawrence Lessig, along with a group of collaborators at
Duke, Harvard, the Massachusetts Institute of Technology, and Villanova,
developed a nonprofit institution called Creative Commons (see “All Hail
Creative Commons” 2002). Creative Commons (CC) works within copy-
right law to ensure both free and open access to informational public goods
and the ability to make ownership claims to creative works through the
intellectual-property system. To better understand what Creative Commons
sets out to do, I examine both what a commons is and what creative aspects
are protected in this new regime.

Commons

A commons is generally seen as the opposite of private property, an open

space that belongs to all rather than a restricted space from which others can
be excluded through socially instituted and legally defined rights and pro-
tections belonging to an individual or a group. Intellectual-property rights
grant restricted access by law to those who make new knowledge; these
rights of exclusion are thought to benefit society by striking a balance be-
tween increased incentives to innovate and greater market efficiency. That
balance is effected in two main ways: First, through different types of prop-
erty rights. The logic behind patents, for example, is to release the trade-
secret status regarding information about an invention to the public so that
others can build on the work, while allowing the inventor to charge royalties
on the use of their invention, thus creating the incentive to innovate. Sec-
ond, limits on the length of time property rights can be held—seventy years
after the author’s death for copyright, twenty years after an application is
granted for patents—are meant to ensure that all creative works are even-
tually available for public use without restrictions. The argument goes that
society benefits from innovations, but innovations occur only when the in-
vestment of labor and capital produces social utility.
Not every novel thing or thought, however, is subject to intellectual-
property claims. If a private-property right means total control, or fully re-
stricted access to those unauthorized, then the alternative to, or the “out-
side” of, the intellectual-property system is the public domain or commons
with no ownership and no restrictions.3 The terms public domain and com-

188 ELTA SMITH

mons, often used synonymously, are poorly defined and contested in legal
theory and practice (Hess and Ostrom 2003). Existing formulations occupy
a counterposition to, and are meaningful only when juxtaposed against, pri-
vate property. Public domain, or commons, often refers to whatever is unpro-
tected by private intellectual-property rights, “either as a whole or in a par-
ticular context, and is ‘free’ for all to use” (Boyle 2003, 30).
Commons, as used by intellectual-property analysts, is a term popularized
by Garrett Hardin’s article “The Tragedy of the Commons” (1968). Hardin
imagined the commons as an open pasture where herdsmen compete for
grazing space for their cattle. A commons for him was a rivalrous resource,
meaning that several or many individuals or groups compete for the use of
that resource, which moreover is not infinitely renewable. The tragedy oc-
curs because everybody gains from using the resource and nobody has an in-
centive to restrict his or her use of it. Consequently, the resource is overused
and fails to “replenish” itself. Typical examples include fish stocks in the
open ocean, or timber forests. Private-property rights or government owner-
ship on behalf of the public are the usual solution to the commons problem,
but some commons are not amenable to easy parceling or are not benefi-
cially “owned” by any one individual or group. The political scientist Elinor
Ostrom, and others working within her school of public- choice theory, have
argued that common-pool resources can be organized and managed by the
likely users, creating public goods instead of negative externalities.4
The “tragedy” of the commons takes a different form in the case of infor-
mation. The problem of overuse is averted because intellectual products are
nonrivalrous; their use by one person does not exclude or otherwise inter-
fere with others’ use of that same information. Images, music, and text are
examples of nonrivalrous goods. But it is more costly to exclude people from
using information than from using more tangible commodities such as fish
or timber. In the face of high costs and nonrivalrous goods, property rights
are thought to be a necessary incentive to promote innovation (for example,
Landes and Posner 2003).
Others, however, have argued just the opposite: that many informational
goods must be freely available without restrictions because they provide
the materials for future innovation (for example, Boyle 2003; Lessig 2001).
Moreover, proponents of public access say, these goods will still be produced
even without the property right. Evidence that information can freely cir-
culate and result in innovative products can be found in the open-source
software movement and to a lesser extent in open-access publication de-
bates (Bollier 2002; Vaidhyanathan 2003 [2001]).5 In both cases incentives

RICE GENOMES 189

to innovation can be extra- economic, with prestige and accreditation as two
of the values that may function in this manner (see Strathern and Hirsch
2004).
Both copyright, which automatically assigns rights, and patents create an
additional dilemma, for there is no way for future users of a work to know
whether, and to what extent, the rights holder wishes to enforce their prop-
erty claims.6 While the public domain or commons might be thought of as
the counterpart or even precursor to private property, in current practice
“public” entitlements must often be carved out of a space that is first desig-
nated “private.”7 Intellectual-property laws as currently conceived shift the
claim to ownership from a state in which new rights must be asserted to
one in which the claims are in place at the moment of “creation” and can
be defended against unauthorized appropriation. Ultimately, intellectual-
property laws shift the terrain of property rights so that controlled access
takes precedence over free use—with the result that access must be carved
out of a realm of controlling ownership instead of the other way around.

Creativity in Creative Commons

Creative Commons is a nonprofit organization that works within intellectual-

property laws, but outside legal and legislative institutions, to create a for-
malized system of public property that complements rather than competes
with copyright laws (Lessig 2004). While the developers of CC see value in
the current intellectual-property system, they also persuasively argue that
greater flexibility would make the innovation system function better. Cre-
ative Commons offers creators a chance to specify how they want others
to use and build on their work, indicating what is free and what is subject
to control. The “spectrum of rights” graphic on the CC website locates Cre-
ative Commons squarely between full copyright protection and the public
domain (see 1). However, the potential for mixing and matching the desire
of a “creator” to allow free use by others and still retain some formal protec-
tions is much more flexible in the middle zone. The website explains.

Too often the debate over creative control tends to the extremes. At one
pole is a vision of total control—a world in which every last use of a
work is regulated and in which “all rights reserved” (and then some) is
the norm. At the other end is a vision of anarchy—a world in which cre-
ators enjoy a wide range of freedom but are left vulnerable to exploita-
tion. Balance, compromise, and moderation—once the driving forces of

190 ELTA SMITH

 1. Spectrum of property rights. From the Creative
Commons website, http://www.creativecommons.org.

a copyright system that valued innovation and protection equally—have

become endangered species.
Creative Commons is working to revive them. We use private rights
to create public goods: creative works set free for certain uses. (Creative
Commons 2010, accessed 22 June 2011)

More specifically, CC provides four formal mechanisms (licenses) for dem-

onstrating to others how a new work can be used: attribution, noncommer-
cial, no derivative works, and “share alike.” A CC license could include any or
all of the specified conditions that help to make known the explicit wishes of
the copyright holder, given that intellectual-property rights in this area grant
protections against reproduction and sale, import and export of a work, the
creation of derivative works, public performance or display of the work,
and the assignment of these rights to others.8 Without CC, the copyright
holder can exercise any or all of these rights, while others are prohibited
from doing so unless they obtain consent from the copyright holder. There
are many potential combinations for CC licenses. For example, creators of
music, movies, images, and text can obtain a license that requires attribu-
tion to a work, but stipulates no payment and allows derivative works. Or
they can specify that future uses of their work are subject to noncommercial-
ization and that those who use it must not change it in any way (no deriva-
tive works).
A “science commons,” adhering to the same principles of “some rights
reserved” as for copyright, was introduced by the CC developers in early
2005. Science Commons (SC) focuses on three frequent areas of contesta-
tion: scientific publication, material-transfer licenses, and databases. The
debate over scientific publication centers on how to make scholarly work ac-
cessible to larger numbers of people, while balancing that goal against the
high costs of production and publication. Science Commons aims to make
copyright negotiation easier in scientific publishing through standardized
licenses for individual works and archiving projects.
Supplementing intellectual-property rules are material-transfer agree-
ments (MTAs), which are contracts between two parties regarding the use

RICE GENOMES 191

of a tangible research material, usually biological (such as genes and model
animals), though chemical and even software transfers are effected through
MTAs. Different MTAs cover exchanges between universities or other publicly
funded research centers, between industry and a university, or between any
combination of these and other research centers, such as hospitals. MTAs
can range from extremely restrictive (both the original materials and all
derivatives from those materials are subject to intellectual-property claims)
to fairly relaxed (if patent claims are not in play, a standard agreement typi-
cally stipulates that the materials must be used for nonprofit or teaching
purposes only and cannot be distributed without the written consent of the
provider). Clearly, even in the least restrictive of situations, MTAs have prop-
erty claims attached to them, and simply sharing materials without such
an agreement is risky business for anything that has commercial potential.
Science Commons is working to standardize MTAs, though some standard-
ization is already in place—particularly through the National Institutes of
Health (NIH)—and to expedite the acceptance of MTAs through negotiations
with universities, industry, and other research centers. MTAs may stipulate
the conditions under which patents will be enforced, whether sharing is al-
lowed (or not), and who owns what once the materials exchange hands.
Finally, databases raise a third set of issues for property in scientific
knowledge. Though they can be protected by copyright if they demonstrate
creativity or originality in their arrangement, most databases of scientific
information are not protected by intellectual-property rights in the United
States or under international law. The United Kingdom enacted a database
law in 1998 that covers any database involving substantial financial invest-
ment (Data Protection Act 1998). In addition to what the Science Commons
developers see as a further encroachment by intellectual-property laws into
previously unregulated domains, they also worry that in current practice,
databases fall into the all- or-nothing category of either wholly confidential
or publicly available information, in the latter case with no rights reserved
by the compiler.
The developers of Creative Commons and Science Commons recognize
that social systems can be tools that complement the law to produce de-
sired ends (Kelty 2004a; Kelty 2004b). Both the CC and SC projects rely on
private voluntary agreements with the holders and users of property rights,
and enforcement comes more from social norms than from legal coercion.
While this approach serves a functional goal of expanding a narrow realm of
property conceptualization and practice, the dynamic and situated character
of property-rights regimes is not captured by either regime (Kelty 2004a).

192 ELTA SMITH

Both CC and SC open up multiple property arrangements, but they do not
reflect the iterative nature of hybrid properties as they are allocated in prac-
tice—in a simultaneous, nonlinear process of making and defending rights.
In fact, most critical accounts of intellectual property begin at the end, so to
speak, arguing that existing rule regimes are too restrictive, not restrictive
enough, dealing with the wrong problems, not targeted at the right people,
or some combination of these.9 The “hard question” for these analysts is de-
ciding what can be covered by intellectual-property rights and what should
be part of the commons (Boyle 2003). In rice genomics, the cultural norms
of science conflict with the terms of intellectual-property laws as suggested
by the SC model, but these competing ideals have generated reorderings of
both systems. Scientific and other norms get mixed together with those of
intellectual-property rights to produce a simultaneous development of new
knowledge and new property claims.

Property in Rice Genomes

Creative Commons and, to a lesser extent, Science Commons illustrate

how a formally recognized regime for hybrid properties can mediate and
facilitate the production and use of new knowledge. One might suspect that
these are not the only arenas in which hybrid properties arise, and indeed
exactly that is happening around the development of rice genomes. I now
turn to that story, picking up where Science Commons has left off, as a
direct route into understanding how technoscientific imaginations shape
the way genomic properties, both public and private, are being constructed
and deployed. Property rights for biotechnology are emerging in every-
day practices at diverse sites of genomic research. Compared with Creative
Commons, the hybrids one finds in these sites of practice are more subtle
and complicated, and they introduce further questions about the way owner-
ship is made visible and thus opened to contestation.
Genome mapping was once a time- consuming and difficult enterprise.
Until the early 1990s, a graduate student might have written her entire
dissertation on the mapping of a single chromosome. The advent of faster
automated-sequencing technologies radically changed the terrain of geno-
mics.10 Now, the sequence of an entire species can be accomplished in only a
couple of years. The last ten years have seen the completion of genome maps
for fruit flies, model plants, mice, rice, and human beings among other or-
ganisms.11 Four different sequencing efforts for rice were initiated by early
2000, two of which were publicly funded while two others were based in

RICE GENOMES 193

private firms. To date, all four groups have produced drafts of the rice ge-
nome, and one of the public projects has produced complete sequences for
all twelve rice chromosomes.
Along with the rapidly growing genome data, property rights are accu-
mulating and being redefined in the work of genome researchers. Debates
over private property and the public domain are critically important not only
in the area of copyright, but also with regard to patents and trade secrets,
and to the fate of databases and access to scientific information.12 Five types
of rights were asserted or negotiated for each rice genome project: trade
secrets, patents, database release, data “sharing,” and publication. Each site
of joint constitution—of genomic information and property rights—can be
explored along four lines of variation: who has access, to what, with what re-
strictions, and subject to whose definition of those restrictions.
The institutional and epistemological orderings and reorderings that
occur in the creation of rice genomes and property rights correspond to
rice in its multiple guises: as scientific information, as a model cereal, as a
major food staple, as a cultural icon, and so forth. The hybrid properties that
emerge in the rice-genome projects are built on particular representations
of genomes and of the “publics” that are imagined to benefit from genome
research. These representations arise in social contexts, through the pro-
cess of producing, disseminating, and controlling new information. How
genomes and their imagined benefiting publics are positioned relies on the
cultural, political, and historical contexts in which both are situated.

Biotechnology Companies: Monsanto and Syngenta

Two corporations produced drafts of the rice genome using two different
techniques, constituting two different genomes and different but similar hy-
brid properties. Monsanto, the U.S. biotechnology giant, began its sequenc-
ing effort in 1998, funding Leroy Hood’s research team at the University of
Washington to produce a draft sequence using a “traditional” approach of
contiguous mapping in clone libraries.13 This technique relies on mapping
the genome from end to end and expects to meet a very stringent error rate.
Their efforts identified approximately 95 percent of the genes, but the map
they produced did not contain enough information to count as a complete
sequence (Bennetzen 2002).
Syngenta also began its sequencing project in the late 1990s. Though the
firm is based in Switzerland, the genome project was run out of the Torrey

194 ELTA SMITH

Mesa Research Institute (TMRI) in Southern California, in collaboration with
Myriad Genetics, a U.S.-based biopharmaceutical company, and the Clem-
son University Genomics Institute (CUGI), which is funded by Novartis. Syn-
genta used a new sequencing method, the so- called whole genome shot-
gun strategy. This technique breaks the genome into small DNA segments,
sequences those pieces many times over to reduce gaps and errors, and then
realigns the now-sequenced fragments in order using automated supercom-
puters. A draft was completed in early 2001, identifying 99 percent of the
genes at 99.8 percent accuracy (International Rice Genome Sequencing
Project 2008; Butler and Pockley 2000).
Both companies present themselves as market- driven enterprises, but
also as benevolent stewards of the public interest (see Grefe and Linsky
1995). Monsanto’s homepage asks the viewer to “imagine” a world in which
small-scale farms in Africa produce abundant cotton, young Asian children
do not go blind from vitamin-A deficiency, and a host of environmental
problems such as soil erosion, energy consumption, and pesticide use find
innovative agricultural solutions (Monsanto 2010). Similarly, Syngenta pro-
vides an overview of its dedication to social responsibility through sustain-
able agriculture, stakeholder engagement, and product stewardship (Syn-
genta 2011). The websites of both companies present visions of abundance
in the face of scarcity and relief for those in need.
A quick look behind each homepage, however, shows the drive behind
the vision. Research is focused predominantly on corn and soybeans, and
products are targeted toward these crops. There are no commercial rice
products and no ongoing rice-genome research projects. The message is
clear to the critical reader: although rice itself is no longer a major biotech
investment for Monsanto or Syngenta, its genetic structure is similar to that
of more profitable cereals such as wheat and maize (Monsanto 2010; Syn-
genta 2011). As in many scientific research efforts, potential profitability and
research investment go hand in hand. Nearly twenty years of independently
initiated projects to map the rice genome in China, Japan, and the United
States passed with little success, until the early 1990s, when researchers
began to realize that rice could facilitate knowledge about more profitable
cereals (Normile and Pennisi 2002). This tension between profit-making
and philanthropy permeates the corporate process of sequencing rice and
deciding how the resulting information is used and held.
A complex set of hybrid property rights was produced through the corpo-
rate genome-sequencing projects. First, private information was made more

RICE GENOMES 195

public in at least two ways: through data-sharing agreements and publica-
tion. Monsanto announced the completion of their genome draft in 2000,
but the results were not published and the data were not placed in a public
database. However, Monsanto negotiated with another sequencing effort,
the International Rice Genome Sequencing Project (IRGSP), to provide that
public consortium with Monsanto’s data to facilitate their efforts. This deci-
sion released the trade-secret status of the information and at the time was a
largely unprecedented collaboration between a private company and public
research effort (Bennetzen 2002; Pennisi 2000). A similar agreement was
reached between Syngenta and the IRGSP in 2002. Publication represents
another layer of public information that was carved out of private property.
Syngenta published its genome results in Science shortly before it agreed to
share its data with the IRGSP. Publication provides additional layers of access
to new information, with dissemination to a wider audience than the IRGSP.
Property rights have advanced into realms that were unimaginable even
fifteen years ago.14 Patents can be issued for a gene itself, for plants trans-
formed with the gene, and for the seed and progeny of the patented plants
(Barton and Berger 2001). The distinction between “nature” and “innova-
tion” has shifted many times, notably through the U.S. Plant Patent Act of
1930, which authorized patenting of asexually reproduced plants, and the
Plant Variety Protection Act of 1970, which extended protection to sexually
reproduced plant varieties. In 1980, the U.S. Supreme Court, in Diamond v.
Chakrabarty, approved patent protection for living organisms, on the ground
that the Patent Act covered “anything under the sun that is made by man.”
That decision was broad enough to include biological organisms, traits, and
genes. While patents may be sought for genes that are “isolated and puri-
fied” from the chromosome, they may not extend to anything “as it exists
in nature.” John Doll (2001), former director of biotechnology for the U.S.
Patent and Trademark Office, estimates that since 1980 more than 20,000
patents have been granted for genes or gene sequences and that another
25,000 are waiting in the queue.
While no genome in its entirety has been patented, as of 2004 the U.S.
Department of Energy cites the number of genome-related patents filed at
more than three million. Seventy-four percent of agriculture patents are
held by private companies, 40 percent of which are concentrated in just five
companies (University of California 2003); Monsanto and Syngenta are two
of the top three agriculturally related patent-holders worldwide. With the
passage of the Bayh-Dole Act, research conducted at universities and other
federally funded institutions has also become patentable. Holding enough

196 ELTA SMITH

key patents on specific genes might amount to ownership of the entire ge-
nome if the “portfolio” of patents includes enough of the most important
genes.
Creating public knowledge requires information release. Accessing that
information, however, is another matter. For example, the companies’ agree-
ments to share raw genome data with the IRGSP stipulated that the consor-
tium could not designate in their public databases which data were produced
by the IRGSP and which were donated by the companies. Since companies
can still patent genes and gene sequences, and readily admit that they did
not release their genome data until they applied for important patents, de-
termining what information mined from the IRGSP database may be subject
to patent protection is difficult, if not nearly impossible.
Additionally, trade-secret release might be considered analogous to
placing information in the public domain (Kennedy 2002), but at the time
of the Science publication, a spokesperson for Syngenta suggested some-
thing altogether different.

Our data is publicly available. To the IRGSP or any other investigators

around the world. It’s just not in the public domain. Think of it like a
book or a movie. It’s available to you, you can get the book, you can watch
the movie; but it isn’t in the public domain, you’ve got to go pay for
it. Somebody owns it, and provides access to it. But we’re not charging
people for access to it for non- commercial uses. So to academics and so
forth it’s available without charge. But what we require is that if a com-
mercial invention is made from the collaboration, that Syngenta has an
option to consider a license for it. (Walgate 2001)

When Syngenta published its results in Science, the company did not deposit
the DNA sequences on which the publication was based in GenBank or any
other publicly accessible database. Such deposits are important to under-
standing the publication results and are crucial for replication. In order to
use the publication results, without the aid of deposits, interested parties
must go directly to the company to see the genetic sequences and must pay
for their use for commercial purposes. Access through publication in this
case is contingent: commercial interests are subject to rules different from
academic research, which must deposit the materials or information under-
lying a publication in order to appear in Science. Ultimately, what may seem
most public, such as data-sharing agreements, databases, and publications,
can still be kept private through patents and licensing agreements.

RICE GENOMES 197

An International Genome: IRGSP

The International Rice Genome Sequencing Project, a consortium of scien-

tists dedicated to sequencing the rice genome, began the first mapping ini-
tiative in 1997.15 Representing a new form of collaborative effort, IRGSP con-
sists of scientists from publicly funded universities and research institutes
in ten different countries: Japan, the United States, Brazil, China, France,
India, Korea, Taiwan, Thailand, and the United Kingdom. From its incep-
tion, the collaborative group has been committed to completing the rice
genome instead of producing only a draft. Using the same approach of con-
tiguous mapping in clone libraries employed by Monsanto, research groups
in each of the ten different countries agreed to sequence particular chro-
mosome segments (Bennetzen 2002).16 Following the Bermuda Principles
concerning human-genome data and intellectual property, the IRGSP seeks
99.9 percent accuracy in its genome map, which means no more than one
error in every ten thousand base pairs sequenced, despite the slow and costly
process.17
IRGSP represents all of the values of rice, and thus the import of rice
genomes for all of the purposes of rice research and cultivation. For ex-
ample, united by a genome, the research groups participating in the con-
sortium portray themselves as a global research body dedicated to a “global”
object—rice. Simultaneously, however, national identities are also mapped
into the imagined genome: the globally produced genome is chromosom-
ally country-specific. For example, Taiwanese researchers sequenced chro-
mosome 4, while another team in France worked on chromosome 12. Many
of the chromosome-sequencing choices were based on particular national
interests regarding the functions expressed on a particular chromosome.
Robin Buell, the lead investigator for the rice genome project at the Insti-
tute for Genomic Research (TIGR), explained that this genome project is
different from others in that it assigns different social, cultural, and eco-
nomic meanings to rice and thus to the sequencing effort, among different
national projects.18 For example, she suggested that TIGR and other U.S.-
based consortium members view rice as a model cereal for understand-
ing the genomes of grains such as maize and barley—much as the biotech-
nology companies do. Thailand, however, received funding from the Royal
Thai government because of the cultural importance of rice and the possi-
bility of catching up in science by participating with more technologically
and scientifically advanced countries in the international effort.
Environmental representations of rice are also wrapped up with those

198 ELTA SMITH

of rice as a marketable good. A newsletter from the IRGSP website notes
that many consumer concerns are directly tied to environmental concerns:
“On the one hand, with a larger and more affluent population there will be
greater demands for higher production and better quality rice. On the other
hand, the same constraints mean that there will be less land, water, and
labor to produce the crop. In short, there will be great demands on biotech-
nology to improve rice production” (Burr 1997). The idea that genomics
will lead to new agricultural products that can overcome ecological stressors
better than, for example, their Green Revolution counterparts produces the
environment as a projected beneficiary to the rice-genome projects as well.
Through its self-identification as an international consortium working
on an international genome, the IRGSP calls for international access to its ge-
nome data. From its inception, the IRGSP decided that its mapping endeavor
would benefit from full disclosure to anybody and everybody who wanted
access. Again following the Bermuda Principles, the IRGSP concluded that
all genome-sequencing data should be “freely available and in the public
domain” to encourage research and ensure societal benefit (Burr and Sasaki
2002). Consortium participants must agree to “share materials, including
libraries, and to the timely release to public databases of physical mapping
information and annotated DNA sequences” (ibid.). The IRGSP guidelines
also stress that individualistic, competitive efforts to map the rice genome
waste both effort and precious resources.
Thus counter to the fundamental reasoning for private intellectual-
property rights, the IRGSP members argue that unrestricted public access is
important and necessary for scientific inventiveness and flourishing. Con-
sortium participation rests on collaboration and timely placement in pub-
lic repositories. New mapping results are first shared with the entire net-
work of participating laboratories, through their own data-banking system,
which is not publicly available outside the consortium, and then with the
scientific community at large, through placement in the DNA Databank of
Japan (DDBJ), the database of the European Molecular Biology Organization
(EMBO), and the NIH-led GenBank in the United States.19
Constructing its own database, with its own rules and protocols, the
IRGSP instituted a new method for collecting, storing, and sharing genome
data. Anyone with Internet access can download the sequence data via any
of the three public databases (DDBJ, EMBO, or GenBank) although there is no
guarantee that the data can be used without restriction because individual
genes and gene sequences may be patented.20 The IRGSP’s requirement that
consortium data must be deposited in a publicly accessible genome bank

RICE GENOMES 199

was an attempt to situate information among a set of actors with a set of
rules and practices that defined the boundaries of genome-related property
(Hilgartner 2004; also Jasanoff 2004).
But the multiple notions of public at play in the IRGSP project do not nec-
essarily match up with the publics that can access the genome data, and the
layers of ownership possible for genome data means that while the genome
level may be relatively accessible, controls on access can be maintained at
other levels. For example, while IRGSP members release their data to “pub-
lic” databases, the IRGSP’s own database is not accessible outside the con-
sortium. Moreover, it is unclear whether consortium members have taken
patents on individual genes. A newsletter on the IRGSP website, dating back
to the inception of the consortium, notes that while withholding sequence
information for patenting is incompatible with consortium rules, there is no
rule that says patents could not be obtained “downstream of data generation
and release” (Burr 1999).
Additionally, any information in the three public databases (e.g., Gen-
Bank) may be patented as well. While the information can be used for re-
search purposes, there is always the possibility that the information is sub-
ject to intellectual-property protection at the gene level or via reach-through
agreements, and the database user is responsible for determining whether
the information is patented.21 The slippage is not unimportant. It indicates
a multivalent and shifting conception of what can or should be public, and
a lack of legal definition to stabilize the terrain. Thus, a public consortium
of scientists, determined to build a publicly accessible repository for the
rice genome, has successfully defined boundaries around what should and
should not be considered proprietary, and for whom, both inside and out-
side the consortium.
Many have argued that the genome map should be in the public domain,
but that genes can still be patented. In a sense, companies and the consor-
tium have negotiated and defined an upper limit of patentability for genetic
information: maps are for everyone, but individual genes that may be iso-
lated from the map are potentially patentable and thus commodifiable—a
far cry from “free” or “unrestrictive.” Lawrence Lessig (2001), writing about
the Internet, eloquently argues that while the information contained therein
is described as “free,” the code that delivers that information is based on an
“architecture of control” that will close off access to new thought and free
expression. The same can be said for genomic information, for which access
is granted “freely” at the level of the genome, but control is exercised at the
level of the gene.

200 ELTA SMITH

A National Genome: Beijing Genomics Institute

Whereas IRGSP is a global research project working on a global genome, the

fourth effort to sequence rice that I will look at is national. In early 2000
the Beijing Genomics Institute (BGI), a publicly funded research group in
China, began sequencing rice. BGI used the same whole-genome shotgun
strategy as Syngenta. BGI’s sequence was produced very rapidly—in only two
years—and while it identified only 92 percent of the genes, the sequence
accuracy is approximately 99.9 percent for more than 90 percent of the
sequence produced thus far (Bennetzen 2002).
The sequencing method was not the only difference between IRGSP’s
project and BGI’s. BGI was also interested in expanding the kind of data avail-
able by sequencing a different rice variety. The sequencing efforts initiated
by Monsanto, Syngenta, and the IRGSP all focused on the Nipponbare cul-
tivar ( japonica subspecies). BGI chose instead to sequence indica, which is
the subspecies consumed by most people in the world, including the Chi-
nese; one source places production of indica at 80 percent relative to other
varieties (Smith and Dilday 2003). While both indica and japonica varieties
are believed to have originated in China, indica, with long grains that do not
stick together when cooked, is preferred by most rice- consuming nations
(Latham 1998).
Explaining the decision, an introductory statement on the BGI web-
site states that the other sequencing projects used the subspecies japonica
(Nipponbare) as “target materials” even though indica is “dominantly planted
in Asia and other regions in the world, and has provided the unique tem-
plate for the unique hybrid rice strain that has greatly contributed to solving
the food supply problem in China” (Rice Information System 2003, empha-
sis added). Commenting on why BGI chose to sequence indica instead of
japonica, the program director said, “There was a feeling that China should
sequence its own rice” (quoted in Normile and Pennisi 2002, 35, emphasis
added).
Thus a genome map that is distinctly Chinese but also Asian is bound
up in the way BGI represents its goals. Moreover, BGI’s success counts in
another way: “China is almost the only developing country in the geno-
mics race, and the only one to make its mark. It has all the usual disadvan-
tages, lack of finance, of supporting technologies and scientists. Whereas
the United States and Japan have about seventy researchers and engineers
per ten thousand inhabitants, China has only six. Despite that, she has come
out well ahead of the west” (Mae-Wan Ho 2001). This text positions China as

RICE GENOMES 201

a developing country, an underdog against better funded and better staffed
developed- country projects. At the same time that it places the United States
and Japan in the developed- country category, BGI also situates itself as point-
edly non-Western. As Kuo argues in this volume (chapter 9), the state re-
mains important in shaping conceptions of life and culture at a global level.
While Chinese participants in the IRGSP imagine themselves as part of a
global genome effort with chromosome-specific national identities, BGI
starts out at the level of the nation in its self-representation.
On its website, BGI explains that the institute initiated its sequencing
project to accelerate and “broaden the scope” of genome research, with a
commitment to placing all of its sequencing information in the public do-
main and to eschewing patents generally (Beijing Genomics Institute 2001).
Like IRGSP, BGI implemented a data-sharing program with DDBJ, EMBO, and
GenBank, but it also made its genome information available to the public
via its own online database.22 On a spectrum of availability, BGI’s genome
project is perhaps the closest to the fully public domain: a new kind of infor-
mation was made available (that about the indica variety); trade secret was
not claimed and patents are frowned on; the results were published in many
forums, making the information accessible to a range of potential users; the
materials and other information underlying the publication were placed in
an assortment of databases; and BGI is committed to sharing its results to
the widest extent possible.

Publication: Science

The fourth site at which to explore the making of genomes and property is
in the journal Science. Unlike consortiums, companies, and countries, pub-
lications do not do their own genome-sequencing work, but they use the
work of others to constitute implicit property claims. To map the develop-
ment of hybrid property in a publication, it is useful to examine the debates
that occurred when Science published two drafts of the rice genome, in early
2002—one by BGI and the other by Syngenta.
Scientific journals are, of course, institutions with their own identities
and discourses. In the case of rice genomics, journals also render questions
about new kinds of property more visible than they previously were, and
in this way more urgent. In April 2002 Science published two rice-genome
drafts. In the pages of the magazine, in newspapers and other print media,
and on the websites of rice-genome researchers, the drafts were roundly
applauded as important developments. The rice genomes were called the

202 ELTA SMITH

“Rosetta Stone” of cereals, which opens up the possibility of understanding
the language of more commercially valuable grains (Normile and Pennisi
2002, 32); the term “Rosetta Stone” was also code for “cereal of the world’s
poor,” and suggested that the rice genome offered potential for unlocking
the secrets to ending poverty and hunger (Bennetzen 2002, 60; Cantrell
and Reeves 2002, 53).
The publication was also surrounded by controversy. Even before the rice
genome was officially announced, a group of twenty concerned scientists,
including two Nobel Laureates, wrote a letter to the editor of Science voicing
dissatisfaction with the decision to allow a private company to publish its re-
sults without conforming to what many Science readers considered to be the
norms of scientific practice. Enacting the Mertonian norm of communism,
which holds that new knowledge should be openly available to advance dis-
covery and innovation, they argued that publication should entail free and
unrestricted access to the data used to produce the article (Amos 2002; De-
clan Butler 2002). Science, along with other major scientific journals, had
long followed the practice of requiring the deposit of genome data in Gen-
Bank or a similar databank as a corollary to publication. The letter empha-
sized that allowing Syngenta to publish its research without this step was
a “very serious threat” to genomics research and a potential threat to using
genomic data for humanitarian purposes (Gaia 2002; Marshall 2002). The
authors suggested that the involvement of market interests in the produc-
tion and dissemination of scientific information was infringing on cher-
ished (if utopian) ideals of scientific practice.
The editorial in the 5 April issue answered these charges. As in a simi-
lar controversy at Science involving the publication of the human genome
by Celera Genomics, the editor Donald Kennedy justified his decision as
follows: “Science normally requires that nucleotide sequence data reported
in its papers be deposited in GenBank. . . . On rare occasions, however, we
make an exception and allow the data to reside elsewhere as long as public
access is ensured. We did that with the historic publication of the human
genome sequence by Celera, copies of which are still freely available with the
sole restriction that it cannot be redistributed” (2002, 13). Effectively, Ken-
nedy adjudicated the construction of a two-tiered property regime for ge-
nome information. Weighing the arguments for community standards and
unrestricted access to proprietary information against making an exception
that would allow greater access to some otherwise restricted information,
and reasoning that accessibility to data is different from the “place in which it
is deposited,” Kennedy determined that an exception was acceptable in this

RICE GENOMES 203

case, as it had been for the human genome (ibid.). However, data availability
in this case meant an agreement allowing the company to provide access to
its information through its own website or via CD- ROM instead of placing
the data in GenBank, as would normally have been required (Torrey Mesa
Research Institute 2004; Marshall 2002).
This was not an inconsequential decision. While publication releases in-
formation about research results, it is generally accepted that results and
descriptions of the process are not sufficient in themselves to permit re-
production of the results in most genome work. Let me offer a clarifying
analogy: publishing sequencing results but not depositing the information
in a database is like producing a telephone directory that tells the reader how
many instances there are of each last name and what regions of the city they
live in, but does not provide specific names, telephone numbers, addresses,
and so forth. Thus, by not placing the information in a database, Syngenta
effectively held onto what is considered the most important part of the infor-
mation necessary for use, namely, the equivalent of the connection between
specific names and specific addresses.
Also, while publication released the trade-secret protection on Syngenta’s
procedures and other sequencing information, it did not prevent the com-
pany from withholding important annotations which provide critical infor-
mation about the usefulness of particular genes or gene sequences. The
scientists who wrote to Science worried that access to and control over in-
formation was at stake; hybrid property is not just about who has rights,
but also about how rights to access are defined among multiple users in the
face of changing institutional circumstances in which increasing amounts
of basic research findings are becoming proprietary (Kennedy 2002).
Though Syngenta eventually agreed to wider release of its raw sequenc-
ing data, that is, allowing the IRGSP to have complete access, the sequencing
data must still be kept confidential from researchers outside the IRGSP and
are only available for noncommercial research purposes, and access is still
limited (Normile 2002).23 Moreover, patents on individual genes are still
possible—a major restriction on information that Donald Kennedy asserted
is in the public domain. Finally, it is important to point out that this public
information is in any case never fully unrestricted or free. Though published
by a not-for-profit organization, Science is in many respects a market- driven
enterprise as well as an academic one. It costs money to subscribe to the
magazine or access its online issues, and scientists do not have open access
to this magazine in all parts of the world.24

204 ELTA SMITH

Hybrid Property Regimes

The debate in Science highlights the importance of rice as a focus of agri-

cultural biotechnology. Indeed many of the reasons that led to the four se-
quencing efforts were also noted in the pages of Science. The following ex-
tract from an editorial provides one example.

Rice, arguably the most commonly consumed food source in the world,
is eaten by 3 billion people daily. Rice crops account for about 10% of the
arable land mass. The rice genome is estimated at 500 million base pairs,
with some 40,000 genes over 12 chromosomes. Agricultural developers
around the world are anxious to identify those genes that could improve
rice yields on marginal soils and provide greater disease and pest resis-
tance, shorter maturation times, and a wider range of tolerable climates.
Rice is important not only in its own right but also as a model for improv-
ing other grain crops because wheat, rye, barley, maize, sorghum, mil-
let, and rice have similar genetic maps. The International Rice Research
Institute estimates that by 2020, 4 billion people—more than half the
population then—will depend on rice as a food. (Bloom 2000, 973)

Here rice is represented at once as a model cereal, a market good, a staple

crop, and an environmental stressor. Genomics, correspondingly, is por-
trayed as the answer to a variety of goals. In the process, hybrid properties
that were negotiated and delineated by the four rice-genome projects and in
Science reflect the multiple publics imagined as using and eventually bene-
fitting from the research. Table 1 illustrates the hybrid properties that arose
through rice genomics. Each horizontal column represents an ownership
claim, from the most restrictive and most legally well-established at the top
(trade secret and patents), to those that are newer or less restrictive (data-
bases, data sharing, and publication). The vertical columns represent the
bundles of hybrid properties in the rice-genome projects. The column en-
titled “private property” illustrates those claims along each of the five owner-
ship dimensions that might comprise the strongest set of private-property
claims. Of course, trade secret is the linchpin of this regime, as without it,
some information is necessarily in the public domain. Patents do release
some information, but at the gene level, rather than at the genome level,
therefore allowing a genome to be held under trade secret while patents are
taken out on commercially important genes or sequences. The far right col-
umn entitled “public domain (commons)” illustrates the strongest possible

RICE GENOMES 205

TABLE 1!A spectrum of rights: Hybrid properties

Private Monsanto Syngenta IRGSP BGI Public domain

property (commons)

Established Trade secret Upheld Released Released No No No

Patents Yes Yes, with Yes, with Contingent, No No

multilevel multilevel downstream
enforcement enforcement only

Database No Not through Not through Yes, but also Yes Yes
release public public has a private
databases: databases: database
accessible on accessible on
company company
websites websites

Contested Sharing No Yes with Yes with Yes, but Yes, but Yes,
IRGSP, but IRGSP, but unclear re unclear re including
commercial commercial annotations annotations annotations
use not use not
allowed allowed

Publication No No Yes, in Yes, online Yes, in Yes, in

Science Science journals,
and online online, etc.
set of public information along the five dimensions I have tracked in this
chapter. In the middle, from strongest private regimes to strongest public
regimes, I have outlined the mix of properties recognized in the four rice-
genome sequencing projects.
These sets of hybrid properties are imagined to most immediately benefit
publics that include participating scientists and other interested research-
ers. However, access is contingent at many levels. Across all four projects
it depends on Internet access at a minimum, but also on the resources and
knowledge to utilize the data. Availability, therefore, does not equal access.
As Rosemary Coombe evocatively observes, “Rather than a planet evenly
comforted by a blanket of warm information flows, we have instead created
a loosely-woven net that is attached at very few points—from which many
are left out in the cold” (1996, 243–44). There still remains a major gap be-
tween the skilled and unskilled, between those who have the resources to
gain access to information and those who do not. The organization of power
may have spread out to more dispersed locations, but it is still concentrated.
Tracing hybrid properties raises questions about ownership and relation-
ships, access to scientific information, and responsibility for where that in-
formation travels, as well as the very social connections along the chain of
knowledge production.

Conclusion

The publication of the rice genomes followed five years of mapping and se-
quencing efforts by four independent sequencing projects. While the publi-
cations in Science made this research and the property debates surrounding
it public for the first time, this was simply the culmination of long-standing
and ongoing negotiations over the kinds of property rights that would
emerge with the new scientific information. From the time the IRGSP began
its mapping effort, in 1997, followed by Monsanto in 1998, new conceptions
of property rights arose alongside the generation of genomic data. Debates
over this information have occurred and continue to occur at different levels
of social organization—within scientific practice, at the national level, and
in international arenas.
National interests, corporate social responsibility, scientific norms, and
profitability all affect the way new genome research is transformed into
property. Creative Commons demonstrates that categorical distinctions
between private property and the public domain (or commons) provide a
structure for argument and in some cases become codified in law. Rice ge-

RICE GENOMES 207

nomes, and the property claims negotiated around them, link the scientists
who make and use the new information for basic research to scientists in-
volved in experimentation on rice and other cereals. Private companies and
scientific publications also assert their organizational objectives—defining
and defending how and where they will deploy rice genomes and for whose
benefit. Hybrid bundles of property rights for genomic data result from and
reflect tacit understandings of how these competing pressures and interests
should be resolved. As such, hybrid property regimes, finally, are impor-
tant modes of governance through which varied values and interests come
together, creating practices that will inform the way we eventually use the
information and understand the meanings of genomes and of rice.

Notes
1. Dennis Normile and Elizabeth Pennisi, “Rice: Boiled Down to Bare Essentials,”
Science 296 (2002), 32–36.
2. See for example Jasanoff 2004; Hayden 2003; Coombe 1998; Haraway 1997;
Haraway 1991; Latour 1993.
3. For further analysis of the terms public domain and commons, see Boyle 2003;
Hess and Ostrom 2003; Litman 1990.
4. See, for example, Dietz, Ostrom, and Stern 2007; Hess and Ostrom 2003;
Ostrom, Burger, Field, Norgaard, and Policansky 1999.
5. “Open code” software was created to allow programmers the ability to view,
amend, and distribute copies of software code (LINUX is the archetypal example). It
comes with a general public license (GPL), which stipulates that derivative code must
retain all the rights claimed for the original code, that is, it must be made available
for others to view, amend, and distribute. For more information about the debate
concerning open-access publications, see “Access to the Literature” 2004.
6. The Berne Convention of 1886 established that copyright protection accrues
from the moment an original work is created; the creator does not need to formally
register or apply for copyright protection for protection to take effect. Minimal quali-
fications of originality apply: a few words or a diagram may qualify. These protections
have been standardized internationally through the World Intellectual Property Or-
ganization of the United Nations. All World Trade Organization members are subject
to the Berne Convention through the Agreement on Trade-Related Aspects of Intel-
lectual Property Rights.
7. This argument does not necessarily apply to that regarding property rights in
land, which may conform more to a line of reasoning that considers a commons to
be the predecessor to private property.
8. There is one exception: “no derivative works” and “share alike” licenses cannot
be used together because “share alike” licenses only apply to derivative works.

208 ELTA SMITH

 9. Bollier 2002; Barton and Berger 2001; Rai and Eisenberg 2003; Boyle 1996;
Buttel and Belsky 1987.
10. Particularly the introduction, in 1986, of the automated DNA sequencer, devel-
oped by Leroy Hood.
11. Generically, a genome is all of the genetic, or hereditary, information con-
tained in an organism. A genome is comprised of chromosomes, which are found in
the nucleus of a cell. Together, the chromosomes contain a full set of the DNA base
pairs, necessary to construct a genome; the total number of base pairs determines its
size. In the case of rice, there are twelve chromosomes and approximately 430 mil-
lion bases. Rice is small relative to other grains; corn has 3 billion bases and wheat
16 billion. But the synteny between the different cereals (i.e., the fact that they have
the same genes in the same order) makes rice a particularly attractive model plant
for scientists. Many discussions of the rice genome include the size of the human
genome, which has 3.2 billion base pairs, as a point of reference.
12. Hilgartner 2004; Rai and Eisenberg 2003; Haraway 1997; and Boyle 1996.
13. A draft sequence is one in which the order of base pairs has been assembled
four or five times, ensuring accuracy and assisting in the eventual ordering of the
base pairs into their correct sequence in the chromosome. In a draft, only approxi-
mate chromosomal locations are known for each ten thousand base pair fragment. A
finished sequence, while not truly “complete,” because there are still gaps and errors,
is considered a “high- quality reference” with only one error per ten thousand base
pairs. This is typically thought to require anywhere from eight to twelve base pair as-
semblies and precise chromosomal locations (see U.S. Department of Energy 2008).
14. See Boyle 2003; Hayden 2003; Rai and Eisenberg 2003; Mackenzie, Keating,
and Cambrosio 1990.
15. The members of this international consortium are from Asia, Europe, and
North and South America. Japan is participating through the Rice Genome Research
Program, a joint collaboration of the National Institute of Agrobiological Sciences
and the Institute of the Society for Techno-innovation of Agriculture, Forestry and
Fisheries. In the United States participants include the Institute for Genome Re-
search; Cold Spring Harbor Laboratory; Clemson University Genomics Institute;
Washington University; the University of Arizona, Arizona Genomics Institute; Rut-
gers University Plant Genome Initiative; and the University of Wisconsin, Rice Ge-
nome Project. The National Center for Gene Research of the Chinese Academy of
Sciences is doing sequence work for China, and the Academia Sinica Plant Genome
Center is working in Taiwan. The remaining participants include France (Geno-
scope), Korea (the Korea Rice Genome Research Program), India (the Indian Initia-
tive for Rice Genome Sequencing), Thailand (the National Center for Genetic Engi-
neering and Biotechnology), Brazil (the Brazilian Rice Genome Initiative), and the
United Kingdom (the John Innes Center). See International Rice Genome Sequenc-
ing Project 2008.
16. Their sequencing responsibilities included: Japan, chromosomes 1, 2, and
6–9 (approximately half of the genome); the United States, 3, 10, and 11; Brazil, part

RICE GENOMES 209

of 9; China, 4; France, 12 and part of 11; India, part of 11; Korea, parts of 1 and 9; Tai-
wan, 5; Thailand, part of 9; and the United Kingdom, part of 2.
17. The Bermuda Principles originated at a meeting in 1996 sponsored by the
Wellcome Trust at which a group of organizations working on human-genome re-
search agreed on two main imperatives: first, genome information should be freely
available and in the public domain; and second, genomic information should be re-
leased as rapidly as possible. The Bermuda Principles were upheld in a second meet-
ing, held in Florida in 2003, and extended to other large-scale genomics projects,
specifically the mouse genome.
18. Robin Buell, personal communication and interview, 20–21 April 2005.
19. GenBank is an international collaboration between the European Institute of
Bioinformatics in the United Kingdom, the NIH’s National Center for Biotechnology
Information in the United States, and the DNA Data Bank of Japan in Mishima. It is a
genetic-sequence database providing an annotated collection of all publicly available
DNA sequences (National Center for Biotechnology Information 2008).
20. IRGSP’s genomic data can be obtained at the Rice Genome Research Program
website, http://rgp.dna.affrc.go.jp.
21. A reach-through agreement stipulates that royalties must be paid on end prod-
ucts that are not covered by the original patent because they include some element
or involve some process that is subject to patent protections.
22. Genomic data can be found on the BGI website, Rice GD: Genome Database of
Chinese Super Hybrid Rice, at http://rice.genomics.org.cn/rice/index2.jsp.
23. Researchers can only search up to 15,000 base pairs of the sequence at a time,
and download only 100,000 base pairs of sequence each week. More can be freely
downloaded if the researchers’ institutions sign an agreement with Syngenta stating
that the data will not be used for commercial purposes (see Torrey Mesa Research In-
stitute 2004), http://www.sciencemag.org/content/suppl/2002/04/04/296.5565.92
.DC1/Goffweb2.pdf, “Accessing Torrey Mesa Research Institute (TMRI) Rice Genome
Data.”
24. The not-for-profit organization, the Science and Development Network
(http://www.scidev.net), does post the content of selected articles from Science and
Nature without subscription or usage fees, though the full content of these journals
is not available through the site.

210 ELTA SMITH

 6
TRAVIS TANNER

MARX IN NEW ZEALAND

“This story makes no sense,” exclaimed the graduate student. “Where is

it going? It’s like a labyrinth with no end in sight. I feel lost. Had Patri-
cia Grace the language skills of Toni Morrison, her novel would have been
better.” These comments, made by a fellow graduate student in a course
on indigenous literature, stunned me. How could someone be so naïve,
I thought to myself ? The insinuation that Patricia Grace, an indigenous
writer from New Zealand, did not measure up to the “great” writers of the
Western canon deeply offended me. I objected, as I often do to these re-
marks, “Better how?” The graduate student replied, “You know, less ‘real.’
Like Toni Morrison. Where’s the literariness in Patricia Grace’s novel?”
For that graduate student, native “literature” is really just glorified
ethnography. According to this view, good literature lacks the strong cul-
tural inscriptions found in indigenous texts. I understood the graduate stu-
dent to mean that fiction (itself a nonpure category) is better than ethno-
graphically informed writing (another nonpure category) because it steers
clear of cultural and historical realities. Reminding the class of the prover-
bial death of the author, the graduate student argued for freedom of textual
interpretation, which was being denied to the “Western” readers in our class
(another nonpure category). But to me this was ethnocentrism masquerad-
ing as a critique of ideology. “Don’t get me wrong,” the graduate student
continued. “Patricia Grace’s novel is very good—from an anthropological
perspective. But as literature it is not very effective.” The student was seri-
ous, and had classroom support. “What is this resistance to indigenous lit-
erature?,” I asked some friends after class. My friends thought for a moment
and replied, “Indigenous literature is labeled inferior by detractors of ethnic
literature. The task of the critic is to show how these texts are just as good as
any other.” I did not feel any better.
The naïve graduate student and my well-intentioned friends share a com-
plicity that can be instructive for a politically minded reading practice of in-
digenous literature that wants to be neither congratulatory nor accusatory.
Attempts to measure indigenous literature by the standards and values of
Western literature facilitate the expansion of global capitalism under the
cover of human betterment (bourgeois human rights, the financialization
of the globe, the commodification of culture, various kinds of development
practices, and so on). The idea that indigenous literature can be “just as
good” as Western literature accomplishes this complicity in the name of so-
called equality. Discrimination need not be overt to be dominant. In fact,
it can be, and often is, more oppressive when the rhetorical signs point the
other way. Thus, we must be vigilant in dredging neoliberal discourse that
purports to be redemptive, to ensure that it is not deployed in the name of
equality. We miss this complicity if we overlook how indigenous texts are
devalued.
In response to this complicity, we can resist the reduction of indigenous
texts to a common denominator of value by reading the textual elements
that resist the cultural abstractions that frame so- called good literature from
the “West.”1 Attention to voice, narrative structure, and culturally informed
modes of communication challenges the norms of good literature in mani-
fold ways, offering critical insight into the past of indigenous-white encoun-
ters, and opening up ways of reading not shadowed by globalized Western
aesthetics. Resisting the complicity of valuing indigenous literature accord-
ing to Western criteria is a political act of extreme importance; it teaches us
to be culturally attuned readers who can negotiate shifting grounds without
losing our convictions. This balancing act informs my readings of politically
charged indigenous texts in this uncertain world.
Using these two exchanges—with the grad student and with my friends—
as a grid to orient my chapter, I explore a nonequivalent mode of reading in
Patricia Grace’s novel Baby No-Eyes. To trace this nonequivalence, I read a
Western theorist (Marx) through Grace to detect the causal chains of straight
storytelling that buttress literature for the West before showing how indige-

212 TRAVIS TANNER

nous modes of storytelling can reshape the parameters of meaning-making.
The parameters I work within are law and temporality in the context of capi-
talism as a means to legitimate exploitation. Because I do not want to be
complicit in the same way as my interlocutors, I will show how Grace’s novel
resists these parameters while working within them; that is, I trace the de-
formations of meaning-making with and against these parameters. While
law and temporality under capitalism are my main focal points, I want to
talk specifically about how Western law and temporality structure history
and knowledge in modernity.2 This requires an analysis of the formal di-
mensions of the story of capitalism. How these structures frame our world
and, with some textual resistance, can be deframed is my readerly project.
Two cases of dispossession serve as the background for Patricia Grace’s
novel: the ongoing struggle for land rights in New Zealand, and an inci-
dent of genetic theft that occurred, in 1991, in Wellington Public Hospital
in New Zealand. Grace juxtaposes the two cases to suggest that disposses-
sion continues today in old and new forms. Land and bodily dispossession
parallel one another in that both are mapped and mined for their precious
properties: natural resources, labor, DNA, and organs. By folding into each
other both land and bodily dispossession, the novel emphasizes that Maori
subjectivity extends beyond the Western ego and how subjection can occur
at the environmental and biological (read spiritual) levels. The connection is
crucial because it situates Maori subjectivity within Maori cosmology. The
destruction of one spells the destruction of the other.
Marx makes a similar observation in the first volume of Capital. In the
section titled “So- Called Primitive Accumulation,” Marx claims that capital-
ism began when the dispossession of public lands forced the peasantry to
sell their labor for survival. But Marx does more than describe a new mode
of production being ushered in by the dissolution of older modes of produc-
tion; he also notes the cultural destruction wrought by dispossession. In a
passage on the expropriation of agricultural production following the enclo-
sures of the commons in England, he says, “By the nineteenth century, the
very memory of the connection between the agricultural labourer and com-
munal property had, of course, vanished” (Marx 1976 [1867], 889, emphasis
added). In these lines we glimpse the loss of identity hastened by disposses-
sion. If land is more than a commodity to be exploited for profit—if it has
social value connecting people to time and place—then we can begin to ap-
preciate the cultural void capitalism creates.3 The connection that links sub-
jects to space is radically severed. But this is more than a literal severance; it
is also symbolic, affecting the psychic dimension of cultural life. Whether or

MARX IN NEW ZEALAND 213

not these memories are accurate is less relevant than how a people’s concep-
tual universe is affected by capital, for whenever people are removed from
spaces that shape their sense of self, the psyche suffers. Dispossession is not
just a material phenomenon. The symbolic-psychic component is equally
important, particularly in the case of indigenous peoples who have sacred
ties to space that extend beyond the physical to the metaphysical. Of course,
Marx was talking about the loss of identity that comes when the private
European laborer is severed from the land. Nonetheless, there is a line con-
necting his thoughts on value and dispossession with the biotechnological
predicament Grace critiques in her novel. This line illustrates the ongoing
phenomenon of dispossession by accumulation.
In Graces’s novel, the character Te Paania wakes from a coma following
a deadly car crash that killed her husband and her unborn baby. On waking,
she also learns that experiments were performed on the fetus by white doc-
tors without her or the family’s consent in the matter: the baby’s eyes were
removed and tested by doctors, reflecting hopes that, in the words of one
Maori character, “remote communities[’] . . . genes may have something dif-
ferent to offer” science, nations, and pharmaceutical companies (280–81).
The novel’s Maori protagonists ardently reject this type of research on the
grounds that commodification destroys identity. As one character, Mahaki,
notes, their “genetic bits are about to become some scientist’s big discovery.
They’re after endangered species . . . Up for grabs, up for patenting, up for
sale, but no proper processes . . .” (187, ellipses in original).
There is historical cause for Mahaki’s alarm. In the 1990s population ge-
neticists recruited by universities and various government-funded projects
began to map human genetic diversity as part of the race to map the human
genome. The project, known as the Human Genome Diversity Project
(HGDP), received worldwide opposition from indigenous activists, who pro-
tested that it was yet another form of colonialism, this time targeting indige-
nous biology. The term biocolonialism became a catchword used by activists
in defense of the cultural values they saw the project destroying. The project
was eventually terminated, in 1996, in the face of growing international
political pressure brought by indigenous groups and their constituents.4
While Maori cosmology is cited in the novel as a reason for rejecting DNA
research—to quote Te Paania, “Genes are the ancestors within us” (280)—I
believe a subtler point can be made. Mahaki does not dismiss science al-
together, but argues that “no proper processes” are being implemented to
guard against exploitation. Te Paania elaborates on this view later in the
novel, when she speaks before a group of scientists.

214 TRAVIS TANNER

 Stop targeting remote communities just because their genes may have
something to offer. At least wait until there’ve been proper codes of ethi-
cal practices and legal confinements established, proper processes for con-
sents to be obtained—processes acknowledging whole community and
intergenerational ownership, processes free from extortion and pretext,
processes that positively acknowledge the right to say no—of people who
may be opposed to their genealogy being interfered with; who don’t like
the idea of their life patterns being taken and owned by someone else;
who don’t want the essence of themselves being altered or disposed of, or
transferred into plants or animals or other humans. Stop pretending that
indigenous people will benefit from this research. (280, emphasis added)

The political message is unambiguous in these lines: tampering with Maori

DNA (moti, or life essence) would do irreparable harm to the people’s sense of
self and community. Cultural knowledge and history could not be tracked if
the community was divorced from its moti. Something like a biological divi-
sion of labor would set in, reducing humans to the bare life Giorgio Agam-
ben (1998) saw operating in the Holocaust camps. Life would cease to have
meaning if knowledge and history became readable for rational information
alone. This suggests that the flattening of temporality in the name of DNA as
a transcendental signifier would, in the making of a general bioequivalence,
greatly limit how people see themselves in the universe. With fewer mys-
teries to be explored, human faith and reason, in all their fallibility, would
become ever more susceptible to the influence of an ever more powerful
matrix of knowledge and power. Human sociality would come to depend on
biology as never before (see Rabinow 1999). Freedom would become bio-
instrumentalized.
While we should heed these warnings and take strong political positions
alongside indigenous groups fighting for their cultural freedom, we also do
indigenous communities a tremendous disservice if we relegate their his-
tories to a pre-genomic history. This disservice comes to light if we take ac-
count of the flexibility and pervasiveness of global capitalism. Situations like
the HGDP, or Grace’s fictional situation, are cases where the rhetorical signs
point the other way, for even the most seemingly anticapitalist values can
be appropriated in the capitalistic juggernaut. Proof in point: culture sells,
especially the exotic kind. Yesterday’s Manichean us-them politics buckles
under this type of logic, which is why we cannot simply read Grace and
HGDP opponents as antiscience advocates. Some no doubt are, but that posi-
tion does not reflect the entirety of Grace’s message. The distinction be-

MARX IN NEW ZEALAND 215

tween antiscience advocates and HGDP opponents turns on what Mahaki
and Te Paania mean by “processes” of knowledge. In terms of legal and tem-
poral parameters, “processes” are the ways in which meaning is made struc-
turally. If Grace is not rejecting science per se, she is rejecting the ways in
which Western science tells its good, straight story. Thus, the novel prompts
us to rethink our hard-and-fast politics along formal grounds. The processes
of meaning-making can be tracked by attending to the novel’s staging of con-
flict between Western and indigenous knowledge systems in its temporal
and narrative dimensions, which will lead us to the messiness of genealogy
the novel endorses.
So what might “proper processes” look like for indigenous thinkers like
Grace? The ellipses that Grace inserts after Mahaki’s comment on proper
processes are ambiguous. Because no answer is given as to what counts
as proper processes, the reader is left to wonder. Te Paania’s statement is
equally vague. No answer is given. It is clear that both Mahaki and Te Paania
disagree (as do I) with DNA research for political reasons, but their rhetoric
slips and reopens the debate. What would count as good science?, they seem
to want to know. What does that practice look like? Perhaps Marx knows.
In “So- Called Primitive Accumulation,” Marx critiques the bourgeois’s
“idyllic methods of primitive accumulation” by showing that, contrary to
the absurd prehistory capitalism tells as its origin story, the history of expro-
priation is “written in the annals of mankind in letters of blood and fire”:
colonialism, brutal child labor, slavery, land theft, and murder (1976 [1867]
874–75). Marx likens this ridiculous story to the story of Christian original
sin that separated the haves from the have-nots.

This primitive accumulation plays approximately the same role in politi-

cal economy as original sin does in theology. Adam bit the apple, and
thereupon sin fell on the human race. Its origin is supposed to be ex-
plained when it is told as an anecdote about the past. Long, long ago there
were two sorts of people; one, the diligent, intelligent, and above all fru-
gal elite; the other, lazy rascals, spending their substance, and more, in
riotous living. The legend of theological original sin tells us certainly how
man came to be condemned to eat his bread in the sweat of his brow; but
the history of economic original sin reveals to us that there are people to
whom this is by no means essential. (ibid. 873)

Against this theological original sin, Marx’s writes the unofficial history of
brutality at the heart of capitalism. His text demystifies the prehistory of
primitive accumulation by exposing its ruthless endeavors: “The spoliation

216 TRAVIS TANNER

of the Church’s property, the fraudulent alienation of the state domains, the
theft of common lands, the usurpation of feudal and clan property and its
transformation into modern private property under circumstances of ruth-
less terrorism, all these things were just so many idyllic methods of primi-
tive accumulation” (ibid. 895). Marx’s rewriting of primitive accumulation
serves as a model for how to rethink colonial histories. The task it sets for
the cultural critic is to read against the grain of official histories for the
gaps and silences that bear witness to the oppressed. Many have been in-
spired to undertake similar projects (the Subaltern Studies Collective, vari-
ous postcolonial scholars, cultural theorists, and so on) to powerful effects.
My interest in Marx, however, is slightly different. What I find intriguing is
his methodology for how to write our counterhistories. As a universal his-
tory of “mankind,” capitalism can tell only a straight story: the Christian
original-sin story that Marx critiques. In this sense, the genealogy of capi-
talism (the haves and the have-nots) eschews complexity for simplicity. In
this historical scheme, past, present, and future are diachronically aligned in
time as a means to justify class, gender, and race discrimination. Circularity
and temporal entanglements—the contingencies of life—are ruled out from
the beginning. Capitalism’s history, in short, is straight . . . and good. No
imagination.
Capitalism needs this straightness to organize itself in terms of gener-
alized equivalence: money, but also the phallus and law. As universal sig-
nifiers, these markers make equivalence possible. DNA is quickly finding
its place as a transcendental signifier alongside these others. Their logic is
similar: to be universal, they must circulate according to abstract principles.
Under their reign, men and women can be compared, as can shoes and
houses or genes and land. Singularity is effaced by the formal properties of
these signifiers. Marx gestures to the abstract form of capitalism in various
places throughout Capital, and analogies can be tracked in Grace’s novel. For
the purpose of this chapter, however, I want to track how law and time code
the propriety of DNA research. If science itself is not the culprit, as our read-
ing of “processes” in Grace and Marx suggests, then there must be another
dimension of capital that engenders physical and metaphysical domination.
This additional dimension is what I call the secret law of value.
Social forms like law are formal sets of codes that order, consciously and
unconsciously, our moods and desires. They mediate life in a universal way
by making everyone structurally “equal.” Typically, commentators of Marx
have shown how labor is the cause of this equalization process that leads to
real (meaning abstract) subsumption. Recall the famous passage in Capital:

MARX IN NEW ZEALAND 217

“With the disappearance of the useful [qualitative] character of the products
of labour, the useful characters of the kinds of labour embodied in them also
disappears; this in turn entails the disappearance of the different concrete
forms [Formen] of labour. They can no longer be distinguished, but are all
together reduced to the same kind of labour, human labour in the abstract”
(Marx 1976 [1867], 128, emphasis added). Advancements in technology and
machinery mark the distinction between formal and real subsumption of
labor, and it is only natural to place biotechnologies on the side of real sub-
sumption. According to real subsumption, value is determined by the so-
cially necessary labor time needed to produce things in comparison to other
producers. The amount of surplus value to be generated from labor is indi-
rectly related to newer forms of technology. As technology develops, labor
becomes less physically demanding, but no less exploitative. That is a secret
of Marx’s labor theory of value, but not the only one.
Everything in Marx’s theory points to labor (formal subsumption) as the
fundamental form of social inequality. Historically this has been the case
as physical bodies and energies were needed to industrialize the planet.
But as we entered a neoliberal era, bodies and their capacities were brought
more and more in alignment with capital’s tendencies to exploit humans.
Collapsing the old division between producers and consumers previously
consolidated under practices of formal subsumption has been the project
of neoliberal capital in search of new bodies to exploit. Yet with fewer and
fewer sources to exploit and with growing global dissent against the forces
of globalization, as we are now seeing in the fallout of the economic crisis of
2008, the instruments of capital have become truly perverse, and it is now
commonplace for people to work against their best interests in the process
of resisting the forces that tyrannize us. This is what Marx called the “real
subsumption” of capitalism. Where once capitalism identified an external
source to exploit for profit, when these sources are exhausted the only thing
left for capital to do is to incorporate these antithetical elements and make
them work against themselves. On the face of it, real subsumption of labor
resembles theories of ideology that seek to explain how people are deceived
about what’s best for them. Ideology critique assumes a class divide between
producers and consumers along which knowledge takes shape. Traditional
Marxism sought to identify this divide and awaken the working classes to a
new consciousness in the hopes of forging different social futures. But what
is the course of action when neoliberalism has collapsed this divide? How
do we even develop a new consciousness when concepts like “equality” and

218 TRAVIS TANNER

“freedom” have been corroded by capital? To address these questions is to
think about the ways in which our symbolic universe has been coopted by
capitalism to the point of making it hard to speak other than in its name.
We arrive at symbolic domination as the cause of exploitation by a gap in
Marx’s own thinking. In Capital, sandwiched between chapter 1, “The Com-
modity,” and chapter 3, “Money, or the Circulation of Commodities,” is a
curious chapter on “The Process of Exchange.” In this chapter Marx reveals
the hidden mechanism of exchange and commodity circulation.

In order that these objects may enter into relation with each other as
commodities, their guardians must place themselves in relation to one
another as persons whose will resides in those objects, and must behave
in such a way that each does not appropriate the commodity of the other,
and alienate his own, except through an act to which both parties consent.
The guardians must therefore recognize each other as owners of private
property. This juridical relation, whose form is the contract, whether as part
of a developed legal system or not, is a relation between two wills which mirrors
the economic relation. (Marx 1976 [1867], 178, emphasis added)

These lines call into question the labor theory of value on symbolic grounds.
What appeared to be the “disappearance of the different concrete forms of
labour” is in fact a product of a “juridical relation.” While it seems in this
passage that law comes to work on behalf of the owners of the means of pro-
duction to ensure their unfair advantages over workers, which is true, we
should also take note of how power is refashioned in this historical shift
from the commodity form to the money form. More than an additional
method by which to secure surplus value from laborers, symbolic domina-
tion like the kind we see in laws that purport to speak on behalf of humanity
become, in perverse fashion, the inroads to a more entrenched subjection.
This is evidenced in how we enter into these relations with consent and
“free” of external force. While exploitation seems to be lacking in this sce-
nario, in reality it has become dematerialized but no less destructive in the
shift from commodities to abstract signifiers like money. It is in the spirit of
skepticism toward this transition that I reevaluate the intentions of genomic
science in indigenous communities.
Far from resulting in a nonexploitative relationship, however, consent
in fact obscures the horrors of capitalism. This is the mystery of symbolic
power. Marx is never explicit about symbolic power in Capital, but we can
glean its importance from various passages on time and discipline scattered

MARX IN NEW ZEALAND 219

throughout the book. Étienne Balibar draws us deeper into this connection
when he notes, “We would today call the analysis of symbolic structure . . .
[a] double language ‘spoken’ by the world of commodities: the language of
equivalence and measurement, given formal expression in the monetary
sign, and the language of obligation and contract, formally expressed in law”
(1995b, 71). And later: “The structure common to economic and juridical
(and moral) fetishism is generalized equivalence, which abstractly and equally
subjects individuals to the form of a circulation (circulation of values, cir-
culation of obligations). It supposes a code or measure—both materialized
and idealized—before which ‘particularity,’ individual need, must yield”
(ibid. 72, emphasis in original). In the place of “individual need” rises a gen-
eral, social necessity governing everything from time, labor power, states of
being and consciousness, and social relations. Balibar attributes this gener-
ality to a juridical fetishism, shifting the terrain of value from labor to law.
Thus, there is a “symbolic structure,” in addition to a “world of commodi-
ties,” that determines value. Appropriating Balibar a bit, we might wonder
how the codes of law affect consciousness and culture? After all, Balibar
notes that these codes are more than material; they are also “idealized” at the
group level, displacing individual identity. This conjecture moves us toward
a theory of subjectivity in Marx based on the symbolic structures of capi-
talism. It suggests that the one common characteristic of social life neces-
sary under capitalism is its abstraction (see Postone 1993). Time, history,
morality, culture, and labor—all forms of life are rendered abstract in the
name of “generalized equivalence.”
If we were performing a deconstructive reading of capitalism, a rhetorical
analysis could perhaps suffice as our critique up to this point. The excava-
tion work we have performed to unearth the duplicitous nature of capital-
istic “equality” and “freedom” would be performed. But it would not move
us beyond the crucial negative critique that is deconstruction’s bread-and-
butter. This is its downside: alternatives are hard to come by. In an effort to
move toward a normative position of some sort, we must realize that there is
more to rhetoric than its power of signification. Something comes through
the symbolic order that is more than symbolic. This something is super-
symbolic in that it has residues of the symbolic and is something more. I
cannot help but think of the Maori moti as this something more that shapes
(forms, Formen) our world.
Our rereading of Marx’s theory of value has uncovered the symbolic
structures that undergird capitalism’s history. In this reading, symbolic

220 TRAVIS TANNER

domination is the key to the abstractions produced by transcendental signi-
fiers like money, DNA, or the law. There is something more about the objective
character of money or DNA that creates subjection under capital. This some-
thing more is fetishism, and it imprints our psychic worlds in consequential
ways. The question we must ask ourselves is: how do we resist the powers
of fetishism? If power functions symbolically at the level of abstract signs,
where do we locate freedom? I propose that new signs are necessary to resist
the allure of capitalism. These new signs are not radically new in the sense
that they exist apart from our world or outside it. I firmly reject, as do Marx
and Grace, the notion that resistance comes from outside capitalism in the
name of “culture.” There is no Archimedean point beyond this world from
which to launch our critique. To make such a claim supports yet another
position of transcendence that threatens to engulf us in abstraction. How-
ever painful it may be, capitalism can only be resisted internally.
Think about the narrative of Capital: why does Marx begin with the com-
modity and end with primitive accumulation? The chronology seems back-
ward. Interestingly, Marx tells a counterstory of capitalism from within
capitalism, beginning his analysis with the predominant concepts and cate-
gories defining capitalism, like commodities and surplus value, only to ar-
rive somewhere else: at a critique of its gaps and silences, founded on the
exploitation and colonization of labor, land, and social relations. Something
similar happens in Grace’s novel as she twists language and novelistic con-
ventions to account for Maori subjectivity, knowledge, and history.
Grace’s novel is composed of a prologue, thirty-seven chapters, and an
epilogue, presented in alternating voices. At the beginning of each chapter
is a nautilus-like design called a koru to remind the reader of the spiraling
narrative form running throughout the novel. The koru represents open-
endedness and is an integral part of the Maori worldview. It describes how
the Maori understand time, history, and narrative. Whaikōrero, or speech-
making, follows a similar pattern. In a recent essay on Baby No-Eyes, the
critic Michelle Keown discusses how whaikōrero or speechmaking struc-
tures the novel: “Baby No-Eyes features a polyphonic narrative structure
which approximates the patterns of Maori whaikōrero or speech-making, in
which different orators take turns to offer individual perspectives on a topic
of discussion” (2005, 152). Like the polyphonic voices Mikhail Bakhtin reads
in Dostoyevsky (Bakhtin 1984, especially chapter 1), or the mosaic voices
Michael Fischer finds in autobiographies by scientists (Fischer 2003, espe-
cially chapter 6), Grace’s alternating voices disrupt the otherwise abstract

MARX IN NEW ZEALAND 221

narratives conditioned by capitalism to provide “individual perspectives” on
shared events. Voices, time, and narration weave in and out of focus in the
novel, overturning the straight-stories that govern capitalism’s conceptual
universe. No wonder the graduate student was confused by and uncomfort-
able with Grace’s storytelling practice. Accustomed to a hegemonic linear
narrative, the student had a hard time seeing the storied alternatives that
exist in other narrative modes within capitalism. I want to stress this last
point about the alternative narratives within capitalism, because there is no
outside of capitalism. A more sophisticated argument is required if we want
to avoid accusations of nihilism and cultural relativism that stalk the either-
or spectrum. Specifically, the critical perspective we gain of capitalism is
afforded by literature like Grace’s novel because in it we see how to disrupt
the symbolic domination that crystallizes in the narrative of capital, which
has also become the narrative of indigenous lives.
While Grace’s polyphonic approach to narrative may be a cultural prac-
tice, I choose to read her as a participant in modernity, rather than position
her on a parallel track alongside modernity. To relegate ethnic literature to
its own separate plane of existence, apart from modernity, risks being exclu-
sionary in the worst possible ways and refuses to acknowledge a more plural
present in favor of a more monological one. This is precisely what Marx and
Grace reject.
If Grace’s story is enmeshed in the sordid history of capitalism and colo-
nialism, she will seek to de-range and reconfigure the narrative and tempo-
ral structures of capitalism to allow other voices to be heard. One such voice
belongs to Gran Kura, Te Paania’s grandmother, who counsels her family
after years of being “good” and “obedient” in missionary schools and so-
ciety to be irreverent and resistant. We hear in Gran Kura’s name the echoes
of koru weaving throughout the generational voices speaking in the novel.
Gran Kura’s voice passes through Te Paania as she learns how to tell “im-
proper” stories—the ones disallowed by colonial society.

We knew we’d been attacked but were not equipped to fight the out-
stretched arm or the insinuations about being proper. I didn’t know then
that a curse was a matter of potent ill-wishing, and that if we were not to
die from it we needed to turn speakings back on those who spoke them
in order to make them void. . . . Even if I did it artlessly and without dig-
nity, it was an attempt at dignity, a rejection of the idea of us not being
proper people with ordinary hopes and a normal desire to learn and be
part of the ordinary world. (89–90)

222 TRAVIS TANNER

Similarly, Te Paania embodies Gran Kura’s defiance when she resists learn-
ing “proper” cooking habits (89) and rebukes a boss who refuses her ade-
quate pay (106). Stooping to indignant acts of cursing and artless speech,
these characters defy the type of subjects they are made out to be in the world
of capital’s embrace. Doubly subject as native and woman, Te Paania taps
into the channels of resistance when she professes, in an anti-Bartlebyian
tone, that there are “no proper processes” to hear the complaints of indige-
nous peoples. What we hear in her defiant speech is not, crucially, a denun-
ciation of genomic science as such, but a plea for the “proper processes” that
are lacking. That she has to make her case in this form of speech is less a
reflection of her personal opinion about science than the result of symbolic
domination that has made it hard to tell different stories. Because capitalism
doesn’t typically take notice of other voices, Te Paania and her grandmother
make their case for social inclusion in a rhetoric of impropriety. This form
of speech isn’t dismissive but radical in its insistence on being heard when
no one is listening. It is my contention that such forms of speech attempt to
punch holes in symbolic domination in politically powerful ways.
These resistances are also cultural in that they represent a method of
refusing identification conferred by centers of power: racism, sexism, and
pharmaceutical capital. Te Paania’s resistance alters the narrative and tem-
poral grids of capitalistic intelligibility by sending these messages of exploi-
tation back to the sender. I repeat what Te Paania notes while reflecting back
on her days in school, “I didn’t know then that a curse was a matter of potent
ill-wishing, and that if we were not to die from it we needed to turn speak-
ings back on those who spoke them in order to make them void. [Later,] I
wasn’t taken by surprise again. No one was able to shut me down from that
day on” (89–90). Te Paania’s resistance is internal to the system in that she
never withdraws from it. Like Gran Kura, who refuses to speak English after
years of repressing her native tongue, Te Paania redirects the curse back
onto the colonial world responsible for its production.
A similar redirection occurs later in the novel when the community re-
jects an offer made by the New Zealand government to buy back land origi-
nally stolen from the people. The conflict leads to a massive demonstration
and eventual occupation of the sacred territory under negotiation. This act
of resistance confuses the white community leaders and government offi-
cials, who are convinced of their own altruism. Why don’t the people want
their land back, they muse? The problem for the native community is one
of representation. Land cannot be represented symbolically in document
signatures or dollar bills. The same goes with DNA. Moti cannot be repre-

MARX IN NEW ZEALAND 223

sented in a genetic map or a drug. Translation doesn’t work that way for the
Maori. Yet this is exactly what law attempts to do: translate, in a generalized
manner, land and bodies into universal codes of signification (health and
wealth). What the white officials and bureaucrats deem a miscommunica-
tion between them and the community is actually a failure of imagination
on their own part.
The novel unambiguously associates law with this failure of imagina-
tion. Landed dispossession and bodily dispossession are equated by the
power of legal doctrine. For example, “They [the scientists] were allowed to
[steal the baby’s eyes for DNA research] because they were allowed to. Law
allowed them. Power allowed them. We had no right to say no, or yes, be-
cause we weren’t people. Baby wasn’t a baby, wasn’t the family’s baby. Baby
was a body, and legally belonged to the coroner” (188). We can compare this
with Mahaki’s thoughts on land theft later in the novel: “They’d [the Maori
community] tried to get it across that it was laws, not people, that were the
enemy, that it was justice at stake; or it was fear inside people that was the
enemy, not the people themselves” (214). The compositional structure of
law cannot do justice to culture. Its reductive form works against the Maori
and other indigenous groups by effacing the rich nuances of tradition and
knowledge like whaikōrero told in more elaborate storytelling practices. As
a vehicle for knowledge and cultural transmission, storytelling connects in-
digenous people to time and place in complex ways. This complexity is lost
when cultural ways of knowing the world are translated into Western cate-
gories. This is precisely what happened in the failed case made by the gov-
ernment men to the community members in the novel, and the failure of
the HGDP’s effort to map genetic difference in the 1990s.5
As a mode of resisting Western categories that reduce Maori culture to
static signifiers, Grace’s novel disrupts any easy translation process. I recall
another student in the indigenous course saying, “You never know where
you are in Grace’s novel. The answers come later, and this is very frustrat-
ing.” The student was responding to the following passage.

There’s a way the older people have of telling a story, a way where the be-
ginning is not the beginning, the end is not the end. It starts from a cen-
tre and moves away from there in such widening circles that you don’t
know how you will finally arrive at the point of understanding, which be-
comes itself another core, a new centre. You can only trust these tellers
as they start you on a blindfold journey with a handful of words which
they have seemingly clutched from nowhere: there was a hei pounamu,

224 TRAVIS TANNER

 a green moth, a suitcase, a birdnosed man, Rebecca who was mother, a
man who was a ghost, a woman good at making dresses, a teapot with a
dent by its nose. (28)

The student is correct to say that this passage does not explicate the action
being described. We don’t find out until much later what the line “there was
a hei pounamu, a green moth, a suitcase, a birdnosed man, Rebecca who was
mother, a man who was a ghost, a woman good at making dresses, a teapot
with a dent by its nose” means. Rather than containing everything we need
to know, this passage refuses to let us identify with Grace or her charac-
ters. The importance of this gesture should not be missed, for it expounds a
theory of culture that is emerging, as opposed to one that already exists in a
contained set of assumptions and beliefs. While reading, the reader is woven
into the text-ile of the story as listeners. As listeners, we have an ethical obli-
gation to reformat the ways we process knowledge in accordance with the
Maori method of storytelling, whaikōrero. Content is less important than
our recognition of culturally specific knowledge practices. The benefit of a
formal versus a content- centered epistemology like the ones presented in
Grace’s novel is that it doesn’t exclude singular attitudes and beliefs about
the world. There is no contradiction, for example, in combining religious
ideas or sentiments. Native Americans have long practiced Christianity
alongside traditional healing ceremonies without trouble. This is why in-
digenous people could conceivably be in favor of DNA research, as Te Paania
suggests in her speech at the end of Baby No-Eyes. The dilemma isn’t over
what knowledge is produced, but how knowledge is constructed, although
some will surely disagree with the construction and the product. Be that as
it may, Grace’s unbounded “processes” aren’t prescriptive in their design
(koru). Rather, they present another grid of intelligibility—one constantly
in the making between speakers and their complex identities.
Whatever union may form between science and culture, the stories that
will be told will necessarily be “improper,” twisted, and nonequivalent. As
we envision what these stories might look like, Grace’s novel might serve as
a model for how to write and read “improperly.” Coupled with a meandering
plot that jumps effortlessly between past, present, and future, Grace’s nar-
rative is a dynamic performance of twisted genealogies. Kinship in the novel
isn’t defined in terms of origin or place, but in terms of entanglements.
Against the organicist notion of indigeneity some uphold in the name of
cultural rights and sovereignty, Grace offers something much different.
Te Paania and her son, Tawera, live with Mahaki and Dave, a homosexual

MARX IN NEW ZEALAND 225

couple, despite the jeers they get from Shane (Te Paania’s first husband) and
others. Gran Kura, Te Paania’s grandmother, learns that her birth mother is
actually her aunt, who had been approached by her parents, according to the
“old ways” (162), when they couldn’t conceive. And then there is the spectral
relationship linking each character with the ghost of the baby who died in
the car wreck. More than a metaphor, the baby’s ghost reminds the reader
of the multiple dimensions of time and understanding running throughout
the novel. These genealogies, together with the reader’s role as listener, com-
bine and disrupt one another in unpredictable ways. It is the nature of Maori
stories to run deep and shallow.
To account for a Maori subjectivity that extends beyond the self to include
the environment, extended kin, and oral histories, Grace composes a text of
layers, folds, and disruptions that functions at once as a political act of cul-
tural determination and as a strategy to resist the very forms she is working
within: the temporal structures of capitalism. If her mode of storytelling
cannot extricate itself from the dominance of abstract time and history, it
can at least re-form these categories in new and inventive ways.
These dynamic stories are simultaneously a critique of capitalism’s ab-
stract historical and narratological forms, and an attempt to make some-
thing more of them. As critique, they show the formal limitations of capital-
ism by exceeding the very parameters within which they are situated. They
emphatically resist the inscription of monological knowledge in the twisted
intricacies that buck straight storytelling. This is why we cannot say defini-
tively whether indigenous cosmologies like the one Grace presents are anti-
science. If we take Mahaki’s earlier elliptical comment seriously, the “proper
processes” that might bring together science and culture are yet to be de-
cided—they are emerging.
Perhaps to tell such stories, we will have to learn to appreciate different
value systems, where voices and histories morph into one another and clash
in a multitude of noise, mystery, and information. Rather than seeking to
control these unknowns, maybe we can somehow foster them without fear
or anxiety. Telling and reading these twisted stories surely will not be easy,
but in them resides our collective futures. They require a new art of story-
telling and of listening, to resist the flat ones that threaten to reduce the rich
knowledges and histories at play in the world.

226 TRAVIS TANNER

Notes
1. By putting quotation marks around “good” and “Western” I do not want to sug-
gest that these constructions have no reality effects. They do, and if I leave off the
quotes in the rest of the chapter, I do so fully aware of their ideological baggage.
2. I include the contemporary moment in my understanding of modernity.
3. Later Marxists like Antonio Gramsci have talked at length about culture under
capitalism, but the kernel of the discussion can be found in Marx. After all, his defi-
nition of capitalism is entirely social: “Capital is not a thing, but a social relation be-
tween persons which is mediated through things” (Marx 1976 [1867], 932).
4. It should be noted that although the HGDP was terminated, the spirit of this re-
search lives on in new projects, most recently in a joint effort conceived by IBM, the
Waitts Foundation, and the National Geographic Society. The moniker for this bio-
avatar is the Genographic Project, http://genographic.nationalgeographic.com. See
also Reardon 2004; Amani and Coombe 2005; Cindy Hamilton 2001; and the web-
sites of the Indigenous Peoples Council on Biocolonialism (http://www.ipcb.org) and
the Action Group on Erosion, Technology and Concentration (http://www.etcgroup
.org), formerly Rural Advancement Foundation International.
5. In her book Race to the Finish (2004), Jenny Reardon argues that the HGDP
project failed because scientists and indigenous communities targeted for DNA re-
search “failed” to work co-productively across technical and cultural idioms. Against
this view I am arguing that the failure of the project, like the rejection of DNA science
and the struggle for land rights in the novel, is due to the representational aspect of
land and the body captured by the transcendental signifiers money and DNA.

MARX IN NEW ZEALAND 227

 7
KRISTIN PETERSON

AIDS POLICIES FOR MARKETS AND WARRIORS

Dispossession, Capital, and Pharmaceuticals in Nigeria

Most of the literature on globalization that theorizes flexible capital, flows

(media, migration, technology), global cities, cosmopolitanism, and local-
global relationships proceeds from an analysis of finance and manufac-
turing capital.1 Such paradigms account for accumulation, speed, and the
migratory patterns of both people and technology via capital circulating
among cybernetic and physical spaces. As one imagines the enormity of
capital movement, what is said of the spaces and places that are emptied
out, from which these voluminous forms of capital are originally extracted?
As it is widely recognized that the African continent continues to provide
raw material in the form of oil, minerals, and cash crops to the rest of the
world in crumbling and nonreproducible ways, can there be an analysis of
an emptied- out space as the left-behind effect of such movement? Can there
be an accounting of this space that is connected but defies overlap with other
spaces in the transnational realm, one that cannot always imagine how raw
material and capital are transformed and consumed beyond its boundaries,
yet one that is not parochial in the estimation of its own loss?
Dispossession and Its Organizational Strategies

When it comes to theorizing Africa’s relationship to globalization, there is

remarkably little said other than that Africa is simply marginalized in the
global political economy.2 However, Africa is being rigorously “reinscribed”
in the world via trade, development, and economic policies, which suggests
an importance greater than simple marginalization. How African states
comply with the World Trade Organization, for example, will largely deter-
mine the role and activities of trade and global governance in ways that are
yet to be imagined, and in ways that are alarmingly on the horizon, such
as the slow and rigorous wiping away of the generic drug industry via legal
measures found in numerous free-trade agreements.
This chapter assesses a form of “lively capital” that begins with the follow-
ing assumptions: wealth accumulation as described by analyses of specula-
tive and manufacturing capital, global cities, and so on cannot solely account
for the contours or performance of global capitalism and Africa’s relation-
ship to it. Rather, Africa is an imperative and integral part of current pro-
cesses of globalization that include the continent’s cultural and economic
representations, the building of new capital markets, and the redirected
efforts of foreign aid that are increasingly being tied to global securitiza-
tion. Instead of thinking about globalization as a unitary capitalism, I am
more interested in theories of capital that may better capture and compli-
cate Africa in the world, as more than one capitalism is at play and at stake
here.3 In these paradigms, therefore, more attention needs to be paid to
wealth extraction and dispossession, whereby the emptied- out material space
is generated by both extractive industries and overlapping configurations
of policymaking and capital mobility.4 This dispossessed space provides the
ground in which emergent and competing kinds of capital, as well as social
and institutional exchange, find their roots and growth. In this particular
instance, they manifest as varying forms of pharmaceutical capital, whose
circulation and existence are tied to oil, debt, and military economies.5
By describing the institution of pharmacy (defined as the discipline of
drug dispensation and composition) and, to a lesser extent, drug manufac-
turing in Nigeria as exemplaries of emptied- out space, I am not referring to
terra nullius, which would imply sheer absence in a colonial imaginary, the
modern ghost of which is invoked by the pharmaceutical industry as “lack
of infrastructure” and used as a prime reason to refuse adequate drug price
reductions. Nor am I privileging the colonial state as a robust entity that ex-
tended its drug- distribution efforts beyond the citizen to the subject, a task

AIDS POLICIES FOR MARKETS AND WARRIORS 229

begging the attention of the postcolonial state. Rather, I am referring to two
means of dispossession: The first is the structural adjustment program (SAP)
of 1986 of the International Monetary Fund (IMF), which was strongly tied
to a rise in militarism in Nigeria and to a protracted prodemocracy move-
ment. The SAP initiated a massive emptying- out of existing health institu-
tions and pharmacy, and it disabled drug manufacturing (via currency de-
valuation, wage decreases, state privatization, and dismantling, etc).6 New
therapeutic institutions emerged, replacing dying institutions in a process
in which professional and patient agencies, strategies, and subjectivities
came into being, literally enveloping other ones. The second is a more re-
fined form of dispossession that attempts to dismantle the generic drug
industry’s market viability through two routes: trade-related intellectual-
property law and specific AIDS treatment policies, both of which emphasize
and privilege proprietary transnational drug companies and the circulation
of their products.
By exploring the near- death of an industry and the subsequent rise of
neoliberal health policies, I show how wealth extraction and other forms
of dispossession are preconditions for generating contradictory imperatives
of capital as they relate to old battles over the social contract, but are largely
being reterritorialized in these scenarios (Ferguson 2005). Marx described
two competing forms of capital, one that perpetuates further production
and the other that perpetuates further circulation (see Marx 1977 [1852];
Marx 1959). More recently, David Harvey’s important insights on capital
mobility, described as “accumulation by dispossession” (2003, 137–82), re-
think the importance of primitive accumulation since 1973, a process that—
in contrast to the formulations of Rosa Luxemburg (1968) and Marx, yet fol-
lowing Hannah Arendt (1968)—remains an important strategy for capitalist
expansion in the twenty-first century.7 Using Marx and Harvey to frame the
larger politics and stakes, I would argue that what we are seeing in these
dispossession and reinvestment strategies is the combination of territorial
and capital logics, with policy logics that specifically emerge in the context
of AIDS.8
Here, I refer to the financial interaction among, and capital movement
facilitated by, policy organizations as well as financial institutions over-
seeing the implementation of policy. In being “brought together” by AIDS,
policy organizations, the state, corporations, and AIDS activists make im-
plicit agreements with each other that generate particular kinds of capital
flows. In this context, implicitness represents the crux of policy logics re-
acting to neoliberal strategies and reform. That is, healthcare systems are

230 KRISTIN PETERSON

increasingly overlooked in favor of policies that address “the gaps” in care,
such as prevention and treatment for HIV, rather than comprehensive care.
Nonexistent robust health-systems infrastructure is a prerequisite for im-
plementing policy that addresses these infrastructure gaps. This has led to
new ideas of health, bodies, and surveillance collated by myriad consenting
actors and institutions that generate abstractions and analysis of “the gaps.”
As a result, the “gaps” in healthcare systems are transformed into the sys-
tem itself, for which humanitarian and government organizations deploy
millions of dollars dedicated to new infrastructure, while health systems
are left to wither in neglect; it is a scenario wherein the logics of health and
economic crises both presuppose and require each other. “Implicit agree-
ments” thus points to how economic and health abstractions become natu-
ralized as normative social and institutional exchange. The policy- driven
capital form is thus simply a question of how capital naturalizes its own
mobility and operation.
Until the 2003 implementation of the U.S. President’s Emergency Pro-
gram for HIV/AIDS Relief (PEPFAR) for select states, including Nigeria, most
AIDS development agencies had favored HIV-prevention policies over wide-
spread treatment. This means that in Nigeria, for example, HIV education
and prevention programs function as an AIDS humanitarian apparatus that
provides protectionist measures for the oil-extraction industry. That is, long-
term and sustainable AIDS-treatment policies would require, first and fore-
most, converting oil wealth into funding for treatment for the nearly five
million who are HIV-positive and many more who are infected with numer-
ous other infectious diseases.9 Fundamentally, any attempt toward wide-
spread treatment necessitates reconfiguring the relationship between Afri-
can states and their corporate partners, between external debt and foreign
aid, between African states and their creditors. Because Africa’s creditors are
also Africa’s AIDS donors (the World Bank, Paris Club members, the United
States), it is perhaps no coincidence that a very particular biopolitical regime
manages both HIV bodies and relationships between the state and humani-
tarian, and international financial institutions.
In these interdependent contexts, the state’s own role is to facilitate,
orchestrate, and permit “accumulation by dispossession to occur without
sparking a general collapse” (Harvey 2004, 115)—constituting the general
gist of an IMF structural-adjustment program. While Janet Roitman (2005),
Achille Mbembe (2000), Jean-François Bayart (1997), and Sean Brotherton
(2008) have all demonstrated how the state in Africa does act in its own
interests, turning dispossession into new kinds of accumulation, I would

AIDS POLICIES FOR MARKETS AND WARRIORS 231

furthermore suggest that the state’s technological capacities are shifting
into other technological priorities that inscribe new patterns of capital flow
and formation.10 In such cases, the state and capital are not always at odds
with one another; it is not always the case that the state erodes while capital
flourishes. Certainly for Nigeria, the primary source of accumulation is not
based on wage labor, but rather on government contracts and oil-rent poli-
tics, through which accumulation is fundamentally channeled via the state,
so that the state and capital actually rearticulate each other.11 If anything,
stringent and lax laws can coexist in the same space to enable and disenfran-
chise certain capital manifestations, where at once the state’s own interests
are both fulfilled and erased. This is a contradiction that largely emerges
in the aftermath of a state privatization as well as within Nigeria’s current
efforts to be more squarely inserted into global markets.
In the rest of this chapter I describe the shrinkage of pharmacy and de-
cline of drug manufacturing since the IMF structural adjustment, and the
lack of quality drugs that has resulted. I also describe the excess of counter-
feits, illegal drug markets, self-medication, and drug-labeling problems as
produced materiality and practice in a “post”-IMF space. I then examine
how two treatment policies (one in Nigeria, one in the United States) map
onto these spatial environments. I pay special attention to the merging of
security and health discourses in the implementation of these treatment
policies. “Household security,” in the context of AIDS, loses ground to “na-
tional security,” giving rise to new policy logics that bypass the aftermath of
healthcare infrastructure dispossessions. Ultimately, I argue, the 1986 IMF
SAP in Nigeria constitutes a particular historical moment that emptied out
Nigerian and other African pharmacies while inaugurating new protection-
ist measures for the global circulations of pharmaceuticals, where new mar-
kets and security cultures thrive.
Frantz Fanon wrote, “It was not the organization of production but the
persistence and organization of oppression which formed the primary social
basis for revolutionary activity” (1966, 88, cited in Robinson 2001, 134).12
In following Fanon, and in viewing dispossession as a form of oppression, I
argue that dispossession is the primary organizational strategy that gener-
ates such protectionist measures, which alter health and medical practices,
including drug production and consumption. The very drive of this dispos-
session are the implicit agreements among institutions that enable capital
to thickly accumulate in ways that contradict the interests of public health. It
may be counterintuitive to imagine that state and other forms of disposses-
sion negate capital accumulation and wealth.13 Indeed, dispossession ulti-

232 KRISTIN PETERSON

mately curtails incentives for foreign direct investment when state services
like electricity no longer function properly and social conflicts carry on amid
scarce resources. But dispossession actually serves as a productive contra-
diction in a Marxist sense. The AIDS policy is a pivoting anchor that enables
the subsidizing of new drug markets and, particularly for Nigeria, keeps the
flow of oil wealth sustained in ways that continually reproduce national and
international elites. In the process, the state both consumes and negates its
own interests; and the population must negotiate a therapeutic economy
and knowledge that edges on a dangerous medical pluralism.

Emptying-Out of Pharmacy,
Dismantling Drug Manufacturing

In the mid-1980s the pharmaceutical-manufacturing industry comprised

over fifty manufacturing firms that produced generics for malaria and
other pertinent endemic parasites and diseases. By 1996, ten years after
structural-adjustment implementation, nearly two-thirds of the industry
bottomed out. Two IMF austerity measures (among others) impacted this
decline. The first, a high tax placed on imported raw materials, was viewed
as a step toward increasing local production of raw materials and justified
by the IMF as addressing the need to wipe out “nonessential” state imports.
The second was the devaluation of the currency, which cut earning power in
half across the country within the first month of structural-adjustment im-
plementation (and led to further declines after that).
The decline in earning power had two effects: 1) it eliminated purchas-
ing power for local manufacturers, who could no longer invest or reinvest
in raw-material production (as of today, 100 percent of all raw materi-
als for drug manufacture are imported to Nigeria at extraordinary costs,
undercutting the IMF’s original claims that its impetus was to improve self-
sustainability); 2) the purchasing power of the consumer was also devas-
tated, whereby those who sought generic Nigerian drugs were left to either
pay more or seek alternatives such as traditional medicines or practitioners
who claimed to have a cure for AIDS. Traditional medicine has always com-
prised part of the therapeutic economy. It is estimated that 70 percent of the
population seeks out traditional healers (due to cost and familiarity) as pri-
mary healthcare providers, which matches most estimates that 70 percent
of the population lives on less than one U.S. dollar per day (Maiwada 2004).
Both private capital flight and the debt repayment are derived almost ex-
clusively from oil wealth, and both represent primary forms of wealth extrac-

AIDS POLICIES FOR MARKETS AND WARRIORS 233

tion.14 State privatization, trade liberalization, the removal of petroleum sub-
sidies, and the devaluation of the naira led to decreased earnings, and food
prices nearly quadrupled. Nigeria faced increased black-market expansion,
heightened poverty, increased crime, food riots, and worker strikes. Primary
healthcare services collapsed, which, again, impeded the IMF’s stated goal
of building self-reliance, as the fund envisioned total cost recovery from
patients who could not afford even basic food commodities (Salako 1997).
In Nigeria capital investments and recurrent payments, such as salaries and
essential drugs, and facilities maintenance were suspended (Samba 2004).
With the introduction of user fees and the sale of drugs liberalized, the pub-
lic consumption of drugs drastically declined. By 1990 the domestic pro-
duction of pharmaceuticals had ceased almost entirely throughout Africa;
most pharmaceutical and medical-supply industries were pushed into bank-
ruptcy, and medical workers fled to the private sector both within and out-
side of Africa (ibid.).
The SAP also affected drug- distribution systems, which were already
facing great difficulties and challenges. The original drug- dispensation pro-
gram was based on a colonial administrative system whereby drugs were
transported to central stores and dispensed by government pharmacists.
After the Nigerian civil war (1967–70) and the oil boom of the 1970s, there
was massive hospital and healthcare expansion. Additionally, overseas
manufacturers found the seventy-million-person market to be highly lucra-
tive, and started to pack and distribute imported drugs in Nigeria. Compa-
nies such as Pfizer, Abbott, Glaxo, Wellcome, and Roche came to Nigeria
and manufactured drugs (Ovbiagele 2000). The colonial system of drug
dispensation could not meet the needs of an expanding healthcare system,
and the government was slow to react. Steeped in postwar reconstruction
efforts, the government was unable to reconstitute or expand the regulatory
structures quickly enough to forestall the growing chaos of drug distribu-
tion (ibid.). With an oil bust producing a severe economic crisis, the govern-
ment took a desperate measure, liberalizing drug-import policies via an “im-
port license” that allowed nonpharmacists to freely import and sell drugs at
huge profits. As a result, massive quantities of fake drugs entered the coun-
try, and military and civilian counterparts together assumed control of drug
markets. It was not until 1990 that the National Drug Policy was executed,
which gave rise to the National Agency for Drug Administration and Control
(NAFDAC), Nigeria’s drug regulatory agency, which remains to this day highly
underfunded.
By 2005 Nigeria had accumulated a total debt of 36 billion USD, at which

234 KRISTIN PETERSON

point the country threatened to repudiate what it deemed an illegitimate
accumulation of debt by former corrupt military leaders who did not pay
as scheduled; late-payment fines and arrears amounted to billions, even
though the principal had been paid off at least three times. By 2001, with
the end of military rule, annual payments to foreign creditors amounted to
$2 billion, while only $300 million was allocated toward the entire national
healthcare budget, designated for 120 million people. The health budget
of 2001 was 1.9 percent of the total national budget (or U.S.$7 per capita)
(World Health Organization Statistical Information System 2001).15
In the same year, nearly half of all drugs in circulation were found to be
counterfeit or substandard, and such drugs are mostly found in thousands
of drug markets across the country (R. B. Taylor et al. 2001). The 2001 sta-
tistic on fake and substandard drugs may be declining, as Dora Akunyili, the
former director of Nigeria’s drug regulatory agency, NAFDAC, started a cam-
paign to confiscate and burn fake drugs in great media and public displays.
As a result, she and many NAFDAC workers were attacked in markets; several
car bombs were detonated; various assassination attempts were made on
their lives; and the NAFDAC headquarters were burned down in 2003. Market
sellers in open drug markets have been rarely prosecuted in the past despite
good laws on the books, and in using their own union protection, they are
fighting the prospect of unemployment. Whether or not Akunyili’s efforts
were effective, the public attention brought to fake and counterfeit drugs
marks a shift in consciousness with regard to the presence of fake drugs in
the country.
In contrast to the numerous illegal drug markets, very few pharmacies
exist, and over 90 percent of those pharmacies are in the urban areas, 30
percent of which are concentrated in the city of Lagos. Out of the thirty-
six states, only six have more than a hundred pharmacies and five states
have fewer than fifteen, which are intended to serve potentially millions of
people, given a population of 130 million (Pharmacists Council of Nigeria
2000).16 There are nearly four times the number of registered pharmacists
as there are pharmacy premises, perhaps pointing to the problems of gain-
ing start-up capital, unstable electric supplies, and unemployment. More-
over, doctors dispense drugs themselves and are not eager to hand over dis-
pensing responsibilities to pharmacists—a state of things to which many
regulatory officials, some of whom spoke to me, have resigned themselves.
As the profession has declined, pharmaceutical practice has itself changed.
Even in the urban areas where pharmacies are accessible, how pharmacists
dispense drugs is highly mystified for many patients, the names and dosages

AIDS POLICIES FOR MARKETS AND WARRIORS 235

of drugs prescribed, for example, rarely being labeled (O. Taylor 1998). In-
deed, to omit such information is a common practice and even the policy of
many hospitals and pharmacies. When I was in Owerri, in the eastern part
of the country, with Mary, a nurse and AIDS activist, we visited her family in
a nearby village and found that her mother-in-law was ill. After taking her to
the doctor, we walked with her to the hospital pharmacy, where she picked
up her prescribed medication. A sign posted next to the pharmacy window,
in both English and Igbo, encouraged patients to ask questions about the
drugs they were receiving. Mary’s mother-in-law received her drugs in a plas-
tic bag, which, marked in pen, stated how many pills she should take per day.
Neither the name nor dosage of the drug was listed. Mary went back to the
pharmacy and asked them to label it “correctly.” The conversation escalated
in the street, with Mary yelling at two hospital administrators about their
nonlabeling policy and a couple dozen patients who had gathered around to
listen. The administrators calmly told Mary that they could not label prescrip-
tions because too many patients self-medicate, which Mary countered with,
“And what happens when your patients have adverse side effects or allergic
reactions to prescribed drugs? How will any medical worker ever know what
was prescribed when the patient has no idea? And what if the patient dies?
Then what?” To these questions, there was no response.
Indeed, concern about self-medication with controlled drugs—which
is, after all, the most common method of treatment—is the most com-
mon justification pharmacists give for nonlabeling. But conversations I
had with pharmacists indicate that something else is at work: the desire
to keep drug knowledge circulating only among pharmacists. Many articu-
lated what seemed like a mantra of using self-medication as an excuse for
non-labeling. Very few wanted to explore the notion of assisting a very large
self-medicating population through labeling.17 The profession of pharmacy,
long held in esteem, has been increasingly devalued, due to the inhospitable
climate of drug distribution and difficulties in competing against “illegiti-
mate” businesses. Perhaps nonlabeling acts as a reconfiguration of exper-
tise wherein making certain knowledge secret confers a sense of authority
on a profession struggling to regain legitimacy or status. Indeed, one of the
newsletters of the Pharmacists’ Council of Nigeria stated at the 1999 annual
meetings that a newly institutionalized honorific, “Pharm,” would precede
the honorifics Mr. and Mrs. The use of this honorific is now common prac-
tice among pharmacists. Together, the mystification of drug knowledge and
the implementation of the new titles establish a sense of control over pro-
fessional loss.

236 KRISTIN PETERSON

 Of course, the control of knowledge does not preclude patients from
seeking the information they want. Patients often obtain their knowledge
of drugs from market sellers, most of whom are not trained as pharmacists.
I have walked through the Lagos drug markets, where the conditions for
storing drugs are generally not ideal, and found both controlled and uncon-
trolled substances. I have watched buyers give sellers lists of symptoms, for
which the seller proceeds to find the appropriate medications in his supply.
Moreover, hospitals and clinics also get their supplies from these markets,
and pick-up trucks with hospital logos regularly pull up to restock their sup-
plies. Not only do patients prefer to buy in markets, but so do physicians. In
Lagos, a report estimated that 58 percent of all physicians identify drug mar-
kets as their vendors of choice, because of availability and ease, despite the
fact that substandard and counterfeit drugs are to be found in some of these
markets (Pharmaceuticals Manufacturing Group, Manufacturing Associa-
tion of Nigeria, 2001).
Many people I interviewed preferred to buy their drugs in the markets,
to save money by avoiding the additional costs generated by seeing a doctor
for treatment and care. Drug availability extends even to roadside “hawkers”
who sell medications of all sorts in traffic jams and along busy and com-
mercial roads, literally appearing and disappearing with the traffic itself.
Sellers can also be found on public transport. While riding on buses, I en-
countered traveling drug salesmen who took turns wooing the crowds by
offering candy and lame jokes about gender relations before launching into
pitches about the efficacy of their goods. The attitude of the crowds on such
bus rides often evolved from boredom and annoyance into enthusiasm and
consumer passion. Pain pills, antibiotics, acne busters, and aloe vera were
offered for sale at various times, and I myself bought some imported Indian
Neem toothpaste.
Manthia Diawara has argued that “West African markets provide a seri-
ous challenge to the scheme of globalization and structural adjustment fos-
tered by the World Bank and other multinational corporations that are vying
to recolonize Africa. . . . [W]hat makes these traditional schemes of global-
ization special is the structural continuity they maintain with contempo-
rary markets in opposition to the forms and structures of modernism that
the nation-states have put in place in West Africa since the 1960s” (1998,
114–15). Indeed, economies are largely controlled and determined inside the
markets (stationary and mobile), not by the banks. Diawara rightly claims
that this poses a challenge to financial institutions that see the nation-state
as the only legitimate vehicle to conduct business (ibid. 116). Diawara de-

AIDS POLICIES FOR MARKETS AND WARRIORS 237

scribes a typical scenario: to cope with the struggling economy, state officials
depend on markets, where currency can be exchanged at higher rates than
what banks offer, where low civil-service wages can be enhanced by bribes,
and where forms of emergency cash may even be provided to a strapped
government (ibid.). This is a system of recycling indebtedness that actually
helps to stabilize a financial crisis and is tied to a conglomeration of state
practices where notions of the public and private are blurred (ibid. 117).
The extent of counterfeit, fake, and substandard drugs located in the mar-
kets and on the streets actually represents a remarkable contradiction. On
the one hand, the dispossession of the Nigerian pharmaceutical industry’s
capacity to, at best, carry out good manufacturing practices freed up space
for new, mostly imported drug products to take root—drugs that can by-
pass regulatory organs of the state. During the 1990s these drugs especially
competed with global company products that had distribution outlets in the
country. In the process of an IMF-generated dispossession that would lay
the ground for new proprietary pharmaceutical capital, counterfeit drugs,
which made upward of 80 percent of the national drug market, became the
thorn in the proprietary distribution agenda. In this sense, the drug markets
provided the very challenge to state privatization and neoliberal reform that
Diawara claimed.18 For Diawara, “As postmodern reality defines historicity
and ethics through consumption, those who do not consume are left to die
outside of history and without human dignity. The traditional markets are
the only places where Africans of all ethnic origins and classes, from the
country and the city, meet and assert their humanity and historicity through
consumption” (1998, 120–21). On the other hand, there are a great number
of counterfeits and fakes that can create severe side effects and injury, which
puts the “right to consume” in jeopardy and thus the role of both the state
and market in question. The “right to consume” needs to be situated in the
context of the “right to produce” and the “right to regulate”—a messy con-
figuration. As these rights of the individual and the nation-state surface as
out of joint, these forms of medical pluralism continue to thrive.
At the very same time that fake and counterfeit drugs were substantially
outcompeting the global proprietary drugs in Nigeria (and counterfeits of
all sorts were doing the same in other parts of the world), demands for in-
creased intellectual-property protection were being issued by private in-
dustry and Western governments via the World Trade Organization. While
NAFDAC has made moves to break down drug markets in the interest of both
protecting proprietary drug businesses (something explicitly emphasized
to me) and public health, and this certainly does protect the intellectual-

238 KRISTIN PETERSON

property rights of the global proprietary industry, it is also giving an unex-
pected boost to the local generic industry, whose products were also largely
copied during the 1990s. In the context of this rebirth, a different form of
dispossession is creeping in, one that poses threats to the local manufactur-
ing industry. This clearing is making room for U.S.-subsidized proprietary
antiretroviral drugs via the politics of trade-related intellectual-property law
as well as AIDS treatment policies. But this more refined emptying- out may
actually destabilize the very new capital forms that are just beginning to be
cultivated in this dispossessed drug landscape.

AIDS Treatment Policies and New Capital Imperatives

In Nigeria there are two major antiretroviral (ARV) treatment policies. One
is the Nigerian government’s, which uses only generic drugs produced in
India by Ranbaxy and Cipla for the 20,000 enrolled patients (out of four
million HIV-positive people, 400,000 of whom are estimated to be in im-
mediate need of ARVs). The second uses both generic and proprietary drugs
that are being supplied by PEPFAR, the largest international health initiative
ever to target a single disease. In Nigeria, PEPFAR subsidizes and distributes
U.S. proprietary drugs to over 100,000 patients.19 Over $20 million for fis-
cal years 2004–6 were allocated to PEPFAR in Nigeria. There is no long-term
plan of sustainability for either PEPFAR or the government’s program. The
initial PEPFAR plan was to allocate drugs and treatment for five years, which
was extended to an additional ten years by the Bush administration. In the
meantime, the Nigerian government plan is slowly yielding ground to PEP-
FAR, which is less expensive for patients.
Both programs involve different treatment regimens, are differently sub-
sidized, and are highly politicized. As a Nigerian government supplier, Ran-
baxy cornered the generic market in the early 2000s, and their drug prices
actually exceeded the cost of similar generics. There have been other ten-
sions: while at the 2004 Nigerian National AIDS conference, I witnessed a
confrontation between Ranbaxy representatives and Nigerian AIDS activists
over the fact that the company was selling ARVs at its booth without requir-
ing prescriptions. There have also been numerous incidents that indicate
that Ranbaxy does not want the more extreme problems of drug distribu-
tion in Nigeria to become public knowledge, particularly around the issue of
counterfeits. The company must contend with a popular Nigerian opinion,
held since SAP, that the majority of counterfeits are made and exported from
India (generics and fakes can be often confused for each other, but fakes are

AIDS POLICIES FOR MARKETS AND WARRIORS 239

often referred to as “India” drugs). Moreover, the Nigerian government has
been accused of poor distribution and operations, the worst of which was a
two-month-long drug shortage in 2002, due to bureaucratic complications,
and with the implementation of PEPFAR, the government is slowly surren-
dering ground to the new U.S. operations.20
PEPFAR constitutes the largest roll out of public-health funding in his-
tory. It follows a particular policy logic initiated by Bill Clinton, who de-
clared HIV/AIDS a national security threat in the mid-1990s. Since then,
the rationales of health and security policies have increasingly merged
in several different international arenas. For example, the emerging U.S.
Africa Command (AFRICOM) intends to integrate staff structures from the
U.S. Department of State, the U.S. Agency for International Development,
and humanitarian organizations into existing military structures to con-
duct tasks ranging from managing AIDS to sharing intelligence. Indeed,
the Office of the U.S. Global AIDS Coordinator, which heads PEPFAR, has
been moved out of U.S. offices managing traditional development work and
now answers to the U.S. Department of State under the secretary of state.
Furthermore, the U.S. Department of Defense has a large role to play in the
PEPFAR countries, including Nigeria, which rank high among U.S. security
concerns. In Nigeria, not only does the Department of Defense have well-
endowed AIDS projects, but so too does the Henry M. Jackson Foundation,
a philanthropic organization dedicated to subsidizing what it calls “military
medicine,” which largely constructs infectious disease as part and parcel of
security discourse.21
Stefan Elbe (2005) shows how these events reflect the ways a range of
actors (international organizations, governments, and NGOs) are cast in the
name of the survival of communities, economics, militaries, and govern-
ments. Key here is how such mobilization is enrolled by the language of
security and emergency, which as Alan Ingram describes “takes HIV/AIDS
out of the sphere of ‘normal politics’ and creates obligations to respond in
ways that are adequate to the new salience of the problem” (2007, 516). As
a result, policy becomes less directed toward civil society and more directed
to security and intelligence (Elbe 2006; Ingram 2007). Vinh-Kim Nguyen
sums up much of these new rationales and deployments through his term
experimentality, which he describes as exercising “a new form of legitimate
domination through highly mobile, disaggregated and mutable governmen-
talities. The latter are biological and political technologies for constituting
populations and transforming subjectivities in a focused manner around a
particular predicament of government. These predicaments are framed in

240 KRISTIN PETERSON

humanitarian terms and call for urgent measures designed to save lives and
prevent suffering, which is understood as an immediate and embodied (or
even biological) phenomenon” (2007, 1).
Aside from the general merging of health, development, and security
organization and rationales, Nigeria occupies a particular place in these new
activities as it is a country that is viewed by the United States both as stra-
tegic to peacekeeping operations in Africa and, perhaps more important, as
key to security efforts related to oil supplies throughout the Bight of Benin.
Oil is crucial because it constitutes a significant chunk of the country’s in-
come, and several authors have demonstrated how security and oil are ab-
stracted, where private forms of health development erase the politics and
violence of extraction.22 In order for the rationales and linkages of partner-
ship development and security to actually take hold and play out, HIV pre-
vention and treatment policies must be rationalized as normative in pre-
cisely the same way as oil extraction and security paradigms (Zalik 2004).
Translating these paradigms into policy requires a particular form of man-
agement: indeed, PEPFAR under the Bush and Obama administrations mir-
rors the ways in which the Iraq and Afghanistan wars are managed—largely
contracted and outsourced to private partners. The indirect result is that
as West African security concerns and expansion appear to be continually
facilitated not only by anti-terrorist efforts and the search for steady oil sup-
plies, but also off the back of subsidized pharmaceutical products that rely
on AIDS treatment policies for their mobility and consumption.
One of the early predecessors to the Bush administration’s PEPFAR ini-
tiative was a lesser-known program that may mark the beginning of multi-
lateral AIDS policy networks: the United Nations (UN) Accelerated Access
Initiative (AAI) of 2000, a joint initiative among the Joint United Nations Pro-
gramme on HIV/AIDS (UNAIDS), the World Health Organization (WHO), and
the proprietary pharmaceutical industry that utilized public-relations firms
to bilaterally negotiate the reduction of high and out- of-reach drug prices
in Africa.23 In exchange, stringent intellectual-property laws were concep-
tualized, proposed, and often implemented for African states in a manner
that favored and protected multinational pharmaceutical companies’ busi-
ness practices in Africa. After a coalition of drug companies withdrew a
well-known suit against South Africa, in 2001, claiming that its 1997 Medi-
cines Act violated World Trade Organization (WTO) regulations on compul-
sory licensing and parallel importation—legislation that South Africa never
acted on—companies taking part in the AAI began to heavily recruit many
African countries to negotiate bilateral confidential agreements with the

AIDS POLICIES FOR MARKETS AND WARRIORS 241

apparent aim of wiping out the generic drug industry. Two years into the
program, ACT UP Paris reported that UNAIDS and the WHO, which orches-
trated the negotiations, never provided technical assistance to participatory
countries in protecting intellectual-property law or creating guidelines on
relations between countries and companies. The WHO and UNAIDS forfeited
power and follow up, which empowered the companies to take advantage of
the lack of UN oversight (ACT UP Paris 2002). The Health Gap Coalition de-
clared, “UNAIDS drug access policies are currently being structured, by and
large, in response to big pharma’s displeasure” (2000).
While these negotiations were hailed as some of the best and only options
to access treatment, even though only 0.1 percent more people were put on
treatment, other issues were crucially erased (ACT UP Paris 2002). At the
end of this program, drug prices were not heavily slashed, but the AAI served
as one of many now existing gateways for the proprietary pharmaceutical in-
dustry to outcompete generics by making policy that eradicated the generic
industry. Such policies and actions have shaped the compilation of future
drug markets, not simply in Africa, but throughout the world.
In addition to bilateral intellectual-property negotiations, the Trade Re-
lated Intellectual Property (TRIPS) Agreement of the WTO, to which Nigeria
is a signatory, gives proprietary pharmaceutical companies exclusive twenty-
year manufacturing, pricing, and distribution rights on their drug patents.
The U.S. government’s Agency for International Development (USAID)
funds the Commercial Law Development Program (CLDP), an initiative of
the U.S. Department of Commerce to “assist” Nigeria in complying with
TRIPS. The CLDP sponsored several meetings jointly with the Nigerian Intel-
lectual Property Law Association between 2000 and 2004. At these meet-
ings, there were many panels and instructions on how to comply with the
TRIPS/WTO geared around how Nigeria can “be on the right side of global-
ization.” Consistently, the discourse, without any explanation, was that the
stronger a country’s intellectual-property law was, the more economically
viable and powerful it would become in the global economy. Compared to
the vast numbers of intellectual-property lawyers in the United States and
European patent offices who have access to worldwide databases that can
easily determine if an invention is new or discern an intellectual-property
violation, the Nigerian patent office awards a patent if the two-page appli-
cation form is filled out correctly. Given such technological and expertise
disparities, Nigeria can hardly be expected to compete internationally or in-
stantly instantiate power in the global economy.
The United States submitted its own drafts of a new Nigerian intellectual-

242 KRISTIN PETERSON

property law to the Nigerian government, in 2002. I acquired these drafts,
which clearly showed that the United States desires a law that favors U.S.
businesses while it wipes out all legal provisions to import less expensive
generic drugs. At the “final” drafting meeting, AIDS activists (with technical
support from international actors like Médecins Sans Frontières [MSF] and
Ralph Nader’s Consumer Project on Technology) muscled their way into the
meeting to demand the inclusion of “healthcare safeguards,” which were in-
corporated into the draft. This was perceived as a great victory.
However, less than a year later, the CLDP returned to Nigeria, apparently
(at least according to rumor) under the instructions of the U.S. Patent and
Trademark Office, which had determined that Nigeria’s new intellectual-
property-law draft did not satisfy U.S. preferences. A secret meeting took
place, without activists’ or government health officials’ knowledge. But the
meeting became known when its “successful conclusion” was announced on
national television.
I acquired the latest intellectual-property draft, which may or may not
be the official document, as, historically speaking, multiple drafts have cir-
culated among Nigerian and U.S. officials, who have generated confusion
over the “real” document. However, lawyers at MSF in Europe analyzed the
draft in my possession and found that it included “data exclusivity” mea-
sures that, in short, effectively reduce the generic drug industry’s capacity
to quickly manufacture generics coming off patent. Such provisions already
carried out in other free-trade agreements allow proprietary drug compa-
nies to keep data confidential. Such an act actually undermines the origi-
nal intent of a patent that exchanged inventive data for short-term exclu-
sive marketing. Moreover, it may be a strategy that slowly whittles away
the public domain. That is, without the data in hand, a generic company is
prevented from developing the technological design to engineer a generic
product, a delay that can essentially extend the life of a patent.
USAID simultaneously funds a great number of local AIDS NGOs to carry
out prevention and education programs. To some AIDS activists, there is
the appearance of a USAID policy contradiction, which supports AIDS activ-
ism yet also works to severely curtail drug access. But there may not in fact
be a contradiction, as prevention and education campaigns are located in
the realm of individual empowerment and responsibility, drawing attention
away from the legal structures that generate obstacles to pharmaceutical
flows. AIDS activists and NGOs have objected to the relationship between the
Nigerian and U.S. governments. But this relationship demonstrates a con-
flict that the state itself has with multilateral organizations. That is, the state

AIDS POLICIES FOR MARKETS AND WARRIORS 243

opposes U.S. and European stances on treatment access at global trading
negotiations, but at the same time attempts to meet the pressure to comply
quietly behind the doors of federal ministries. This represents an increas-
ingly common strategy utilized by the United States, whereby it capitalizes
on the lack of communication between ministries, and between ministries
and Nigeria’s Geneva representatives; and bilateral and regional (trade or
otherwise) agreements become the alternative avenue and means for com-
pliance when global negotiations continually fail. Yet what exactly does it
mean for Nigeria to buy generic drugs for its own national antiretroviral
program while at the same time it cooperates with the U.S. government to
legally wipe out generic drug access? Such an action will effectively make its
own antiretroviral program illegal. Nigeria still has not complied with TRIPS,
and it is not clear when or if it will happen.

Conclusion

The “implicit agreements” made among multilateral institutions funda-

mentally drive a political economy that relies on dispossession as its pri-
mary organizational strategy. Unlike the massive state and economic ad-
justments made under the IMF that literally teeter economies on the edge
of collapse, a sustained dispossession is very particular and targeted; it takes
place amid already chaotic economic and social environments and therefore
must operate in more delicate ways that do not threaten the existing thresh-
olds of disintegration. The most particular example is found in struggles
over intellectual-property designs, which do not necessarily destroy entire
economies, but target specific industries that are viewed as especially com-
petitive; and the massive introduction of free ARV drugs that will not be sus-
tained over time will also have a similar impact on this industry.
While dispossession on a large scale produces sustained clearings for
new transnational capital to take root, there is something far more produc-
tive in the margins, as Janet Roitman would put it. But at the same time,
dispossessed capital and its new formations and mobilities have to rely on
other orchestrations of individual and institutional struggles and consent
that should suggest just how we might rethink political economy. Rationales
for public health and imperatives of capital, and humanitarianism efforts
and security cultures, combine and conflict, but ultimately show that the
AIDS crisis itself is the greatest thorn in any country’s national neoliberal
agenda, or perhaps its greatest opportunity.

244 KRISTIN PETERSON

Notes
1. Some of the literature on the global and globalization that informs my thinking
follows. On the global city, see Sassen 2001. On cosmopolitanism, see Cheah and
Robbins 1998; Derrida 2001. On globalization, transnationalism, and global net-
works, see Grewal and Kaplan 1997; Appadurai 1991; Appadurai 2001; Jameson and
Miyoshi 1998. On neoliberalism, see Comaroff and Comaroff 2000. On finance mar-
kets, see Lee and LiPuma 2002.
2. Notable recent exceptions include Ferguson 2006; Mbembe 2001; Cooper
2002; Moore 2005. James Ferguson (2006) in particular has referred to Africa as the
“inconvenient case” that runs against contemporary works of globalization, which
describe unencumbered transnational flows; particularly provocative is the analysis
by Ferguson (2005) of the way that capital does not flow but “hops” through priva-
tized spaces, especially of oil extraction.
3. I acknowledge Kaushik Sunder Rajan for helping me think through this argu-
ment.
4. I acknowledge Don Moore who spoke to me about how “emptying- out” as a
form of dispossession is generated by political technologies that contribute to cre-
ative destruction accompanied by consequential material realities.
5. Few of the globalization paradigms in circulation today entirely apprehend the
complicated ways that African states are positioned in these scenarios. That is, global
cities, finance markets, and widespread manufacturing bases do not exist on the con-
tinent in congruent ways found elsewhere in the world; and local-global relationships
do not adequately capture the nature of the state where kinship and private and pub-
lic forms of power commingle (Ake 1996).
6. Contrary to widespread popular dissent, the IMF negotiated a SAP with then
head of state General Ibrahim Babangida shortly after he took over by coup d’état.
This event marks the beginning stages of a protracted prodemocracy movement
that coexisted with a heightened culture of militarism characterized by the quest
for wealth and violence. With rising poverty and lack of security, a culture of militar-
ism lingers now into the current civilian era and importantly informs retrospective
debates and discourses about IMF fallouts such as governance, and the politics of
healthcare, pharmacy, and drug manufacturing.
7. Julia Elyachar (2005), Janet Roitman (2005), and Donald Moore (2005) examine
the micropolitics of dispossession and the various forms of reinvestment and politi-
cal stakes in Egypt, the Chad Basin, and Zimbabwe, respectively.
8. George Caffentzis (1995) made an almost identical argument about structural
adjustment and dispossession in Africa, where he traces its dramatic impact on social
transformation.
9. According to official statistics, oil wealth makes up over 46 percent of Nige-
ria’s gross domestic product and accounts for 85 percent of the country’s foreign ex-
change (World Bank Report 2004). The rumor on the street in Lagos is that 40 per-
cent of Nigeria’s crude oil goes missing each year (Apter 2005).

AIDS POLICIES FOR MARKETS AND WARRIORS 245

 10. Brotherton, however, refers to the Cuban state.
11. For more recent excellent analyses on oil in Nigeria, see Watts 2001; Watts
2004; Apter 2005; Naanen 2004; Okonta 2004.
12. I first found an analysis of this quote in Avery Gordon’s introduction to Cedric
Robinson’s The Anthropology of Marxism (2001), which is reprinted in Avery Gordon’s
Keeping Good Time (2004).
13. James Ferguson (2005), however, points to how these scenarios become pos-
sible when capital hops, rather than flows, into privatized sectors, like oil extraction.
14. A. P. Robertson estimates that “capital flight from Nigeria alone vary from $50
billion, to 135–150 billion, to 3,000 billion British pounds” (n.d. 5).
15. The Nigeria debt- cancellation deal of 2006 included forgiving all but the U.S.
$12 billion owed to Paris Club members. This deal included adhering to the contro-
versial IMF Support Policy Instrument, which is extended to countries that do not
need IMF loans but that nonetheless seek IMF endorsement signaling an easier re-
lease of funds from multilateral donors and banks. This mechanism extends older
forms of legitimacy-making in the context of debt-worthiness (not necessarily credit-
worthiness). In return, countries must adhere to the usual privatization schemes
geared toward foreign direct investment. Nigeria agreed to completely privatize the
national energy sector and reorganize its banking sector, among others, in exchange
for the deal.
16. In fact, one pharmacist who has worked in the national inspectorate estimated
to me that 95 percent of all registered pharmacies would not actually pass inspection;
they manage to get their licenses in exchange for money to “look the other way,” as
he put it.
17. A survey by A. O. Bright and O. Taylor (1999) showed that irrespective of
socioeconomic stratum, self-medication is very high, recording 75 percent as the
lowest figure. It concluded that if pharmacists refuse to assist the self-medicating
population, then morbidity, mortality, iaotrogenicity, and other adverse effects will
be on the increase. Their statistics on reasons for self-medication are worth reporting
here: cheapness, 32.9 percent; effectiveness, 71.35 percent; sure relief or cure, 85.23
percent; time saving, 66.19 percent; respondents with clear knowledge of pharma-
cists, 88.79 percent; respondents who would ask for pharmacist intervention, 52.49
percent; respondents who would see doctors first if ill, 9 percent; respondents who
feel they do not need a pharmacist, 36.11 percent.
18. Julia Elyachar (2005) shows how in the aftermath of structural adjustment the
poor—their networks and social practices—have been incorporated into the rhetoric
and logics of free market expansion by the World Bank and other institutions that use
an explicit neoliberal vision (and not other alternatives) to implement such policies
and practices.
19. There are several other international bilateral treatment programs that are
also part of this mix.
20. It should be noted that at least one indigenous Nigerian drug-manufacturing
firm was poised to begin producing anti-HIV medication. The subsidization of both

246 KRISTIN PETERSON

U.S. and Indian products has essentially eliminated the prospects of Nigerian manu-
facturing at this time.
21. The other top two PEPFAR countries that get Department of Defense funding
are Tanzania and Kenya, perhaps matching antiterrorist efforts since the 1998 U.S.
embassy bombings in those countries.
22. Apter 2005; Okonta and Douglass 2003; Watts 2001; Zalik 2004; Ingram
2007.
23. The pharmaceutical industry was represented by five companies: Boehringer
Ingelheim, Bristol-Myers Squibb, GlaxoWellcome, Merck, and Hoffmann-La Roche.

AIDS POLICIES FOR MARKETS AND WARRIORS 247

 PART THREE

GLOBAL KNOWLEDGE FORMATIONS

 8
ANDREW LAKOFF

DIAGNOSTIC LIQUIDITY

Mental Illness and the Global Trade in DNA

“Information is, at the end of the day, the coin of the genomics realm.”
ANTONIO REGALADO, “INVENTING THE PHARMACOGENOMICS BUSINESS”

Discussions of globalization processes often describe an increasingly rapid

flow of information, capital, and human bodies across national borders in
the wake of technological innovation and political- economic transforma-
tion. As a number analysts have noted, such increasing global circulation
operates in relation to regulatory techniques and governmental strategies—
at local, national, and transnational levels—that both encourage and con-
strain these flows (Brenner 1999; Sassen 2000).1 Examples of such tech-
niques include intellectual-property regimes, immigration policies, and
environmental standards. The negotiation of institutionalized regimes of
coordination or harmonization—the linking of places through the creation
of commensurable standards—is often necessary to make such circulation
possible. By the same token, technical and regulatory regimes can also block
the movement of goods or persons, as in the case of barriers to the sale of
genetically modified foods or ethical codes concerning the sale of human
organs.2 Recent studies of the creation and enactment of standards regimes
provide helpful tools for the analysis of the micropractices involved in cre-
ating zones of potential circulation (Bowker and Star 1999; Espeland and
Stevens 1998; Alder 1998). This chapter combines an ethnographic descrip-
tion of the process of transnational standards coordination with an analysis
of the macropolitical contexts in which such commensuration practices un-
fold. It follows a particular set of transnational flows, involving human DNA,
biomedical knowledge, and capital, whose direction is intimately related to
the relative presence of regulatory and technical regimes within different
national spaces. The goal of the chapter is to indicate the salience of episte-
mic practices for understanding the generation of value in an economy of
biological information.
Specifically, I follow an attempt by a French biotechnology company to
find and patent genes linked to psychiatric illness among a group of Argen-
tine mental patients. This genomics research was significant in its institu-
tional form, as well as in its potential implications for the reconfiguration
of knowledge about mental illness. As an alliance between biotechnology
and psychiatry across continents, and between public and private institu-
tions, it represented a new type of assemblage oriented toward the under-
standing and regulation of human behavior. The central problem it raised—
both practical and epistemological—concerned the potential universality of
genomic knowledge about mental disorder. The success of the company’s
gene-hunting effort hinged on the global validity of a set of diagnostic stan-
dards that, it was hoped, would make possible the commensuration of di-
vergent illness experience into a common classificatory scheme. Such com-
mensuration, in turn, would enable psychiatric illness to be represented as
genomic information, and would thus make the illness experience of Argen-
tine patients convertible with that of patients in other parts of the world.
How such experience was rendered liquid—that is, able to circulate and to
potentially attain value as information—is the focus of this chapter. I show
that in the case of mental illness, the effort to generate a space in which in-
formation flows seamlessly between biomedicine and the market is chal-
lenged by the difficulty of knowing just what a psychiatric disorder is. The
extraction of valuable knowledge from patients’ DNA relies on the develop-
ment of diagnostic standards whose validity and extendibility remains in
question.

Diagnostic Liquidity

In June 1997 the French genomics firm Genset announced a collaboration

with the psychopathology department of a public hospital in Buenos Aires
to collect and map the DNA of patients suffering from bipolar disorder. The

252 ANDREW LAKOFF

genes or markers linked to susceptibility to bipolar disorder, if found, were
to be patented by Genset as part of its strategy to enter into partnerships
with major pharmaceutical companies for the development of new diagnos-
tic and therapeutic technologies.
The process of gathering large amounts of data about the prevalence of ill-
ness in populations has historically been linked to state-based public-health
initiatives: in order to gauge and improve the health of the population, na-
tional and multilateral health agencies have, in collaboration with public-
health experts, sought to accumulate knowledge about the spatial incidence
of disease. Recent genomics research in places like China, Iceland, Russia,
and Argentina is distinctive in that it is often conducted by private database
firms in collaboration with local clinics. The case I describe here—in which
the actual collection of DNA was carried out by local clinicians working in
public hospitals, under contract to a genomics database firm—is not atypi-
cal of such arrangements—though it was more informal and less visible
than, for example, deCODE’s work in Iceland. This pattern of collaboration is
conditioned on recent economic and technoscientific developments: on the
one hand, the emergence of health as a significant global marketplace, and
on the other hand, the rapid development of DNA-sequencing technology
and bioinformatics in the wake of the Human Genome Project. For this
reason, highly capitalized biotech firms have become interested in the pos-
sibility of attaining valuable genetic information through research on spe-
cific local populations. In this emergent space of exchange between indus-
try and the life sciences, the role of government remains salient: the health
marketplace as a target of technoscientific innovation is structured by the
legal forms that ensure that biological information can attain value—that is,
intellectual-property regimes.
It should be emphasized that this strand of genomics research targets
health consumers in the advanced industrialized countries. The most valu-
able information in the health marketplace pertains to specific kinds of
populations: North Americans and Europeans at risk of chronic illness,
whose insurance will pay for the extended use of patented medications.3 In
this context, the type of DNA collection and analysis I describe here seeks
to demarcate specific illness populations that are simultaneously poten-
tial market segments. As this case illustrates, in poorer parts of the world
patients serve as potential sources of valuable knowledge rather than as tar-
get markets, and they are often easier to access due to relaxed regulatory
controls.
The Genset bipolar study was one of a number of transnational projects

DIAGNOSTIC LIQUIDITY 253

in the late 1990s involving newly minted genomics database firms based in
the United States or Western Europe and health clinics in other parts of the
world that were contracted to provide supplies of DNA from sample popula-
tions.4 The sense was that there were hidden riches buried in the genomes
of these clinically diagnosed patient populations.5 As the Human Genome
Project progressed, what the legal theorist James Boyle called “an intellec-
tual land grab” (1996, 9) began as genomics database start-ups competed to
find and patent genes or genetic markers linked to common, complex dis-
orders.6 Like other claims to property rights in genetic material, the Genset
study was, as Sheila Jasanoff writes, “a project in mining nature for extract-
able entities that can freely circulate” (chapter 4, this volume).7 While the
value of such genes was still a matter of speculation, genomics database
companies were confident that patented sequence information would prove
a marketable resource in the burgeoning health marketplace. In Argen-
tina, Genset sought to secure a supply of blood samples from an ethnically
diverse patient population whose genetic background was similar to that
of European and North American target markets, but without certain of
the regulatory and legal complications that characterized such work in the
North.
At stake in the process of gathering, analyzing, and developing propri-
etary knowledge from patients’ DNA samples was the relation between truth
and value in the global biomedical economy. At the scientific level, the trans-
lation from genetic material to significant information depended on the
validity of the diagnostic criteria used in gathering sample populations—
criteria that in the case of psychiatric disorders had emerged in local and
contingent circumstances. The economic value of such information, mean-
while, hinged on an intellectual-property regime that granted monopoly
rights to genomic innovation and on a market—or an imagined future mar-
ket—that structured demand for such information. Transnational epidemi-
ology, in turn, made it possible to locate that market and estimate its size.
A key question arose in Genset’s research that focused attention on the
classificatory devices to be used in gathering the sample population: to what
extent could these diagnostic criteria be claimed to measure the same thing
across different spaces? How to know, for instance, whether a case of bipolar
disorder in the United States was the same “thing” as a case of bipolar dis-
order in Argentina? Recent work in the social studies of science and medi-
cine has investigated the processes through which the apparently universal
validity of biomedical knowledge is materially and discursively forged via
the standardization of practice across multiple domains.8 This work indi-

254 ANDREW LAKOFF

cates that the spread of standardized protocols does not necessarily produce
equivalent practices in diverse sites (Mol and Law 1994). Thus, for example,
Timothy Choy demonstrates the variable ways in which a “standard” tech-
nique for measuring air pollution is implemented across structurally dif-
ferentiated global space (Choy, chapter 3 in this volume). In the case of the
Genset study, what must be examined is the complex process of commensu-
ration that was necessary for subjects with diverse histories and experiences
of illness to both recognize themselves as having bipolar disorder and to be
so classified by doctors. At the same time, the difficulties faced in conduct-
ing the study illustrate local epistemic and political challenges to producing
such equivalence.
To analyze the process of forging consistent illness populations so that
Argentine patients’ DNA could enter into circulation, I borrow the term
liquidity from the field of finance. Bruce Carruthers and Arthur Stinch-
combe (1999) analyze liquidity in futures markets as an example of the pro-
duction of standardized value—the creation of generalized knowledge about
value out of idiosyncratic personal knowledge. They argue that producing
equivalence out of specific entities involves both social regulation and po-
litical negotiation. Standardization is a social and cognitive achievement:
buyers, market makers, and sellers have to share the conviction that “equiva-
lent” commodities are really the same. Turning an illiquid asset into a more
liquid one is a process of reduction and standardization of complexity.
To be transferable—liquid—an asset must lose its particularity and
locality. Classificatory technologies work to simplify, stratify, and standard-
ize such assets. Thus—to use Carruthers’s and Stinchcombe’s example—
a distinctive house becomes a liquid asset only when there are agreed- on
conventions for evaluating it in comparison with other houses. Similarly,
William Cronon (1991) has shown how wheat was made into a liquid com-
modity in nineteenth- century Chicago through the invention of a set of
technical standards for classifying the characteristics of specific bushels of
wheat in terms of more general quality grades that made it unnecessary
for buyers to inspect each bushel purchased.9 Individualized evaluations
of quality were thus shifted into collectively sanctioned criteria, enabling
bushels of wheat to be abstracted and circulated as currency. In order to suc-
cessfully implement such a system, the existence and legitimacy of a gov-
erning body that regulates the practice of measurement is crucial.
It is possible to consider the circulation of bipolar patients’ DNA in terms
of this process of abstraction through technical classification: the patients’
illnesses assumed potential informational significance—and therefore,

DIAGNOSTIC LIQUIDITY 255

value—only insofar as their specific life trajectories could be brought into
a shared space of regulated measurement. That is, their illnesses had to
be made “liquid.” From the vantage of genomics research, one should not
need to know about the specific life trajectory of the person from whom
DNA has been extracted in order to evaluate the significance of the informa-
tion it bears. Diagnosis is the convention that produces such equivalence.
In the case of bipolar disorder, what might seem like an implausible asso-
ciation then becomes natural: a young woman who has attempted suicide
in Buenos Aires is brought into potential relationship with a middle-aged
man in Chicago who goes bankrupt through risky business ventures. They
are both members of a group of previously distinctive individuals who now
share a diagnosis.10 The emergent group is alternately an epidemiological
population, a market segment, and a community of self-identity.
Thus, while “liquidity” is typically understood in terms of finance, here
techniques of classification enable biomedical knowledge to be assimilated
to the domain of market exchange, shaping a hybrid commercial-epistemic
milieu. In biomedicine, forging such a space of liquidity requires consis-
tent classificatory practice among doctors—a problem that remains fraught
in psychiatry, especially in Argentina. In what follows I describe how doc-
tors in Buenos Aires performed classificatory work with psychiatric patients
in order to render their illnesses liquid—that is, abstract and therefore ex-
changeable. This process involved the temporary extension of both a tech-
nical and an ethical standards regime. The setting of the DNA collection in
Argentina revealed not only the reliance of technoscientific objects, such as
bipolar genes, on such regimes, but also the limits to their extension.

Circulatory Networks

The bipolar study crystallized through a contingent set of associations and

opportunities—though one structured by the processes of biological value
creation. In 1997 Daniel Mendelson, an unemployed Argentine molecular
biologist, was making a living by supplying genetic material from human
organ tissue to Genset, a French biotech company that was building a cDNA
library—a compilation of expressed human genes for use in detecting sig-
nificant genetic information. Mendelson’s work was a bit grisly. He would
call up contacts who worked in forensic-pathology laboratories in Buenos
Aires hospitals, and ask them to send over healthy tissue from newly dead
cadavers. Genset wanted various organs for its collection: kidneys, hearts,

256 ANDREW LAKOFF

even brains. Once the tissue was sent over to him, Mendelson would process
it in a lab he had rented at the Campomar Institute, a well-known biological-
research center near the Parque Centenario in Buenos Aires. He had been
trained there before leaving to do postdoctoral work at the Pasteur Institute
in Paris with his wife, Marta Blumenfeld, also a molecular biologist. Now
she was vice president of genomics at Genset, and he was struggling to
establish a beachhead back home in Buenos Aires.
Mendelson had a new idea: they could expand their business of providing
genetic material by obtaining DNA samples from patients with mental dis-
orders. Genset was looking for populations of patients who had been diag-
nosed with schizophrenia and bipolar disorder for its gene- discovery pro-
gram in complex diseases. An old friend of Mendelson’s and Blumenfeld’s
from school now worked as a psychiatrist at a general hospital in Buenos
Aires where patients could be recruited. After some back-and-forth nego-
tiation, the details were worked out: Genset would give a hundred thousand
dollars to Hospital Romero for structural improvements, and in exchange,
doctors there would provide blood samples from two hundred patients diag-
nosed with bipolar disorder, types I and II.11
Genset was in a hurry to acquire such material. As a genomics database
company, its strategy depended on finding and patenting genes linked to
susceptibility to common, complex diseases. With its growing patent port-
folio and proprietary genomic-search technologies in hand, Genset sought
partnerships with large pharmaceutical firms to develop new diagnostic and
therapeutic applications. It had recently formed strategic alliances with Ab-
bott Pharmaceuticals, a leader in the diagnostics market as well as the maker
of the leading medication for bipolar disorder, and with Janssen Pharma-
ceuticals, producers of the antipsychotic drug Risperdal. Pharmaceutical-
industry strategists expected the next series of significant discoveries of
drugs for mental disorder to come out of the Human Genome Project;
closer on the horizon was the prospect of diagnostic tests linked either to
disease-susceptibility or medication-response. In order to have commercial
rights to such products, Genset had to beat a number of competitors, in both
the academic realm and the private sphere, to the relevant genomic loci. The
alliance with Abbott was an early signal that major players in the pharma-
ceutical industry saw genomics as an important strategic arena. Given the
possibility of royalties on a range of products, it seemed in the late 1990s—a
moment of intense speculation in the life sciences, both conceptual and
financial—that genomic information had potentially exponential value. As

DIAGNOSTIC LIQUIDITY 257

one biotech analyst wrote of the collaboration, “The Genset-Abbott deal is
clearly geared toward creating a resource that the pair can sell again and
again” (Regalado 1999, 45).
The value of such resources relied not only on the construction of a mar-
ket in genomic information, but also on the prospect that something scien-
tifically significant would be found—which was by no means a foregone con-
clusion. Despite decades of academic research and a string of false alarms,
no genomic loci had yet been confirmed to be linked to any of the major
psychiatric disorders. According to Mendelson, it had only recently become
possible to hunt seriously for such genes. First, developments in molecular
biology and information technology now allowed genome-wide searches for
disorders characterized by complex genetic and environmental interactions.
Genset’s proprietary SNP (single nucleotide polymorphism) map provided
dense markers to guide its researchers through the immense human ge-
nome, giving it an edge over academic and private-sphere competitors.12
And second, it was now possible to forge coherent populations of clinically
diagnosed patients: standardized criteria for diagnosing bipolar disorder
had been spelled out in 1980 with the publication of the third edition of the
diagnostic manual of the American Psychiatric Association and had evolved
in subsequent editions.13
Mendelson explained the process of looking for single nucleotide poly-
morphisms—natural variations in the genome—associated with bipolar dis-
order: if Genset could find a corresponding variation in multiple patients, it
was likely that a susceptibility locus would be near, or statistically associated
with, that variation. It was not a new or original scientific idea, he admitted,
but it was one that was, practically speaking, daunting, requiring massive
gene-sequencing and bioinformatics capabilities. Five years before it would
have been technically unimaginable.
Once Mendelson and Blumenfeld made arrangements with Genset on
the one hand, and with the hospital on the other, there was some delay in
getting the DNA collection going. First, the Buenos Aires city government
blocked the project on the grounds that it violated a law against trafficking in
blood. After the concerned parties convinced the city’s legal office that DNA
was distinct from blood, and therefore saleable, another problem emerged:
according to city regulations, a public hospital could not be paid by a private
company for its services. This regulation was eventually circumvented, with
the help of contacts in the municipal government, by changing the wording
of the contract from “payment” to “voluntary donation.” By the time such
regulatory hurdles had been taken care of, six months had passed.

258 ANDREW LAKOFF

 And then, when the study finally began, doctors at the hospital faced an
unexpected problem: they could not find enough bipolar patients. It turned
out that bipolar disorder was rarely diagnosed in Argentina. The North
American diagnostic system in which it was recognized had not permeated
the Argentine mental-health world, nor had “bipolar identity” spread to raise
awareness of the condition among potential patients (Jamison 1997). With-
out such techniques of classification in place, the extraction and exchange
of DNA could not begin. Doctors in the men’s ward at Hospital Romero re-
mained in need of donors even after recruiting at a nascent self-help group
for patients with bipolar disorder, and were forced to make announcements
in the newspapers asking for volunteers. In July 1998 a number of articles
appeared in the city’s major dailies describing the symptoms of bipolar dis-
order and promoting Romero’s study.14 These articles were in part geared
to inform the public about what bipolar disorder was, given the absence of
general knowledge of the condition. The publicity campaign turned out to
be quite successful in drawing volunteers to the hospital, and by late Sep-
tember, psychiatrists in the men’s ward were almost two-thirds of the way
through their assignment to compile two hundred samples. I was able to ob-
serve some of the collection process.

Collection (I)

Hospital Romero is located in a working-class neighborhood in the southern

part of Buenos Aires. The hospital does not seem a likely place to be linked
to cutting- edge genomic research. Built in the 1930s, much of Romero is
visibly crumbling, testimony to the current conditions of public-health
infrastructure in Argentina. The psychopathology service is in especially
poor shape—Genset’s promised donation would go a long way, it turns
out. On a Tuesday morning in September, a diverse group lingers around
wooden benches in the entryway, all waiting to be attended: patients and
family members, pharmaceutical- company representatives (known as vali-
jas, or “briefcases,” because of the satchels full of samples and promotional
literature they carry around), and various cats who have wandered in from
the hospital grounds. Through a swinging door, I enter the men’s wing,
passing a dozen old cubicles, where a few patients lie on sagging cots, on the
way to the examination rooms. Some of the other patients are playing cards,
or listening to the radio. The floors are of once white, broken tile; the smell
of ammonia is in the air.
A woman in her fifties, led by her daughter, is shown into a small room,

DIAGNOSTIC LIQUIDITY 259

bare except for a few chairs. They have traveled to Romero from a town about
an hour away, having seen an article in La Nación on the study of bipolar
disorder being conducted there. After a preliminary phone interview, they
were invited for an examination at the hospital. The mother and daughter do
not seem particularly interested in the details of the gene study. They have
come not so much to give blood as to ask for help: a diagnosis, a drug, a com-
petent doctor. Gustavo Rechtman, a staff psychiatrist in his thirties, inter-
views them for about five minutes. He is formal and to the point, asking first
whether the woman has had any depressions. Yes, she answers, looking to
her daughter for reassurance. Very serious ones, adds the daughter—with
suicidal thoughts. And are these sometimes followed by euphorias? She
nods. Has she used any medications? She has taken antidepressants in the
past, and lithium—though, Rechtman notes, perhaps at too small a dosage.
Her weight indicates that there might be a thyroid condition. Rechtman
gives his diagnosis: bipolar disorder, type II—with hypomania. He men-
tions Fundación Bipolares de Argentina (FUBIPA), the support group for
bipolar patients and their families that helped publicize the study, but dis-
courages the woman from seeking further treatment at Romero: it is very
busy here, he says, and besides, this is a men’s ward.15 Instead, he will write
a note to the doctor at her health clinic telling him of the diagnosis.
Rechtman then explains the scientific research to them: a French labo-
ratory is doing a genetic study in order to eventually create a treatment, to
see if the genes of patients are different from normal genes. It will have no
direct benefit for her. Is she willing to participate? A glance at her daugh-
ter. Sure. A form is filled out: age, gender, marital status, occupation, eth-
nicity, financial status, familial antecedents, medication history. Then she
is brought to a larger room, where test-tubes sit on the table, some already
filled with blood. A male nurse, after considerable difficulty, finds a vein. A
notebook is annotated, a code number put on the test tube. While the blood
is drawn, the woman is handed a consent form, which she glances at briefly
before signing. The blood will then travel the same route as the organ tissue
before it—DNA will be extracted at Campomar and sent by special courier
on to the Genset research campus at Evry, outside of Paris.
The transferability of genetic material depended not only on Genset’s
technical capacities to derive information from the patient’s blood, but also
on the extension of an ethical-legal regime that sanctioned the technique:
norms and regulations surrounding the circulation of genetic material be-
tween public institutions and private companies, and across national bound-

260 ANDREW LAKOFF

aries. The consent form legally detached the DNA from the patient. Drawn
up by psychiatrists at Romero, it did not mention the possibility that the ex-
tracted genetic material might be patented. In a context where biomedical
research was relatively rare and doctors retained significant authority, the
consent form was not a well-recognized device, and therefore was some-
thing of a hollow ritual designed to meet the demands of the North Atlantic
ethical sphere—it would be a part of the protocol that the firm would in-
clude along with any scientific achievements in a patent application or pub-
lication. What the patient received at the hospital was not a payment, but a
diagnosis and a referral.
In general, the circumstances of the study did not especially concern ob-
servers I spoke with in Buenos Aires. Only a foreign company, some com-
mented—and certainly not the Argentine state—could possibly do such
advanced scientific work here. As for the role of the private sphere, given
Argentina’s recent history of state violence and political corruption there
was little sense that private companies were less trustworthy than the state.
And compared to some scandalous medical experiments that had recently
been publicized, this one seemed fairly innocuous, involving only the taking
of blood, and might lead to scientific advance.16 Meanwhile, there was little
worry over the political implications of finding genes linked to mental illness
or discussion of a return of eugenics—although, especially from members
of the city’s large corps of psychoanalysts, there was considerable skepticism
as to whether anything significant would be found. Nor was the question of
whether genes should be patentable much broached, except insofar as trans-
national bioethics discourse was beginning to be imported by a small circle
of legal scholars.17 Both anxieties and promises around the Human Genome
Project, so prevalent in the North, had not yet arrived in Argentina.18
For some Argentine scientists, publicity around the Genset study pro-
vided an opportunity to encourage more local attention to such issues.
Mariano Levin, a molecular biologist who had worked in France with Gen-
set’s scientific director, Daniel Cohen, suggested that Argentina was an ap-
pealing place for the study precisely because of its lack of regulations on
genetic research and patenting, not to mention that it was a good bargain
for Genset. Cohen is a “marchand de tapis,” he remarked, a rug merchant.
For what was pocket change in the field of genomics, Genset would receive
samples of diagnosed patients from a population whose ethnic origins were
similar to those of target drug and diagnostic markets in Europe and North
America. As Blumenfeld said, the city’s “outbred population,” predomi-

DIAGNOSTIC LIQUIDITY 261

nantly of Italian, Spanish, and Jewish descent, was one reason, along with
its large supply of well-trained psy-professionals, that Genset chose to work
in Buenos Aires.
Of several articles that appeared in the Argentine media concerning the
gene study, only one, in the short-lived progressive weekly Siglo XX, was
critical. This piece was accompanied by pictures of multiple Barbie and Ken
dolls, and a table, translated from Mother Jones, showing multinational phar-
maceutical companies’ claims to patented genes. The article began with a
joking reference to an Argentine penchant for melancholia: “In Canada they
study the gene for obesity. In Chile and in Tristan da Cunha, that of asthma.
In Iceland, that of alcoholism. In Gabon, that of HIV. In the international
partitioning of the body by the Human Genome Initiative . . . the French
private company Genset chose Argentina to investigate the genetic roots
of manic depression, as if this illness were an innate characteristic of the
national being” (Goobar 1998, 66).
The Genset study was used, in the article, as an opening for a discus-
sion of the potential abuses of transnational genomics research. “It’s a huge
business straddling the frontier between medicine and biopiracy,” said a ge-
neticist who wished to remain anonymous. Why did Genset bother to go to
Argentina to look for the genes? Mariano Levin was quoted in the article:
“In this country there are no laws on genetic research and patenting, which
diminishes the risks and costs if something goes badly, and increases the
benefits if the research is successful” (ibid.). Levin’s argument was not that
such research should not be conducted in the country, but rather that Argen-
tina needed to adopt and implement new forms of regulation—and ideally,
to develop its own biotechnology research sector—in order to avoid being
exploited by multinational firms seeking inexpensive genetic resources.
Alejandro Noailles, the director of Romero’s psychopathology ward, sus-
pected that the peripheral status of Argentine clinicians made the coun-
try an especially good place for Genset to do the study. This is a private
company, he emphasized in our first meeting, with a purely cost-benefit
logic, and it is relatively inexpensive for them to do the study in Argentina.
But even more, they won’t have to share patent rights with those who do
the work of collecting the samples: if the company were to do the study in
Europe or the United States, he surmised, they might have to split the pro-
ceeds with the clinicians.
The key legal device making illness-susceptibility genes potentially valu-
able was the agreement that well- characterized genes could be registered as
intellectual property, which had been supported, though not without con-

262 ANDREW LAKOFF

troversy, by European and United States patent offices since a landmark
1980 Supreme Court decision allowing living organisms to be patented
(Rabinow 1995; Jasanoff 1995). Patents guarantee an exclusive license to
commercialize discoveries for a limited time—normally twenty years. The
question of what kind of DNA sequence information was sufficient to grant
patent rights was a matter of some contention. In 1998 the director of bio-
technology examination at the U.S. Patent and Trademark Office gave a pro-
visional answer: “For DNA to be patentable, it must be novel and non- obvious
in light of structurally related DNA or RNA information taught in nonpatent
literature or suggested by prior patents” (Doll 1998, 690). After an initial
stage of broad acceptance of patent claims on new genetic information, the
tendency by the late 1990s was toward a narrower vision of patentability—
an insistence that the biological function and potential uses of the sequence
be well demonstrated. Patent or no, the eventual value of such information
was uncertain, as genomics-based products remained far on the horizon.19
Genset’s research strategy of opportunistically seeking genetically
heterogeneous patient populations was distinct from that of some other
genomics companies, such as deCODE, which sought to leverage the ethnic
homogeneity, detailed genealogical records, and comprehensive clinical
data available on the Icelandic population for its potential informational
value.20 Genset’s research also provoked a far more muted response from
the public than deCODE’s work in Iceland: while deCODE’s project led to a na-
tional referendum and a spirited transnational debate on its ethical implica-
tions, research like Genset’s remained mostly within the background noise
of the 1990s biotech boom. An exception was an article in the Guardian,
which noted that gene patenting was far from an exclusively North Ameri-
can phenomenon: “European firms have become some of the most enthusi-
astic stakers of claims on human DNA. Patent applications on no fewer than
36,083 genes and DNA sequences—28.5% of the total claimed so far—have
been filed by a single French firm, Genset. Andre Pernet, Genset’s chief ex-
ecutive officer, said: ‘It’s going to be a race. The whole genome will have been
patented two years from now, if it hasn’t been done already’” (Meek 2000).
Genset had fashioned itself as a company specializing in disorders of the
central nervous system—specifically bipolar disorder and schizophrenia. As
its founder, Pascal Brandys, said, “I believe that the brain is the next frontier,
not just in genomics but in biotechnology as a whole” (Genetic Engineering
News 2000). Given the increasing size of the central nervous system (CNS)
market, genes linked to mental illness that might provide new targets for
drug innovation or lead to diagnostic technologies were potentially quite

DIAGNOSTIC LIQUIDITY 263

lucrative. Worldwide drug sales for CNS disorders were $30 billion in 1999,
and CNS was the fastest growing product sector in the United States pharma-
ceutical market; by 2000 CNS disorders had overtaken gastroenterological
illness as the second largest market segment, after cardiovascular condi-
tions.21 A venture capitalist noted the increasing interest in the CNS market,
invoking the familiar image of the land rush: “Every doctor knows that the
brain is the final frontier of medicine, but VCS [venture capitalists] are just
now starting to sniff opportunity. There’ll be a lot of opportunities to play
this sector because there are just so many problems that fall under the head-
ing CNS” (Herrera 2001). Such opportunities ranged from Alzheimer’s dis-
ease to attention deficit disorder, anxiety, and schizophrenia. One question
that was crucial to the eventual success of such ventures was whether illness
populations as they had been classified according to the diagnostic standards
of the American Psychiatric Association could be delineated at the genetic
level.

Diagnostic Infrastructure

Noailles had recently returned from a visit to Genset’s high-tech labora-

tory near Paris, stocked with millions of dollars worth of gene-sequencing
machines and high-speed computers. There a committee of European psy-
chiatrists had gone over the research protocol for the study with Romero’s
staff to ensure consistent diagnostic practice. It was hoped that such stan-
dardized diagnostic protocols would mediate between the subjective inter-
pretation of the clinician and the impersonal evidence of the gene. Genset’s
protocol presumed that for the purposes of gathering consistent popula-
tions, psychiatric disorders were not inherently different from other com-
mon illnesses with complex inheritance patterns, like osteoporosis or dia-
betes. From this vantage, the process of making illness liquid should have
been a relatively straightforward process, at least at the level of diagnosis.
However, as Genset’s experience in Argentina proved, the ecology of exper-
tise and the dynamics of patient identity in psychiatric disorders are con-
siderably distinct from more stabilized areas of biomedicine.
Genset’s collection process was based on a more general assumption,
in cosmopolitan psychiatry, of the existence of an undifferentiated global
epidemiological space. The World Health Organization (WHO) estimated
that 2.5 percent of the world’s population between the ages of 15 and 44
suffered from bipolar disorder (World Health Organization 2001).22 If this
were the case, where were the Argentine bipolar patients? Why was it so

264 ANDREW LAKOFF

difficult for Romero’s doctors to come up with two hundred samples? Like
the WHO, Genset’s research protocol presumed that bipolar disorder was a
coherent and stable entity with universal properties. But as a number of sci-
ence studies scholars have argued, the existence of a given technoscientific
object—here, bipolar disorder—is contingent on its network of production
and stabilization.23 An individual experience of suffering becomes a case of a
generalized psychiatric disorder only in an institutional setting in which the
disorder can be recognized, through the use of specific concepts and tech-
niques that format the complexities of individual experience into a general-
ized convention.
Beginning with the publication of the third edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM- III), published by the American
Psychiatric Association in 1980, a diagnostic infrastructure came to under-
pin diverse phenomena in U.S. psychiatry, ranging from drug development
and regulation, to third-party reimbursement, clinical research, and patient
self-identity. The goal of these classificatory standards was reliability: if the
same person went to two different treatment centers, he or she should re-
ceive the same diagnosis and treatment in each place. Such standards made
it possible to forge comparable populations for research and to measure the
relative efficacy of specific intervention techniques. The Research Diagnos-
tic Criteria (RDC), forerunner to DSM- III, was developed in the 1970s for just
this reason—the need to have a standard gauge so that researchers could
meaningfully measure response to given medications across populations.
The RDC was addressed to the problem of the low reliability of diagnostic
procedures, which hampered large-scale, comparative research in psychia-
try. As its creators wrote, “A major purpose of the RDC is to enable investiga-
tors to select relatively homogeneous groups of subjects who meet specified
diagnostic criteria” (Spitzer, Endicott, and Robins 1978, 774).
The connection between the RDC and the DSM- III is significant in that it
shows how government regulations on market entry for pharmaceuticals—
the FDA’s clinical-trial requirements—eventually played a key role in trans-
forming psychiatric epistemology, structuring the need for diagnostic stan-
dards that led to the DSM revolution. Once enacted, these conventions then
proved useful across a number of arenas of administration and practice—
for insurance administration, transnational epidemiology, patient self-
identification, and the re-biologization of psychiatry as a clinical-research
enterprise.24 Diagnostic standardization in psychiatry thus made mental ill-
ness potentially transferable between the domains of industry, government,
and biomedicine.

DIAGNOSTIC LIQUIDITY 265

 However, psychiatrists trained to see patients in terms of an individual
life course are often resistant to the imposition of systems of standardized
diagnosis.25 Such classification presumes a distinctive model of illness,
which Charles Rosenberg (2002) has described as the “specificity model”
characteristic of modern biomedicine. According to this model, which first
came to prominence in the mid-nineteenth century, illnesses are under-
stood as stable entities that exist outside of their embodiment in particular
individuals and that can be explained in terms of specific causal mechanisms
located within the sufferer’s body. Disease specificity is a tool of adminis-
trative management: it makes it possible to mandate professional practice
through the institution of protocols; to engage in large-scale epidemiologi-
cal studies; to rationalize health practice more generally (Timmermans and
Berg 2003). At the intersection of individual suffering and bureaucratic ad-
ministration, the technology of standardized nosology helps to “make ex-
perience machine readable,” as Rosenberg writes (2002, 250).
While the DSM met the demand for consistent diagnostic practice across
diverse sites, the question remained whether the forging of such populations
was based on valid—rather than simply reliable—criteria of inclusion.26
Standardized psychiatric measures are founded on contingent agreements
on behavior rating scales among experts rather than on pathophysiological
measures. This is where psychiatric genomics research such as Genset’s
faced a conundrum. On the one hand, this research required that codified
diagnostic standards be in place. At the same time, it sought to eventually
remake these standards by producing a new technology of measurement,
one that would transcend the subjective evaluation of the clinician: the gene-
based diagnostic tool.
The problem of how to definitively recognize a given illness phenotype
remained critical to psychiatric genomics research, leading to professional
reflection on the process of mutual adjustment between the surface and
substrate of mental disorder. In a review of “psychiatry in the postgenomic
era” in 2002, two leading experts focused specifically on this challenge—as
a conceptual as well as a practical problem.

There will be critical conceptual difficulties and none are more impor-
tant than readdressing the phenotypes of mental disorders. The ability of
genomic tools to find the appropriate disease-related gene(s) is limited
by the “quality” or homogeneity of the phenotypic sample. . . . There will
be a somewhat circular process of understanding phenotype as we gain
a better understanding of genotype; this, in turn, will affect our under-

266 ANDREW LAKOFF

 standing of phenotype. All of this circularity may seem unsettling and
unsatisfying to philosophical purists and it is difficult to see any way out
of a process of constant adjustment. However, in the meantime, it is criti-
cal that we collect broad and thoughtful phenotypic information and not
be handcuffed by diagnostic criterion sets that have reliability as their
strong suit but were never meant to represent valid diagnostic entities.
(Kopnisky and Hyman 2002)

Thus experts were at once using the agreed- on definitions of illness

phenotypes such as bipolar disorder and assuming that these definitions
were provisional and would be superseded by advances in genomics. In-
deed, the psychiatrists who were gathering blood samples at Romero were
skeptical that the diagnostic protocol given to them by Genset would be suf-
ficient to find a gene. In our discussions they remarked that several differ-
ent forms of the illness were being conflated in the study’s protocol. A jour-
nalistic account of the study characterized this concern: “For the Argentine
psychiatrists, this classification could be insufficient. As a matter of fact,
they admit, other classificatory schemes point to the existence of up to six
types of presentation of the illness, which for a long time was considered a
psychosis and now is characterized as an affective disorder” (Navarra 1998,
section 6, page 4).

Genotype and Phenotype

How did the modern form of “bipolar disorder” come into being in the
first place? It is an especially intriguing category of illness because it seems
to exist on both sides of certain key boundaries of mental disorder—the
boundary between affective and thought disorder, or in psychoanalytic epis-
temology, between neurosis and psychosis. Moreover, its increasing visi-
bility over the past two decades relates to the rise of pharmaceutical treat-
ment in psychiatry.
From the early twentieth century until the introduction of psychophar-
maceuticals, in the 1950s and 1960s, the “functional psychoses” such as
manic- depression and schizophrenia were seen as chronic conditions re-
quiring life-long institutionalization. With the introduction of psychotropic
medication and then regulatory demands for randomized clinical trials, a
drug market in antipsychotics and mood stabilizers was created and popu-
lations for clinical research were delineated.27 Following confirmation of the
effectiveness of lithium in the 1960s, bipolar disorder became a rare suc-

DIAGNOSTIC LIQUIDITY 267

cess story within psychiatry, able to be managed if not cured.28 Despite the
disorder’s relatively privileged place in the field, the boundaries of the dis-
order as well as its origins and its defining symptoms remained at issue up
through the 1990s.
According to the American Psychiatric Association’s DSM- IV (1994)—
which guided Genset’s protocol—bipolar disorder was characterized by fluc-
tuations in mood, from states of manic excitement to periods of abject de-
pression. The presence of affective disorders within the patient’s family was
also a diagnostic clue. There were at least two types of bipolar disorder: type
I was “classic” manic- depression, characterized by severe shifts in mood
between florid mania and depression; type II included cases where severe
depression is punctuated not by full-blown mania, but by mild euphoria,
“hypomania” (American Psychiatric Association 1994). The condition had
to be diagnosed longitudinally, since in its synchronic state it could be diffi-
cult to differentiate the manic phase of bipolar disorder from the delusional
symptoms of schizophrenia, or at the other extreme, from the melancholia
of major depression.
But it was uncertain whether bipolar disorder was truly distinguish-
able from schizophrenia or depression, as the ambiguous status of “schizo-
affective disorder” suggested. Genetic and neurological studies continued
to confound researchers trying to establish consistent means of differentia-
tion. Estimates of its prevalence in the population ranged from 0.5 percent
to 5 percent, depending on the criteria of inclusion used.29 Some psychia-
trists argued that there was a “psychotic continuum” from bipolar disorder
to schizophrenia, from predominately affective traits to thought disorder.30
Meanwhile, expert advocates of the diagnosis claimed that many actual bi-
polar patients had been incorrectly diagnosed with unipolar depression and
given antidepressants, which could set off a manic episode (Akiskal 1996).
Such proposals would radically expand the bipolar population. Geneticists
struggled to define the disorder’s boundaries in order to gather consistent
populations for research: “There is growing agreement that in addition to
BPI [bipolar illness], MDI [manic- depressive illness] encompasses several
mood disorders related phenomenologically and genetically to BPI. These
include bipolar disorder type II . . . some cases of major depressive disorder
without manic symptoms . . . and some cases of schizoaffective disorder (in
which symptoms of psychosis persist in the apparent absence of the mood
disorder). The MDI phenotype may include other, milder manic- depressive
spectrum disorders such as minor depression, hypomania without major de-

268 ANDREW LAKOFF

pression, dysthymia, and cyclothymia, but this is less certain” (MacKinnon,
Jamison, and DePaulo 1997, 356).
Would finding susceptibility genes once and for all pin down the thing-
ness of the disorder? In academic studies of the genetics of bipolar disorder,
the late 1990s were a time of frustration. While twin and family studies had
indicated heritable susceptibility since the 1930s, hopes that the advent of
techniques for gene identification in molecular biology would quickly make
it possible to find the biological mechanisms involved were disappointed.
After a period of excitement in the 1980s, as various reports of loci for
linked genes appeared, a decade later the glow had receded after repeated
failures to replicate such studies (Leboyer et al. 1998). Experts gave dour as-
sessments of the state of the field: “In no field has the difficulty [of finding
genes linked to complex disease] been more frustrating than in the field of
psychiatric genetics. Manic depression (bipolar illness) provides a typical
case in point,” wrote two Stanford geneticists (Risch and Botstein 1996, 351).
By 2001 newly reported findings of a susceptibility locus on chromosome 10
were greeted warily by researchers (Bradbury 2001, 1596).
There were a number of possible suspects for the mixed results: “The
failure to identify BP-I loci definitively, by standard loci approaches, prob-
ably reflects uncertainty regarding mode of inheritance, high phenocopy
rates, difficulty in demarcation of distinct phenotypes, and presumed ge-
netic heterogeneity,” wrote a team at University of California, San Francisco
(Escamilla et al. 1999).31 In other words, these researchers thought that con-
ceptual difficulties around defining the phenotype for diagnostic purposes
posed an insuperable technical challenge. The Stanford researchers, in con-
trast, argued that no dominant gene had been found because of the biologi-
cal complexity of the inheritance mechanism.32 Surveying the state of the
field, some geneticists posed a worrisome question about the diagnostic
entity they were looking at: “The question remains: do our modern defini-
tions of clinical syndromes (presently considered as phenotypes) accurately
reflect underlying genetic substrates (genotypes)?” (Leboyer et al. 1998).
In other words, for the purposes of genetic studies, was there really such a
thing as bipolar disorder?
The phenotype question created a paradox for these studies: on the one
hand, genetic research promised to resolve such problems by making clear
the underlying biological processes: “Currently the major problem is the un-
known biological validity of current psychiatric classifications and it is worth
bearing in mind that advances in molecular genetics are likely to be instru-

DIAGNOSTIC LIQUIDITY 269

mental in providing the first robust validation of our diagnostic schemata”
(Craddock and Jones 1999, 586). In order for such validation to occur, re-
searchers had to know what they were working with. Yet they lacked objec-
tive tools to do so: “In the absence of a clear understanding of the biology
of psychiatric illnesses the most appropriate boundaries between bipolar
disorder and other mood and psychotic disorders remain unclear” (Crad-
dock and Jones 1999, 586). Genetic studies might even turn out to under-
mine the notion of a clear distinction between these disorders: “One of the
exciting developments has been the emergence of overlapping linkage re-
gions for schizophrenia and affective disorder, derived from studies on in-
dependently ascertained pedigrees. These results raise the possibility of the
existence of shared genes for schizophrenia and affective disorder, and the
possibility that these genes contribute to the molecular basis of functional
psychoses” (Wildenauer et al. 1999, 108).
The unfulfilled promise of genetics led psychiatry back to an old curse:
the problem of how to stabilize its objects—that is, how to ensure that its ill-
nesses were “real” things, whose contours could be recognized and agreed-
on by diverse experts. Despite the discipline’s adoption of neuroscientific
models, and ongoing genetic and neuroimaging research into mental dis-
orders, the question of the relation of psychiatry to biomedicine remained:
to what extent could psychiatric conditions be considered equivalent to “so-
matic” illnesses? The effort to achieve such equivalence was one rationale
for the re-biologization of U.S. psychiatry beginning in the 1980s (Lakoff
2000; Luhrmann 2000). Difficulties in confirming genetic linkage chal-
lenged the legitimacy of psychiatric knowledge, and the very existence of its
objects. A leading researcher expressed frustration at the place of psychiatry
in genetics research: “[Psychiatric geneticists] continue to face an obstacle
that does not hinder their colleagues who investigate non-psychiatric dis-
eases; psychiatric phenotypes, as currently defined, are based entirely on
clinical history and often on subjective reports rather than directly observed
behaviors. . . . In no other branch of medicine have investigators (and practi-
tioners) been called on to demonstrate time and again that the diseases they
study really are diseases” (Gelernter 1995, 1762, 1766).

Epistemic Milieu

This problem was especially palpable in Buenos Aires, as doctors struggled

to locate patients who had been diagnosed with bipolar disorder. The dearth
of bipolar subjects in Argentina was due not to a cultural difference in the

270 ANDREW LAKOFF

expression of pathology or to the country’s genetic heritage, but to a differ-
ent set of conceptions and practices, within its professional milieu, of the
salient forms of disorder and the tasks of expertise.33 The nosological revo-
lution in North American psychiatry—the shift to DSM- III and its succes-
sors beginning in 1980—had not extended to the Southern Cone. In Argen-
tina, the DSM faced professional resistance on both epistemological and
political grounds. The pervasive presence of psychodynamic models among
psy-professionals led to an emphasis on the unique clinical encounter be-
tween doctor and patient, and a suspicion of diagnostic categories that pur-
ported to generalize across cases. Meanwhile, there was political opposition
to the incursion of such standards on the grounds that they were being im-
posed in the interest of managed care and pharmaceutical industry inter-
ests. Many Argentine psychiatrists associated the use of the DSM with neo-
liberalism, the privatization of state industries, and the dismantling of the
welfare state.
A number of absences also made resistance to standardization more fea-
sible: in contrast to the North American situation, the Argentine psychi-
atric profession was not structured by a demand to forge populations for
epidemiological or neuroscientific research. Disciplinary prestige did not
come from producing scientific articles in transnational journals, and pro-
fessional training did not include an emphasis on standardized diagnostic
classifications. Further, insurance reimbursement systems did not require
the use of “evidence-based” protocols in diagnostic and intervention deci-
sions. Thus, while the Argentine patient population had been made avail-
able for genomic research in ethicolegal terms by Genset’s contract with
Hospital Romero and the consent form, it had not been rendered equivalent
in epistemological terms.
Across the hallway from where the genetic study was being conducted,
the women’s ward of Romero’s psychopathology service achieved the sur-
prising feat of practicing Lacanian analysis within a public hospital that
served a predominantly poor and socially marginal population.34 A num-
ber of times women who had received a bipolar diagnosis and then given
blood samples for the Genset study in the men’s ward were later hospi-
talized across the way, during psychotic episodes. Such patients’ claims to
be bipolar were mostly disregarded by the physician- analysts there, who
saw such self- diagnosis as a form of resistance to subjective exploration in
psychoanalytic terms, and considered “bipolar disorder” to be a condition
that owed much of its existence to the promotional efforts of the pharma-
ceutical industry.35 As they saw it, their task was to penetrate beneath these

DIAGNOSTIC LIQUIDITY 271

generalizing categories to understand the distinctive life history and process
of subject-formation of the patient.
Meanwhile there remained the question of how the patients themselves
understood their condition. Given the prevalence of psychoanalysis in
Argentina, and the absence of the kind of patient self-help movements that
have transformed the North American milieu, it was not necessarily a recep-
tive site for the inculcation of “bipolar identity.” The problem for Genset was
at one level a technical one: how to find a pool of patients that would prove
amenable to genomic research. But insofar as psychiatric diagnosis also
names a subjective mode, the question involved self-identity as well. Bipolar
self-identity—which emerged in the United States as part of a burgeoning
self-help apparatus—was not widespread in Argentina.36 To what extent
did subjects who entered Romero come to see their own life trajectories in
terms of an illness characterized by extreme mood swings that had a biologi-
cal underpinning? An unusual case during the sample collection illustrated
some of the complex interactions between patient self-understanding and
professional diagnosis that characterizes psychiatric conditions.

Collection (II)

On a Thursday morning in the men’s ward, more potential DNA donors have
come for their appointments. In one examination, a young woman does
most of the talking, rapidly and in disjointed bursts. She is a psychoana-
lyst, she explains, and so she does not believe in genetic explanations. But
a patient of hers, a friend—who had read about the study in the paper—
told her that she had certain characteristics that seemed like they could be
“bipolar,” so she decided to come, just in case, out of curiosity. She does
not want to give her name: professionally, she says, it would be bad for her
reputation if it were known that she had come to find out about her ge-
netic makeup. It soon becomes apparent that the woman thinks that there
is already a genetic test available for bipolar disorder, and she has come to
Romero to take it. She is not sure whether she really wants to know, or even
if it would be possible to know such a thing through a blood test. When
Rechtman finally makes it clear that in fact there is not yet a genetic test,
but the hospital is collecting samples in the hopes of finding such genes, she
begins to protest the very premise of the study.
“How can you possibly know a person’s diagnosis if you haven’t been
treating them?,” she demands. She cuts off Rechtman’s response, explain-
ing that in psychoanalysis, you have to establish a transferential relationship

272 ANDREW LAKOFF

with the patient in order to see the psychic structure. The whole operation
seems rather suspicious to her. She eyes the anthropologist: what is he writ-
ing down? Rechtman tries to calm her, explaining the rationale for diagno-
sis: “There are certain signs of the disorder—for instance, what was it that
your friend noticed?” The woman lists a few symptoms: insomnia, cocaine
use, depressions, an eating disorder. “My analyst says that I’m an obsessive,”
she explains.
“But the psychoanalytic clinic has its limits,” she muses. “Perhaps if there
were something physical?” They debate further, back and forth, and the dis-
cussion becomes acrimonious. Finally, Rechtman tries to close off the ex-
amination: “I wouldn’t include you in the study, because it’s not clear what
you have.” “But what else could it be?,” she asks, now almost wanting to be
convinced. “Maybe it’s what your analyst says, obsessive neurosis,” he sug-
gests skeptically. “But I suspect that it is bipolar disorder.” She muses for a
moment, then poses another question: “What does Prozac have to do with
all this?” Rechtman throws up his hands. At last, they reach a labored con-
clusion, agreeing to disagree. Her DNA will not be among the samples sent
by courier to Paris. She has rescued her professional pride, and declined to
shift her identity. Educated, middle class, and porteña, she retains her model
of mental distress.
Despite her protestations, the woman’s presence at the hospital indicated
a certain urge to shift her conception of herself, to try new explanations and
interventions. Because the experience of psychiatric disorder interacts with
the characteristics of the disorder, its diagnosis is a moving target.37 Psychia-
try, in part because it depends on patients’ subjective reports of their symp-
toms, has had a difficult time shifting the disorders under its purview into
stable things in the world. The search for genes related to mental illness is,
among other things, an attempt to turn mental disorders into more durable
entities. Yet it seems that the discovery of loci of genetic susceptibility would
not necessarily make such illnesses less complex. As the interaction above
illustrates, knowledge of susceptibility is likely to add a layer of complexity to
patient self-understanding and to provide a set of new possibilities of interven-
tion, rather than to reduce mental illness to purely organic determination.38

Local Conditions

The historian Ken Alder writes, “understanding the process by which arti-
facts come to transcend the local conditions in which they are conceived and
produced should be one of the central tasks facing any satisfactory approach

DIAGNOSTIC LIQUIDITY 273

to technology” (1998, 501). The DSM emerged from a specific conjuncture
within North American psychiatry in the 1970s, and spread to other sites—
both administrative and scientific—because of its ability to make behavioral
pathology transferable across domains. The DSM was not just an isolated set
of technical innovations within psychiatry. Its eventual widespread use in
professional milieus (and resulting controversies from such use) had to do
with its ability to serve a diverse set of needs: for drug development given
regulatory guidelines; for insurance protocols based on “evidence-based
medicine”; for the re-professionalization of psychiatry as a biomedical sci-
ence.
Technical protocols such as diagnostic standards structure the produc-
tion of a space of liquidity: they mediate between the domains of science,
industry, and health administration. Such technologies are part of an infra-
structure, both material and conceptual, that enables goods, knowledge, and
capital to flow across administrative and epistemic boundaries. They link
social needs such as health to profit-seeking ventures and to scientific com-
munities. The use of such technologies in material practices such as pro-
fessional standardization and DNA collection underlies the abstraction of
a global biomedical information economy. In this sense they point to the
“conditioned contingency” (Rabinow 2004) of phenomena such as the Gen-
set study and the value of bipolar genes. There was no inevitable telos—no
underlying logic of capital—directing the creation of value from Argentine
patients’ genes. At the same time, there were “structural” reasons for the
form that the assemblage took: it was no coincidence that patients from
Buenos Aires were providing material for the creation of products destined
for consumer markets in the North.
The case also points to limits to the capacity of standards to transcend the
local. The setting in Argentina indicates that the extension of a diagnostic
infrastructure does not occur uniformly across space but rather through net-
works, and must be supported or imposed by institutional and regulatory
demands. The shift in North American and Western European psychiatry
from “clinical” to “administrative” norms had not taken hold there by the
late 1990s, despite efforts to privatize parts of health management along
North American lines. The advance of the DSM was an element in a health
apparatus oriented toward bureaucratic management that had not suffused
the Argentine milieu. Nor was there a significant patient-activist movement
shaping collective action around the recognition and legitimacy of specific
disorders. And a professional culture whose epistemological forms were in-
commensurable with the DSM was entrenched. For these reasons, individual

274 ANDREW LAKOFF

clinicians retained considerable autonomy in terms of diagnostic and thera-
peutic practices.
The difficulty of finding bipolar patients in Buenos Aires pointed to the
halting extension not only of diagnostic standards, but also of modes of
self-identification around illness labels such as bipolar disorder. In order
to be a viable diagnostic entity, the disorder needed an epistemic niche in
which it could take root and thrive. Bipolarity came into being temporarily
in the men’s ward of Hospital Romero, but only through the imperative to
find a sufficient sample of patients for the Genset study. In turn, it disap-
peared when patients traveled to the women’s ward. Patients’ illnesses were
rendered liquid without permanently transforming patient-identity, since a
diagnostic infrastructure for managing health in terms of specific subpopu-
lations was not in place. Thus, while information may be “the coin of the
genomics realm,” the extraction and circulation of such information is not a
simple matter. In the case of mental illness, the value of genomic informa-
tion depends on the stabilization of the very thing it claims to represent—
the disorder itself.

Notes
Thanks to Kaushik Sunder Rajan and to the participants in the “Lively Capital” work-
shop for their generous comments and suggestions. Earlier versions of this chapter
have appeared in Theory and Society 34 (2005) and in Andrew Lakoff, Pharmaceuti-
cal Reason: Knowledge and Value in Global Psychiatry (Cambridge University Press,
2006).
1. For the description of an emergent anthropology of global technoscientific and
administrative forms, see Collier and Ong 2004.
2. For the case of the organ trade, see Cohen 2004. For the case of Europe as a
“technological zone,” see Barry 2001.
3. For an analysis of the logics of value underlying the identification of “unhealthy”
populations in need of chronic medication in rich countries, see Dumit (chapter 1 in
this volume).
4. A project conducted in rural China by Millennium Pharmaceuticals in collabo-
ration with Harvard University and seeking genes linked to asthma provoked a scan-
dal after an investigative report appeared in the Washington Post (Pomfret and Nelson
2000).
5. “Mining” was a common metaphor for the search for potential riches hidden in
the human genome. As an article about a Genset research collaboration in China put
it in 1996, quoting Genset’s president: “China’s population is a gold mine of genetic
information. The country’s rural populations have remained relatively static this cen-
tury, so each region has a unique blend of genes and diseases. This makes it much

DIAGNOSTIC LIQUIDITY 275

easier to trace hereditary diseases back to defective genes, which are unusually abun-
dant where the disease is prevalent. ‘You can treat regional local populations almost
like single families,’ says Brandys” (Coghlan 1996, 4).
6. The kind of mapping Genset was engaged in—which sought to find markers
of genetic variation (single nucleotide polymorphisms, or SNPs)—did not presume
a causal relation between a given DNA sequence and the presence or absence of dis-
ease; rather, it hypothesized that certain markers of variation could be correlated to
greater susceptibility to that disease.
7. Important recent anthropological analyses of the conditions of possibility for
genomic value include Hayden 2003 and Sunder Rajan 2005.
8. Examples include studies of organ donation, evidence-based protocols, and
government-funded biomedical research. See Hogle 1995; Timmermans and Berg
1997; Epstein 2007.
9. Michel Callon (1998) describes the process whereby objects are “disentangled”
from their immediate surroundings and made calculable as one of “enframing.”
10. Genset would eventually check the validity of its findings of a “psychosis gene”
among Quebecois and Russian populations against the sequence information ex-
tracted from its Argentine bipolar samples (Blumenfeld et al. 2002).
11. A note on the names used in this chapter: I have used pseudonyms both for
the hospital and for the doctors where the research was carried out, in order to pro-
tect the privacy of my informants there. Because the Genset research is public knowl-
edge, I have identified the firm and its employees by name.
12. This strategic edge proved temporary: I interviewed Mendelson before the an-
nouncement, in 1999, of the “SNP Consortium” by a group of major pharmaceutical
companies, academic centers, and the Wellcome Trust, a collaboration designed to
undercut the strategic position of database firms like Genset. By 2000, Genset was
forced to remake itself as a drug- development company given the unproven profiti-
bility of genomics database firms.
13. Its precursor, manic- depression, was first named by Emil Kraepelin around
1900. See Kraepelin 1904.
14. As an article in La Nación put it: “Currently, the hospital needs more sporadic
patients to complete the sample that is awaited in France” (Navarra 1998).
15. Unlike patient groups in the United States, FUBIPA and similar groups are a
relatively marginal phenomenon in Argentina and are typically run by local experts
in the disorder rather than by patients and family members.
16. One highly publicized example was the Wistar Institute’s field trial, in 1986,
of a recombinant rabies vaccine in cattle outside of Buenos Aires, in which no Argen-
tine authorities were informed of the experiment (Dixon 1988).
17. It appeared, for instance, through the UNESCO Bioethics initiative, represented
in Argentina by the legal scholar Salvador Bergel, who opposed the licensing of ge-
netic material (Bergel 1998).
18. To the extent that imagery of a dystopian genetic future entered the popular
imagination, it was via the film Gattaca, rather than through newspaper editorials by
vigilant watchmen. This can be contrasted with the deCODE case in Iceland (Palsson

276 ANDREW LAKOFF

and Rabinow 1999). On the other hand, Argentina was one of the first countries to
ban cloning in the aftermath of Dolly, a result of the power of the Argentine Catholic
Church to define the boundaries of reproduction.
19. Indeed, a group of major pharmaceutical companies, in partnership with
the Wellcome Trust, was able to circumvent the biotech effort to patent and license
SNPs—markers of human genetic variation—by forming a consortium, in 1999, to
make such markers publicly available, significantly hindering the business strategy
of companies like Genset. Database companies were then forced to shift into drug
development, an even more treacherous and uncertain field.
20. For contrasting analyses of the deCODE project, see Palsson and Rabinow 1999
and M. Fortun 2001. Another difference was that the Argentine subjects of Gen-
set’s study were not prospective consumers of the technologies under development,
whereas the deCODE project guaranteed Icelanders access to Hoffman-LaRoche prod-
ucts developed from the research.
21. See the IMS Health website, http://www.imshealth.com, accessed August
2000.
22. Typical estimates in the bipolar-genetics literature were around 1 percent. But
some experts thought it was as high as 5 percent. Much depended on the criteria of
inclusion, and the means of distinguishing bipolar disorder from overlapping syn-
dromes such as schizophrenia, unipolar depression, and attention deficit disorder.
23. For a description of how certain mental disorders come to thrive in specific
political, cultural, and professional niches, see Hacking 1998.
24. In this sense the DSM can be considered a “biomedical platform,” as Peter
Keating and Alberto Cambrosio (2000) describe it, operating to connect clinical con-
ventions with biological conventions, individuals with populations.
25. For the distinction between the clinical and the administrative as different
modes of justification in medical work, see Dodier 1998.
26. For a lucid analysis of questions of reliability and validity in psychiatric diag-
nosis, see Allan Young 1996.
27. For the story of the emergence of the “specificity” model in psychopharma-
cology in relation to regulatory demands, see Healy 2002. For the history of FDA
regulations and the demand for proof of efficacy and safety in clinical trials, see
Marks 1997.
28. Though discovered in 1949, lithium was not widely adopted until its effec-
tiveness was confirmed in the early 1970s—in part because it was not a proprietary
compound and so there was little marketing incentive for conducting the requisite
clinical trials, but also due to the lack of interest in biological treatment of manic-
depression among psychodynamic psychiatrists, then predominant in U.S. psy-
chiatry.
29. A key difference is in whether both bipolar type I and type II are included. In
the Romero study both types were included (Kessler et al. 1997; Angst 1998).
30. For example, the psychiatrist Timothy Crow (1986) wrote, “The psychoses
constitute a genetic continuum rather than two unrelated diatheses.” By the same
token, there was some question as to what sort of entity “psychosis” was. Did the

DIAGNOSTIC LIQUIDITY 277

term cover a specific set of syndromes, or simply give a new name to madness? The
meaning of psychosis had shifted from its original distinction from neurosis; at first,
the term had indicated mental disorders not linked to organic lesions, whereas the
neuroses were associated with the nerves themselves. It then settled into indicating
serious mental pathology, usually marked by delusion or hallucination.
31. In another paper, the same group placed blame on the uncertainty of the rela-
tion between phenotype and genotype on the seemingly multiple ways the “under-
lying disease” expressed itself: “Genetic studies of psychiatric disorders in humans
have been inconclusive owing to the difficulty in defining phenotypes and under-
lying disease heterogeneity” (McInnes et al. 1999, 290).
32. “We believe the explanation lies elsewhere [than genetic heterogeneity],
namely that the genetic mechanism underlying the disease in these families is more
complicated than postulated, leading to a reduction in [statistical] power” (Risch and
Botstein 1996, 352).
33. Lawrence Cohen (1998) describes a similar problem on his arrival to study old
age in India: an apparent lack of patients with senile dementia.
34. For the historical context of psychoanalysis in Argentina, see Plotkin 2000
and Vezzetti 1996.
35. I describe these dynamics in more detail in Lakoff 2006.
36. For an analysis of the “cultural life” of bipolar disorder both as a diagnosis
and as a mode of self-understanding in the contemporary United States, see Martin
2007.
37. Ian Hacking (1999) argues that psychiatric identity is an example of the type
of classification he calls “interactive kinds.” As opposed to “indifferent kinds,” like
trees, these are classifications that interact with the thing being classified.
38. Paul Rabinow provides some guideposts for thinking about the way in which
genetic identity might interact with new forms of political rationality. He identifies
groups whose affiliation is based on a common disorder or genetic risk, and who in-
fluence health policy and scientific research, as emerging signs of such biosociality.
“Such groups,” he writes, “will have medical specialists, laboratories, narratives, and
a heavy panoply of pastoral keepers to help them experience, share, intervene, and
‘understand’ their fate” (Rabinow 1996, 102).

278 ANDREW LAKOFF

 9
WEN-HUA KUO

TRANSFORMING STATES IN THE ERA

OF GLOBAL PHARMACEUTICALS

Visioning Clinical Research in Japan, Taiwan, and Singapore

If we follow only one value, . . . no options can be chosen other than an “ultimate solu-
tion.” . . . In other words, choosing an ultimate solution implies the confirmation of a
particular value and viewpoint.
YOICHIRO MURAKAMI, ANZENGAKU [ON SECURITY]

Over the past two decades pharmaceuticals have become more standard-
ized and globalized, and since the 1990s an increasing number of prescrip-
tion drugs have been developed and marketed. This trend has turned global
pharmaceuticals into an emergent subject of research consisting of analysis
of lively interfaces between life and capital, science and society, on levels
from the individual to the global.
In this area, two perspectives hold special significance. One concerns the
standards and regulatory techniques that facilitate the spread of globaliza-
tion. In Global Pharmaceuticals: Ethics, Markets, Practices, Adriana Petryna,
Andrew Lakoff, and Arthur Kleinman show that standards and regulations
are used not only to make pharmaceuticals more scientific and reliable, but
also to give pharmaceuticals a cross- cultural and thus indisputable quality
(Petryna, Lakoff, and Kleinman 2006). As Yoichiro Murakami notes, any
“ultimate solution” for all variations and discrepancies is inevitably not free
from a particular viewpoint that channels all interests in a certain direction.
In connection with this, Andrew Lakoff presents in this volume (chapter 8)
an ethnographic account that traces how the “liquidity” of an illness (a term
borrowed from the field of finance) is achieved through rapid flow and cir-
culation of genetic information and capital across national boundaries. This
account reiterates the warning by Petryna, Lakoff, and Kleinman to anthro-
pologists: “As standards travel, their social and economic embeddedness is
revealed” (2006, 12).
The second perspective on global pharmaceuticals concerns clinical
trials. Certainly, the pharmaceutical industry has its reasons for running
clinical trials globally: nowadays more trials are required for approval and
more subjects are required for each trial; moreover, the subjects must be
recruited in a more timely fashion. Nonetheless, what is at stake in the de-
mand for larger pools of human subjects is how body and life are conceived
in the pharmaceutical industry—how can the latter turn these bodies, which
are distinct individuals embedded deeply in various social and environmen-
tal contexts, into seemingly interchangeable clinical-research subjects? How
can it be assumed that pharmaceuticals that are tested on a narrow range of
subjects will be “available” for all bodies?
This necessitates a notion of biopolitics beyond Michel Foucault’s (1997),
and requires new frames in order to be comprehensible.1 For example, in
the chapter “Globalizing Human Subjects Research” (2006), Petryna ob-
serves the move of clinical-research trials to regions considered ethically lax
and thus competitive. On the other hand, looking at how “ideal treatment
responders” are defined and located, Lakoff (2006) questions the seem-
ingly perfect triad of illness, pharmaceuticals, and target populations. Both
Petryna and Lakoff call attention to how life and body should be reconcep-
tualized in the presence of global pharmaceuticals.
Complementing these two perspectives on global pharmaceuticals,
the present chapter discusses the regulatory regime, focusing not on how
people may be affected by regulations, but on how the world of pharma-
ceuticals itself formulates operational standards.2 Echoing Sheila Jasanoff
(chapter 4 in this volume), who addresses the judicial aspects of how life and
nature are constituted for public concerns, my approach here is institutional
and transnational. The field for this chapter is the International Conference
for Harmonisation (ICH), a series of meetings initiated by the United States,
the European Union, and Japan with the aim of establishing uniform stan-
dards for proprietary drugs.3 In particular, I will analyze a controversial topic

280 WEN-HUA KUO

discussed at the ICH, concerning the acceptability of foreign clinical data,
and will look at how Japan, Taiwan, and Singapore have responded.4
This topic arouses discussion, especially in Asia, because of how differ-
ences among populations may be negotiated. In theory, this discussion has
to do with the question of whether any easy equation can be made between
the test population and the target population for a drug. The existing litera-
ture often refers to this debate in terms of racial differences, which in the
U.S. context means the differences between whites and nonwhite minori-
ties.5 Although the configuration of racial categorization deserves serious
study, as debated at the ICH, I focus on the state, exploring the intricate pro-
cesses of negotiation and self-government that occur when states deal with
global pharmaceuticals. While it is generally regarded from the corporate
viewpoint as a “non-tariff barrier,” race in this chapter is taken rather as a
reference that triggers “frictions,” to echo Anna Lowenhaupt Tsing’s notion
of how the local deals with the universal (2004). This approach lays bare the
emerging characteristics and visions of Japan, Taiwan, and Singapore as they
negotiate the requirements for imported pharmaceuticals, while addressing
the overarching need to not compromise the health of their populations.
Before looking into the East Asian encounter with the ICH, I would like
to clarify what I am taking “global” and “the state” to mean here. The former
concerns the qualification of international conferences as an ethnographic
site, for which I offer three justifications. First, the conference is itself a dis-
cursive site at which participants present their current attitudes on certain
issues or even open new topics. Unlike extant regulations and published
papers, these cutting- edge ideas are fresh and have the potential to change
or to influence one another. The second reason relates to the conference’s
interactive function. As an occasion for the interchange of opinions, the con-
ference involves the seemingly contradictory functions of comparing differ-
ent opinions, on the one hand, and working together, on the other. It is a
complex, highly dynamic zone, where various actors are compelled to trade
information, persuade one another, and exchange visions.6 Thus the confer-
ence is an arena where both controversies and conventions are expected.7
The third reason can be found in the conference’s accumulative and periodic
nature: participants at a conference act on the information they receive, and
their actions will be recounted at future meetings. Through publication of
proceedings and presentation slides (now often online), the information is
disseminated in a lasting way, spreading and generating new information.
The conference is a living archive, and participants rely on this kind of refer-

TRANSFORMING STATES 281

ence material in order to reconstruct memories which themselves represent
the nature of the conferences.
Following closely the performance of Asian states within and outside
the global site of the ICH allows us to appreciate their characteristics. Cer-
tainly, some bureaucracies and institutions do constitute the state as an act-
ing entity. Nonetheless, this chapter is not intended as a simple return to the
“bring the state back in” approach (see Evans, Rueschemeyer, and Skocpol
1985), which would discuss the mechanisms by which each state formulates
policies on pharmaceutical regulatory trends.8 Rather, this chapter aims to
capture how, seen from a global viewpoint, one state interacts with others.
As Ernest Gellner (1983) reminds us, the state is a political shell in which
culture can be shared and nationalism crafted. The aim of the inquiry at
hand is thus not to define what the state is or should be; rather, it is to dis-
tinguish one “political shell” from another in the face of globalization.9
The political shell analogy fits well with our discussion of pharmaceutical
regulations. Although the ICH aims to establish universal standards for drug
approval, agreement is not necessarily easy to achieve, even if each state rec-
ognizes the importance of regulations and is capable of making them. While
they may look alike, regulations can be distinct from one state to another,
depending on the political culture in which they are derived and nurtured.
A study by Sheila Jasanoff (2005a) of the United Kingdom, Germany, and
the United States is a salient example. Jasanoff advances two arguments con-
cerning these states’ attitudes toward biotechnology. First, the policies con-
cerning life sciences have become a more or less self- conscious project of
nation-building at a critical juncture in world history. Second, political cul-
ture does matter to contemporary politics. The present chapter follows this
trajectory, supplementing it with cases drawn from Asia. Taking advantage
of the rich archive compiled by the ICH, I carry out an interpretative ethnog-
raphy of the real-time behavior of Asian states in regard to globalization.
Indeed, it would be worthwhile undertaking an investigation into the
state in the era of global pharmaceuticals at the complex interfaces between
the Western and the non-Western, the global and the local, business and sci-
ence. I am not just interested in a simple explanation of how globalization
is sweeping over the non-Western world. As Michael Hardt and Antonio
Negri suggest (2000), globality “should not be understood in terms of cul-
tural, political, or economic homogenization. Globalization, like localization,
should be understood instead as a regime of the production of identity and
difference, or really homogenization and heterogenization” (2000, 45). I am
interested in how “state” and “race” were first challenged by science just as

282 WEN-HUA KUO

the ICH was about to merge regulatory territories, and then referenced by
the state strategies and visions that are currently being developed.

Looking into the Secret Box of Regulations:

Understanding the ICH

The industry likes to portray itself as producing pharmaceuticals as highly

regulated commodities.10 Since the 1960s major pharmaceutical markets
have established their own regulations primarily in response to emerging
drug disasters such as that surrounding thalidomide, and as a result the
regulations have developed into a huge, complicated system.11 Scholars at
the Center for Drug Development, Tufts University, estimate that in the
United States it takes an average of eight to twelve years to get a product to
market and costs millions of dollars.12
Increasingly rigorous requirements have lengthened the premarketing
period for new products. However, this is not the biggest obstacle the in-
dustry has had to face in the past two decades. Like other sectors, the phar-
maceutical industry has long sought a global market, and this desire is be-
coming more intense. Extremely high standards have protected monopolies
by raising the barriers facing new market entrants. But those who can af-
ford entry need to recover costs as soon as possible for a simple reason—the
effective marketing period of approved drugs has shortened and so has the
period for which drugs are protected by patent.
What makes this situation even more difficult is that regulations created
in the different major pharmaceutical markets may look similar, but are
not simply interchangeable, as each must respond to specific requirements
and concerns. A seemingly trivial but crucial difference that regulators like
to cite is the “room temperature” criterion used in tests to assess the sta-
bility of a drug. Before the introduction of universal guidelines, tempera-
ture controls in such studies were set by the sponsor and were appropriate to
the locality. This earlier system necessitated new stability data for registra-
tions in different regions, even if the climatic difference between the origi-
nal location of study and the location where the drug went to market was
no more than one or two degrees Celsius.13 Such additional regulations are
undoubtedly an impediment to the industry, as it is impractical to meet all
such demanding standards, and this delays still further the launch of prod-
ucts to market. At the same time, regulatory agencies may have to respond
to public-health crises that the delay may cause among patients who cannot
afford to wait.

TRANSFORMING STATES 283

 From the perspective of standardization, the ICH is a unique project
serving as a communication platform for the regulator and the regulated,
thus presenting what seems to be the perfect way to accelerate the global
accessibility of the latest cures—each party understands that universal stan-
dards cannot be achieved without the involvement of the other. Even so,
unlike the World Health Organization (WHO), which specializes in health
issues under the conventional political scheme of the United Nations, the
ICH is selective and technology- oriented.14 It invites only a handful of mem-
bers, whose pharmaceutical innovations and markets represent over 85 per-
cent of the world total, and claims to work only on practical issues concern-
ing the quality, safety, and efficacy of pharmaceuticals.15
The dynamics between industry and regulators, and among different
regulatory bodies, may be observed in the way in which the ICH tries to
achieve consensus. The “ICH-process,” a five-step procedure, has been drawn
up to ensure that each guideline is properly discussed and implemented in
all ICH regions. Proposals for new harmonization must be brought to the
steering committee to initiate an ICH action. If accepted, a proposal is as-
signed to an expert working group, which advises on the technical aspects of
harmonization topics (step 1). When a primary guideline is drafted, it must
first be distributed to and achieve consensus among all the invited experts
(step 2). When the draft is complete, it is brought back to each region for
feedback on related topics (step 3). Each guideline must be agreed on by all
experts and each ICH region before being submitted to the steering commit-
tee, where the guideline is confirmed (step 4). The final step, which makes
the ICH unique, is a follow-up mechanism applied to determine whether a
guideline is adopted by local regulatory agencies within six months of its re-
lease (step 5). It takes an average of twelve to eighteen months for a guide-
line to be implemented through this five-step process.16
This may strike a chord with readers who are familiar with Sheila Jasa-
noff ’s notion of “republics of science,” according to which democracy “is
not a singular form of life but a common human urge to self-rule that finds
expression in many different institutional and cultural arrangements”
(2005a:290). Indeed, acknowledging that science cannot be immune from
politics (or, as Jasanoff would suggest, “scientific cultures are at one and the
same time political cultures”), the ICH’s intention in creating this diplo-
matic harmonization procedure is that diverse regulatory practices be re-
spected in the making of universal standards. Nonetheless, in accordance
with the wishes of all participants, the ICH has proven to be not a hurdle but
a catalyst for the standardization of standards. From its first meeting, held

284 WEN-HUA KUO

in 1991, to its sixth (ICH 6) in 2003, the ICH has set up fifty-four guidelines
in the categories of quality, safety, efficacy, and multidisciplinary issues.17
The industry appreciates this. For instance, Stuart R. Walker, of the Center
for Medical Research International, comments, “As a result of this initiative,
the drug regulatory process has become smoother, quicker and less burden-
some” (Nutley 2000, 9). Praise like this has also come from regulators, for
whom the ICH has been a resounding success by making the world of phar-
maceuticals “flat.” It seems to have achieved both phases of a complicated
commercial and scientific mission.18
The ICH is not satisfied to stay within its initial three regions, but has fur-
thered the attempt to spread its new standard to the rest of the world. Based
on a resolution made at the ICH 4 in 1997, the ICH has begun to expand,
seeking to implement as many guidelines as possible in non-ICH regions
(ICH 1997, revised in 2000). In 1999 the ICH Global Cooperation Group
(GCG) was formed to serve as a bridge to other countries affected by these
guidelines. Although the GCG’s mission may be to raise the quality of clini-
cal research in these countries to global standards, it functions passively to
ensure that the direction of regulatory flow from the ICH to non-ICH regions
is irreversible. The primary objective of the group, it is claimed, is “to act as a
resource for the understanding, and even acceptance, of many of the guide-
lines” (Nutley 2000, 10).19 Although the markets outside of the ICH regions
are too tiny to be incorporated into the original plan, the ICH has decided to
extend the margins of its guidelines and incorporate these places. By stan-
dardizing standards, it continues to work toward the goal of a single global
market and health community. For the ICH, the ultimate solution is already
here; it is merely a question of when it will be implemented.

One Problem, Three Answers: Asian States and the ICH

How would the ICH affect Asian states? A conventional account is provided
by the anthropologist Kalman Applbaum, who, tracing the introduction of
a new group of antidepressant SSRIs (selective serotonin reuptake inhibi-
tors) to Japan, shows how medical knowledge and capital work together in
a top- down, West-initiated approach (Applbaum 2006). Applbaum portrays
a hierarchical, dichotomous world, with typical American pharmaceutical
companies that zealously sell their products to Asia, on the one side, and
a silent Japan that is unwittingly “educated” about diseases and accepts its
treatment, on the other. Mediating between the two, the ICH is cast as a
mere instrument through which this capitalist wish is fulfilled.20

TRANSFORMING STATES 285

 The globalization process that Applbaum presents is fascinating, but
one-sided, not only omitting mention of local reactions, but also skipping
the technical yet subtle debate at the ICH, and this weakens the account. I
shall apply a “slow-motion” approach to trace how Japan, Taiwan, and Singa-
pore (in that order) encountered the ICH, step by step, in various situations
at different times. The ICH decision “to eliminate redundant trials” was uni-
versally applicable, yet each state responded differently.
Japan was the first of the states to come across the ICH. Unlike the Euro-
pean Union and the United States, where most global pharmaceutical com-
panies are located, Japan was invited to the ICH not because of its ability
to carry out pharmaceutical research and development, but because of its
huge market, ranked second in the world, and its tough regulatory require-
ments.21 Before 1986 a company that sought to sell drug products in Japan
nearly always had to repeat the clinical trials required in Japan, using Japa-
nese subjects. Even after a notification was enacted allowing acceptance of
foreign data “in principle,” it was very rare for concessions to be granted.22
The industry was frustrated and complained that Japan was practicing phar-
maceutical protectionism.
Japan did not let this accusation lie, but brought up at the ICH the issue of
race in relation to drug behavior. Osamu Doi, then representative of Japan’s
Ministry of Health and Welfare, thought it crucial for the acceptability of
foreign clinical data and argued that a consensus on the issue should be
reached at a global scientific occasion like the ICH. On his insistence, it
was agreed that population differences, such as sex and age, would be dis-
cussed.23 At the time, nobody imagined that this topic, later called “E5,”
would become one of the most difficult ever discussed by the ICH. Six years
of discussion produced only a vague guideline. Its vagueness, however, gave
Taiwan the chance to speak for itself.
It is not necessary to review exhaustively the discussion of how differ-
ences among populations were dealt with by the expert working group (for
a detailed science and technology studies analysis, see Kuo 2008). In brief,
Western nations stressed the fundamental unity of humankind and claimed
that further clinical trials should be pursued only if it could be determined
that real differences, unique to Asians, exist. Japan, on the other hand,
taking for granted the genetic and cultural distinctness of its population,
insisted that no trials should be foregone unless the similarity between the
Japanese and other ethnic groups, such as whites, could be proved.24 Thus
after an agreement was reached on waivers for pharmacokinetics studies on
the basis of a study comparing individual variations and interethnic differ-

286 WEN-HUA KUO

ences, proposals were submitted in two divergent directions. While experts
from the European Union and the United States asked for more waivers in
late-phase clinical trials, which are more expensive and time- consuming,
Japan, in order to discover possible differences, expected a trials system with
equal representation of different ethnic groups; that is, whites, blacks, and
Asians (in this instance, Japanese).25 Neither of these proposals pleased all
parties, and there was a deadlock.
It was Roger L. Williams, an expert from the FDA, who saved the discus-
sion by bringing in the concept of the bridging study. Technically, “bridging”
means undertaking extra studies to generate the necessary information for
extrapolation of late-phase clinical data to the population of an untested re-
gion. In practice, however, it was a diplomatic compromise intended to re-
lease tension by leaving part of the procedure ambiguous and open. From
the Western viewpoint, the bridging study was a way to test whether exist-
ing data could be extrapolated to a local region where the product was to be
marketed, and was only to be applied if the product was suspected of being
ethnically sensitive. From Japan’s viewpoint, however, bridging studies were
considered a way to allow additional studies designed especially for Japan,
formatted as full studies but using fewer Japanese samples. Because the ICH
respects local agencies’ judgment as to whether a drug may have ethnic-
related effects, Japan could require each producer to provide additional
data.26 Although confusion remained, the guideline was agreed on in 1997
and implemented a year later.
Taiwan followed the E5 issue at the ICH3, but did not get actively in-
volved until implementation, for two reasons. First, despite its considerable
record as a buyer of pharmaceuticals, Taiwan’s market is much smaller than
Japan’s.27 Like other markets of its size, Taiwan always feels under great
pressure to bargain for more local trials before granting approval, not with-
standing global industry regulations on new drug approvals.28 Second, and
more general, is Taiwan’s political situation. In spite of its economic vitality
and connectedness, Taiwan has not been allowed to join international gov-
ernmental organizations, including medical ones. Although some Taiwan-
ese experts have seen the need to form a network for regulatory science in
Asia, it is hard to realize this without a specific focus.29
The E5 guideline gave Taiwan a concrete topic on which to speak. In con-
trast to Japan’s ambiguous attitude toward the guideline, the Taiwanese gov-
ernment immediately announced that it wanted to be the first non-ICH state
in Asia to adopt the E5 guideline, including the controversial sections.30 The
Center for Drug Evaluation (CDE), an FDA-like institute, was established in

TRANSFORMING STATES 287

Taiwan in July 1998 to offer high- quality in-house reviews of new drug appli-
cations. In effect, it took responsibility for the implementation of ICH guide-
lines and the handling of all international affairs relating to pharmaceutical
regulatory science.
What made the CDE famous were its evaluations of differences among
populations. On the one hand, it recognized differences between Asians and
Caucasians; but it did not insist that clinical data produced in relation to one
population could not be applied to another after careful evaluation. Using a
genetic survey of Asian populations, the CDE required bridging studies only
when the application was considered ethnically sensitive, and welcomed
Asian data from outside Taiwan.31 By 2003 local trials had been deemed
necessary for bridging studies only for fifteen out of sixty-two applications,
and there were convincing reasons for bridging in each case (Lin, Chern, and
Chu 2003).
The CDE’s aggressive approach attracted international attention and led it
to head a forum on bridging studies at the Asia-Pacific Economic Coopera-
tion (APEC), the only influential international forum where Taiwan is recog-
nized as an independent political entity.32 Starting in 2000, the APEC net-
work provided Taiwan with a way into the ICH, where it was invited, as the
APEC representative, to the satellite meetings of ICH5 and ICH6. At both of
these meetings, Taiwan was characterized as an exemplary non-ICH coun-
try that had engineered a situation enabling the industry to make available
the latest medicines while protecting the health of its people. In fact, this
win-win situation has other implications for Taiwan. Unlike Japan, which en-
gaged only reluctantly in the globalization process, Taiwan, which has been
long isolated from the world, grabbed the chance to be heard and made the
best use of it.
Compared to these two states, Singapore was rather behind in follow-
ing ICH developments. Although in 1995 APEC proposed that its headquar-
ters for the Coordinating Centre for Good Clinical Practice (GCP) be based
in Singapore, as an aid to its burgeoning biomedical-research industry, in
drugs regulation Singapore was behind Japan and Taiwan. It did not renew
its regulatory system until 1998, when a center for drug evaluation was
established, involving the collaboration of the National Science and Tech-
nology Board, the Ministry of Health, and Singapore General Hospital.33 The
system developed slowly before being incorporated in 2001 into the Health
Sciences Authority, a new institute derived from the existing regulatory sec-
tion of the Ministry of Health. Singapore missed not only the E5 debate, in
which Japan was closely involved during the early 1990s, but also the chance

288 WEN-HUA KUO

to form a professional and independent regulatory institute, as Taiwan did
in the late 1990s.
However, this did not prevent Singapore from attempting to catch up
with other Asian states. Where APEC served as a gateway for Taiwan’s global-
ization, the Association of Southeast Asian Nations (ASEAN) served as Singa-
pore’s platform.34 In order to create a single pharmaceutical market, ASEAN
countries hope to harmonize regulations for pharmaceutical registration on
the basis of ICH guidelines and through mutual recognition among regu-
latory agencies.35 With the initiative of the ASEAN Consultative Committee
for Standards and Quality, a Pharmaceutical Product Working Group was
formed in 1999 to establish common technical requirements and develop
quality guidelines for product registration.36
Even so, Singapore’s role in ASEAN is ambiguous. Although Singapore
shares with other ASEAN states the will to form a single pharmaceutical mar-
ket, their developmental statuses are different. Some states in this region
continue to rely heavily on high- quality generic drugs. But Singapore has
made much progress in healthcare, and its pharmaceutical market, though
small, is able to utilize cutting- edge medications. Singapore has also begun
to involve itself in ASEAN activities and regularly shows up at the APEC net-
work. But although some global companies have set up their Asian subsidi-
aries in Singapore, Singapore remains unsure of its strategic position in the
global network of pharmaceutical regulation.37

Crafting Genomic Race, Bridging States,

Going Global: Three Post-E5 Positions

Let us continue our analysis of the agendas that Japan, Taiwan, and Sin-
gapore developed to cope with the ICH in the new millennium. In retro-
spect, these positions might be seen as responses to the E5 guideline and the
concept of the bridging study.38 The previous section introduced the three
states in the chronological order in which they encountered the ICH. But in
this section, the three states will be presented in a comparative frame: their
agendas are related but distinct, each reflecting a particular concern of the
regulatory environment and vision, thus interacting with and negotiating
commercial concerns in specific ways.39
Bridging studies were not the solution that Japan expected. Using two
analogies, the cartoon below expresses how the Japanese authority conceived
of itself in the bridging-studies scheme (see 1). Japanese clinical data are
portrayed as either a tiny ant on a huge elephant (foreign data), or as a baby

TRANSFORMING STATES 289

 1. Echoes from
the past: Japan’s
perception of the
E5 Guideline.

turtle (nascent bridging data) on the back of its mother (existing foreign
data). From this perspective, Japanese clinical trials are considered inferior
to those of the world leaders. Japan has to wait until other countries finish
their trials, and its contribution to the world, compared to multinational
clinical trials, is extremely small. Believing itself a world power, Japan views
the “bridging study” as a design that discriminates against the Japanese and
thus needs to be corrected.
The Japanese vision of clinical trials is clearly about ensuring the involve-
ment of the Japanese at each stage of the trials. If we apply the conventional
dichotomy of race versus ethnicity (i.e., biology/heredity versus culture/so-
ciety), it may be hard to understand what Japan means by “the Japanese.”
But my analysis of the E5 debate at the ICH reveals that in the globalization
scheme Japan’s existence is at stake (Kuo 2008). Japan used two regulatory
practices to achieve its vision. The negative one, as the industry soon real-
ized after implementing the E5 guideline, was to reject so- called retrospec-
tive bridging studies—studies that aim only to generate Japanese clinical
data to complement the application package. By October 2003, when the
ICH6 was held, only a handful of cases which claimed to apply the concept
of bridging had been accepted.40
Meanwhile, as a positive strategy, there appeared an agenda called “global
drug development,” proposed by the Japanese regulatory authority as an

290 WEN-HUA KUO

alternative way of doing global clinical trials. In relation to the various popu-
lations among which the tested product may be applied, trials using a global-
drug- development scheme have to fulfill two requirements: sufficient num-
bers of Japanese test subjects and early involvement in the design of clinical
trials. It was in this context that the idea of the “genomic” race was put for-
ward, for Japan had to provide a scientific basis for what it means by “Japa-
nese subject” in this clinical-research scheme.
Only by understanding this can we understand the aims of the Advanced
Life Science Information System (ALIS) and pharmacogenetics—two scien-
tific endeavors urged by the Japanese government. Both are necessary for
supporting the concept of genomic race to justify clinical trials. Sponsored
by the Japan Science and Technology Agency, ALIS is an integrated, infor-
mational gateway that englobes all projects concerning genomic research by
and about the Japanese.41 Consisting of several databanks and open to the
public, ALIS is intended to make the Japanese accessible and “visible.” For
instance, one of the projects that ALIS links to is the database of Japanese
Single Nucleotide Polymorphism (JSNP), which has identified and collated
up to 150,000 SNPs from the Japanese population to construct a dataset in
order to probe the relationship between polymorphisms and common dis-
eases or reactions to drugs.42 Obviously, this is the new definition of “the
Japanese” that the Japanese regulatory authority favors for global drug devel-
opment. As an official of the Ministry of Health, Labor, and Welfare (MHLW)
revealed, “From now on, the intrinsic factors of racial difference can be re-
placed by the genome” (Yakujinippo [pharmaceutical news] 2001).
Even so, this new definition requires a theoretical tool in order to work in
clinical trials. To serve this need, a statistical method called “genomic statis-
tics” was developed by Masahiro Takeuchi at Kitasato University and later
adopted by the MHLW to explain how differences among populations should
be dealt with to make better global trials.43 At the APEC symposium in 2003
on statistical methodology for evaluation of bridging studies, Takeuchi pre-
sented the main concept of genomic statistics as follows: in order to avoid
statistical biases in clinical research due to inappropriate population selec-
tion, genomics should be applied to identify the right groups for testing. In
other words, the test populations are chosen by their genomic characteris-
tics, or “molecular profiling.”44
At first glance, the above methods have nothing to do with the Japa-
nese in particular. Indeed, pharmacogenomics is not a “Japanese” science,
nor does genomics belong exclusively to Japan. However, Joan Fujimura’s
study of Japan’s Human Genome Project has suggested that culture should

TRANSFORMING STATES 291

be considered a set of particular practices existing at particular times and
places; it is “both a heuristic device for discussing local and global actions
and movements and a concept that is being continuously produced through
actions and discourses about these actions” (Fujimura 2000, 84). Echoing
this point, the present chapter further emphasizes how these universal sci-
ences find their strategic uses in Japan’s vision of global trials. The reason
is simple: genomics is so extremely expensive that few states can afford it.
When these sciences are introduced to create a higher standard for global
clinical research, Japan, which is willing to spend as much money as nec-
essary to prove its distinctness, will participate more in these trials, or at
least have the opportunity to represent all Asian populations. This is Japan’s
way of living with globalization. In fact, during my interview with Masahiro
Takeuchi, I reminded him that in his explanation of global clinical trials, he
had said “Japanese” when he should have said “Asians.” He did not deny it:
“Well, yes. But do you think it will make any difference?”45
While Japan has chosen to focus on the concept of the Japanese, Taiwan
has tried to prove the existence of the Taiwanese state. Taiwan’s regulatory
authority, the CDE, successfully made itself visible at the ICH by way of the E5
policy separating race from the state—Taiwan recognizes the differences be-
tween Asians and other populations, but does not insist on Taiwanese data
as a requirement for every drug proposed for sale in Taiwan. However, this
policy advantage is losing importance, as the paradigm is shifting to global
drug development. In response, three statistical methods were presented
in 2003 at the APEC symposium on statistical methodology for evaluation
of bridging studies.46 Despite their scientific merits, these methods also
have policy implications: they provided the CDE with tools to “save” bridging
studies in the scheme of global clinical trials.
The first is the group sequential method, which proposes a practical ap-
proach that includes patients from new regions, such as Asian states, as
part of the recruitment for the whole study for submission to the “origi-
nal” region (Europe and the United States in most cases). In this sense,
the bridging study is considered a substudy of a global trial. In order to
ensure the consistency of the study protocol, special sample sizes and de-
signs are required. In the same scenario, the second method can be called
a “weighted- discounted” approach. It is derived from the traditional Z-test
method and is based on the argument that information already obtained
from the original study will have a huge effect on the partition of sample
space in the bridging study. Thus, the results of the latter must be weighted
according to the region in which it is conducted. I call the third statistical

292 WEN-HUA KUO

method “multicentered-hierarchical.” Recognizing that each state market
in the Asia-Pacific region is too small to bargain for a full clinical trial, this
method suggests a hierarchical operational structure that groups the cen-
ters recruited in a transnational clinical trial. In order to establish reason-
able measures for all regions in which the product would be marketed, this
method insists that every region should have a representative center and
that a “state effect” should be attached.
Like pharmacogenomics, these methods appear abstract scientific elabo-
rations; they seem to have nothing to do with any state in particular. How-
ever, as with genomics and Japan, there are policy assumptions implicit in
these methods, and despite differences in methodology and statistical tech-
niques, they share the same goals. They aim not only to prove that bridging
studies are still workable in a multinational situation, but also to empha-
size the importance of “regional differences,” which do not appear in the E5
guideline, and to ask for the inclusion of subjects from every state where
the product is to be marketed. Only from this perspective can we under-
stand Taiwan’s strategy for embracing globalization. Taiwan is attempting to
demonstrate its existence by building a statistical network through bridg-
ing studies. Not having been considered a state for over thirty years, Taiwan
appreciates the ways of extending the use of bridging studies, which allow
every state to make a “fair” contribution to global clinical trials. Only thus
can Taiwan’s functionality as a state be preserved.
Singapore lagged behind Japan and Taiwan in the E5 debate. The eth-
nicity question was even more complicated for Singapore than for the other
two states. It seemed impossible to use a scientific tool to deal with the
ethnic complexity of Singapore’s population.47 However, Singapore chose
simply to ignore the differences altogether, so that it could “skip” the dispute
over bridging studies.48 Identifying its state as a rising star in Asia’s boom-
ing biobusiness and a node in the global network of clinical research, Singa-
pore’s Centre for Drug Evaluation arrived at a clear policy decision regarding
the E5 guideline and bridging studies: it made the best use of the former
while ignoring the latter.49 As the center’s director John Lim commented,
“If we are global, there will be no need for bridges.”50 Singapore claimed to
be able to provide the best sites for clinical trials of Asian people, but did not
seek to apply the results to its own nationals.
This policy reflects Singapore’s vision of making itself a global state by
effacing regional differences. Singapore is not in a position to be a primary
reviewer of drugs, so it hopes instead to be the first East Asian country
with access to the latest drugs marketed in the most advanced countries.

TRANSFORMING STATES 293

This standpoint can be discerned in the pharmaceuticals reviewing system
introduced by the Centre for Drug Evaluation, which aims to streamline the
global flow of pharmaceuticals through Singapore (Wong and Lim 2003).
For example, “verification” evaluation is the quickest route for new drugs
that have been granted marketing approval by the benchmark regulatory
agencies recognized by the Health Sciences Authority.51 This process was
designed to accept results from those authorities in order to shorten the
time between primary review and marketability. To this end, Singapore has
drawn up a dossier format and review requirements comparable to those
of the ICH, following the leading regulatory authorities. In addition, its
English-language environment enables Singapore to maintain ties with its
former colonizer and its former colonies outside Asia.
The Southeast Asian pharmaceutical network consists of both external
links to the West via Singapore and internal connections within the region
itself, and Singapore is well aware of this. Over the past five years Singapore
has been enhancing its regional connections through ASEAN. In 2003 Sin-
gapore was appointed to chair the ASEAN Implementation Working Group
on ASEAN common technical documents (ACTD), leading the realization of
ACTD implementation with Malaysia and Thailand (which is currently the
APEC representative for the ICH GCG).52
One cannot say that Singapore is the only nation making this enhance-
ment of regional connections happen; however, considering the strategic
position of its global industries, Singapore will certainly benefit from this
homogenous regional market of pharmaceuticals. It has deregulated all
requirements, including those concerning race-related effects, in order to
have access to the most advanced products as soon as the West. In addition,
it is engaged in regional networks, such as the APEC and ASEAN, to make
“pathways” through which these products can be sold in other Asian states.
Unlike Japan’s vision of a nation-state made up of a Japanese race, or Tai-
wan’s struggle to gain recognition as a state, Singapore sees its advantage in
global networking. The network exists and therefore so does the state.53

Monitoring Transforming States

in the Global-Genomic World

What is the future of the pharmaceutical industry as it marches into Asia?

Some reports, such as Scrip 100 (2006), portray the situation much like a
typical market-research report and dwell on identification of the right mar-
kets and penetration of their trade barriers. For example, Ian Schofield, a

294 WEN-HUA KUO

Scrip 100 reporter, forecasts that China and India, two rising economies in
Asia, are potential markets as well as growing threats. Japan is still criticized
by the industry for the tardiness of its regulatory practice and the difficul-
ties in conducting acceptable clinical trials, but seems to have been let off
the hook by the industry, which is more interested in making sales than in
settling scores (Schofeld 2006). For such reports, national difference seems
to be out of the question. Japan’s changing attitude toward the acceptability
of foreign clinical data is noted, which the industry considers an “improve-
ment,” and explained as a response to emerging business rivals in the re-
gion, like Singapore and Korea. This story of pharmaceuticals and globaliza-
tion fails to take account of any cultural or social aspect of the state.
Yet if one uses the example of the regulatory standardization of phar-
maceuticals, it is clear that no two states behave alike in the face of global
capitalism. Only at the lively interfaces where the state meets the global
can we identify their distinct characteristics. This chapter may be read as a
rough-and-ready sketch of how Asian states resist the mighty wave of glob-
alization, a kind of story that may be found anywhere. However, that is not
my goal. Echoing the notion of Michel Foucault (2001:170–71) of the epi-
stemic changes which allow only some problems and not others to come to
the fore, I attempt to trace a particular process in the dawn of the genomic
era, where pharmaceuticals and related clinical research have to be global
and universal. This specific moment problematizes the previously invisible
issues concerning the state and population differences as issues in the world
of pharmaceutical regulation. What is at stake is perhaps why state and race,
which are inextricable from the making of nation-states, merge at the fron-
tier of global clinical research.
Michael Fischer’s notion of anthropological voice is useful in this con-
text (Fischer 2003). The challenge for anthropological voice, Fischer argues,
should be considered with a keen understanding of the modern world and
of the role that anthropology can play in it. The challenge in renewing the
notions of the ethnographic and anthropological voice “is not the disappear-
ance of difference, of different cultures, or of ways of organizing society
any more than it is not the disappearance of class, capital, unethical ex-
change, power, or gender relations. On the contrary, the challenge is that
the interactions of various kinds of cultures becoming more complex and
differentiated at the same time as new forms of globalization and modern-
ization are bringing all parts of the earth into greater, uneven, polycentric
interaction.” Considering “the aspiration for cross- culturally comparative,
socially grounded, linguistically and culturally attentive perspectives,” the

TRANSFORMING STATES 295

challenge for anthropology is “to develop translation and mediation tools
for helping make visible the differences of interests, access, power, needs,
desire, and philosophical perspective” (Fischer 2003, 3).
What I hope to have achieved in this chapter is consonant with the above
challenge. I have explored on the national level what anthropological voices
we can appreciate when the world consciously becomes global and genomic.
I have argued elsewhere (Kuo 2008) that different conceptualizations of race
and ethnicity cannot easily be understood unless encountered in the arena
of clinical research. In this chapter, my focus has been on the state, an arti-
ficially organized yet strategically lively actor, which, together with other
states, composes the world politicoeconomic infrastructure.
Only with the above intention in mind can we understand that when race
became an issue at the ICH, it did not reflect simply nationalism. This chap-
ter has shown the two functions of race in this story. First, race is itself a so-
cially contextualized topic which is fluid and always questionable. Any scien-
tific attempt to clarify it creates confusion and reveals the cultural and social
assumptions behind it.54 Second, as an issue for discussion at the ICH, race
is a point of reference by which we monitor state actions. In other words, it
is a “lens” that allows one to observe and appreciate the “deep play” of Asian
states, a notion inspired by Clifford Geertz’s famous article (1973) on this
global platform. Thus, the examples of Japan, Taiwan, and Singapore may
not be used simply to “fill in” a conceptual gap between individuals and
the world, as political scientists may claim. For us, they are anthropological
voices, and always in transformation.
Let me end this chapter by summarizing these voices. Japan seems to
be the only state that holds strongly to the concept of a coherent Japanese
nation. Yet this idea may not faithfully reflect either the composition of the
Japanese population or what Japanese nationals think of themselves. Rather,
it presents a vision of the Japanese state clashing with globalization. Accord-
ing to this vision, the Japanese race and the Japanese state are two sides of
the same coin. As we can see from Japan’s reaction at the ICH, this vision
understands race more as a collectivity than as a question of purity. Race is
the basis of Japan’s claim to uniqueness, and the state is the subject that in-
sists on the category and benefits from it.55
Taiwan has other concerns about statehood. Unlike “normal” states, Tai-
wan has been politically isolated for some time and is always eager to prove
itself a good “citizen” in the global village. As seen in the ICH discussions,
although bridging studies presume a “West- center, East-peripheral” world-
view, this presumption is not a problem for Taiwan. By the same logic, the

296 WEN-HUA KUO

E5 topic gave Taiwan a bridge to the world. While Japan pushes the genomic
view for global clinical trials, Taiwan survives through bridging studies by
making statistical bridges to other regions. Although these methods have
not yet been accepted and implemented as policies by other Asian states,
Taiwan’s CDE is ready to promote this vision as long as it makes Taiwan’s
voice heard in the global arena.56
A shining star in biotechnology, Singapore is recognized as a competi-
tive hotspot in the network of global business.57 Very few may remember
the small city-state’s cultural complexity, and its government tends to ignore
this fact whenever it is a barrier to business. This willful ignorance is how
the Singaporean state is attempting to survive globalization. Unlike Taiwan,
which recognizes the ethnic distinctness of Asians and has taken advantage
of this in its bridging studies, the Singaporean state does not see any benefit
in such a strategy.58 Singapore’s vision is thus to boost and to be at the hub
of the pharmaceutical sector in Southeast Asia.
Although the state and its transformative nature form the main concern
of this chapter, I do not intend to reject other concerns that link the local to
the global within the topic of the body and pharmaceuticals. As Lakoff and
Jasanoff have argued in this volume (chapters 8 and 4), the role of the state
remains salient in the space of exchange between life and business: by cre-
ating regulatory regimes, states ensure the economic value of pharmaceu-
tical innovations. All these factors distract the state from its ideal and naïve
aim of “protecting its people’s health.”
The present text situates itself within a literature that attempts to under-
stand global pharmaceuticals through various research schemes and regu-
lations. Further analysis of the state’s role in global schemes is carried out
by looking at its transformations through the transformations of its regula-
tory systems. Hardt and Negri have pointed out that the world that capital is
faced with is not really “smooth” but “defined by new and complex regimes
of differentiation and homogenization, deterritorialization and reterritorial-
ization” (2000, xiii). Echoing this argument, the present chapter has shown
that each of the states in question has its own concerns, which are not exclu-
sively related to either health or capitalism. One is led to the conclusion that
it is too early to declare the demise of the state in the name of globalization.
Instead, the world is being referenced and fundamentally changed in terms
of state and race.
The introduction of this new world perspective inevitably refreshes our
understanding of the state as an entity which is “co-produced” with other
states. As an open conclusion, let us return to Ernest Gellner’s observation

TRANSFORMING STATES 297

on the state in the modern world. Viewing two ethnographic maps before
and after the age of nationalism and looking at a political map of the mod-
ern world, he observes, “There is little shading; neat flat surfaces are clearly
separated from each other. . . . We see an overwhelming part of political
authority has been concentrated in the hands of one kind of institution, a
reasonably large and well- centralized state” (Gellner 1983, 139–40). In con-
cert with this reflection, the present chapter argues that every state deserves
ethnography. Gellner is right. In the era of global pharmaceuticals, the state
still matters.

Notes
1. One theoretical elaboration of how capital functions in the era of genomics and
clinical research is Kaushik Sunder Rajan’s Biocapital (2006).
2. A study that does look at the effects of regulation is Joseph Dumit’s “Drugs for
Life” (2002), which argues that people are “destined to become ill” when the criteria
for normality broaden.
3. The full name is the International Conference on Harmonisation of Technical
Requirements for Registration of Pharmaceuticals for Human Use. For a concise
introduction to the ICH, see Nutley 2000.
4. The topic was titled “Ethnic Factors in the Acceptability of Foreign Clinical
Data.” This topic was also named “E5,” the fifth topic under the category of efficacy at
the ICH.
5. For example, there has been a heated debate about Bidil, the first drug approved
by the FDA to treat heart failure among “self-identified” African Americans, with re-
gard to its impacts on the racial politics in the United States. Numerous forums,
such as websites, discussion boards, and conferences, have been formed, among
which the conferences organized, since 2005, by the Massachusetts Institute of Tech-
nology’s Center for the Study of Diversity are typical in discussing race along with the
social contexts it locates and the policy implications it carries. Jonathan Kahn, one of
the regular presenters at these conferences, has studied Bidil intensively and wrote a
paper, “Harmonizing Race” (2006), that compares the ICH E5 guideline to the FDA’s
regulations on ethnic difference. Additionally, Steven Epstein, who wrote Inclusion
(2007), has also addressed the ICH in reference to the ethnic politics of the United
States on clinical trials.
6. With the notion of actors, I refer to Bruno Latour’s works on the making of
social actions. See Latour 1987.
7. Compare Peter Galison’s notion of the “trading zone” in Image and Logic (1997).
8. Although still understudied, the state has been investigated by anthropologists
from various perspectives. For instance, Michael Fischer’s Iran (1980) attributes the
Shiite denial of the legitimacy of the Pahlavi regime to tensions located in the context
of dualistic dynamics involving the global and the national, capitalism and Islam, and

298 WEN-HUA KUO

modernity and tradition. Tracing the introduction of modern agriculture to India,
Akhil Gupta’s Postcolonial Developments (1998) criticizes the discourse of underdevel-
opment by showing how being drawn into global political economy has become a
dilemma for the Indian state. James Scott’s Seeing like a State (1998) looks at the state
by analyzing tensions between state authorities and various “unstable” individuals
in the failures of state projects throughout history. Emily Martin’s work on the state
(1999), by contrast, views the evolved modern state as a flexible organism capable of
responding to requests.
9. In order to study the problem of the nation-state in the global scene, the po-
litical sociologist Horng-luen Wang (2000) proposes an institutional approach. He
defines a nation-state as a political and cultural product derived by demarcating a
territory within the networks of the global. According to Wang, when dealing with
a modern nation-state, one can draw no clear line between culture and politics, or
between nationalist reality and pure nationalism. Instead, the nation-state is an in-
stitutionalized form of life whose existence relies on the operation and context of a
given institution.
10. A typical discourse can be seen in a publication of the Pharmaceutical Re-
search and Manufacturers of America, Pharmaceutical Industry Profile 2006 (PhRMA
2006).
11. To be exact, this growth includes the expansion of the pharmaceutical industry
and the FDA. In the mid-1970s statistics became involved, as clinical trials became
highly complicated and difficult to manage. Both regulators and industry hired more
experts and statisticians for clinical trials, and their efforts made clinical trials data
management highly technical and abstract that was impenetrable to outsiders. For
further description of the dynamics that developed between the regulated and the
regulator, see Kuo 2005, chapter 2, 100–109.
12. There have been debates over the actual cost of innovating each new drug. The
figures given by the PhRMA (and challenged by critics such as Marcia Angell, James
Love, and Sidney M. Wolfe) show that the actual cost per innovated drug increased
from $259 million in 1990 to $302 million in 1995. According to a 2001 study by the
Tufts Center for the Study of Drug Development, this has lately increased to $802
million. The most- cited study evaluating the average cost of bringing a new chemical
entity to the market is DiMasi et al. 1991. For PhRMA’s reasoning on this cost, see
PhRMA 2000. For the main criticisms of the figures released by PhRMA, see Public
Citizen 2001.
13. This does not consider the problem of humidity, which was not specified be-
fore any universal standard was established.
14. The WHO founded the International Conference of Drug Regulatory Authori-
ties (ICDRA) in 1980 to allow the drug regulatory authorities of WHO member states
to meet and discuss ways to strengthen collaboration and exchange information.
Before the inauguration of the ICH, the ICDRA was a means of aiding the WHO and
regulatory authorities in their efforts to improve the safety, efficacy, and quality of
medicines. Even so, as a purely administrative meeting of regulators, ICDRA did not
achieve as much as it aimed to. In fact, in the opening speech of the third ICH con-

TRANSFORMING STATES 299

ference, in 1995, Hiroshi Nakajima, then director general of the WHO, urged that the
achievement of the ICH should be shared by all WHO member states, not just ICH re-
gions.
15. The ICH has six voting members, including regulatory agencies (the FDA, the
Japanese Ministry of Health and Welfare, and the European Community) and indus-
try representatives (PhRMA, the Japan Pharmaceuticals Manufacturing Association,
and the European Federation of Pharmaceutical Industries and Associations). Some
organizations, such as the WHO, Health Canada, and the European Free Trade As-
sociation, are nonvoting observers. The International Federation of Pharmaceutical
Manufacturing Associations, which is also a nonvoting member, functions as secre-
tariat.
16. For an updated and detailed description of the ICH process, see “The ICH Pro-
cess for Harmonisation of Guidelines,” available at the ICH website, http://www.ich
.org.
17. According to the ICH website (last visited on 18 July 2011), the number of final-
ized guidelines has increased to sixty. The number of guidelines in the categories of
quality, safety, efficacy, and multidisciplinary issues is 24, 13, 18, and 5, respectively.
I shall refer to ICH conferences using the letters “ICH” plus a number denoting chro-
nology; for example, the sixth ICH conference will be indicated by “ICH6.” Although
the seventh conference—originally scheduled for 2007—was canceled, the steering
committee and expert working group meetings were held in Brussels in May and in
Yokohama in October.
18. This is a remark often heard in my interviews with regulatory agencies and
industry representatives. For them, there seem to exist no conflicts between public
health and the sale of drugs as all regulatory boundaries are dissolved. Even so, some
of the ICH’s achievements have been assessed critically by scholars such as John
Abraham and Tim Reed (2002), who criticize the ICH for working to accommodate
the industry’s desire to loosen requirements. In another essay, John Abraham (2002)
even casts the ICH in the longer trend of the development of pharmaceutical regula-
tions, in which the industry plays an aggressive role to making drug approvals easier
and faster.
19. This statement was later modified: “To promote a mutual understanding of
regional harmonisation initiatives in order to facilitate the harmonisation process re-
lated to ICH guidelines regionally and globally, and to facilitate the capacity of drug
regulatory authorities and industry to utilize them” (ICH website). Nevertheless, the
hierarchal structure imposing ICH standards on non-ICH regions remains the same.
20. For this, Applbaum cites exactly the ICH’s E5 topic, claiming that it facilitates
the move to accept foreign clinical data, and thus achieves the “most significant for
opening the door [of the Japanese market] to global activity in the industry” (2006, 91).
21. According to Visiongain’s report Japanese Pharmaceutical Market, 2006–2011,
in 2006 Japan’s pharmaceutical market generated sales totaling $60 million, ap-
proximately 11 percent of the world market.
22. Notification no. 660, “Handling of the Data of Clinical Studies for Pharma-

300 WEN-HUA KUO

ceuticals etc. Conducted in Foreign Countries,” announced by the director general of
the Pharmaceutical Affairs Bureau, 29 June 1985.
23. Personal conversation with Osamu Doi in Tokyo, 7 August 2006.
24. Japan uses the term minzoku to summarize its conceptualization of bodies
and cultural distinctions. This is the term used in the Japanese version of the E5
guideline (also in the official Japanese version), and is key to understanding this de-
bate. In brief, the dichotomy between biological concepts and social- cultural con-
cepts offers little insight into the idea of minzoku, which relates more to the idea of
“nation” or, in a practical sense, to that of “nation-state,” which blends ideas of race,
ethnicity, and the political institutions that manifest them.
25. In addition to the pharmacokinetic study, which belongs to phase 1 of clini-
cal trials and uses a small group of healthy volunteers to assess the basic behavior
of a drug, phase 2 and 3 studies must be completed before approval can be granted
to a new drug. Performed on a larger group of healthy people and patients, phase 2
studies are designed to assess how well the drug works and at what dosages. Phase 3
studies are more expensive than phase 2 studies; most are multicentered trials in-
volving large patient groups, of three hundred to five thousand or more, depending
on how the disease works, and are intended as definitive assessments of the drug’s
efficacy.
26. Another ICH example—similar to the E5, but less controversial—is the E10
guideline (titled “Choice of Control Group in Clinical Trials”). According to this
guideline, the use of placebos should not be universal, but depend on the research
design and population. This issue was brought up for discussion at the ICH in part
because comparative clinical trials were the dominant method of gathering data, yet
the use of placebos was considered unethical in Japan. Recognizing this regulatory
difference, guideline E10 leaves it to local regulatory authorities to judge the accept-
ability of clinical data.
27. According to IMS Health, Taiwan is the twentieth-biggest individual market
in the world, consuming U.S. $2.2 billion in pharmaceuticals in 2003. On the global
pharmaceutical market map (in U.S. dollars), it trails Japan ($52.4 billion), Korea
($3.9 billion), Australia ($3.1 billion), India ($3.4 billion), and China ($4.0 billion) in
the area known as the Africa-Asia-Australia region; http://www.imshealth.com/por-
tal/site/ims, accessed 11 August 2003.
28. The development of clinical-trial regulation in Taiwan has a complicated his-
tory which deserves a serious study of its own. In essence, it is not determined solely
by the government but also by the PhRMA and the U.S. trade representative. After
1989, through U.S.-Taiwan trade negotiations, high- quality (and costly) clinical trials
were first imposed, at the request of the industry, to block local competitors. This
bar was elevated even further before the ICH guidelines were introduced. However,
as pointed out by Oliver Yoa-Pu Hu, former director general of Taiwan’s Bureau of
Pharmaceutical Affairs, it was also the PhRMA that, after 1994, asked Taiwan to re-
move clinical-trial requirements because they were found to be no longer necessary.
By claiming that the existing trials were not “scientific” enough and thus formed an

TRANSFORMING STATES 301

“inappropriate non-tariff barrier,” the PhRMA accused the Taiwanese government of
erecting trade barriers in its annual reports to the U.S. trade representative, asking
for higher pressure to suppress these local trials (from a personal conversation with
Hu in Taipei, 20 October 2003). For selected annual reports the PhRMA prepared for
U.S. trade representative on the estimation of trade barriers during the years Dr. Hu
mentioned, see PhRMA, Trade Estimate Report on Foreign Trade Barriers (NTE). Avail-
able at http://www.cptech.org/ip/health/phrma. Last accessed on 18 July 2011.
29. In 1995 Taiwanese experts and medical advocates founded the ICH-Taiwan,
a strategic, mission- oriented committee under the auspices of the Department of
Health. Of the three working groups, one is designated to promote Taiwan as an
operational center for clinical trials. For more details on ICH-related initiatives in
Taiwan, see Chen 1998.
30. Another competitor in this region, Korea, revised its Good Clinical Practice
regulation in accordance with ICH guidelines and in 2001 introduced the concept of
the bridging study.
31. Lin et al. 2001. It is the first survey widely covering populations in East Asia
and the first to genetically locate the so- called Taiwanese on a global map. It became,
and still is, the core scientific study supporting the CDE’s bridging study policy.
32. The full name of this network is the APEC Network of Pharmaceutical Regula-
tory Science-APEC Joint Research Project on Bridging Study.
33. The most notable regulation in this revision is the Singapore GCP guidelines,
which had not been updated since their establishment in 1978. As Taiwan and Korea
had done for their GCP guidelines, Singapore revised its GCP by adopting the ICH E6
guideline (Ministry of Health, Singapore, “Singapore Guideline for Good Clinical
Practice (SGGCP),” available at www.gcphelpdesk.com/index.php/knowledge-base/
item/download/6, downloaded on 18 July 2011). For the development of Singapore’s
regulatory environment in the 1990s, see Fong 1998.
34. The ten member countries are (in alphabetical order): Brunei Darussalam,
Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thai-
land, and Vietnam.
35. Indonesia’s National Agency of Drug and Food Control, Malaysia’s Drug Con-
trol Authority, the Philippines’ Bureau of Food and Drug, Thailand’s Food and Drug
Administration, and Singapore Health Sciences Authority, Centre for Pharmaceuti-
cal Administration, and Centre for Drug Evaluation represent the most progressive
agencies in this region and play active roles in the harmonization process.
36. Before this initiative, pharmaceutical review processes varied. Different docu-
ments were required for registration, and the average time needed for registration
ranged from seventeen weeks to eighteen months. Although progressing slowly, this
project is still ongoing, as reported in the ICH- GCG meetings (the latest of which took
place in Brussels in November 2008). For an evolutionary account of clinical trials in
Southeast Asia and harmonization initiatives, see Ellick Wong 2003.
37. Starting with Eli Lilly’s the Lilly-NUS Centre for Clinical Pharmacology in
1997, leading pharmaceutical companies, such as AstraZeneca, Bristol-Myers
Squibb, GlaxoSmithKline, Merck KGaA, MSD, Novartis, Novo Nordisk, Pfizer, Sanofi-

302 WEN-HUA KUO

Aventis, Lundbeck, Schering AG, and Schering-Plough, have set up their biomedical
research centers in Singapore.
38. It may be noticed that it is not only the Asian states discussed in this chapter
that need to readjust their standards of clinical trials to take into account ethnic dif-
ference. Referring to the U.S. context, Jonathan Kahn’s “Harmonizing Race” (2006)
compares the different racial categorizations in FDA regulations and the E5 guide-
line, pointing out that although the FDA has adopted the ICH categorization in its
regulations, it still advises product sponsors to use the original categorization, which
includes Hispanic or Latino as an independent category, in its data collection, even
outside the United States.
39. For more information on the comparative approach, see Sheila Jasanoff ’s De-
signs on Nature (2005), which contains a good discussion of why comparison is nec-
essary to understand regulations in the transnational context.
40. At the meeting of the APEC Network of Pharmaceutical Regulatory Science in
2003, Elaine Esber reported complaints from the industry such as “E5 has resulted
in a request for more studies, rather than less”; it is “a convenient excuse for requir-
ing a local registration study and calling it a bridging study”; “requests are for data,
country by country, not as a region”; “there are ulterior motives for requesting that
studies be done, e.g., protect local industries”; “E5 is being implemented as a trade
barrier”; “most companies are doing studies just to not get into an argument”; “gov-
ernments are not being flexible”; and many others. For the successful cases using
bridging studies, see Uyama et al. 2005.
41. These multi-institutional projects include Human Organized Whole Genome
Database, Japanese Single Nucleotide Polymorphisms, Human Genome Sequenc-
ing, Eukaryotic Comparative Genome Browser, Structural Initial Data Library of
Amino Acid Residues, SNP Database Network in Japan, and the Japanese node of the
International HapMap Project. Each project involves about three to five research in-
stitutes from Japanese industry and academies.
42. For a brief history and discussion of the JSNP project, see Hirakawa et al.
2002.
43. Personal conversation with Kazuhiko Mori in Tokyo, 20 September 2007.
44. Takeuchi cites a study in the New England Journal of Medicine (NEJM) in which
patients of diffuse large-B- cell lymphoma are divided into three subgroups accord-
ing to their genetic profiles; each subgroup had a distinct t survival rate after treat-
ment. In other words, there is a correlation between genetic expressions and cancers,
as well as between genetic expressions and clinical outcomes. See Rosenwald et al.
2002.
45. Interviewed at Kitasato University, Tokyo, 23 August 2004.
46. Connected with leading universities, industry, and regulatory agencies, Tai-
wan has a strong pool of Taiwanese experts in biostatistics, especially in the field of
clinical trial design. This also makes this symposium significant in terms of global
clinical trials. The following methods are presented in the symposium held. For their
presentations, see National Health Research Institutes 2003.
47. Unlike Japan, which tends to vaunt the “homogeneity” of its population,

TRANSFORMING STATES 303

or Taiwan, where Han Chinese are predominant, Singapore, whose population is
a mere 3.44 million, consists of people of at least three origins—the Chinese, the
Malay, and Indians, along with others.
48. The decision not to study ethnic effects in pharmaceuticals can be also seen
in another state on the Asian side of the Asia-Pacific region, Australia, whose popu-
lation is over 30 percent Asian.
49. As a part of the Health Sciences Authority, the Centre for Drug Evaluation
merged with Centre for Pharmaceutical Administration to found the Centre for
Drug Administration in 2004.
50. Cited from John Lim’s PowerPoint presentation, titled “Procedure of Consul-
tation and Evaluation,” delivered at the 2001 APEC Network of Pharmaceutical Regu-
latory Science meeting, Taipei, 25–26 May. This presentation is not in the public
domain.
51. These agencies are the FDA, the Medicines and Healthcare Products Regu-
latory Agency, the Therapeutic Goods Administration (Australia), the European
Agency for the Evaluation of Medicinal Products, and Health Canada.
52. It is expected that there will be complete implementation of common docu-
ments for pharmaceutical applications and twinning-system programs allowing in-
formation exchange for specific areas within ASEAN states.
53. Although beyond this chapter’s scope, as a meditative footnote on social
theory I would like to note that the difference among Japan, Taiwan, and Singapore
is not just one of national variation; it reflects fundamental concepts of how the
state forms a vision of its future. I would like to refer the case of Japan and Taiwan
to Benedict Anderson’s Imagined Communities (1983), according to which visions are
somehow formed on the basis of the infrastructure of people living in the land. In
other words, visions are formed from within the state. However, this comment may
not be entirely applicable to Singapore, which is too tiny to claim state value with-
out considering influences from outside. This characteristic becomes more obvious
when researchers of globalization start working not only on individual states, but on
multiple states and their interaction. In addition to the present chapter’s discussion
of the development of pharmaceutical regulations, Aihwa Ong and Charis Thomp-
son have recently completed work on global trends in biotechnology and stem- cell
research. Both discuss Singapore in their problematic.
54. A recent failed attempt to “fix” race is the Human Genome Diversity Project,
an international project that seeks to map the diversity and unity of human species
by DNA sampling. For a critical analysis of how this scientific enterprise was initiated
and collapsed, see Reardon 2004.
55. This view can be found in the recent resolution by the Pharmaceuticals and
Medical Devices Agency (PMDA) to initiate a research agenda for global drug devel-
opment based on the diversity of populations. For more detail, see the PowerPoint
reports in “PMDA Challenges for Global Drug Development” 2007.
56. In a study that I am currently conducting, I follow up on what the CDE pro-
poses regarding the bridging of clinical data among Asian states. In accordance with
the vision presented in this chapter, this project has the following preliminary result:

304 WEN-HUA KUO

moving beyond making statistical bridges, Taiwan has been seeking to construct a
regional network of regulatory science. This network should function not only as a
scientific one that integrates clinical data produced from Asian states, but also as an
administrative platform, where each state respects the presence of other states by
mutual recognition.
57. Readers may be reminded here of a study by Aihwa Ong (2000) of the chang-
ing nature of citizenship and governance as seen in Southeast Asia. Ong argues that
the developmental state encouraged spatial fragmentation of citizenship and gover-
nance in order to cope with the demands of the global economy. Although Ong is also
working on different aspects of how states function, she considers the Singaporean
state as a mere collection of functionaries, whereas I regard it as an agency or gate
that controls the flow of capital. However, we both agree on and capture the charac-
teristic flexibility that Singapore uses to survive. For a recent evaluation of the state
endeavor of Singapore’s biopharmaceutical performance, especially the Biopolis Sci-
ence Park and the science and technology plan for 2010, see Holden and Demeritt
2008.
58. This standpoint was clearly stated by John Lim, currently the chief executive
officer of the Health Sciences Authority, at the Symposium of APEC network on Phar-
maceutical Regulatory Science (Tokyo, 12–13 October 2006). Even so, a state’s vision
or voice does not necessarily reflect that of its people. For example, Kerry Holden and
David Demeritt question the ICH guidelines introduced by the Singaporean govern-
ment, asking “why international guidelines, such as the ICH- GCP, appear neutral in
the face of multi-racial, cultural, and ethnic societies; or what these guidelines do for
science and how they improve it” (Holden and Demeritt 2008, 80).

TRANSFORMING STATES 305

 10
KIM FORTUN

BIOPOLITICS AND THE INFORMATING

OF ENVIRONMENTALISM

Consider Texas City, in Galveston County, Texas, in the middle of the biggest
petrochemical corridor in the United States. Texas City is home to a huge
Union Carbide plant, which I have kept an eye on for a long time as a way to
continue my engagement with the Bhopal disaster, my focus in earlier re-
search. Texas City was the site of a catastrophic industrial disaster in 1947,
when a freighter loaded with ammonium nitrate blew up, igniting a chain
reaction that ripped through the chemical plants that surrounded the city.
Over 500 people were killed; thousands were injured; over 3,000 homes
were destroyed.1 In 1987, Texas City was the site of what union workers call
an “almost Bhopal.” A contract worker at Marathon Oil dropped a compres-
sor on a tank of hydrofluoric acid: 1,000 people were injured; 3,000 people
were evacuated. The local economy still revolves around chemicals. There
are so many point sources that it can seem impossible to know where to start
an effort to reduce local pollution (Fortun 2001).2
By typing in the zip code for Texas City at Scorecard.org, in 2004, I got
to a webpage titled “About Your Community,” Galveston County.3 There
were sections on air, waste, land, and water, and also on environmental jus-
tice and on “setting environmental priorities.” At the bottom of the page, I
was encouraged to “explore the maps” to see how air pollution in Galveston
County compared with other communities, and to locate polluters and see
how close they were to my home and workplace. In the section on air, I was
told that, based on the most current data of the Environmental Protection
Agency (EPA), Galveston County was among the dirtiest 10 percent of all
counties in the United States in terms of noncancer hazards from hazard-
ous air pollutants (HAPs). I was also told that 250,158 people in Galveston
County faced a cancer risk more than 100 times the goal set by the Clean
Air Act—84 percent from mobile sources (i.e., cars and trucks), 14 percent
from point sources (i.e., large industry), and 2.5 percent from area sources
(small businesses; see 1).
I then clicked on “What’s Your Risk?” This page told me that the average
inhabitant of Galveston County had an added cancer risk of 790 per mil-
lion, and that the highest contributor to cancer risk was diesel emissions.
I could click through to more information on diesel emissions, or instead
click through to more information on “Cancer Risks” or “Noncancer Haz-
ards.” I could also click through to more information on “Caveats.” Here I
could read why exposure estimates from 1996 might not accurately pre-
dict current exposures; why exposure modeling is uncertain; why uncer-
tainties increase with focus on small geographic areas or individual sources;
why health-risk assessment also involves important uncertainties; and about
caveats applicable to specific chemicals or emissions sources.
Backing up to the page on “Cancer Risks and Noncancer Hazards,” I real-
ized that I could also have clicked on two specific chemicals: diesel emis-
sions, the HAP with the highest contribution to cancer risk in Galveston
County, or acrolein, the HAP with the highest contribution to noncancer haz-
ards. Clicking on either of these chemicals took me to a full chemical profile
that included information on human health hazards, on how the chemical
ranked as a hazard compared to other chemicals, on who used the chemical,
and on where it was released across the United States. The profiles also in-
cluded information on regulatory coverage of the profiled chemical, on basic
tests done (or not done) to identify hazards associated with the chemical,
and on the data that was missing yet needed to make a safety assessment. At
the bottom of the profile was a list of links to numerous other sources that
had more information on the chemical profiled, collected from states, the
U.S. EPA, and international sources. As I scrolled through the page on diesel
emissions, a pop-up window blinked at me to type in my zip code again, in
order to take action. I could send a prewritten email to the EPA or a similar
letter to the Texas governor, Rick Perry.

BIOPOLITICS AND ENVIRONMENTALISM 307

 1. Cancer risks
and noncancerous
hazards in
Galveston.
Screenshot from
http://www
.scorecard.org,
2004.
2. Environmental burdens, Galveston.

Back on the page titled “About Your Community” for Galveston County, I
could click through to learn “Who Is Polluting Your Community” and “What
Are the Major Pollutants.” By clicking on the first of these, I got to a list of
companies that were required to report their emissions to the U.S. EPA’s
Toxic Release Inventory (TRI), a pollution database established by law in
1986 and the first federal database that Congress stipulated be accessible
to the public in a computer-readable format. Union Carbide’s big Texas City
plant was fourth on the list, releasing 1,101,343 pounds. The worst polluter
was Sterling Chemicals, which emitted 8,812,611 pounds. I could also pull
up a list of TRI companies ranked across the state of Texas. Here, Union
Carbide’s big facility in Texas City was ranked 58th. The worst polluter, in
terms of total pounds released, was a BASF plant in Freeport, which released
21,492,909 pounds.4
Instead of following up on BASF, I returned to an “Environmental Re-
lease Report” focused specifically on Union Carbide’s Texas City plant. On
this page, I clicked to view a pop-up map that showed TRI facilities in Gal-
veston County. Clicking on any one of the icons that dot the map pulled
up a company name and a graph that showed trends in environmental re-
leases between 1988 and 1999. The map allowed me to zoom way in, or

BIOPOLITICS AND ENVIRONMENTALISM 309

way out, but it did not provide street names. Since I was familiar with the
area, I still got a sense of how the ten TRI facilities in the area were clus-
tered. I was also able to view a line graph that showed how the Texas City
Union Carbide facility ranked among all TRI facilities in the United States
for major chemical release and waste generation—it was in the 90th per-
centile. I could also see that the top-ranked ozone- depleting chemical at
the facility was chlorodifluoromethane, and that the top-ranked cancer risk
came from releases of benzene while the top-ranked noncancer risks came
from vinyl chloride. Next I viewed a list of pollution releases at this facility
sorted by health effect. The list told me that 184,513 pounds of recognized
carcinogens, and 180,600 of suspected carcinogens, were released into the
air in 1999. The list also told me the pounds of air releases that were recog-
nized and suspected blood toxicants, developmental toxicants, endocrine
toxicants, immunotoxicants, kidney toxicants, gastrointestinal toxicants,
muscular toxicants, neurotoxicants, reproductive toxicants, respiratory toxi-
cants, and skin or sense organ toxicants.
Scorecard told me how many pounds of toxics were released in a given
year by a given facility. I was also able to learn about probable risk, body sys-
tem by body system, based on a hazard-ranking system that compared all
chemicals to benzene, a known carcinogen, to indicate cancer potential, or
toluene, a developmental toxic, to indicate noncancer risk. The ranking sys-
tem provided users with relatively stable reference points for thinking about
an otherwise confusing array of health risks.
Yet another section on Scorecard’s report on Union Carbide’s Texas City
plant was “What We Don’t Know about Chemical Safety and Harm.” Click-
ing there opened up yet another storyline—a story about the information
that was not available for this or any other facility, even for high-volume
chemicals.

Informationalism in Practice

A functional change in a sign-system is a violent event. . . . Yet if the space for

change (necessarily also an addition) had not been there in the prior function of
the sign-system, the crisis could not have made the change happen. The change in
signification-function supplements the previous function. “The movement of signifi-
cation adds something . . . but this addition . . . comes to perform a vicarious function,
to supplement a lack on the part of the signified.” The Subaltern Studies collective
scrupulously annotates this double movement.

310 KIM FORTUN

[What one gets] is a theory of change as the site of displacement of function between
sign-systems.
GAYATRI CHAKRAVORTY SPIVAK, “SUBALTERN STUDIES”

The information experience that I have just described took place at Score-
card.org, a website that was supported by a relational database that con-
tained profiles of over 6,800 chemicals. The website integrated local pollu-
tion information for the United States with information on health risks and
with information on relevant environmental regulations. It allowed users to
produce customized reports and encouraged communication with the U.S.
EPA or with a polluting company.
Environmental Defense launched Scorecard in 1998, saying that its pur-
pose was to make the status of the environment as easy to check on as the
local weather. Shortly after, Chemical Week described the website as the
“Internet Bomb” because of its potential effect on the reputations of chemi-
cal companies. Greenpeace has referred to Scorecard as the gold standard
of environmental information systems because it provided opportunities
for movement from information to collaborative action, and because it was
partly built on open-source software, which Greenpeace says operates ac-
cording to the same tenets as radical environmentalism.
I describe Scorecard here to draw out how environmental information
systems are an important site of biopolitics today, indexing what I think
of as the “informating” of environmentalism.5 With the term informating I
want to draw out how information technology and culture animate change
at multiple scales, sometimes provoking critical changes in sign systems.
Such shifts enable articulation previously impossible or unrecognizable, dis-
placing what I call “discursive gaps.” It is, of course, widely acknowledged
that “informationalism” is a key dimension of global order today.6 One of
my broad goals is to map how the environmental field is a site of and influ-
ence on this order. I also want to make a specific argument about how in-
formationalism works. In addition to driving and undergirding policy and
law, organizational priorities, and the practice of various social actors, infor-
mationalism is routing desire and shaping subjectivity, configuring what
people want to do and what they think is both possible and obligatory. In-
formationalism sets up, for example, how policymakers conceive of efficacy,
how scientists think of civic commitments, how citizens conceive of knowl-
edge and rights, and how people experience health and illness. Its effects are
cultural, as well as political and economic.

BIOPOLITICS AND ENVIRONMENTALISM 311

 It also can be said that the extraordinary productivity of information-
alism emerges from the level of practice and from the particular type of
labor that informationalism engenders. Informationalism, through its ma-
terial grounding in informatics, facilitates information production, flow,
and processing. Of particular critical interest are moments of processing,
when “information” is put into the boxes and categorization schemes that
informatics depends on. It is a stage of necessary reduction, a stage when
substantive differences are massaged away. Moments of processing are also
moments of play. Informatics provide the means to archive, order, visualize,
and reorder data, of different types, in large quantities. The capacity to order
and reorder—quickly and without great expense—is of critical importance.
Through informatics, differences are worked out, powerful relationships
are established, or not, and it becomes possible to say some things but not
others. This makes informatics an important site of cultural production and
ethical action today.
In allowing for and encouraging reorderings, informatics operate with
what can be called a logic of supplementarity (following Derrida’s concep-
tion), enabling substitutions and additions that have the potential to recon-
sider what a system can say and do, encouraging displacements and realign-
ments. Informatics thus destabilize established systems by design. Though
the context always matters, informatics can be conceived as a material cul-
tural form that is valenced in particular ways. Through the facilitation of
constant reordering and revisualization of one’s “object” of concern, infor-
matics tends to push fields in which they operate into iterative rather than
into reproductive modes.7
I am driven toward a generalizing argument here in part to provoke re-
consideration of the now common argument that digitization is a disen-
chanting, reductive project that compels what Donna Haraway calls “the god
trick” by promising total knowledge. This argument is not incorrect. But
neither does it account for all that is going on through informatics. I want
to tell the other side of the story. A story about the ways people are invest-
ing in informatics, often in intensely creative ways. A story about the critical
potential of informatics as a mode of production. A story about how infor-
matics are allowing for new ways of sorting and arranging differences—
between social groups, between the normal and the pathological, between
the acceptable and the unacceptable, between knowledge and overwhelming
complexity. A story about work within and around discursive gaps.
Discursive gaps are gaps in what discourses can say or even recognize.

312 KIM FORTUN

They are what people can’t get their heads and tongues around. They oper-
ate through disavowal and ignorance.8 Important cultural work is done in
efforts to displace discursive gaps, and environmental information systems
can provide critical tools. Designers and users of environmental informa-
tion systems work in NGOs, in government labs, and at home computers,
as professionals, parents, citizens, and journalists, connecting to data re-
sources and other users in ways unimaginable even a decade ago. Bit by bit,
together, they are changing what counts as an environmental problem. Their
work produces what Gayatri Spivak calls “discursive displacements”: shifts
in sign systems brought about through movement within the system, which
brings previously latent signification to the surface.
Environmental politics, particularly toxic politics, includes people, crea-
tures, and issues that are difficult to assimilate into established narratives
about truth, responsibility, and health. Extraordinarily expert environmen-
tal information systems, somewhat ironically, draw these people and issues
into visibility. They make “the environment” accessible to understand-
ing and governance, configuring—quite literally—what counts, and what
does not.

Bit by Bit

Greenpeace and Worst-Case Scenarios

“Information strategies” for dealing with environmental risk became the

explicit focus of law in the United States, in 1986, through passage of the
Community Right-to-Know Act, Title III of the Superfund Amendments
and Reauthorization Act (SARA). Widely regarded as the primary legislative
response to the Bhopal disaster in the United States, the act mandated a
range of initiatives to support emergency planning and public access to in-
formation (Hadden 1994). High-risk facilities, for example, had to provide
the information needed by local rescue personnel to plan emergency evacu-
ations.9 By the time amendments to the Clean Air Act were passed, in 1990,
this had evolved into a mandate for “worst- case scenarios” for 66,000 high-
risk facilities around the United States. A worst- case scenario shows the
radius within which people will die if there is a massive toxic release from a
plant without adequate evacuation, as happened in Bhopal. Although worst-
case scenarios were supposed to be ready for distribution by June 1999,
in August 1999 President Bill Clinton signed the Chemical Safety Infor-
mation, Site Security and Fuels Regulatory Act, which blocked Internet

BIOPOLITICS AND ENVIRONMENTALISM 313

posting of information about any facility’s “offsite consequence analysis”—
worst- case scenarios.10 The chemical industry argued that this legislation
was needed to prevent dangerous information from falling into the hands
of terrorists. Information thus became the hazard.
Greenpeace took up the work of publicizing worst- case scenarios none-
theless, insisting that “chemical security” depended on it. Only if dangers
were publicly known, Greenpeace argued, would initiative be taken to
secure plant premises and to substitute high-risk chemicals and processes
with safer alternatives. According to a Greenpeace editorial in the New York
Times in September 2004, a study conducted by the Army Surgeon General
after 9/11 found that up to 2.4 million people could be killed or wounded by
a terrorist attack on a single chemical plant. The EPA followed through with
the study, identifying 123 chemical plants where an accident or attack could
threaten more than a million people, and 7,605 plants that threatened more
than a thousand people. The EPA also determined that it could use the Clean
Air Act to compel chemical plants to improve security. Responsibility for
chemical security was nonetheless given to the Department of Homeland
Security, which did not have the power to enforce security measures and
thus had to rely on voluntary efforts. According to Greenpeace, the Depart-
ment of Homeland Security also “tried to reduce the threat of catastrophic
attack with the stroke of a pen, . . . announcing that the number of plants
that threatened more than 1,000 people was actually only 4,391, and the
number that endangered more than a million people was not 123 but two”
(Hind and Halperin 2004).
“Chemical security” has become justification for withdrawing environ-
mental risk information from the public domain. Environmentalists have
pushed back with a double logic, arguing both that the chemical industry
is a weak link in the U.S. homeland security program and that the risk of
a terrorist organization taking advantage of worst- case scenarios does not
outweigh the hazard of an uninformed public. Nevertheless, the Chemical
Safety Site Security and Fuels Regulatory Act made it illegal to electronically
publish detailed worst- case scenarios. Most significant, high-risk compo-
nents of a plant—such as a storage tank of ammonia—cannot be identified,
which not only keeps “terrorists” from locating them, but also thwarts citi-
zens hoping to formulate and implement specific risk-reduction plans. The
potential for local environmental action has been undercut. Greenpeace has
skirted the restrictions by moving to another scale, with visualizations that
are effective without the outlawed level of detail. Other kinds of information

314 KIM FORTUN

3. New Jersey–New York Bhopal scenarios. Courtesy of Greenpeace,
http://greenpeaceusa.org.

substitutes for the information that the law has taken offline. In mapping
a potential worst- case scenario at the Kuehne Chemical Company in South
Kearney, New Jersey, for example, Greenpeace draws out the population
density of the area and many well-known landmarks—Times Square, the
Statue of Liberty, Newark Airport, Giants Stadium—that would be affected
by a worst- case release (see 3). In another visualization, Greenpeace overlays
worst- case scenarios for forty chemical plants between Baton Rouge and
New Orleans. While plant-specific information is not included, the cumula-
tive warning is powerful (see 4).
Greenpeace does not deny the significance of “chemical security.” Infor-
mation about potential catastrophic environmental risk is recognized as a
charged resource. Rather than skirting the complexity, Greenpeace has en-
gaged it, creatively using digital-mapping capabilities to make catastrophic
risk potential visible, without providing the kind of detail that could con-
tribute to sabotage at the local level. Environmental hazards remain on-

BIOPOLITICS AND ENVIRONMENTALISM 315

4. Bhopal scenarios on the Mississippi. Courtesy of Greenpeace, http://greenpeaceusa.org.

screen—and are highlighted as being of particular concern in a world riv-

eted by terrorist threats—while crude reifications of homeland security are
disrupted.11

We-Acting against Asthma

Consider the work of West Harlem Environmental Action (We Act) on

asthma. Asthma incidence in the United States has increased dramatically
and unevenly in recent years. Poor and minority children get sick and die
from asthma much more frequently than wealthier, white children (see 5).
Access to care has long been acknowledged as part of the problem. Indoor
pollutants—mold, rodent and cockroach feces, dust, second-hand smoke, all
often found in low-income housing—have also been recognized as signifi-
cant. The force of the outdoor environment—air pollution—is still coming
into view, however, and the development of informatics is a key part of the
story.
Connecting outdoor air pollution to asthma incidence is enabled by digi-
tal mapping, modeling, and visualization tools—tools that draw previously

316 KIM FORTUN

5. EPA asthma facts.

invisible connections to the surface. For example, polluting industrial facili-

ties can be seen in proximity to low-income and minority neighborhoods.
Connecting particular exposures to particular health outcomes—a notori-
ous challenge—also becomes more manageable, if far from straightforward.
Asthma incidents can be connected to ozone levels, for example, or asthma-
related hospitalization can be connected to traffic flows and to the uneven
distribution of these flows in different neighborhoods.
We Act, an environmental-justice group, has done important, cutting-
edge work of this sort. Using data available from the U.S. Census, the U.S.
Department of Transportation, the N.Y. State Department of Health, and
the N.Y. State Metropolitan Transportation Authority—in collaboration
with researchers at Cornell, Columbia, and Mount Sinai Hospital—they
have simulated real-time asthma hospitalization rates for neighborhoods
around Manhattan (see figures 6–7). The picture presented is not “real”—it
is based on data from previous years—but its real-time effect creates a sense
of urgency while making clear significantly uneven distributions of disease
incidence.
In another set of visualizations, We Act connects asthma hospitalization
rates to proximity to diesel-fume-producing facilities, which are linked to

BIOPOLITICS AND ENVIRONMENTALISM 317

6. Hospital admissions for asthma.

demographic data to show how asthma risks disproportionately burden mi-

nority communities (see 8). With a series of snapshots of the same problem,
from different angles, asthma becomes visible as an environmental-justice
problem. We Act has reordered existing data to draw previously invisible re-
lationships, old problems, and possible remedies into visibility.12

318 KIM FORTUN

7. Polluting facilities and child hospitalization.

Scorecard Redux

Before Scorecard, the task of gathering data on pollution in a particular area,

or related to a particular health risk, was tedious and frustrating. Bill Pease,
the designer of Scorecard, learned about this in his first few months at En-
vironmental Defense, in 1995. As its senior environmental health scientist,
he was swamped with requests from grassroots groups needing help obtain-
ing and interpreting information about toxics in their community. Pease
needed a way to save people the time required to go from government office

BIOPOLITICS AND ENVIRONMENTALISM 319

8. Bus depots in communities of color.

to government office, to the library to the polluting facility in search of in-

formation that often wasn’t available without argument or delay. He also
needed to provide grassroots groups with tools for interpreting the data they
collected. His solution was to build an internal database and to hire a team
of environmental scientists and database consultants. Their plan, until they
consulted with the MIT computer scientist Phillip Greenspun, was to build
a standalone program that could be downloaded, or distributed on CD- ROM.
Greenspun convinced him to go the way of the Web.13
Over a billion pages can potentially be produced in Scorecard. The result,
for the users, is both exhilarating and overwhelming. Consider the possi-
bilities for environmental action produced by Scorecard in Texas City. One
could decide to work at the county level, knowing that mobile sources and
diesel emissions pose the greatest health hazards. Or one could work at the
facility level, focusing on Union Carbide’s Texas City plant, trying to re-
duce benzene releases, for example—since benzene is the chemical released

320 KIM FORTUN

from this facility that poses the highest cancer threat. As part of one’s cam-
paign, one could link up with other communities at high risk from benzene
releases and point out to the company and the press that Union Carbide’s
Texas City plant is the fourth worst polluter in Galveston County and is in
the 90th percentile of worst-polluting companies in the United States. An-
other strategy would be to focus specifically on ozone- depleting chemicals,
targeting chlorodifluoromethane at Carbide’s Texas City plant, while target-
ing other chemicals that are major contributors to ozone depletion released
from other facilities in the area, and perhaps around the country.
Any of these efforts would be riveted by uncertainties. Scorecard pro-
vided the information base and encouraged one to act on it, at the same time
highlighting how little is known about chemical toxicity, and how data in the
Toxic Release Inventory is incomplete, out- of- date, and often inaccurate.
This double gesture—providing information as the basis for action, while
qualifying the validity of the information—is characteristic of environmen-
tal information systems. Often, they produce working knowledge, which is
nevertheless claimed to be imperfect knowledge.
The goal of Scorecard was not to reassure the user, but to interconnect
her—with different types of information, with the regulatory process, with
people in both similar and different locales, with ways of visualizing and
spatializing phenomena that were usually represented in abstract, imper-
sonal terms. Getting “straight to the point” was not the goal. Instead, users
were encouraged to wander through different kinds of information, much of
it flagged as uncertain, visualizing comparisons, piecing together a picture
of reality to work with.14 High levels of information literacy were required,
and cultivated.
Scorecard allowed users to zoom in to the local and out to the national,
clicking through graphs that provided snapshots of pollution dispersion,
and through to chemical profiles that characterized pollution hazards. The
experience of Scorecard could be dizzying. But Scorecard took on some of
the most recalcitrant problems within environmental politics—the need to
deal with too little, as well as too much, information; the need to deal with
contested scientific findings and intractable uncertainty about long-term
effects; the need to think locally, as well as comparatively and globally.

Informating Environmental Ethics and Politics

Understanding and governance of “the environment” has always required

extraordinarily ambitious information collection and processing.15 Consider,

BIOPOLITICS AND ENVIRONMENTALISM 321

for example, Richard Groves’s account of the specimen processing involved
in the development of India’s famous botanical classification systems, and
the role of the printed book in the uptake of these classification systems
in Europe in the sixteenth century (Grove 1995). Consider, too, Groves’s
description of how understanding of tropical deforestation emerged from
networks of scientific societies throughout the colonial world (Grove 1995).
Since the Second World War, the ever-growing quantity and diversity of
industrial chemicals in use have made the information collection and pro-
cessing needed to keep track of “the environment” even more challenging.
Philosophical discourses about the environment often miss this, however,
remaining caught in frustratingly rigid oppositions between nature and
technology, between lay and professional knowledge, between truth and
uncertainty, and anthologies compiled for teaching environmental studies
tend to underwrite this exclusion, despite dramatic growth in the amount
of environmental information produced and circulated in recent years, de-
spite the important though often undramatic role that information politics
has come to play within environmental politics.
Environmental information systems need to be recognized as significant
and contested sites of political action, because they are sites where con-
ventional ways of thinking about the environment are being reconfigured.
Quite literally. Setting up a comparison or connecting bits of information
previously unrelated performs cultural work. So do click-throughs. Zoom-
ing in and out, learning to consider the implications of scale involves what
Antonio Gramsci termed “elaboration,” the labor of working out common
sense. This kind of labor can’t be reproductive. It involves a play of signs and
systems that is always unsettling.
The stakes are high. In the environmental field, technology and culture
shape what is and is not perceptible in particularly powerful ways. Many
environmental issues—toxics, climate change, biodiversity—are simply
unseeable without technical prosthetics. Technical prosthetics also enable
complex operations of difference. The environmental field, like so many
fields, is riveted by such differences and hasn’t yet learned to deal with
them.16 Environmental health problems, for example, may be “caused” by
industrial pollutants, vehicle emissions, class, race, and individual suscep-
tibility. Such multiple determinism is not well dealt with in law, regula-
tion, scientific practice, or the public imagination. Environmental informa-
tion systems like Scorecard have begun to shift the grounds. They are a site
where common sense is being reconfigured.17 Knowledge is being made,
circulated, legitimated, and internalized in new ways. Complex orderings

322 KIM FORTUN

of reality are constantly emerging and continually being displaced. Biotruth
becomes a moving object. Biopolitics are being reconstituted.18
The informating of the environmental field deserves critical attention,
as does the work of informating writ large. To be informated is to be beset
by possibilities for constant reordering and revisualization. When fields of
practice are informated, previous latent signification often comes to the sur-
face; discursive gaps—spaces where established analytic and explanatory
language fail, spaces where hegemony comes to crisis—can be displaced.19
Fields of practice that have been informated are thus sites “of the displace-
ment of function between sign-systems” (Spivak 1987, 198). They are a place
where change happens, sites of transaction between the past, present, and
future.

Notes
1. In the spring of 2010 the Houston Chronicle posted recently discovered photos
of the Texas City disaster. See “Texas City Blast of 1947” 2010.
2. Texas City suffered yet another disaster on 23 March 2005, when a British
Petroleum (BP) refinery there exploded, killing 15 workers and injuring more than
170 others. A follow-up report by the U.S. Chemical Safety and Hazard Investigation
Board documented a litany of plant design and safety problems behind the disas-
ter. On 30 October 2009 the U.S. Occupational Safety and Health Administration
(OSHA) imposed an $87 million fine, the largest in OSHA’s history. BP challenged the
fine. “Remember the 15,” a website to commemorate workers killed in the disaster,
provides a timeline of related events, at http://www.rememberthe15.com.
3. The information experience described in the forthcoming description took
place in 2004; details reflect this. On 1 November 2005 Environmental Defense
transferred responsibility for and ownership of Scorecard to another nonprofit or-
ganization, Green Media Toolshed (GMT). GMT stopped updating Scorecard in
2006. Meanwhile the EPA developed better tools of its own to encourage use of
environmental-risk information. See, for example, a review by Timothy Barzyk and
others at EPA’s National Exposure Research Laboratory (Barzyk, Conlon, Hammond,
Zartarian, and Schultz 2009). The EPA’s online resource most similar to Scorecard is
at the “My Environment” link at http://epa.gov. The United States National Library of
Medicine’s ToxMap site also works rather like Scorecard, allowing users to visualize
TRI data (as well as Superfund data) along with census data, health data, and so on.
See http://toxmap.nlm.nih.gov.
4. I have also watched BASF over the years, since a labor lockout at a BASF plant
in Geismer, Louisiana, helped mobilize the first major labor-environment coalition
in the mid-1980s. To draw the public into the issues, the Oil, Chemical and Atomic
Workers union ran a billboard suggesting the high stakes, asking if Geismer could
become “Bhopal on the Bayou.”

BIOPOLITICS AND ENVIRONMENTALISM 323

 5. Important recent work on environmental information systems examines their
uptake to address biodiversity, climate change, and a range of other issues (Bowker
2001; Edwards 2010; Edwards 1999; Sieber 1997; Sarewitz, Pielke, and Byerly 2000).
Erich Schienke (2006), Lane DeNicola (2007), and Alex Sokolof (2006), doctoral stu-
dents at Rensselaer, wrote dissertations on environmental information systems in
China (regarding the development of geographic information systems in panda con-
servation and air-pollution management), in India (regarding the development of
remote-sensing expertise for environmental applications), and at Greenpeace Inter-
national (regarding the development of information infrastructure in a globalizing
NGO). These dissertations significantly advanced my understanding of environmen-
tal information systems.
6. Manuel Castells contrasts informationalism to industrialism, locating its ori-
gins in the 1970s and in technologies like the microprocessor, optical fiber, trans-
mission control protocol (TCP), Internet protocol (IP), and so on. The productivity of
informationalism, according to Castells, “lies in the technology of knowledge genera-
tion, information processing and symbolic communication” (2000, 17). Castells also
explicates informationalism as a global ordering force, noting that the “multimedia
world will be populated by two essentially distinct populations: the interacting and
the interacted, meaning those who are able to select their multidirectional circuits
of communication, and those who are provided with a restricted number of prepack-
aged choices. And who is what will be largely determined by class, race, gender and
country” (ibid. 371). Alberto Melucci argues that “in the contemporary context, we
can define domination as a form of dependent participation in the information flow,
as the deprivation of control over the construction of meaning” (1996, 182).
7. Elsewhere, Mike Fortun and I have developed the idea that environmental in-
formation systems (particularly microarrays and databases in the emerging field of
toxicogenomics) can be “experimental systems” of the sort theorized by the biologist
and historian of biology Hans-Jörg Rheinberger (Fortun and Fortun 2005). Rhein-
berger explains that “an experimental system in which a scientific object gathers
contours and becomes stabilized, at the same time must open windows for the emer-
gence of unprecedented events. While becoming stabilized in a certain respect, it
must be destabilized in another. For arriving at new ‘results,’ the system must be
destabilized—and without a previously stabilized system there will no ‘results.’ Sta-
bilization and destabilization imply each other. If a system becomes too rigid, it is no
longer a machine for making the future; it becomes a testing device, in the sense of
producing standards or replicas. It loses its function as a research tool” (1998, 291).
8. Focusing on discursive gaps is particularly relevant in the anthropology of
technoscience today because of the pace of change across technoscientific fields,
partly driven by impressive developments in information processing and sharing
capabilities. Scientists and technologists themselves now routinely comment on how
established concepts and methods have become somewhat exhausted. They need
new ways of handling data and of judging its significance, and new ways of collabo-
rating across disciplinary boundaries. They are socially and intellectually situated
to recognize needs and possibilities for new types of knowledge, produced and vali-

324 KIM FORTUN

dated in new ways. They are subjects-in- doubt, struggling for language, defying pre-
dictable cultural patterns. This is the case in much work around toxics, for example.
9. Another key component of the Community Right-to-Know Act (1986) was the
TRI, which provided the base data for Scorecard.org. The TRI contains data reported
by a range of (but not all) industrial and federal facilities that produce or handle listed
toxic chemicals. The goal of the TRI was to allow the EPA as well as citizens to track
and evaluate routine, legal emissions.
10. The EPA provides an overview and links to the full text of the act at its website,
http://www.epa.gov.
11. Greenpeace’s portfolio “Worst Case Scenario Chemical Disaster Maps,” last
updated 5 May 2005, is available at its website, http://www.greenpeace.org. Also see
“Greenpeace ‘Dossier’ on Chemical Security,” last updated 22 July 2009, available at
the same website. Also see Orum 2008; Ember 2007a; Ember 2007b.
12. In 2005 coverage by the New York Times of a program in Harlem that increases
access to healthcare for children with asthma noted that rates of asthma in Harlem
were “found to be more than five times the national average, with 31.4 percent of
children found to be sick” (Santora 2005). It was also noted that “experts can pro-
vide no specific explanation for either the dramatic rise in asthma generally or why
it is so prevalent in poorer communities like central Harlem” (ibid.). Researchers at
Columbia’s Center for Children’s Environmental Health have conducted a number
of studies in West Harlem, attending to a range of possible asthma drivers and trig-
gers, including air pollution (Patel and Miller 2009; Gilliland et al. 2005; Kinney,
Chillrud, Ramstrom, Ross, and Spengler 2002).
13. Greenspun’s website, http://philip.greenspun.com, explains that the software
behind Scorecard emerged from the work of the Scalable Systems for Online Com-
munities research group at MIT, which Greenspun founded and then spun out into
ArsDigita, built by him into a profitable ($20 million in revenue) open-source enter-
prise software company.
14. The argument that discursion—a meandering through material—produces
an outcome valued differently than linear movement toward a stable conclusion is
now often made with regard to the value of hypertext, as in the assertion by George
Landow (1992) that there has been a “convergence” between critical theory and tech-
nology. This reasoning, however, is not new. In his introduction to a collection of
personal essays, for example, Philip Lopate (1995) describes how the essay’s “un-
methodological method” has been utilized across time, from Montaigne and Bacon,
through the Frankfurt School, and in different cultures. Theodor Adorno, for ex-
ample, is said to have seen rich, subversive possibilities in the “anti-systemic” prop-
erties of the essay—in the way an essay wanders through information and thought,
rather than working within dominant frameworks of thinking and straight through
to a conclusion. For Adorno (1991), the essay was a technology for thinking outside
the grand philosophical systems of his time. Environmental information systems, in
my view, have a critically similar potential.
15. I cast my critique here against “environmental ethics” to encourage anthro-
pologists working on environmental issues to follow the lead of anthropologists who

BIOPOLITICS AND ENVIRONMENTALISM 325

have developed very important, empirically grounded critiques of bioethics (Cohen
1999; Das 2002; Michael Fortun 2008; Rabinow 1996; Rapp 2000b). While bio-
ethics is much more professionally codified and funded than environmental ethics,
both set many terms of debate and standards of judgment.
16. Recall, for example, the “intersectional sensibility” advocated by the critical
race theorist Kimberlé Crenshaw (1990, 1991). Crenshaw criticizes identity politics
for asking people to be either raced, woman, or queer, and for ignoring intragroup
differences—which makes it difficult to deal with domestic violence in black commu-
nities, for example, and limits the standing that women, in particular, have before the
law. Intersectional sensibilities involve recognition of multiplicity: the simultaneous
examination of race, ethnicity, sex, class, national origin, sexual orientation, and so
on. Toxicologists would call this “cumulative effect” and recognize that both scientific
and legal-regulatory worlds have great difficulty dealing with it.
17. Note that for Gramsci common sense is never immobile. Common sense is
always continually transforming itself, leveraging available discursive resources.
Common sense is an open system, so to speak. Its porosity is what makes it an im-
portant site of struggle.
18. Note Kaushik Sunder Rajan’s interesting use of constitutionalism within bio-
politics (Sunder Rajan 2002).
19. One can also think in terms of discursive risks. If discursive gaps are where
hegemonic language fails, the discursive risk is that hegemonic constructs will,
nonetheless, be imposed on these gaps, causing a misrecognition of what is going
on that effectively quells the possibility of a different kind of future. Discursive risks
threaten to make the future a reproduction of the present. In the environmental field
today, such risks have truly tragic dimensions. I draw here on Derrida’s opposition
between the future as it can be known and calculated now, and “l’avenir,” that which
will come, unexpectedly perhaps with the force of revolution (Derrida 1990). This re-
lates to my interest in Rheinberger’s notion of “experimental systems” that, through
their technical operation, open up such a future.

326 KIM FORTUN

 PART FOUR

PROMISSORY EXPERIMENTS AND

EMERGENT FORMS OF LIFE

 11
MIKE FORTUN

GENOMICS SCANDALS AND OTHER

VOLATILITIES OF PROMISING

Promises and promisings suffuse the life sciences today. But what is it that
is marked, gestured toward, or accomplished by these words, promise and
promising, in the multiple scientific, legal, political, cultural, and other con-
texts in which they are written or uttered? How many ways of promising are
there on the plateaus of genomics? I will not count them all, but offer only
a few ethnographic waypoints.

Linkage analysis and positional cloning have had a remarkable track record in lead-
ing to the identification of the genes for many mendelian diseases, all within the
time span of the past two decades. Several of these genes account for an uncom-
mon subset of generally more common disorders such as breast cancer (BRCA- 1 and
-2), colon cancer (familial adenomatous polyposis [FAP] and hereditary non-polyposis
colorectal cancer [HNPCC]), Alzheimer’s disease (ß-amyloid precursor protein [APP]
and presinilin-1 and -2) and diabetes (maturity-onset diabetes of youth [MODY]-1, - 2,
and - 3). These successes have generated a strong sense of optimism in the genetics
community that the same approach holds great promise for identifying genes for a
range of common, familial disorders, including those without clear mendelian inheri-
tance patterns. But so far the promise has largely been unfulfilled, as numerous such
diseases have proven refractive to positional cloning.
NEIL RISCH, POPULATION GENETICIST (RISCH 2000, 850)
As I’ve said in the past, [Genentech] has a promising pipeline and room to grow based
on its cancer and cardiovascular drugs. . . . The potential for IDEC [Pharmaceuticals]
will get better as the company’s promising compound Zevalin comes to market. . . .
With that in mind, the outlook for the remainder of 2000 is quite promising.
“JUDGMENT DAY IS HERE FOR BIOTECHS,” WORLDLYINVESTOR.COM,

20 JULY 2000 (NADINEWONG 2000)

Genomics is real. In the end, I am sure its promise will materialize.

JURGEN DREWS, FORMER PRESIDENT FOR GLOBAL RESEARCH AT

HOFFMANN- LA ROCHE (QUOTED IN LICKING ET AL. 2000)

“Biotech valuations in Germany are not built on anything fundamental,” says Michael
Sistenich, a fund manager at DWS. He says chief executives promise more than they
can deliver to build up their valuations.
“TAKEOVERS CURE FOR GERMAN BIOTECHS,” FINANCIAL TIMES,

14 JUNE 2000 (FIRN 2000)

You can only pay so much for promises.

“THE REASON TO AVOID BIOTECH STOCKS,” MOTLEY FOOL,

5 APRIL 2001 (MCCAFFERY 2001)

DeCODE promises that Icelanders will get any drugs or diagnostics based on their
genes for free during the patent period—a promise [Jorunn] Eyfjord calls “a joke. . . .
How many drugs do you think are going to be developed, and how many people will
really benefit from that?”
“PHYSICIANS WARY OF SCHEME TO POOL ICELANDERS’ GENETIC DATA,”

SCIENCE, 1998 (ENSERINK 1998)

A promise was made somewhere.

MEMBER OF ALTHINGI (ICELANDIC PARLIAMENT), INTERVIEW WITH

THE AUTHOR, REGARDING HOW ICELAND’S HEALTH SECTOR DATABASE

ACT (1998) CAME TO PASS

These ethno-epigraphs span genres, contexts, nations, and domains of ac-

tivity in their multiple instantiations of promising’s multiplicity. They cover
the entire territory of the “lively capital” of genomics: a complex landscape
comprising fissured zones of biotechnological research, economic predic-
tions and bets parlayed in what was perhaps the most speculative economy
we’ve witnessed, political deal-making, and personal oath-taking. Each zone
is in turn layered and imbricated with the others, begging for some hyper–
Geographical Information System interface to help us visualize the spectral
superimpositions.1

330 MIKE FORTUN

 But this chapter will have to do in the meantime. The statements quoted
above make it clear that molecules are promising, the sciences of those
molecules are promising, outlooks are promising, markets are promising,
and, yes, people in particular contexts are promising. The differences—
swearings, speculatings, vowings, hopings, anticipatings, sheer happen-
ings—are far from trivial. Indeed, in the path that I follow below, it is the
trivialities of promising—its mundane instantiations in specific situa-
tions—that become essential, and essential to map in careful detail. The
specificities of promising that I diagram are drawn from my fieldwork on
deCODE Genetics—a field which, I hasten to point out, is not limited to the
territory of Iceland, where deCODE has its corporate headquarters and re-
search facilities. My fieldwork, conducted mostly from 1998 to 2003 but in
some ways still ongoing, occurred in the multiple territories of genomics
gestured toward in the ethno- epigraphs: the densely intermeshed worlds
of politics, finance, and emergent genomic technoscience in which deCODE
Genetics is one particularly volatile “hot spot.”2
I offer a brief sketch of deCODE’s financial history, drawn in part from my
book Promising Genomics: Iceland and deCODE Genetics in a World of Specula-
tion. The book is structured like a genome, consisting of twenty-three chs—
chapters, chromosomes, chiasma—twenty-three pairs of twisted doubles,
double binds, intertwined differences that cannot be resolved or settled, but
remain ever volatile. The book is structured like a genome because both are
structured like writing: material marks riddled with chiasma, promising
much more than their signs are said to “code for.” Each volatile couplet is a
site where it is necessary to play, to muddle through, to speculate, or above
all, to promise.
Acts of promising are perhaps the performative speech acts par excel-
lence. Donald MacKenzie, Karin Knorr- Cetina, Michel Callon, and others
in science studies have recently become interested in performativity per-
taining to financial markets, but the genealogy by which I approach and
understand promising diverges from theirs.3 While we all acknowledge the
importance of J. L. Austin (1962) as an early analyst of promises and other
performatives, my genealogy swerves more toward the “Continental” tradi-
tion represented by figures like Jacques Derrida, Avital Ronell, and Shoshana
Felman. MacKenzie, Knorr- Cetina, Callon, and company tend to be inter-
ested in performativity in a rather restricted domain: economists’ equations,
financial instruments like derivatives, electronic stock-trading systems, and
the like. Derrida, Ronell, and Felman encourage us to trace the dissemina-
tion of promises and other performatives into a far more general economy.

VOLATILITIES OF PROMISING 331

 In How to Do Things with Words (1962), Austin diagrammed not the dis-
tinction between constative and performative statements, but their zones
of entanglement and indiscernibilities. In the process, Austin loosened the
coupling between the intentional subject and the performative utterance.

Thus “I promise to . . .” obliges me—puts on record my spiritual assump-

tion of a spiritual shackle.
It is gratifying to observe in this very example how excess of profun-
dity, or rather solemnity, at once paves the way for immorality. For one
who says “promising is not merely a matter of uttering words! It is an in-
ward and spiritual act!” is apt to appear as a solid moralist standing out
against a generation of superficial theorizers: we see him as he sees him-
self, surveying the invisible depths of ethical space, with all the distinc-
tion of a specialist in the sui generis. Yet he provides Hippolytus with a
let- out, the bigamist with an excuse for his “I do” and the welsher with a
defence for his “I bet.” Accuracy and morality alike are on the side of the
plain saying that our word is our deed. (Austin 1962, 9–10)

Over numerous writings, Derrida articulated how promising is dissemi-

nated throughout language, rather than being the exclusive quality or effect
of a particular subset of speech acts, the ones Austin called “commissives.”
Derrida thus dislocates promising not only from any intentional subject,
but from any localizability in a particular set of speech acts. He dislocates
the location of promising entirely, making promising occur as a kind of
general feature of language—although that’s not the most promising way of
putting it.

Each time I open my mouth, each time I speak or write, I promise.

Whether I like it or not: here, the fatal precipitation of the promise must
be dissociated from the values of the will, intention, or meaning-to-say
that are reasonably attached to it. The performative of this promise is not
one speech act among others. It is implied by any other performative,
and this promise heralds the uniqueness of a language to come. (Derrida
1998, 67)

An immanent structure of promise or desire, an expectation without a

horizon of expectation, informs all speech. As soon as I speak, before
even formulating a promise, an expectation, or a desire as such, and when
I still do not know what will happen to me or what awaits me at the end
of a sentence, neither who nor what awaits whom or what, I am within
this promise or this threat—which, from then on, gathers the language

332 MIKE FORTUN

 together, the promised or threatened language, promising all the way to
the point of threatening and vice versa, thus gathered together in its very
dissemination. (Ibid. 21–22)

Derrida’s analysis, if trusted, would indicate several things for future ana-
lyses of promising like this one. First, promising occurs everywhere in lan-
guage, which is never sufficiently present to itself to fully guarantee all its
workings or capacities. Language runs on credit, if you like—which is not
to say, as you surely know, that bills don’t fall due. Second, the fact that
promising occurs everywhere in language means it would also be at work,
or in play, within the analytic language which produces such a statement
as “promising occurs everywhere in language.” Et voilà: promising turns
threatening—and just as quickly turns back again. The promise of language
is its threat, its poison its gift.
The stage is set for scandal, of an unusual if all-too- common kind. Sho-
shana Felman’s The Scandal of the Speaking Body (2002) carries on in the
Austinian and Derridean legacy to detail how promising is a material, em-
bodied, and necessary feature of any speaking—that is, writing. Promises
and similar performatives represent an impropriety that inhabits everything
that is proper—a genome, a science, an economy, an oath, an ethnography.
The most solemn and profound promise is simultaneously quotidian and
singular, inhabiting the field of practice rather than some theoretically gen-
eralizeable plane.

With Austin as with psychoanalysis, the irreducible triviality of the idio-

syncratic is that of a practice of the singular.
Of a practice, that is, of what belongs to the order of doing. For un-
like saying, doing is always trivial: it is that which, by definition, cannot
be generalized. . . . Thus true History, belonging to the order of acts or
of practice, is always—however grandiose it may be—made up of trivi-
alities.
The same is true of writing. (Felman 2002, 78)

Analyzing promising—or coming to better appreciate its forcefulness—is

therefore a job for history, ethnography, or other practices that find the triv-
ial important.
This “irreducible triviality” amounts to a “radical negativity” that, accord-
ing to Felman, links promising indissolubly to scandal, or at least to the
possibility of scandal. The reasons for this are complex, as are the linkages
themselves, and it’s important to plumb some of this complexity to keep

VOLATILITIES OF PROMISING 333

from falling into a moralism in which “scandalous” is simply equated with
“sinful” or “shameful.”

Radical negativity . . . belongs neither to negation, nor to opposition, nor

to correction (“normalization”), nor to contradiction (of positive and nega-
tive, normal and abnormal, ‘serious’ and ‘nonserious,’ ‘clarity’ and ‘obscu-
rity’)—it belongs precisely to scandal: to the scandal of their nonopposi-
tion. (Ibid. 101–4)

The scandal, in other words, is always in a certain way the scandal of

the promise of love, the scandal of the untenable, that is, still and always,
the scandal—Don Juanian in the extreme—of the promising animal, in-
capable of keeping his promise, incapable of not making it, powerless
both to fulfill the commitment and to avoid committing himself—to avoid
playing beyond his means, playing, indeed, the devil: the scandal of the
speaking body, which in failing itself and others makes an act of that fail-
ure, and makes history. (Ibid. 111)

Continuing briefly in this highly philosophical and thus nontrivial vein,

I would return to the promises of genomics and say: genomics can’t avoid
playing beyond its means. The genomicist, like Don Juan—or a genome, or
this chapter—can’t help but overcommit. That this scandalous fact opens
the way for shameful events should not become cause for an analysis and
politics based on resentment: those seductive genomicists need to be restrained,
made to speak and do only what is proper, what they can guarantee. . . . But the
alternative to this kind of Nietzschean ressentiment (“science studies, all too
science studies”) is not the nihilism of “anything goes,” but an exposition of
what Felman calls the “scandal of the outside of the alternative, of a negativity
that is neither negative nor positive.” These are to be found in the trivial
events that “history cannot assimilate” but are “nevertheless the cornerstone
of History” (ibid. 105, 107, emphasis in original).
That’s what I promise myself, anyway, and here is where my questions
begin again: since promising structures genomics (and structuring means
rendering it volatile, speculative, and potentially scandalous), and since
promising structures finance, rendering it volatile, speculative, and poten-
tially scandalous, then what are the historical “trivialities” that structure
promising? More specifically: what structured the promises that could be
made about genomics as science and as business, generator of future knowl-
edge and generator of future capital, in turn- of-the-millenium U.S. and Ice-
landic discursive, institutional, and cultural regimes? If genomics as science

334 MIKE FORTUN

and business depends on performative utterances and devices, what can
possibly function as a performative utterance or device? And like a genome
or a book, what kind of environment do they have to be crossed with or
folded into if they are to work at all?
Those are the structuring questions of the chiasma chapter chromosomes
of my book, and I can only take up a few of them here, reshuffled and re-
mixed outside of the context of the book. And in recounting the deCODE Ge-
netics story, I will have to be even more selective, and essentially give only
a financial history of deCODE, a narrow slice through what Eve Sedgwick
(2003) calls the “periperformative vicinities,” that vast expanse of forces at
work in the deCODE events, including an expatriate celebrity killer whale;
territorial fishing limits and the wars, laws, and new forms of property they
provoke; not fish-mongering, but what Skuli Sigurdsson (2001) calls saga-
mongering, as Icelandic history is repackaged in mythological wrapping; the
prescient novels of Halldor Laxness; the chiasmic double bind that verges on
doublespeak, in the system of “presumed consent” that all living and dead
Icelanders were said to have given in legislation deemed unconstitutional
years later; and last but far from least, promises of the Icelander’s genetic
homogeneity.
Promises are a kind of forward-looking statement (I only foreshadow this
important concept here), and if you are what the U.S. Securities and Ex-
change Commission (SEC) calls a “sophisticated investor,” you will know that
you are not supposed to base your investments solely on forward-looking
statements—for example, those statements made in the early history of the
Human Genome Project to the effect that “the human genome is the Holy
Grail of biology.” Such statements, especially when uttered by Nobel Laure-
ates such as Walter Gilbert, do have their performative effect, not the least
of which was leveraging $3 billion out of the U.S. Congress in the late 1980s
to support the kind of technoscientific infrastructure development for geno-
mics for which the private sector showed little interest. So in 1987, when the
Nobelist and Biogen founder Gilbert promised venture capitalists and Big
Pharma companies that genetic-sequence information was valuable, no one
bought it, but a mere ten years later, you could take the promise of genomic
information to the bank.
Or at least to venture capitalists. In the late 1990s, when the small hand-
ful of genomics companies then existing—Incyte Pharmaceuticals, Human
Genome Sciences (HGS), Millennium Pharmaceuticals—were only begin-
ning to ink multimillion dollar agreements with “Big Pharma” corporations,
the first financing for deCODE Genetics was $14 million from venture capital

VOLATILITIES OF PROMISING 335

firms Polaris Ventures and Atlas Ventures. Shortly thereafter, deCODE and its
hitherto unknown CEO Kári Stefánsson lit up the scientific press and inter-
net finance chat rooms when it announced it had been promised up to $200
million in research and operating funds by Hoffman-LaRoche for genomic
research into a number of complex diseases, utilizing the genealogies and
genotypes of what was described as the “homogeneous” Icelandic popula-
tion. Years later, you could learn from SEC filings that Roche never paid any-
where near this promised potential sum, but at the time the only thing that
mattered was the simple fact of its circulation as the biggest number ever
promised to a genomics company. Not only did deCODE have no products,
but it also had no scientific publications to its name and no real research
program or track record; it promised to work toward certain research mile-
stones involving the isolation and characterization of genes and gene prod-
ucts extracted from the DNA extracted from the blood of Icelanders, then
analyzed against the extensive genealogies constructed by Icelandic families
over decades and centuries, now centralized and computerized. Like many
such oaths, this one had to be ritualized, and here the nation-state enters the
frame of the story, as the Icelandic prime minister David Oddsson passed
the pen between Roche’s Jonathan Knowles and deCODE’s Kári Stefánsson
as they inked their vows in the futuristic Perlan dome atop Reykjavík’s geo-
thermal hot-water tanks.
Nearly simultaneously, legislation was introduced into the Icelandic par-
liament (Althingi) that would create a Health Sector Database (HSD) con-
taining the medical records of all Icelanders, alive and dead alike, that would
be licensed exclusively to one genomics company (nameless, but hardly a
mystery) for a research and business effort that combined genealogical,
genotypic, and phenotypic analysis. “A promise was made somewhere,” in
the words of one Althingi member, that bound private and state fortunes:
deCODE drafted the legislation, the “charismatic” Stefánsson lobbied for it
while simultaneously building the deCODE infrastructure and brand, and
Prime Minister Oddson led the conservative- centrist coalition that, after
months of political wrangling, media sideshows, and social upheaval, man-
aged to pass the HSD legislation late in 1998. Some promise, somewhere,
was kept, and a year or so later Stefánsson prepared for deCODE’s initial pub-
lic offering on NASDAQ.
In that spring of 2000 deCODE still hardly even had a pipeline, let alone
anything resembling a promising product like a patented gene or a thera-
peutic protein. All this time and for years afterward, deCODE was routinely
referred to as “an Icelandic company” by journalists, anthropologists, and

336 MIKE FORTUN

other people who might have been expected to know better. Despite, or
rather because of being legally incorporated in Delaware, started with capital
from U.S. firms, and running entirely on Roche financing—which if it could
be assigned a meaningful address, would have to be Switzerland or New
Jersey—this performance of Icelandicness was crucial to deCODE’s brand,
the mark that distinguished it from the rest of the genomics pack like Mil-
lennium, Human Genome Sciences, and Celera. In fairness, I should point
out that a numerical argument in favor of deCODE’s non-Icelandicness only
really became available when it filed its registration statement with the U.S.
Securities and Exchange Commission, in March 2000, when it was con-
firmed that Roche had the single largest stake in the company, at 13.4 per-
cent of the shares, followed by three venture- capital firms holding roughly 7,
7, and 6 percent of the shares. When you counted in the individual holdings
of the venture capitalists, it was clear that over 50 percent of the company’s
stock was in non-Icelandic hands.
I have come to value the filings of the Securities and Exchange Commis-
sion, and think they are a much underutilized resource for historians. The
SEC is far from a perfect institution, and its mechanisms meant to force
disclosure of corporate information are also imperfect. For example, if you
wanted to know the actual amount of money that Roche promised to pay
deCODE for reaching a particular milestone, you would find that that infor-
mation had been given confidential treatment and was filed separately, in-
accessible to investors and the stray ethnographer:

(a) Major Research Programs. Subject to the terms and conditions of this
Agreement, for each Major Research Program then in effect on the rele-
vant due date, Roche shall pay to deCODE the following amounts, which
shall be due and payable as follows:
<pAGE> 33
[CONFIDENTIAL TREATMENT REQUESTED]
<pAGE> 34
[CONFIDENTIAL TREATMENT REQUESTED]
<pAGE> 35
(b) Minor Research Programs. Subject to the terms and conditions of this
Agreement, for each Minor Research Program then in effect on the rele-
vant due date, Roche shall pay to deCODE the following amounts, which
shall be due and payable as follows:
[CONFIDENTIAL TREATMENT REQUESTED]
<pAGE> 36

VOLATILITIES OF PROMISING 337

 [CONFIDENTIAL TREATMENT REQUESTED]
<pAGE> 37

Similarly, the exact financial terms of the agreements between deCODE and
its collaborators, like the Icelandic Heart Association, who were channeling
patients, blood, and information to deCODE in exchange for payments, were
also blacked out.

COLLABORATION AGREEMENT BETWEEN THE ICELANDIC HEART ASSOCIA-

TION, HJARTAVERND AND ISLENSK ERFDAGREINING EHF.

If IE or its parent company, deCODE genetics Inc., succeeds in contract-

ing for the sale of individual Research Projects or their conclusions or
sells the results of a Research Project to a third party, HV will receive as
its share [CONFIDENTIAL TREATMENT REQUESTED] of all payments to IE
or to deCODE genetics Inc., . . .

If IE or deCODE genetics Inc. concludes a contract with a third party pur-

suant to Paragraph 2 above, IE will pay to HV [CONFIDENTIAL TREATMENT
REQUESTED] on signature of such contract, and thereafter an annual
amount of [CONFIDENTIAL TREATMENT REQUESTED] during the course
of the Research Project in question, the total amount never to exceed
[CONFIDENTIAL TREATMENT REQUESTED]. In the event that the Research
Project is concluded in a shorter time than five years . . . HV will receive
on such conclusion the amount which remains unpaid of the [CONFIDEN-
TIAL TREATMENT REQUESTED] for the Research Project in question. . . .
This payment is in addition to and independent of the [CONFIDENTIAL
TREATMENT REQUESTED] payment pursuant to Paragraph 2 of this Chap-
ter III.

Nevertheless, the SEC forced deCODE to disclose and not simply promise,
if it wanted to get investment from eager Americans dreaming that geno-
mics was the next big thing after the internet and the dot- coms. The SEC
also forces disclosure of more generic risk information, so Icelanders who
had been treated to little but glowing accounts that practically guaranteed
future genomic riches for themselves and for their nation could read for
the first time in March 2000, often in solid caps supplemented by finer
print, that deCODE’s “RELIANCE ON THE ICELANDIC POPULATION IN OUR
GENE DISCOVERY PROGRAMS AND DATABASE SERVICES MAY LIMIT THE AP-
PLICABILITY OF OUR DISCOVERIES TO CERTAIN POPULATIONS,” THAT “ETHI-
CAL AND PRIVACY CONCERNS MAY LIMIT OUR ABILITY TO DEVELOP AND USE

338 MIKE FORTUN

[OUR DATABASES] AND MAY LEAD TO LITIGATION AGAINST US OR THE ICE-
LANDIC GOVERNMENT”—INDEED, “CERTAIN PARTIES HAVE ANNOUNCED AN
INTENTION TO INSTITUTE LITIGATION TESTING THE CONSTITUTIONALITY
OF THE ACT”—and, in my favorite chiasmic double bind, “OUR COLLABORA-
TORS MIGHT ALSO BE COMPETITORS.”
You can argue that this is rather thin gruel for critical analysis or politi-
cal opposition, and I might agree, but it is way thicker than the press re-
leases that deCODE had been issuing until then, which was pretty much all
that investors, Icelandic or otherwise, had to go on. Promising Genomics de-
scribe how the rules about making such statements about genomic futures
had changed in the mid-1990s. Performative utterances are utterly context-
specific, and the institutional and legal context for making what the SEC
calls “forward-looking statements” and I call promises changed dramati-
cally when the U.S. Congress became dominated by the Republican Party
in 1995. The Private Securities Litigation Reform Act of 1995 was one of the
first pieces of legislation pushed through by Speaker of the House of Repre-
sentatives Newt Gingrich as part of his “Contract with America.” Corporate
CEOs could promise anything—I exaggerate, but I trust that you are what
the SEC calls “sophisticated investors” and that you know I exaggerate, and in
any case I include this cautionary statement about my exaggeration—CEOs
could promise anything, orally or in writing, and not be sued later, as long as
such performative statements were accompanied by other statements (like
SEC filings) that said, in effect, don’t rely on that performative statement.
These expanded safe-harbor provisions structured the expanding bubble of
Internet and biotech initial public offerings (IPOs) in the late 1990s.
Genomics companies like deCODE Genetics, Celera, Millennium, and
Human Genome Sciences have existed entirely in a historically specific
regulatory framework of corporate disclosure—a framework that sanctions
and encourages the promissory quality of the “forward-looking information”
which these corporations produce and thrive on. What is forward-looking
information? An SEC document in 1994 made this distinction: “Required
disclosure is based on currently known trends, events, and uncertainties
that are reasonably expected to have material effects, such as: a reduction
in the registrant’s product prices; erosion in the registrant’s market share;
changes in insurance coverage; or the likely non-renewal of a material con-
tract. In contrast, optional forward-looking disclosure involves anticipating
a future trend or event or anticipating a less predictable impact of a known
event, trend or uncertainty” (U.S. Securities and Exchange Commission
1994b, 10).

VOLATILITIES OF PROMISING 339

 Since its establishment in 1933 as part of the New Deal, the SEC had pro-
hibited disclosure of forward-looking statements; corporations, it might
be said, swore not to promise, but only to disclose. With the market crash
of 1929 fresh in its institutional memory, the SEC regarded such forward-
looking statements as “inherently unreliable,” the kind of speculative ac-
tivity that had bubbled and burst the economy so recently; in its role as pro-
tector of investors and preserver of trust in capital and its markets, the SEC
worried that “unsophisticated investors would place undue emphasis on the
information in making investment decisions” (ibid. 2). This philosophy pre-
vailed for thirty years.
But in the mid-1960s the SEC formed the Wheat Commission to recon-
sider these matters, and to speculate once again on the question of specula-
tive statements. Despite the fact that the Wheat Commission’s 1969 report
found that “most investment decisions are based essentially on estimates of
future earnings”—that is, “based on” something that, at least in part, was
spectral or speculative—they did not recommend changing disclosure re-
quirements at that time, apparently for the sole reason that that was the way
things had been done for thirty years: “Commission stated that its decision
not to mandate disclosure of forward-looking statements was based on its
desire not to deviate too far from its historical position of prohibiting such
disclosure” (ibid.).
In 1972 the SEC held further hearings and solicited more comments, only
to announce its “intention” to promulgate rules that, while not requiring the
disclosure of forward-looking information, would nevertheless encourage its
voluntary disclosure; the SEC also promised corporations some limited pro-
tections from any subsequent antifraud litigation. But it never issued those
new rules, citing “opposition from commenters,” and simply deferred to
the future once again, hoping that the issue would be taken up again by its
newly formed Advisory Committee on Corporate Disclosure.
The courts, in the meantime, had begun to issue rulings that bore on
similar questions revolving around such notoriously difficult yet ever nec-
essary concepts as “facts,” “intentionality,” and “prediction.” In the case with
the almost allegorical title, Marx v. Computer Sciences Corporation, the courts
first addressed the question of whether “predictions or statements of opin-
ion could ever be considered to be ‘facts’ which could be said to be false or
misleading for purposes of liability under the securities laws” (1974, 507
F.2d 485). The court found that “while predictions could properly be char-
acterized as facts, the failure of a prediction to prove true was not in itself
actionable. Instead, the court looked at the factual representations which

340 MIKE FORTUN

it found were impliedly made in connection with the prediction; namely
that, at the time the prediction was made, it was believed by its proponent
and it had a valid basis” (ibid.).4 Promising, in this conceptualization, was
predicated on the purity of some interiorized intent—a common formula-
tion of promising that Austin demonstrated “paves the way for immorality”
(1962, 9).
In its “concept release” in 1994 the SEC noted new trends in capitalism
that suggested the need for change in disclosure requirements. There was
“increasing interest” in both corporations and in the analyst and investment
communities for “enhanced disclosure of information that may affect cor-
porate performance but is not readily susceptible of measurement in tradi-
tional, quantitative terms. . . . Among such qualitative informational items
are workforce training and development, product and process quality and
customer satisfaction. . . . Companies are beginning to experiment with
voluntary disclosure of the utilization of an intangible asset termed ‘intel-
lectual capital,’ or employee knowledge. In this connection, another federal
agency has urged more corporate disclosure of the use of measures of ‘high
performance work practices and other nontraditional measures’ of corporate
performance” (U.S. Securities and Exchange Commission 1994b, 10).5
The SEC also included in its “concept release” some suggestions from
legal scholars as to how the speculative status of forward-looking state-
ments might be recodified. John Coffee offered a “Bespeaks Caution” doc-
trine under which “a forward-looking statement would be protected so long
as it were properly qualified and accompanied by ‘clear and specific’ cau-
tionary language that explains in detail sufficient to inform a reasonable
person of both the approximate level of risk associated with that statement
and the basis therefore” (U.S. Securities and Exchange Commission 1994b,
20). (The “reasonable” if not “sophisticated” investor returns as ideal asses-
sor here again, precisely at a time when the sheer increase in the number
of investors into the U.S. securities market might have called for some re-
consideration of the security of these characterizations.) In addition, “the
suggested safe harbor would not require that the forward-looking statement
have a ‘reasonable basis’ (as under existing Rules 175 and 3b-6) because, ac-
cording to Coffee, this requirement often raises factual issues that cannot
easily be resolved at the pre-trial stage” (ibid. 21). These suggestions—in
which the volatile and hence litigation-inviting concepts of “fact,” “reason,”
and “basis” are devolatilized by a second cautionary statement that simply
names them as volatile—would in fact become central features of the new
disclosure landscape.

VOLATILITIES OF PROMISING 341

 The Private Securities Litigation Reform Act (PSLRA) of 1995 was sup-
posed to have multiple effects, the two most vital being to reduce the num-
ber of “frivolous lawsuits” brought against corporations by their shareholders
and to expand the “safe harbor” for forward-looking statements. The high-
tech, infocentric corporations of Silicon Valley were a main force behind the
passage of the legislation. As an editorial in the Washington Post stated it on
the day of the final congressional vote (which would override President Clin-
ton’s veto of the bill): “When the price of a company’s stock drops sharply,
the present law invites suits on the questionable grounds that the company’s
past expressions of hope for its future misled innocent stockholders. This
kind of suit has turned out to be a special danger to new companies, particu-
larly high-technology ventures with volatile stock prices. . . . The bill would
protect companies’ forecasts as long as they did not omit significant facts.”6
Money magazine spoke in the name of protecting “small investors like you,”
and was more critical of the proposed legislation, characterizing it as “a li-
cense to defraud shareholders” by “help[ing] executives get away with lying”:
“High-tech executives, particularly those in California’s Silicon Valley, have
lobbied relentlessly for this broad protection. As one congressional source
told the Washington bureau chief for Money, Teresa Tritch: ‘High-tech execs
want immunity from liability when they lie.’ Keep that point in mind the
next time your broker calls pitching some high-tech stock based on the cor-
poration’s optimistic prediction.”7
What the PSLRA of 1995 accomplished is perhaps best described by Pills-
bury Madison and Sutro, the law megafirm that occupied a central position
in these events as counsel to the Securities Litigation Reform Coalition, a
political action committee consisting of close to two hundred corporations
and their CEOs.8 By their own description, Pillsbury Madison “assisted in
framing the debate surrounding the bill, aided in drafting the statute, and
provided members of Congress and Congressional and White House staffs
with ‘real world’ information about the frivolous lawsuits that have plagued
both mature and emerging companies over the past decade.”9 The webpage
from which these words are excerpted is a part of their ongoing “framing”
work (since the establishment of frames, margins, and reading practices of
exclusion and inclusion is a never- ending task), explaining to their clients
and others the possible meanings and effects of the new law.
Pillsbury Madison called the safe-harbor provisions of the 1995 legisla-
tion “the most important provision” for most companies. It embodies the
“belief that the U.S. capital markets will benefit from an increased flow of
forward-looking information” (ibid.). The final legislation adopted a strong

342 MIKE FORTUN

form of John Coffee’s “bespeaks caution” doctrine, making a company
which makes forward-looking statements “immune from civil liability if the
forward-looking statement is identified as a forward-looking statement. The
legislative history accompanying the bill makes clear that it is unnecessary
to state explicitly that ‘This is a forward-looking statement.’ Instead, cau-
tionary words such as ‘we estimate’ or ‘we project’ likely will be sufficient”
(ibid.).
In sum, the PSLRA authorized statements about the economic future
by establishing a “safe harbor” that protected corporations from share-
holder lawsuits.10 “Oral forward-looking statements” (such as things said
on IPO “road shows” or teleconferences) and “written forward-looking state-
ments” (such as ebullient press releases) were sanctioned, so long as they
were marked as such, and so long as potential investors—“sophisticated” or
not—were also directed to other, more “cautionary” texts. Pillsbury Madi-
son again: “The general requirement that a forward-looking statement be
accompanied by a listing of ‘important factors’ can be met by a statement
identifying the information as forward-looking along with a further state-
ment clearly conveying the message that actual results may differ materially
from the results predicted in the forward-looking statement and referenc-
ing a ‘readily available written document’ that contains cautionary language”
(ibid.).
Such documents often turn out to be SEC filings: registration prospec-
tuses, quarterly and annual reports, and the like. But before turning to some
examples of such forward-looking and cautionary statements in the geno-
mics world, I will roughly sketch a few additional effects that this legislation
seems to have had on the economy more broadly. The full and final effects
of the PSLRA, according to most sources that I’ve seen, remain unclear.
Whether it has reduced the number of lawsuits (and whether there were, as
certain surveys “suggested,” so many of them in the first place), whether it
has given CEOs “a license to lie,” and whether it has increased market vola-
tility while parting the sophistication- challenged investor from his and her
money—all remain relatively uncertain, unknowable, or at least open to de-
bate (see, e.g., Perino 1997). But some signs of this uncertain future are still
worth reading and pondering.
In their delectably named article, “Enter Yossarian” (1998), Elliott Weiss
and Janet Moser analyze the Catch-22 set up by the PSLRA: plaintiffs in
securities-fraud cases need to show that a company knowingly misrepre-
sented matters in a forward-looking statement, but can only do so by being
granted discovery, which they can’t get since they can’t file suit based on

VOLATILITIES OF PROMISING 343

forward-looking information now protected by the expanded “safe harbor.”
This fissure is also plumbed by Douglas Branson, who describes the effect
as one of the substitution of “mere” words or ink for “due diligence.”

The PSLRA provision provides that if a statement is “accompanied by

meaningful cautionary statements,” plaintiffs are denied discovery and
the court must dismiss allegations as to the false or misleading nature
of the statement when presented with a dispositive motion. (Branson
1998, 517)

The effect of the PSLRA provision, as with stronger forms of the judge-
made bespeaks caution doctrine, is to substitute mere cautionary words
for the due diligence traditionally associated with preparation of state-
ments in disclosure documents. Rather than building a due diligence
file that, through research, establishes more than plausible, and often
alternative, bases for making the statements made in the documents,
securities lawyers will plaster forward-looking statements with caution-
ary warnings. . . . No incentive now exists for hiring the traditional, clas-
sical securities lawyer who quarterbacked the research and other effort
necessary to do the due diligence exercise. Instead, Congress has placed
a premium on buying and using ink by the barrel. (Ibid. 518)

Are there nonvolatile rules for distinguishing a “forward-looking state-

ment” from a historical matter of fact, a promise from a disclosure? The
legal scholar Richard Rosen suggests not:

Of course, it would be wonderful to have a rule that allowed courts and

litigators unfailingly to be able to discriminate among the cases and to
allow discovery to proceed only in those in which there was some reason
to believe that, notwithstanding adequate cautionary language, the com-
pany’s management really did know that the predictions were not likely
to come true. But because no such rule could ever be constructed, any
rule will either allow a few dishonest issuers to win motions to dismiss
or will impose enormous costs on honest companies and their share-
holders. Congress has struck the balance in favor of protecting compa-
nies and their shareholders—a balance which strikes me as absolutely
correct. (Rosen 1998, 657–58)

One might agree with Rosen insofar as it is indeed impossible to con-

struct “unfailingly” discriminatory rules for calculating fissures, volatilities,
and chiasma such as these opened up by forward-looking information. But

344 MIKE FORTUN

it would be prudent and even reasonable to question the “balance” that he
hyperbolizes as “absolutely correct,” since it in fact depends on a far-from-
certain calculus of the fissure: how does one know that, in the chasm opened
up by forward-looking information, there won’t be an “enormous” number
of dishonest issuers and only a “few” costs to honest companies? Rosen’s un-
substantiated calculation is little more than a political endorsement of the
balance that Congress—no, more specificity is in order: that a Republican-
dominated, Newt Gingrich–led, futures-market-giddy Congress—indeed
“struck”: a forceful cut that transfers many of the financial risks and the
burdens of proof, discovery, and due diligence from corporations to their
presumably “sophisticated shareholders.” Like the ones in Iceland.
Let’s return to 1999. The Health Sector Database legislation, which pre-
sumes the consent of all living and dead Icelanders to have their medical
records placed in a database to be built and exclusively licensed to deCODE,
has been passed by the parliamentary coalition led by David Oddson’s In-
dependence Party, in late 1998. The $200 million promise from Roche has
been sworn, but is far from being in the bank. (As later SEC filings by deCODE
show, Roche only ever paid $76 million on this promise: basically, the oper-
ating expenses it had agreed to, plus a very few—certainly nowhere near the
number that would have made it possible to reach the $200 million prom-
ise—“milestone payments” for work done by deCODE.) The IPO on NASDAQ
has not even been mentioned in public. Like all biotech startups with a high
“burn rate” (in the neighborhood of $2 million per month), deCODE needed
operating capital. Where to get it? On the “gray market.”
As in the United States., in the mid- to late 1990s “the securities mar-
ket changed quite a bit” in Iceland, Finnur Sveinbjörnsson told me in 2001;
he was then president of the Icelandic Stock Exchange, or ICEX. Trained as
an economist, Sveinbjörnsson had worked for the Central Bank of Iceland
early in his career, then for the Ministry of Commerce on issues related to
the European Economic Area, and from 1995 to 2000 for the Bankers Asso-
ciation, a lobbyist organization. He continued:

The securities departments in banks have grown tremendously, mostly

because of the abolishing of foreign exchange controls, which meant that
there was interest in foreign securities, and the banks responded. Also
because there was appetite for corporate and local government bonds,
and these entities responded by switching some of their financing away
from traditional bank loans to the bond market. Furthermore many in-
vestors suddenly realized that there were more possibilities than just

VOLATILITIES OF PROMISING 345

 opening a savings account. They could invest in securities, both bonds
and stocks, and get much nicer returns than previously. So there was
basically an explosion, from both the supply and the demand side in the
securities market.11

There was also more money to invest.

Many individuals have become rich in this country. The main source of
wealth has been the quota system in fishing. There are a number of indi-
viduals who have sold their quotas and left this business, so they have
gotten out of this business, and suddenly found themselves with con-
siderable amounts of money in their hands. This money has to a large
extent gone into the securities market. Furthermore, some of this in-
creased activity has been financed through foreign money—money bor-
rowed by Icelandic banks from overseas and lent to their local customers.
Some individuals have borrowed and used the proceeds to speculate in
the market.

“There was an unclear, or gray, provision in the securities legislation,”

Sveinbjörnsson explained. “Apparently the legislation did not prevent pro-
fessional investors from selling shares to the public without having to ful-
fill the stringent requirements of a public offering, as long as prospective
buyers came to the investors asking for the shares—that is, active promotion
and selling was clearly out of bounds but responding passively to demands
was within limits.”
While the Icelandic financial institutions and professional investors may
not have taken out ads in the newspapers, they did talk actively to journalists
and played, like their foreign counterparts, a certain part in the securities
hype of the late 1990s. Pumped up by these glowing media accounts and
the general securities exuberance, hundreds of Icelanders bought shares
in deCODE on this “gray market,” through these Icelandic financial institu-
tions.
This was a very high number in the eyes of the Icelandic financial au-
thorities, especially for securities so widely acknowledged as risky and re-
quiring long-term financial strength to withstand likely losses. “The prob-
lem of the gray market was discussed thoroughly last winter and into the
spring [1999–2000],” Sveinbjörnsson continued, “in a committee that the
Ministry of Commerce set up with representatives from the market, from
the stock exchange, from the ministry itself. This committee reviewed the
legislation in our neighboring countries, and in the U.S., and came up with

346 MIKE FORTUN

recommendations that were enacted by Althingi in the fall of 2000, thereby
closing the legislative loophole that had allowed the gray market to develop.”
The journalist James Meek, writing for the Guardian, helps us with a sketch
of those whose money passed through this loophole before it was closed, in
what amounts, and with what personal effects.
“I’d never bought stocks before,” Henrik Jónsson told Meek. “I watched
the TV news carefully and saw the stock prices rising consistently. You had
stories in the media telling people how high Decode stocks were rising. My
heart is crying” (Meek 2002). Jónsson had bought 5 million krónur worth of
deCODE stock at $56 per share in the spring of 2000. He had been disabled
in a traffic accident, and the sum represented nearly a quarter of the finan-
cial settlement he had fought to obtain from the insurance companies. The
shares were priced at $6 when he returned to the National Bank of Iceland,
in 2002, to sell the shares they had sold him.
Meek collected numerous such stories when he was in Iceland in the fall
of 2002. Perhaps the worst story was that of the anonymous E., who had also
bought in at the height of the exuberance in the spring of 2000, plunking
down 30 million krónur—about $400,000—over three separate occasions.
Some of the money he borrowed from the state- owned National Bank, from
which he also bought the shares; in that case, E. mortgaged his house. He
agreed to buy more from the Agricultural Bank, and arranged another loan
with the Bank of Iceland. A day later, the Bank of Iceland canceled all its
loans to buy shares, but the Agricultural Bank would not let E. off the hook.
He spent the next month trying to arrange other financing, during which
time the share price fell from $64 to $50, but the bank insisted he still pay
$64. Meanwhile, the National Bank moved to foreclose on its loan. “I asked
them if I could wait at least until the shares rose to $15. The lawyer from the
bank said, ‘You must know these shares won’t go up.’ I said, ‘You sold me
these shares, telling me they would go up to $100.’ He said, ‘If you’re going
to blame us you’d better pay up’” (ibid.). There are hundreds of such stories,
at least, each one deserving a place in a future archive.
The loophole that was the gray market in Iceland had a structure in which
the media played an important part. But for the intricacies of the mecha-
nism, you have to turn back to the fine print of the SEC filings. So let’s allow
deCODE to disclose the basic elements of the story: “There is no public mar-
ket for the Preferred Stock although some banking institutions in Iceland
have been making a market for privately negotiated transactions among
non-U.S. persons in the Series B preferred stock. Our stock transfer records
indicate that approximately 10 million shares of Series B preferred stock

VOLATILITIES OF PROMISING 347

were transferred during 1999 in approximately 7,000 transactions and ap-
proximately 1.1 million shares of Series B preferred stock were transferred
during January 2000 in approximately 2,700 transactions. The majority
of these transactions had an Icelandic financial institution as one of the
counterparties.”12
To elaborate: in June 1999 deCODE, a good eight months before it would
be bound by the U.S. SEC to disclose this to any investors and a full year be-
fore its stock went public on NASDAQ, sold 5 million shares of its Series B
stock at $7.50 per share to a holding company in Luxembourg, Biotek Invest,
apparently set up for this and only this function. At the same time, an “oral
agreement”—and while deCODE, like any U.S. corporation, is legally a per-
son, one may wonder what mouth it employs to make these kinds of spo-
ken promises—was made that deCODE would be paid twice that amount if
two conditions were met: if the Luxembourg company sold at least half of
the shares at $15, and if the price in “the Icelandic market” didn’t go below
$15 for the six months remaining in 1999. Those two conditions were not
only met, but exceeded: 6,000 transactions were made in deCODE stock at
prices between $30 and $65 per share on “the Icelandic market”—known as
“the gray market” when you’re not reporting to the SEC. By comparison, at
deCODE’s IPO on the NASDAQ, in July 2000, the share price opened at $18,
bubbled briefly to $27, and was never again in the vicinity.
Biotek Invest sold the shares to Icelandic banks and securities compa-
nies; the Icelandic financial institutions, empowered through an “interpre-
tation” of existing law—interpretation is never far from speculation—sold
the shares to Icelanders eager to invest in “an Icelandic company” that they
had been told was uniquely positioned to understand and perhaps cure ge-
netic diseases, a story publicized by Icelandic journalists, with the encour-
agement of the Icelandic financial institutions, in newspaper stories and
electronic media that would later be cited by some anthropologists, bioethi-
cists, and assorted others as evidence of a “democratic discussion”; and the
financial risks accrued at the bottom of this speculative chain. As part of the
promise, written and oral, Biotek Invest got a 7 percent commission, plus
interest. By this mechanism, a total of $69,750,000 flowed from the bank
accounts of Icelanders to the bank account of deCODE. Biotek Invest was
liquidated in December 2000, having existed for barely a year and a half; as-
sets of $5.25 million were transferred to some equally anonymous company,
called Damato Enterpises, in Panama City, Panama. This is where the dis-
closure ends; anything else would be pure speculation.

348 MIKE FORTUN

 Eventually deCODE would get its largest capital injection from its IPO on
the NASDAQ, for which it had filed its S-1 registration statement in March
2000. In this event, too, promising was at work in yet another way. At
deCODE’s IPO, on 17 July 2000, some 11 million shares were sold, grossing
$198,720,000. Morgan Stanley, the underwriters, took nearly $17 million of
this as commission and expenses.
In December 2001 a class-action suit was brought against deCODE Ge-
netics by the law firm of Milberg Weiss. This was hardly unusual at the
time; over a thousand such securities-fraud class-action suits were filed in
the Southern District Court of New York alone (where the deCODE case was
filed) in the wake of the market’s collapse that year. Milberg Weiss, a law firm
which “dominates its field [securities class-action suits] to a degree that no
private firm does in any other kind of litigation,” accounted for a large num-
ber of these. A co-founder of Milberg Weiss, William Lerach, would later
bring a case against Enron. Lerach was among those who had convinced
President Clinton that he should veto the Private Securities Litigation Re-
form Act of 1995, a veto overturned by the Republican- controlled Congress.
Indeed, according to one lawyer who lobbied for the PSLRA, “The whole idea
behind the law was to destroy Lerach” (Toobin 2002).
The complaint was complex, but centered on the charges that deCODE and
Kári Stefánsson, along with the co–lead underwriters of their IPO, Lehman
Brothers and Morgan Stanley, had made “materially false and misleading
statements” in their SEC prospectus and “engaged in a pattern of conduct
to surreptitiously extract inflated commissions” greater than the ones they
had disclosed.13 One mechanism by which this extraction occurred was that
the “Underwriter Defendants agreed to allocate deCODE shares to those
customers in the Offering in exchange for which the customers agreed to
purchase additional deCODE shares in the aftermarket at pre- determined
prices.”14
Between January 1998 and December 2000, 460 “high technology and
Internet-related companies” had come up for sale on the public markets;
class-action suits against 309 of these, including deCODE, were consolidated
for coordination and decision of pretrial motions and discovery, to be con-
ducted by Judge Shira Scheindlin. The consolidated defendants, including
Morgan Stanley, asked for dismissal of all the cases.15
Judge Scheindlin’s 238-page decision attempts to sort out the various
complaints against the various underwriter defendants, and decides which
complaints will be dismissed, and on what grounds. The decision does not

VOLATILITIES OF PROMISING 349

discuss the deCODE case directly, but it is listed as one of the cases that is
dismissed on the basis of “No Allegation of Motive” to violate Rule 10b-5,
which prohibits market manipulation through devices such as tie-in agree-
ments. In other words, even if Morgan Stanley and Lehman Brothers did
in fact require their customers to buy deCODE stock after the IPO in a tie-in
agreement, because there was no evidence presented that they sold the stock
in this period, the claim was dismissed. As Judge Scheindlin put it, “Mere
ownership in the absence of profit-taking does not establish a motive that
would support a ‘strong inference that the defendant acted with the required
state of mind.’”16 Here again is a case in which intentionality, the ethical cri-
terion based on what Austin called “an excess of profundity,” in fact “paves
the way for immorality”—or at least getting out of court.
But the SEC can prevail where courts may not.17 In a settlement with the
SEC in January 2005, Morgan Stanley agreed to pay a $40 million civil penalty
for “attempting to induce certain customers who received allocations of IPOs
to place purchase orders for additional shares in the aftermarket.” “These
cases underscore the Commission’s resolve,” read the SEC’s press release,
“to ensure the integrity of IPO markets by prohibiting conduct that could
artificially stimulate demand or higher prices in the aftermarket—whether
or not there is manipulative effect.”18
Some Morgan Stanley sales representatives referred to this practice, of
their customers’ buying in the immediate aftermarket, as fulfilling their
“promises” or “commitments.” In the suit against Morgan Stanley, the SEC
at one point used the deCODE case to illustrate how such promises took
place: “In a third IPO, a sales representative e-mailed the syndicate man-
ager, ‘just for the record . . . despite a less than stellar allocation [a customer]
was in buying decode in the aftermarket yesterday. As they said they would.
Almost 200m at $28.’ The syndicate manager responded, ‘i am very aware
of their aftermarket. Kudos to them and it will be remembered.’”19 Here, at
the most quotidian level, the sales rep informs his manager about a promise
carried through: a customer had fulfilled their oral agreement to buy shares
of deCODE, “as they said they would,” even though they had not been treated
in a “stellar” manner. One almost admires the informal moral economy of
promising at work here, as the manager expresses his familiarity with this
gentleman’s arrangement, grants his kudos, and hints at the promise to
come, as they always do in these kinds of gift exchanges: it will be remem-
bered.

350 MIKE FORTUN

Conclusion

Of course, every promise by its very structure is excessive. . . . Is not every promise—I
do, I will forever and ever—not a little drunk with itself, dipped in some witches’ brew
or Dionysian concoction?
AVITAL RONELL, THE TEST DRIVE

Promising, and promising genomics in particular, is a matter of excess—the

scandalous excess of quotidian matters of all kinds, from finance to flesh and
everywhere in between. Matter promises, harboring excessive capacities and
thereby offering itself to us and our technoscientific infrastructures for fur-
ther becomings. Biological matter in particular has the promise folded into
it, and not just spoken about it. An organism like you, me, or a zebrafish ex-
ceeds its genetic “code.” It exceeds its “nature” or genes, it exceeds its “nur-
ture” or environment (which in turn is always exceeding itself and chang-
ing), it exceeds every wonderful technoscientific tool that has ever been
invented and that ever will be invented to handle the truths of it. It’s the
“inability” of any given present or any given thing to coincide with itself, or
to identify fully with its opposite partner, or to fully differentiate itself from
its partner, that underwrites the possibility of its becoming something else.
More, more, more: that’s why we and zebrafish and every other geno-proteo-
transcripto- culturomic enterprise develop. Like the statements we speak, we
ourselves are forward-looking. We promising animals are networks of differ-
ential reproduction—evolving biological matter—wired to other networks
of differential reproduction—the experimental systems of the life sciences
that Hans-Jörg Rheinberger has diagrammed for us—webbed into the net-
work of differential reproduction which we speak and which speaks us, lan-
guage, a language of promising.
Promisings of genomics fan out from what Richard Doyle (2003) calls the
“constitutive ambiguity” that inhabits flesh and finance alike, a real depen-
dency on some “unthinkable and incalculable future” that provokes inces-
sant thoughts, calculations, and other activities that produce the “liveliness”
of bodies and capital. Organisms, illnesses, events, politics, finance, techno-
logical development—all of these are matters of excess that happen without
our full understanding or control, as the cumulative, emergent effect of a
multiplicity of forces—promises.

VOLATILITIES OF PROMISING 351

Notes
1. Inventing an ethics of promising will be akin to the project of “learning to speak
with ghosts” delimited by Derrida in Specters of Marx (1994, xix).
2. See Michael Fortun 2008 for a more detailed and expansive map of these terri-
tories, from which much of the present text has been extracted.
3. See MacKenzie, Muniesa, and Siu 2008; Knorr- Cetina and Cicourel 1981.
4. The SEC also cited “more extreme positions” taken by some courts, which ruled
that “soft,” “puffy” statements “upon which no reasonable investor would rely” would
not be actionable, unless they were worded in the language of a guarantee.
5. The footnote to this passage refers to two documents to substantiate this his-
torical argument: a Harvard Business School Working Paper, “Improving the Corpo-
rate Disclosure Process” (Eccles and Mavrinac 1994), and an article in Fortune, “Your
Company’s Most Important Asset: Intellectual Capital” (1994).
6. This editorial was inserted into the Congressional Record (104th Congress,
S19147) by advocates of the legislation.
7. In another example of the mass media being targeted to the reading and cita-
tional practices of a few readers, this editorial too was included in the Congressional
Record (104th Congress, S19147).
8. As a side note, Pillsbury Madison (now Pillsbury Winthrop) also did the legal
work for Genentech, in the first (and highly volatile) biotech IPO, in 1980. See Stewart
1984.
9. See http://pillsburylaw.com/articles/securities_reform_act_1995.html, ac-
cessed 3 March 2000.
10. Protected them in federal courts, at least. One effect of the PSLRA was to cre-
ate a rush to file suits in various state courts, a problem addressed by the Securities
Litigation Uniform Standards Act of 1998, which preempts class-action suits filed in
state courts.
11. Interview with Finnur Sveinbjörnsson, January 2001.
12. deCODE Genetics Form 10-12B/A, 6-20-00, 4, available at the U.S. Securities
and Exchange Commission website, http://www.sec.gov. Series A preferred stock
is the stock owned by the venture capitalists; Series C stock is the stock owned by
Roche; the Series B stock sold to the Icelanders came in part from a repurchase of
these stocks, and a repurchase of 333,333 shares of Kári Stefánsson’s common stock.
13. Linda Rubin v. deCODE Genetics, Inc, Lehman Brothers, Inc., Morgan Stanley and
Co. Incorporated, Kári Stefánsson, and Axel Nielsen, doc # 01- CC-11219, filed 5 Decem-
ber 2001 in United States District Court, Southern District of New York, 2.
14. Ibid., 8.
15. Opinion and Order In re: Initial Public Offering Securities Litigation, Shira A.
Scheindlin, U.S.D.J., United States District Court, Southern District of New York,
03-01555, 19 February 2003.
16. Ibid., 165.
17. For a discussion of the SEC’s strategies in such cases where legal proceedings

352 MIKE FORTUN

may not be viable, or may simply take too long, see the interview with a former SEC
lawyer in Fortun and Fortun 1999.
18. U.S. Securities and Exchange Commission 2005.
19. SEC v. Morgan Stanley, No. 1:05 CV 00166, United States District Court, Dis-
trict of Columbia, filed 25 January 2005, available at the U.S. Securities and Exchange
Commission website, http://www.sec.gov.

VOLATILITIES OF PROMISING 353

 12
CHLOE SILVERMAN

DESPERATE AND RATIONAL

Of Love, Biomedicine, and Experimental Community

1. The Chelation Kid. From Tinnell and Taillefer 2007a. Courtesy of Craig A. Taillefer and
Robert Tinnell.

How many times have you, now almost nine, sent us back to our lovers’ laboratory
Dark with dashed expectations, challenging us to let go and try again?
JACK ZIMMERMAN, PREFACE TO JACQUELYN MCCANDLESS,

CHILDREN WITH STARVING BRAINS

A diagnosis of autism is commonly experienced as a devastating blow for

the family of an affected child, no matter how deep their concerns may have
been prior to the moment of diagnosis. This is not surprising: autism is
typically characterized as an incurable and lifelong neurological disorder,
strongly heritable and treatable only imperfectly, via behavioral interven-
tions and psychopharmacology. Rates of diagnosis have increased to ap-
proximately one in 175 children in the United States, raising concerns of en-
vironmental triggers among both parents and clinicians (Shieve et al. 2006).
The disorder, now seen as occurring along a spectrum of severity, was first
described by the child psychiatrist Leo Kanner in 1943 (Kanner 1943). It
is characterized by a triad of deficits, involving significant impairment in
communicative, behavioral, and social domains, with onset before the age
of three (American Psychiatric Association 2000). Given the dire progno-
sis offered by most specialists, parents might easily be moved to investigate
any promising treatment option, erring in favor of an interpretation of their
child as injured rather than congenitally disabled, and of that injury as a
chronic but treatable condition, rather than a static and irremediable pre-
natal event. Even Bruno Bettelheim (1967), notoriously associated with the
theory that cold and emotionally distant mothers caused their children to
develop autism, believed that a theory of injury offered more hope for both
parents and children than a theory of hereditary disability. For many par-
ents, culpability seemed like a small price to pay for the promise that they
might be able to help their child.
To speak of treating autism, let alone curing the disorder, is to invite
attributions of desperation on the part of parents and charlatanism on the
part of practitioners in both professional circles and the popular press (e.g.,
Levitz 2005; Harris and O’Connor 2005; ScienceDaily 2007). Newspaper
articles regularly accept the characterization of parents as willing to try
anything to normalize their child’s development, and the attitude toward
parents’ knowledge and ability to critically evaluate treatments is similar
in academic studies on the use of alternative treatments in autism (Shar-
tin 2004; Levy et al. 2003; Levy and Hyman 2003). Nevertheless, listservs
are alive with discussions of the relative benefits of various detoxification
preparations and the minute details of appropriate supplementation relative
to body weight, all healthcare practices that take place outside of certified
medical knowledge about children with autism. University-based research-
ers attribute their findings to the insights of parents without formal medi-
cal educations, and materials available at parent conferences involve com-
plex explanations of biochemical mechanisms connecting physiological to
neurological dysfunction, which parents listen to with undivided attention,
and often master.1 For many parents, “there comes a point when you’ve just
got to experiment,” because of the paucity of options available within the
realm of conventional treatments (Shartin 2004).

DESPERATE AND RATIONAL 355

 The 2005 revision of Jon Pangborn’s and Sidney Baker’s popular autism
treatment manual opens with the statement “Individuality is key” (2005, 1).
The authors suggest that obligations other than those pertaining to conven-
tional medical practice apply to the private decisions regarding care for an
affected child: “As you read forward, keep in mind the huge difference be-
tween public and private policy, because this distinction will make your job
much easier: to decide what to do next for the child in your care. The threshold
for making a good decision for a single child is tiny compared to the burden
of proof for establishing public policy. Public policy is, moreover, disease-
oriented, whereas private health policy is oriented almost solely toward pro-
tecting and healing the individual” (ibid. 3). Within the community that
Pangborn and Baker are addressing, the concepts of recovery and cure are
common currency, achieved through what are termed “biomedical” inter-
ventions. These encompass a range of conventional and unconventional
therapies, united by the premise that autism is a treatable medical condi-
tion. These practices involve a fragmenting of the diagnostic category that, if
taken seriously, could be quite disruptive to established research programs
in autism. Because it is defined behaviorally, autism is a syndrome, a set of
related symptoms. It is not a single disease with a known pathophysiologi-
cal mechanism. Observable autism symptoms may be secondary to a range
of other underlying causes, rather than associated with a single, definitive
disease process.2 For parents and practitioners treating autism as a medical
condition, the difficulty of producing standard treatment practices validated
by clinical trials stems from the fact that “autism,” far from representing a
“pure culture,” is in fact a complex set of overlapping conditions (Herbert
2005b; Happe, Ronald, and Plomin 2006). As Pangborn and Baker suggest,
those running carefully constructed research programs or implementing
public policies that assume an underlying biological homogeneity in the
population of people diagnosed with autism might find such a statement
difficult to accept, lacking, as it does, a comprehensive solution tailored to
an entire population. Instead, this perspective offers parents a practical ave-
nue through which to act on their conviction that their children are actively
suffering as a result of their autism and that they require treatment as much
or more than they require benign acceptance of their differences.
In this chapter, I describe the production of biomedical knowledge in one
parent-practitioner community and the process of persuasion and affective
involvement through which parents and new practitioners come to take part
in a set of practices called biomedical interventions for autism. Social rela-
tions based on shared experiences of affect alter the possibilities of vision,

356 CHLOE SILVERMAN

the formation of trust, and the ways in which the success of therapies are
measured in this community. Although I am considering the formation of
community as a response to a medical condition, I am less concerned with
the shared biological attributes of affected children or the formation of iden-
tity around a common diagnosis (as in Rabinow 1996). This community did
not arise spontaneously—its growth was orchestrated by a group of con-
cerned parents and practitioners who have been instrumental in promoting
alternative treatments for autism.
This community also does not operate somehow “outside” of the eco-
nomic and commercial frameworks of contemporary biomedicine, or, in-
deed, apart from forms of expertise or representations of biological systems
that are informed by those same commercial interests. Healthcare is seri-
ous business, even, or especially, when part of what is on offer is the poten-
tial for a child to interact more successfully with their parents and other
people around them (see also Haraway, chapter 2 in this volume). Parents
describe the work of caring for affected children, including the use of re-
sources, training in medical techniques, and hours of effort, as an act of love,
in favor of a description of this work as attentive, knowledgeable labor. This
is an ideological choice, akin to what Sharon Hays (1998) has called “inten-
sive motherhood,” but pairing the sense that everyday parenting is a special
type of expert labor with the urgency of caring for a sick child.3 By using the
language of love parents are at once making a claim for a form of situated
knowledge and invoking a terminology of obligation (Haraway 1991). This
alliance between the affective, the anecdotal, and the everyday is part of
what gives efficacy to biomedical treatments for autism, but it is also what
can make them difficult to translate and reproduce in conventional medical
frameworks.

The Edge of Reason

Parents of children with autism spectrum disorders are not unique in their
experimental bent: chronic disorders or “contested illnesses” which are
poorly or incompletely treated within contemporary biomedicine often lead
sufferers to seek explanations outside of authoritative accounts of disease
causation (P. Brown et al. 2001). Michelle Murphy has described the types of
everyday practices of self- care and emphasis on “biochemical individuality”
and personal ecology that have informed communities of those who suffer
multiple chemical sensitivity (Murphy 2000; also see Kroll-Smith and Floyd
1997). The movement to treat autism as a medical condition through the use

DESPERATE AND RATIONAL 357

of dietary, nutritional, and detoxification regimes is a movement similarly
built on experiential knowledge and pragmatic interventions firmly situ-
ated within daily life. As such, it depends on parents’ knowledge of their
particular child’s moods and responses, but it also draws on older traditions
of medical cookery that have been largely marginalized as “alternative” ap-
proaches within conventional biomedicine (Schiebinger 1991). These affec-
tively laden practices of feeding, medicating, or ministering, and the forms
of knowledge associated with them, work to persuade members to join the
community and reward their commitments. However, they also limit the
ability of the community to translate this work into the language of what
they call “mainstream” or “conventional” medicine, which prefers labor as-
sociated with dispassionate forms of rationality. To the degree that parents
and practitioners are successful in reframing autism as a set of treatable
medical conditions, they must seek to erase the affective and situated com-
ponents of their labor, exactly those elements of practice that are most intu-
itive at the level of their families and communities.
Despite the widespread perception that biomedical treatments involve
questionable rationales, these alternatives often lie comfortably within
medical epistemology. They are seen by participants as shifts in treatment
perspective or renunciations of standard diagnostic frameworks, not as a
choice to abandon medical understandings of autism, but to embrace them
more completely. However, they do not offer diagnosis-specific treatments
of the type that many hope will emerge from genetic and pharmaceutical re-
search. Unconventional treatments are hesitant, experimental, and gradual,
based on practices of monitoring and watchfulness. Parents see biomedi-
cal interventions as attempts to modify a process of ongoing disruption or
damage, not a fixed structure. They reference development, change, and
also promise, an idea that is important to biomedicine, most notably ge-
netics and genomics (Sunder Rajan 2003; Haraway 1997). As Mike Fortun
has argued (chapter 11 in this volume), it is the “undecidability” of promises
that keep investors interested, especially if that investor is a parent with
a decided prior commitment to the well-being of their child. However, in
the case of autism, parents are invited to monitor progress even as they in-
vest—they may hope for a cure, but they will take note of any improvement.
Their commitment is only as strong as their belief that an intervention is
working. The price of an unfounded promise is parental mistrust, so while
practitioners may work to define the criteria for success in the broadest pos-
sible terms, they are also cautious to not promise more than they can poten-
tially deliver. To quote Jon Pangborn and Sidney Baker, “In other words, every

358 CHLOE SILVERMAN

treatment is really a diagnostic trial,” where responses or failures to respond
are clues about the underlying condition (2005, 29, emphasis in original).
They explain that “in chronic illness, symptoms are very helpful in naming,
but seldom in explaining, the exact mechanism of problems that involve a
‘snowball’ effect in which many symptoms are secondary to the initial dis-
ordered mechanism. Chronic illness does, however, present an opportunity
for symptoms to indicate progress made as the result of intervention. The
key to using symptoms as a guide to monitoring progress is to focus not only
on the defining of major complaints, but on the whole pattern” (ibid. 47).
In the process of tracking the effects of interventions, parents must learn
to see behavioral symptoms as proxies for underlying metabolic and physio-
logical dysfunctions. While the “major complaints” in autism include the
familiar triad of deficits in behavior, communication, and socialization, the
“whole pattern” represents an interconnected set of physical symptoms re-
sponsive to minor variations in care. In practice, trials, monitoring, and the
ongoing process of diagnosis and treatment are carried out by parents. These
forms of love are hard work. Because each child is ultimately their own refer-
ence point, knowledge about how to carry out biomedical interventions is
distributed among parents and clinicians, and expertise is contained within
the community as a whole, rather than in reference to an established body
of facts about a discrete and defined disease entity.
Domestic scale interactions based on love and care, attachments that are
typically seen as opposed to reason and rationality, actively contribute to
rational work in this community. Nevertheless, acts carried out in the fulfill-
ment of parental obligation are suspect and not viewed as legitimate sources
of knowledge. By dismissing them, we impoverish our language for talking
about passionate forms of labor, the ethical ambiguity of commitments to
truth, and the functional work of desperation. In other words, when we pay
attention only to the desperation of parents and their eagerness to find a
cure for their children at any cost, we run the risk of assuming that parents
are merely victims of promiscuous hype and of the promise of cures on the
part of unreliable hucksters, instead of savvy consumers capable of drawing
on a formidable expertise regarding their own children.
Nevertheless, relations of affect are not by definition innocent or harm-
less. A loved one can become the object of experiment as well as the pre-
cious object of devotion, and familial obligations can have tragic as well as
productive bodily consequences. An editorial in the New York Times argued
that by “mythologizing recovery,” parents of children with autism are led
to feel that they have failed their child if they cannot effect a cure, lead-

DESPERATE AND RATIONAL 359

ing to a perverse logic where even murder can be rationalized as an “act of
love” (McGovern 2006). Parents’ devotion to their offspring, especially in
instances where severe disabilities can make it difficult for parents to under-
stand their children in terms of conventional narratives of kinship, can be
used to justify extreme measures (Rapp 2000a; Rapp and Ginsburg 2001).
That parents desire a stronger connection with their child is no guarantee
that their judgments will always be secure or that their experiments will not
be dangerous.
Love runs through this discussion. Parents claim the authority of in-
vestment, partiality, and passion as the source of their own “lay expertise”
(P. Brown 1992; Epstein 1996). Unlike other communities of lay experts,
parents challenge both the mode of production and the products of biomedi-
cine, arguing not only for different treatment priorities, but also for altered
frameworks for conceptualizing autism. This is a case study in partial per-
spectives in the sense in which Donna Haraway has employed the term,
meaning that being partial is at once about being situated, embodied, and
incomplete, but it is also about being impassioned, not neutral, and unwill-
ing to recognize the claims of neutrality of others as unproblematic (Har-
away 1991). Instead of seeing love as a term opposed to objectivity, parents
describe love as a process that enables new forms of objectivity, a relation-
ship to medical investigation that occupies the fertile edge of the domain of
reason. They apply this passion in the form of intellectual inquiry, collabora-
tion, experiment, and research, to argue against the centrality of neurologi-
cal difference in autism and for the primacy of molecules and metabolites
and the molecular correlates of what we call affect and social reciprocity.
Biomedical treatments for autism remain controversial. Frustrated par-
ents speak out against the treatments after they fail to produce cures for
their children (e.g., Laidler 2004), while pediatricians regard even measures
as limited as dietary modification as, at best, poorly understood and poten-
tially dangerous (Arnold, Hyman, Mooney, and Kirby 2003; W. Weber and
Newmark 2007). Supporters argue that the inconsistent responses of chil-
dren to treatments is a mark of the heterogeneity of the underlying condi-
tion. The issue is further complicated by the fact that treatments occur prior
to an established consensus regarding the facts about autism, on rapidly de-
veloping children. Perceptions of efficacy are also contextualized, meaning
that treatments may work for reasons other than the mechanisms ascribed
to them, or they may affect factors not included in conventional outcome
measures that focus only on behavioral variables. Arguments over efficacy
go to the heart of technologies of knowing, from the randomized controlled

360 CHLOE SILVERMAN

trial to unquantifiable forms of intimacy, touch, and scrutiny. Controversies
over biomedical interventions in autism address both the epistemological
problem of what we can know and the political problem of what we choose
to investigate.

The History of a Perspective: Defeat Autism Now!

(DAN!) and Biomedical Treatments

In calling attention to a parent movement based on biomedical interven-

tions for autism spectrum disorders, I rely on my experiences over several
years with the Defeat Autism Now! (DAN!) project of the Autism Research
Institute.4 At a time when as many as 70 percent of the parents of children
diagnosed with autism try some form of “biologically based” treatment as
an alternative to conventional approaches, DAN! lies within a broader set of
social and communicative networks that share explanations, texts, and prac-
tices (Wong and Smith 2006). A number of professionals have multiple af-
filiations, and DAN! doctors are often present at conferences for Autism One
or the National Autism Association, both of which advocate similar thera-
peutic approaches.5 The Autism Research Institute is neither the largest
nor the best-funded of the parent groups involved in research on the aut-
ism spectrum disorders. However, understanding their work is crucial for
understanding the ways in which families with autism intervene in medical
knowledge production and the complicated ways in which commercial, sci-
entific, therapeutic, and professional interests collide in an organization that
seeks to recruit practitioners as well as parents.
DAN! conferences bear a genealogical relationship to both parent advo-
cacy in general and the formation of specific activist groups. They are run
by the Autism Research Institute (ARI) in San Diego, founded by Bernard
Rimland, a co-founder in 1965 of the National Society for Autistic Children
(now the Autism Society of America), which was formed in part to promote
Applied Behavior Analysis (ABA), an educational and therapeutic technique
developed by O. Ivar Lovaas at UCLA during the 1970s. Premised on a neuro-
logical theory of autism opposed to the psychogenic theory then favored, ABA
was not yet established as conventional treatment and was regarded by some
proponents of psychotherapeutic treatments as a form of conditioning tanta-
mount to abuse (Bettelheim 1967, 111–12). In 1964 Rimland wrote Infantile
Autism as a challenge to the psychogenic theory of autism promoted by psy-
chologists such as Bruno Bettelheim, drawing together existing research on
neurological and genetic factors in autism and proposing a theory of etiology

DESPERATE AND RATIONAL 361

and directions for future research. Rimland’s book situated the neurological
identity of autism squarely in terms of the case series used by Leo Kanner
to characterize autism in 1943, reinterpreting Kanner’s characterizations of
parental aloofness in terms of a possible set of hereditary factors (an inter-
pretation that persists in contemporary genetics studies).6 While research
into the genetics of autism evolved into a search for associated genes, Rim-
land turned his attention to the practical problems of treatment and the lack
of diagnostic scales that took medical problems into account. He spent years
refining instruments to examine factors left out of the definition of autism,
producing an “Autism Behavioral Checklist,” appended to Infantile Autism,
that asked questions about regression as well as parent characteristics and
the child’s eating habits.7 This instruction in a system of monitoring and
care has become part of the practice of the DAN! community.
During the late 1960s, in collaboration with Linus Pauling and based on
research in the emerging field of orthomolecular medicine, Rimland began
experimenting with megavitamin therapies through his Institute for Child
Behavior Research in San Diego (later the Autism Research Institute). He
recalled that during the mid-1960s, parents began contacting him regarding
the therapy, and that “even though few of the parents were acquainted with
each other and each was trying quite a variety of vitamins, the same small
group of vitamins was being mentioned again and again. As the number of
parent-experimenters grew, it began to include more parents whom I knew
personally to be intelligent and reliable people. At that point I contacted a
number of doctors in California and on the East Coast who had been experi-
menting with vitamin therapy. The combined information from the doctors
and parents convinced me that I could not, in good conscience, fail to pur-
sue this lead” (Rimland 1976, 200).
Rimland’s initial vitamin study recruited parents through the National
Society for Autistic Children. The results were suggestive, indicating that
when combined with magnesium to prevent deficiencies associated with
high doses of B-6, the therapy helped some children (Rimland 1973). At the
same time, Rimland was becoming increasingly convinced that the diag-
nostic entity of “autism” in fact referred to a range of different medical syn-
dromes (Rimland 1971). As early as 1976, Rimland could write, “I am firmly
convinced that very little progress may be expected in finding cause and
treatment for mental illness in children until the total group of children
now loosely called ‘autistic,’ ‘schizophrenic,’ ‘psychotic,’ or ‘severely emo-
tionally disturbed’ can be subdivided in a scientific way into smaller homo-
geneous subgroups. . . . I believe the children loosely called ‘autistic’ or

362 CHLOE SILVERMAN

‘schizophrenic’ actually represent a dozen or more different diseases or dis-
orders, each with its own cause” (1976, 203).
Rimland was instrumental in convening the first DAN! meeting, in Janu-
ary 1995, with Sidney Baker, a physician with a background in functional
medicine, and Jon Pangborn, an industrial biochemist and the parent of a
child with autism. At the time, all three were increasingly concerned about
rising rates of autism diagnoses, just as all three became more concerned
during the 1990s about the possibility that childhood immunizations could
trigger autism.8 As a parent of a child with autism and a scientist (with a doc-
torate in experimental psychology), Rimland represented the paradigmatic
parent-activist, using his set of prior skills in autism research while publicly
referencing his own “autistic” tendencies.9 Other doctors who have attended
DAN! meetings over the past decade tell different stories about their involve-
ment with the organization. A number of them, like Rimland, discovered
orthomolecular medicine and orthomolecular psychiatry in the 1960s, dur-
ing or after their formal medical training, while others have backgrounds in
functional medicine or nutritional biochemistry, and others associate their
use of biomedical treatments with evangelical Christian backgrounds or
other religious traditions. Nearly all of them explain their interest in the
treatability of autism in similar terms. They became frustrated that the
medical conditions experienced by children with autism and reported by
their parents were being written off as “comorbidities” by many of their col-
leagues and were struck, when parents approached them for help, by the
physiological variability in the population. Many explain that they initially
became aware of biomedical treatments by “listening to parents” and that
they have been repeatedly impressed by the responses of children to these
treatments and by the nuanced observations of parents.10 Whether doctors
approached treating autism within the context of their naturopathic or inte-
grative medicine practice were recruited by parents or came to the DAN!
model through their own search for answers as the parent of a child with
autism, most doctors take care to emphasize that while their methods may
be drawn from biomedicine, their knowledge of any particular child comes
mainly from that child and from his or her parents.

An Experimental Community: Biomedicine as Practice

At the center of the DAN! movement is the DAN! guide, officially Autism:
Effective Biomedical Treatments (Pangborn and Baker 2005), which has grown
from a spiral-bound sheaf of suggestions handed out at the first DAN! meet-

DESPERATE AND RATIONAL 363

ing to a commercially produced publication that parents are encouraged
to share with their child’s doctors.11 The treatment method that the guide
outlines requires an explicit though often individualized set of tests and
regimes. These proceed stepwise through levels of difficulty and often ex-
pense, with more complex treatments requiring monitoring by a medical
professional. The first stage is an “elimination diet,” which involves remov-
ing foods associated with sensitivities in children with autism, which DAN!
practitioners associate with both physical and behavioral symptoms. Two
popular diets are the gluten-free/casein-free (“gf/cf ”) diet and the Specific
Carbohydrate Diet (SCD).12 The second stage involves nutritional supple-
mentation, with the aim of repairing the metabolic processes that are under-
stood to be malfunctioning in children with autism, paying specific atten-
tion to problems with methylation and oxidative stress.
Chelation, the third stage of treatment, is also the most contentious. Origi-
nally developed as a treatment for acute heavy-metal poisoning, it involves
the oral administration of molecules that selectively bind to heavy metals,
which are then excreted through urine. The process is time- consuming and
unpleasant: treatments must take place throughout the day, and a doctor
must monitor the child to ensure that heavy metals are being excreted. DAN!
practitioners emphasize that chelation only has a positive impact on a sub-
set of children and that it should be carried out with nutritional supports,
alongside treatment for intestinal dysbiosis, a yeast overgrowth that can be
exacerbated by some chelating agents (Autism Research Institute 2005).
The practice of chelation is supported by theories about the toxic effects of
mercury preservatives in vaccines (although other environmental exposures
to heavy metals are sometimes implicated), lending ideological valences to
the choice to begin chelation treatment. Because of the risks involved in
the treatment if administered incorrectly and other concerns about medical
licensing, only certain doctors will oversee chelation.13 These are frequently
doctors who have a background in functional or environmental medicine
and who believe, at some level, in a hypothesis of autism etiology that em-
phasizes the role of toxic environmental exposures.
All of these steps are supported by parental reports of improved function-
ing and behavior and the remission or amelioration of medical symptoms
such as allergies and gastrointestinal problems. They are also connected,
in complex and suggestive ways, to the findings of laboratory and clinical
studies of nutrition and metabolism in children with autism, a growing
literature produced by academic researchers who have become interested
in the anecdotal results reported by DAN! practitioners. This literature pro-

364 CHLOE SILVERMAN

poses that the behavioral symptoms of autism are often caused by altered
immune responses to certain foods, oxidative stress, and impaired methyla-
tion (which would impede the removal of toxic substances from bodies);
potential functional impairment or even genetic vulnerabilities in detoxi-
fication enzymes such as methionine synthase or glutathione transferase;
neuroinflammation; and overt gastrointestinal pathologies (Jyonouchi, Sun,
and Le 2001; James et al. 2004; Vargas et al. 2005; Page 2000). DAN! doc-
tors describe a group of children with bodies that are unable to sustain the
daily burden of metabolism in the presence of toxic environmental sub-
stances and complex modern foodstuffs. The explicit aim of their collabo-
rative efforts is to produce a metabolic and biochemical model of autism,
and to this end, they speak of an “emerging picture” of the biochemistry of
autism. Within this framework, designations of biomedical treatments as
either “complimentary” or “alternative” are meaningless, because the meth-
ods promoted at DAN! conferences have the potential to redefine autism as
a medical entity.14
Prior to each DAN! conference, presenters and other scientists and doc-
tors gather at a “think tank” to address emerging issues, workshop the talks
that they will be giving, and address potential revisions or additions to the
DAN! guide. Their exchanges are energetic and occasionally contentious—
the practicalities, rationales, and potentials of treatments are argued over in
a precise biochemical jargon during sessions of brainstorming that approach
the sublime. Many participants in the think tanks are also active members of
the DAN! doctors listserv, a list which is used primarily to discuss treatment
modalities and therapeutic options. Topics on the list range from attempts to
standardize processes like chelation, to speculations from parent-scientists
about disease mechanisms, to checks on possible drug or supplement inter-
actions, to requests for help in interpreting confusing laboratory results.
Doctors ask for advice on cases that are unfamiliar or recalcitrant to treat-
ment. Some of the most broadly based researchers and acknowledged au-
thorities on the list do not have conventional medical educations.
If doctors focus on the epistemological consequences of framing autism
as a treatable medical condition and the practical implications for patient
care, parents who attend DAN! conferences describe a process of laborious
experimentation and therapeutic trials, characterized by incremental im-
provement and occasional sudden leaps in functional behaviors. Some of
them turn to spreadsheets as a way to visualize the effects of the multiple
variables in diet and medication against their child’s daily behavior over
days, weeks, or months.15 “Katie,” a parent quoted in the recent DAN! treat-

DESPERATE AND RATIONAL 365

ment guide, says that the most important thing “is daily record keeping”:
“The advantage of going to all this trouble is that I can look back and say
‘Well, treatment A was wonderful for speech, but we also had a lot of night-
waking while on it—so what adjustment might I need to make?’ So much of
what we are doing is trying to restore balance to our children’s metabolisms”
(Pangborn and Baker 2005, 17).
For both parents and doctors, the DAN! approach is a work-in-progress,
a framework for approaching autism as treatable. As such, it is far from
proscriptive and is highly responsive to promising new leads or suggestive
data. The DAN! community exists primarily for the purpose of circulating
knowledge about biomedical treatments, rather than for advocacy, but this
does not mean that the circulation of knowledge in the DAN! community is
apolitical. Members of the community see the interventions themselves as
a politics, involving a choice about how to conceive of autism that upsets
established structures of medical and scientific authority. The knowledge
that circulates is also broader than “mere facts”; it involves craft knowledge
pertaining to treatment choices and treatment preparation, such as tricks
for getting children who would prefer to subsist on chicken nuggets to con-
sume a diet consisting of rice, meat, and organic produce, or information
about where and how to request and obtain compounded medications for
“off-label” uses. Parents solicit and dispense advice of this type on a constel-
lation of listservs, discussion groups, and newsletters that may be only tan-
gentially connected to DAN! meetings and the Autism Research Institute.
Although lists like the Autism Biomedical Discussion Group welcome par-
ents who want discussion and feedback on medical interventions, the mod-
erator warns parents in no uncertain terms that they can turn elsewhere for
support and commiseration.16
Just as the DAN! guide and conferences inform discussions on listservs,
parents who have experienced success using biomedical interventions reach
out to parents new to the autism diagnosis through memoirs and hand-
books, including Unraveling the Mystery of Autism and Pervasive Developmen-
tal Disorder: A Mother’s Story of Research and Recovery (2003 [2000]), Karen
Seroussi’s account of treating her son with an elimination diet, and Lynn
Hamilton’s combined memoir and handbook, Facing Autism: Giving Parents
Reasons for Hope and Guidance for Help (2000), both of which emphasize the
importance of parental devotion and determination in the search for infor-
mation about treatments. Jacquelyn McCandless’s book, Children with Starv-
ing Brains: A Medical Treatment Guide for Autism Spectrum Disorder (2003),
details McCandless’s own journey from psychiatrist to autism treatment

366 CHLOE SILVERMAN

2. The Chelation Kid. From Tinnell and Taillefer 2006a. Courtesy of Craig A. Taillefer and
Robert Tinnell.

specialist and DAN! doctor as a result of the diagnosis of her granddaugh-

ter, Chelsea.17 McCandless and her husband, Jack Zimmerman, use the lan-
guage of love as an explanation for what they see as a reciprocal process
of healing that takes the form of diligent experimental medical practice as
opposed to the allopathic model of medical treatment: “The children with
starving brains challenge our capacity to love—particularly in regard to the
qualities of patience and perseverance, devotion beyond the usual parental
call of duty and the capacity to think and act creatively ‘out of the box.’ Often,
it is only after a profound challenge to our capacity to love, such as the rear-
ing of an ASD child, that we come to realize how much more there is to dis-
cover about loving” (Zimmerman, in McCandless 2003, 194).

Crossing Over: Testimony, Reflexivity, and Recruitment

DAN! conferences are oriented outward, toward recruiting and training new
DAN! doctors and parents. Parents may offer to pay the registration fees for
their children’s doctors as an incentive for them to attend the conference
and receive an introduction to the DAN! approach.18 Attending a conference
represents the beginning of a process that involves more than a simple com-
mitment to treating autism using biomedical interventions. It also involves
acquiring a specific vocabulary, learning to visually perceive symptoms that
may be invisible to those not trained to pay attention to medical conditions
in children with autism, becoming skilled in interpreting unconventional
laboratory tests and parental reports of idiosyncratic behaviors, tics, or food
cravings, and developing the confidence to suggest medical treatments that
are regarded as questionable by much of the broader medical community.

DESPERATE AND RATIONAL 367

 Potential DAN! doctors do not see their embrace of biomedical treatments
as a choice to move away from reliable medical knowledge. Rather, they ex-
perience their choice as an affirmation of medical principles that have been
abandoned by allopathic medicine. Within the DAN! community, diets are
seen as biomedical interventions, as much or more than the use of antipsy-
chotic medications, because they are understood to address the pathological
mechanisms of the disorder, rather than the symptoms alone. The collective
sense of parents and physicians that the experimental approach of DAN!,
though it may take longer to produce results than psychopharmacology, is
a more certain way of addressing the underlying causes of the disorder is
reflected in discussions among doctors and in promotional literature. For
example, the Autism Research Institute’s “Autism is Treatable” campaign
focused on using advertising and public-relations strategies to promote the
message that, simply put, autism is treatable.19 DAN! conferences have in-
cluded panels of parents explaining that most children will respond to some
set of interventions. The book produced in conjunction with the campaign
detailed tentative success stories, close relationships with advising physi-
cians, and therapeutic optimism based on individualized treatment strate-
gies (Rimland and Edelson 2003).
Conference presentations and treatment recommendations must be
translated into practices and reproduced in daily routines if parents are to
see results and become committed to the program of interventions. The
methods of monitoring and care advocated at DAN! conferences train par-
ents to see their children’s symptoms as altered by variations in nutrition,
medication, toxin levels, and immune responses. As parents learn to watch
their children in new ways, they also learn to attribute changes not to chance
or normal processes of development, but to positive effort. Likewise, practi-
tioners using these methods are converted through the experience of seeing
children “actually respond” for the first time since they have been treating
children with autism; their tangible experiences help confirm their mem-
bership in the group.
Modes of interpretation are also built into laboratory tests and the inter-
pretive skills of researchers. DAN! treatments depend on a network of inde-
pendent laboratories with specialized tests for measuring the baseline and
post-treatment levels of various enzymes, nutrients, antibodies, and heavy
metals for purposes of diagnosis, treatment selection, and evaluating out-
comes.20 A typical set of tests might check for nutrient levels, both acute and
delayed allergies, and markers of heavy-metal toxicity or yeast overgrowth.
Doctors who treat autism using conventional approaches regard these tests

368 CHLOE SILVERMAN

with some skepticism, describing them as a way of exploiting parents des-
perate for information or, at best, as tools that are too poorly standardized
to be useful. Insurance companies often fail to cover the tests, so parents
are compelled to pay out of pocket. DAN! practitioners argue that threshold
effects caused by genetic vulnerabilities in conjunction with environmental
triggers can manifest in a variety of fashions and that these vulnerabilities
and potential treatment strategies become visible through the patterns in
lab workups. Under this interpretation, doctors have been quietly charac-
terizing the biochemistry of autism for at least twenty-five years. One re-
searcher commented,

It is IMPORTANT, if present models are to change, that concrete data about

the chemistry of those with autism is made a public record. Professionals
with whom I have shared my own daughter’s chemical workup have been
miffed by what they’ve seen, because this sort of workup is not usually
done; since these sorts of results are unfamiliar they are viewed as only
a curiosity when they are seen individually. How can a neurologist be-
come convinced he needs to know about his patient’s immune/metabolic
status unless the results of a great many of these workups is put to pub-
lic inspection? How indeed, can we get reimbursement for these sorts of
workups by our insurance companies if it is unclear what the data will
mean once we get it because there is nothing to compare it to? This all
hinges on publication to a wide audience.21

At a DAN! conference in 2005, a meeting was organized to introduce

“mainstream” practitioners from the local community to the methods of
seeing promoted at DAN! conferences, intended as a “bridge” between the
two medical frameworks. The practitioners connected to DAN! gave short
presentations, oriented toward the concept that individuals with autism
have metabolic, immunological, and nutritional variations from typical
populations, and that it is possible to intervene and alter these variations to
produce behavioral effects, or, as the flyer for the meeting argued, “In the
light of these findings, to view autism as a static encephalopathy may mean
to overlook potentially valuable treatment opportunities.”22 Each presenter
devoted their talk to one metabolic system. During the question period,
one participant, an experienced chemist who had not encountered these
methods previously, asked if he could use a sheet of butcher paper to write
on and, as the presenters watched, he drew a diagram of the ways that the
various biochemical pathways implicated in autism formed an interlocking
series of reactions. One might, he suggested, intervene at various points in

DESPERATE AND RATIONAL 369

order to produce a response with effects throughout the system—a point
that DAN! practitioners regularly make, but one the chemist constructed
himself just from hearing the didactic presentations on disease mecha-
nisms, even though these presentations had barely touched on treatment
implications.
Via instruction in these methods of interpretation and vision, DAN! prac-
titioners and families focus their efforts on converting qualified practition-
ers. With increased familiarity, families also work a process of conversion on
themselves. Although “conversion” suggests a process based on faith rather
than on experimental validation, I do not want to suggest a process of in-
doctrination or induction into “irrational” nonscientific belief systems, but
rather a secular community that is acutely aware of the social context of sys-
tems of reason, and the difficulties inherent in translation and proof. DAN!
doctors recognize that even if they have presented a rational alternative to
conventional medical approaches to autism, the majority of their colleagues
will not recognize it as valid because they have not yet learned to visualize
autism in this new framework.23 This understanding comes up frequently in
conversation at DAN! meetings because of the reflexivity that is the dubious
privilege of a marginal group; individuals whose testimony is continually
questioned are more likely to consider the source of their own beliefs. DAN!
practitioners struggle with the conflicting demands of maintaining their
practices as clinicians, treating children based on detailed parent reports,
the need to maintain their credibility and medical certification, and their
desire to generate biomedical facts that are legible and credible to regulatory
agencies and medical associations.
While the shared practical and affective dimensions of autism treatment,
rather than a specific, shared, theory of causation or etiology, help to con-
stitute this emerging community of parents and practitioners, a collective
vision of autism as dynamic and treatable does indeed emerge from these
practices. This vision is deeply practical. It involves attending to dimensions
of the disorder that are physiological as much as neurological, including
skin ailments, levels of “stimming” or self-stimulatory behavior and self-
injury, exacerbations of gut disturbances or variations in mood, all of which
may be mapped to different dietary or other biomedical regimens. This leads
to a blurring or reframing of the diagnostic category of autism itself, from
one based on behavioral features and an imputed underlying genetics to a
(no less real) category based on “measurable factors in the immune, endo-
crine and metabolic systems,” leading to “a diagnosis of biochemical cer-

370 CHLOE SILVERMAN

3. The Chelation Kid. From Tinnell and Taillefer 2006b. Courtesy of Craig A. Taillefer and
Robert Tinnell.

tainty rather than one build around behavioral things that may change as
people respond to a whole host of different sorts of therapy.”24
While it is possible to seek genetic causes for behavioral symptoms, the
search for metabolic biomarkers and the insistence on “biochemical indi-
viduality,” and that “every child is biochemically unique,” points to a deeper
reframing that goes beyond seeking interim solutions prior to a final, ge-
netic, answer. Seeking explanations for autism at the level of cellular sig-
naling involves a choice of perspective, potentially away from autism as a
monolithic diagnosis and toward autism as systemic disorder with neurologi-
cal manifestations in which “we do not know how many different kinds of
underlying molecular, cellular, metabolic and tissue perturbations may lead
to a connectivity disturbance sufficient to produce autism” (Herbert 2005a,
355).25 This shift in perspective is an option for parents and physicians alike.
Physicians welcome it as an intellectually satisfying way to approach the prac-
tical problems that they encounter as they try to create treatment programs
for children with autism. Parents describe it as a consequence of their work
as parents, where attention to individual needs is one qualification for the job.

Visceral Responses: Efficacy, Therapy,

and Diagnostic Vision

The work of diagnosing and treating gastrointestinal issues in autism can

illustrate the broader concerns related to characterizing the diagnosis, estab-
lishing modes of intervention, and developing new techniques for seeing in
diagnostic terms. The use of vitamin B6 and magnesium, or subcutaneous

DESPERATE AND RATIONAL 371

injections of methyl-B12, or the elimination diets described in Special Diets
for Special Kids (Lewis 1998) would provide equally apt examples: each inter-
vention shares similar barriers to legitimacy in the medical community.
While parents have long complained about the allergies and gastrointestinal
issues experienced by their children, only recently have these issues and the
possibility of a new diagnostic category of “autistic enterocolitis” been ac-
cepted by anything approaching the broader medical community, and those
clinicians who have responded to the claims of parents have been slow to
publish their results (e.g., White 2003; Kushak, Winter, Farber, and Buie
2005; Krigsman 2007).
Doctors are often hesitant to associate themselves with discussions about
gastrointestinal problems in autism because of the public association be-
tween digestive symptoms, the measles-mumps-rubella vaccine, and the
controversy that has surrounded scientific articles that have attempted to
validate a connection between the two (Wakefield et al. 1998; Murch et al.
2004; Erickson 2005; Richler 2006). In contrast, parents claim on listservs,
website testimonials, and at conferences that often the first (and sometimes
the only) effect of a strict elimination diet is that their child’s chronic diar-
rhea or constipation was resolved. Gastrointestinal problems have been
commonly explained as results, rather than causes, of the neurological dis-
turbance in autism. In order for children with autism to receive treatment
for gastrointestinal issues, the problem and the symptoms literally had to
acquire diagnostic visibility in children who often cannot communicate the
cause of their distress.
A pediatric gastroenterologist was present at the first DAN! meeting that I
attended. He seemed uncomfortable among the exhibitors and milling par-
ents, dressed formally in a navy suit. Parents of his patients had requested
that he attend, and when I spoke with him, he wanted me to understand
that he was not necessarily in support of the broader set of ideas or concerns
represented at the conference and was concerned about the claims made by
some of the other physicians present. Six months later he was at a meeting
on the opposite coast, willingly considering the possibility of gut issues in
autism. He allowed that certainly many children with autism had exception-
ally difficult gastrointestinal problems that could go unnoticed by doctors fo-
cused on their cognitive disabilities. Perhaps, he suggested, stress associated
with a child’s inability to communicate was the cause of the symptoms that
parents reported, possibly as a result of the known neurological connections
between the gut and brain (e.g., Gershon 1998). In another six months, he

372 CHLOE SILVERMAN

presented preliminary data at a DAN! conference on a set of children diag-
nosed with autism that he had treated with medications for bowel inflam-
mation, even though he remained skeptical about any distinct gastrointes-
tinal condition associated with autism. One video clip that was screened at
this conference showed a child screaming and writhing on the floor, press-
ing his hands into his stomach. To the audience, the child was clearly ex-
pressing agonizing pain due to gut inflammation, and the group reacted as
the presenter knew they would, with gasps of sympathy and knowing gri-
maces. To them, the child’s suffering was obvious. To another audience, he
would have been merely “tantrumming.” Similarly, photographs that par-
ents provided of children angling their bodies over chairs and placing pres-
sure on their abdomens would be seen as “posturing” or forms of stereo-
typed behavior by an uninitiated audience. Parents knew that they were
attempts to attain a degree of comfort and relief.
To the extent that gastrointestinal symptoms in children with autism are
acknowledged by conventional practitioners, they are often dismissed as co-
morbidities or “just the autism.” In the world of biomedical interventions,
they are reinterpreted as food sensitivities. At my first DAN! meeting I was
invited to join a group of young mothers from Louisiana while they talked
among themselves, mainly about the bowel problems of their children. One
participant leaned over to me and confided that, “If you hang around autis-
tic parents enough, all we talk about is poop.” For a community that under-
stands their children’s problems as arising at least partially from gut dys-
function, the facts of foul-smelling bowel movements, chronic diarrhea, and
the subtle nuances of each become important observational diagnostic tools
that are de facto a special province of parents.
Parents share the common currency of experience, but filtered through
the conviction that this experience can be rendered legible. Gestures of pain
are indeed communicative, and behavioral symptoms can be addressed at
the level of malfunctioning physiology, even before the exact nature of the
cognitive dysfunction is precisely understood. Technologies of interven-
tion, like the technologies of faith, present tangible results prior to explicit
comprehension. Neither parents nor practitioners see their recognition and
treatment of gastrointestinal issues in autism as a comprehensive explana-
tion for every case of the disorder, but they do see it as a partial solution to
particular cases. Interventions, the success of which are predicated on a par-
ent’s willingness to serve as devoted recordkeeper and nurse, are valuable to
parents because of their tangible, observed benefits, but they are also valued

DESPERATE AND RATIONAL 373

because they present a rational approach to an otherwise unmanageable ex-
perience, that of caring for a child whose moods and bodily functions resist
understanding by those who ought to know them the best.
In any practitioner’s transition from utilizing conventional treatment
modes to more biomedically oriented approaches, such “frameshifts” in
vision are especially important. For practitioners considering incorporating
DAN! approaches into their practices, a key concern is the threat of liability
for using “unproven” treatments, when even recommending elimination
diets could lead to investigations by state medical boards. The choice to
move away from accepted practice on the strength of individual observa-
tions and parental demand is one vital shift. However, the most important
transition may be a shift in the relative weighting of the available informa-
tion for treating apparently neurological conditions. One practitioner who
considers a variety of perspectives in treating autism characterized her own
experiences this way.

A key transition in my own understanding of this disorder has been

taking careful and thorough medical histories of my autistic and other
neurobehavioral patients, and taking their physical complaints seriously.
These complaints, once one learns to ask about them, turn out to be so
common that it has become impossible for me to ignore them or assume
that they are less important than the behavioral features. These children
cannot be assumed to have nothing more than brain and behavior prob-
lems, since so many of them are also physically ill. A critical question is
whether—and if so how—these things are related.26

DAN! doctors are by definition converts. While they have conventional

medical or nursing degrees, doctors offering therapies outside the consen-
sus treatments contend with identities that are compromised, if not out-
right “heretical” (Wolpe 1990; Wolpe 1994). Most doctors who are willing to
accept the professional costs that come with offering alternative approaches
emphasize the importance of listening to parents. Many see themselves
as part of a movement with the objective of altering medical practice and
with this, the prospects for children with autism. Those doctors who wish
to maintain their legitimacy emphasize the specialized or disciplinary as-
pects of their work as neurologists, gastroenterologists, or immunologists
who treat specific problems in children who happen to have autism; those
who are less concerned with their institutional status come increasingly to
identify themselves as DAN! doctors, first and foremost.

374 CHLOE SILVERMAN

The Heart of the Matter: Desperation,
Commitment, and Trust

When I first attended a DAN! conference, I shared the experience of many

first-time parent attendees. I was utterly overwhelmed. I thought about this
sensation in terms of trust, because this was the determination that I felt
called on to make of the presenters and exhibitors. Who could be trusted?
Trust and truth claims are the currency of modern science, and have been
described in terms of a legacy of rules stipulating economic independence
and invulnerability to influence as a prerequisite for scientific “witnessing”
(Shapin 1999). “First-time” parents often leave the room during the initial
slide lecture in tears, either because they are suddenly faced with the possi-
bility of improving the prospects for a child that had been described as vir-
tually untreatable, or out of sheer confusion at the unmediated outpouring
of biochemical terminology and PowerPoint diagrams presented from the
podium at the front of the room. I felt equally at a loss, and tried to cope by
treating the problem as a task in science studies and asking myself how par-
ticipants defined evidence and experience, what types of each they valued,
and how and when observations and theories stabilized as biomedical facts
(Shapin and Schaffer 1985; Latour 1988).
Later, I came to think of the problem in terms of persuasion followed by
commitment—in other words, a decision to initiate a trial rather than a re-
lationship of absolute trust on the part of parents. This led me to spend less
time working myself into knots of doctors to listen in on their metabolic
speculations, and more time chatting with moms in the lobby of the con-
ference hotel, asking them why they decided to try biomedical treatments.
One parent, who showed me a photograph of her dreamy- eyed daughter,
said that when she first considered biomedical approaches her friends told
her that only the desperate would try diets and supplements. She had de-
cided that she was desperate enough when her daughter tried to jump out
of the car in the center lane of traffic. Her story was not unusual. Parents
grow weary of those that see acts of desperation and rationality as mutually
exclusive, especially when it becomes evident to them that few experts rec-
ognize the difficulties of their daily lives or their ability to critically evaluate
treatment options. Their decision to bring the work of medical treatment for
their children into their homes reflects a rejection of the despair brought on
by a negative prognosis for their child, an embrace of the idea that their en-
counters with their child can meaningfully shape his or her development,

DESPERATE AND RATIONAL 375

4. The Chelation Kid. From Tinnell and Taillefer 2007b. Courtesy of Craig A. Taillefer and
Robert Tinnell.

and a skepticism of the “legitimate complexity” of expert medical knowl-

edge that itself has long been a part of American vernacular medical prac-
tices (Starr 1982).
Parents of children with severe genetic disorders are also seen as pushy
and driven to distraction by the severity of their children’s suffering. How-
ever, only the parents of children with autism are suspected of manifesting
some kind of forme fruste symptoms of the same disorder, themselves. Par-
ents of children with autism are questioned at every level, from their compe-
tence as parents (because of their presumed inborn lack of affect, inherited
by their children, they are ill-equipped to raise children with affective prob-
lems), to their “perseveration” on the effects of chemical exposures or the
limitations of available treatment programs. As the parents of disabled chil-
dren, they are seen as desperate and vulnerable, willing to mortgage their
houses to pay for unproven therapies. The image of the desperate parent is
so persuasive that it can overshadow the identities of parents who are also
researchers or practitioners. Although within the DAN! community, research
on one’s own child, professional practices, and clinical experimentation can
run together, other professionals will go to significant lengths to hide the
fact that they are doing research as a result of their child’s diagnosis, espe-
cially when the research might be associated with a “hysterical” parent belief
about vaccines or environmental toxins.
Parents take this suspicion of partiality and turn it on its head, explain-
ing that being part of their child’s life means coming to know their child in
biomedical terms, if that is the means through which they can help their
child. They are acutely aware that their status as caring relatives compro-
mises their claims for objectivity, to the degree that the appearance of objec-

376 CHLOE SILVERMAN

tivity depends on a claim of moral neutrality (Daston and Galison 1992). In
contrast, they argue that it is precisely their intimate involvement with their
child and their absolute devotion to their child’s well-being that allows them
to understand how their child responds to treatments in ways that a profes-
sional observer with commitments to standard disease models and commu-
nity standards could never aspire to.

Biomedical Pluralism and Invisible Labor

The combination of accusations that parents are compromised witnesses to

their children’s physiology and the demands of daily attentiveness associated
with biomedical interventions for autism suggests some problems with dis-
cussions of contemporary illness-based social groups. Analyses of these
groups often assume that communities spontaneously organize around dis-
ease categories through either an affinity born of shared experience or the
desire for information. They also suggest that the need for advice or infor-
mation about a condition can potentially be met by attentive medical practi-
tioners, if those practitioners are persuaded to take the condition seriously.
Finally, they expect that the work associated with the daily requirements of
care for a condition is a “natural” response to being sick, or loving some-
one who is, and therefore requires no extensive explanation. All of these be-
liefs are reasonable, but in their evocations of spontaneous or effortless acts,
none of them do justice to the knowledge and labor associated with complex,
chronic conditions like autism spectrum disorders.
As Bernard Rimland recognized when he first began talking to other
parents with affected children, autism only looked like a single condition
through the lens of diagnostic instruments designed to view it that way. This
story is, in some sense, the reverse image of the story told by Lakoff, where
a psychologically complex condition was made to resolve into a biomedically
concise characterization (Lakoff, chapter 8 in this volume). For autism, di-
rected efforts to destabilize rather than refine the category, supported by an
alliance of functional-medicine practitioners, not-for-profit research insti-
tutes, nutritional-supplement manufacturers, maverick researchers, and in-
dependent laboratories, encounter entrenched resistance from those whose
research programs depend on the stability and reality of autism as a biologi-
cally “true” population. The efforts of parents and professionals using bio-
medical treatments to reframe autism as a chronic illness rather than as a
fixed genetic and neurological condition are aided by the absence of genes,
diagnostically distinctive patterns of metabolites, or dysmorphologies that

DESPERATE AND RATIONAL 377

consistently mark children with autism as a biologically separate popula-
tion. The work that constructs autism as a stable population occurs largely
at the level of qualitative observations guided by diagnostic questionnaires
and checklists (e.g., Lord, Rutter, and LeCouteur 1994; Lord et al. 2000).
A focus on metabolic processes before genetics, environment before “in-
nate biology,” and development before hardwiring is a shift in perspective
that renders certain processes more or less visible, certain interventions
more or less possible, but does not negate any specific approach. DAN! prac-
titioners incorporate genomics, psychopharmacology, and behavioral thera-
pies into their practices. This perspective is replicated in a variety of ways.
For parents, it takes hold almost incidentally, as an after- effect of learning to
manage the disrupted biochemistry of their children. Practitioners acquire
it as a result of their education and background, or their personal experi-
ence of the effects of treatment and their desire to help affected children.
Doctors and parents refer to their techniques as “biomedical interventions”
simply because they understand them to be continuous with techniques
drawn from conventional biomedicine, part and parcel of the same system
of reason and rationality. Neither parents nor practitioners using biomedi-
cal treatments have had much success explaining their approach to skepti-
cal outsiders because of their relentless focus on the individual as opposed
to the population and because of their preference for explanations drawn
from functional medicine and biochemistry. Only recently have members
of the DAN! community made an effort to reach the broader community
of researchers and clinicians working on autism by conducting controlled
clinical trials and publishing peer-reviewed articles and case reports with
well- documented theories of pathological mechanisms (e.g., Adams and
Holloway 2004).
In one world, parents sit with their child in a doctor’s office, receiving
a diagnosis that they have probably already suspected. They are told that
autism is a fixed and lifelong neurological condition, which will someday,
through the efforts of academic research and family contributions of genetic
material, become susceptible to pharmacological interventions or prenatal
diagnostic screening. During this visit, they may be given information that
will lead them to take part in one of the autism genetics initiatives currently
in progress. The parents may leave the office and immediately begin their
own research, or perhaps time passes, their child fails to improve with be-
havioral therapies, and life becomes increasingly unmanageable. Either way,
the parents enter another world, seeking advice through handbooks, the
Internet, or exchanges with other parents. In this world, parents exchange

378 CHLOE SILVERMAN

diet tips and learn to administer vitamin injections, attend conferences, and
talk tentatively about improvements and recovery. There are few reports of
miracles, but there is a considerable amount of hope. In both worlds, the
massive efforts of parents, involving attention, monitoring, care, and ob-
servation, are described as acts of love. Both perspectives are firmly part of
biomedicine as defined in terms of biological knowledge or commitment to
applying that knowledge in the service of biomedical treatments. Their in-
compatibility in the eyes of so many experts does not necessarily mean that
one perspective is irrational or unscientific, but that it is difficult to come
to terms with the idea that biomedicine itself can accommodate more than
one set of methods or epistemological commitments.
The cognitive and physical effort of making room for those multiple per-
spectives is part of the affective labor involved in the private, home-bound
work of treatment and care, the commitment to an experimental attitude
that will yield results only sparingly and without the comfort of expert sup-
port. The caring labor involved in treating children medically is not, parents
believe, simply treatment carried out by a loving parent, but a kind of care
that can only be carried out with love because (in the words of one theorist
of disability) “labor unaccompanied by the attitude of care cannot be good
care” (Kittay 2001, 560; also Kittay 1999). Our tendency to naturalize caring
labor as the only reasonable response of a typically loving parent to a sick
child can obscure the varieties of care that are available to parents, and the
rational effort involved in making choices amid so much variety. Caring for
a child with challenging behaviors or medical complications involves almost
endless labor, leading parents to wonder how anyone could suggest that the
solution to their financial woes might be to get a “real job,” as in Tinnell and
Taillefer’s comic.
Donna Haraway describes the value that humans attach to companion
animals as “encounter value,” the worth that individuals place in the con-
nection between them and another living being (Haraway, chapter 2 in this
volume). A conventional approach to capitalist investment would assume
that people devote resources to someone else—animal or human—because
of the rational possibility that they too will benefit in the long run; there-
fore, the argument proceeds, parents spend themselves into debt exploring
therapies for their children in the hope that their children will reward their
investments. Any parent knows that such a line of reasoning is nonsensical:
parents care for their children out of love and experiment with treatments
because they appear to help, even a little bit. It would also be easy to con-
clude that the resources that parents sink into what are seen as unproven

DESPERATE AND RATIONAL 379

treatments for their children is a symptom of the search for a lost encounter
with their children, who (according to self-advocates with autism) are not
so much sick as irreducibly other (Sinclair 1994). The parents of “The Che-
lation Kid” would beg to differ. For them, the central encounter takes place
through their ability to see responses to treatments and to work, steadily and
unwaveringly, toward recovery. For these parents, faith is not promissory or
endlessly deferred (M. Fortun, chapter 11 in this volume), but is found in the
experimental practices of care and treatment and in the incremental gains
accrued along the way. Parental faith is not based on the promise that any
given treatment will lead to a certain recovery, but in the act of testing inter-
ventions.
Biomedical treatments for autism, in their pragmatism, tentativeness,
and relentless individuality, represent another way of seeing. They present
a claim of intimate knowledge against the medical certainties of hereditary
disorders and standardized diagnostic questionnaires, or, put differently, a
faith that emerges from and is indeed inseparable from the practices that
it dictates. The practical and epistemological choices that emerge from this
perspective are at once far-reaching and painfully limited. Affective experi-
ences do not circulate along the same channels as other facts: you have to
try them out for yourself. As users of an alternative economy, comprised of
functional-medicine practitioners and nonconventional forms of testing and
laboratories, advocates of biomedical treatments will therefore continue to
face skepticism. The “private policy” of healthcare is simultaneously fraught
with meaning, based in practice, and often limited to the treatment of one’s
own children in one’s own home or to the clinics of physicians with stag-
gering caseloads, and for that reason, the reasonable experiments of parents
and their more far-fetched acts of faith will continue to be indistinguishable
to many observers.

Notes
I am grateful to Kaushik Sunder Rajan, Kris Peterson, Susan Lindee, and Martha
Herbert, as well as all of the participants in the Lively Capital workshop, for their
comments on earlier drafts of this chapter. Any errors of fact, misstatements, or
omissions are, of course, my own.
1. One example among many in which researchers have credited their insights
to parents is the ongoing research on gut microbiology carried out in the laboratory
of Sidney Finegold, who attributed his research program to the observations and re-
search of Ellen Bolte, the mother of a child with autism. Bolte contacted Finegold
in the process of seeking a doctor to treat her child with vancomycin, an antibiotic,

380 CHLOE SILVERMAN

based on her hypothesis that some of her son’s symptoms were due to neurotoxins
produced by gut flora. Both publications resulting from this research list Ellen Bolte
as a coauthor. See Sandler et al. 2000, or the earlier study, Finegold et al. 2002.
More recently, researchers have provided validation for parent claims that a subset
of children eventually diagnosed with autism regress between their first and second
birthdays, as in Werner and Dawson 2005, and that children with autism show sig-
nificant improvement in communication and behavior during fevers, as in Curran
et al. 2007.
2. A number of researchers have made this observation, but I am drawing mainly
on Martha Herbert’s ideas (for example, Herbert 2011).
3. In making the connection between Hays’s work and parenting children with
autism, I draw on Stevenson (2008, 199).
4. The acronym for Defeat Autism Now!, DAN!, is commonly used in conversa-
tions among parents and some practitioners, but is never used in the organization’s
own materials, where the full name is always spelled out. I have chosen to follow
spoken usage here. The organizations that I describe in this chapter, including the
Autism Research Institute’s Defeat Autism Now! conferences, now called Autism
Research Institute Conferences, have in some cases changed significantly since the
chapter was written in 2005. For a more current description, see Silverman 2011.
5. See the National Autism Conference website, http://www.nationalautismcon
ference.org/; the Autism One website, http://www.autismone.org; the Unlocking
Autism website, http://www.unlockingautism.org; the Talk About Curing Autism
website, http://www.tacanow.org; and the Generation Rescue website, http://www
.generationrescue.org, all of which promote biomedical interventions, although
they have slightly different orientations in terms of advocacy. A number of clinical
research and treatment centers explicitly research biomedical interventions as well
(with varying degrees of emphasis), including Thoughtful House, http://www.thou
ghtfulhouse.org; the Center for Autism and Related Disorders, http://www.center
forautism.com; and the University of California, Davis, M.I.N.D. Institute, http://
www.ucdmc.ucdavis.edu/mindinstitute. All websites accessed 10 February 2008.
6. Somewhat ironically, Rimland’s tentative suggestion has become the basis for
a vast number of research programs. Rimland wrote, “If it should turn out that early
infantile autism is biologically—not psychologically—determined, then the only
logical way of accounting for the parents’ unusual personalities and intelligence is
biologically. This would mean that basic personality structure may, in at least some
cases, be far more closely tied to the biological makeup of the individual than has
heretofore been realized. Unless autism can be shown to be largely psychogenic in
origin, or the evidence presented by Kanner and others concerning the parents can
be disqualified, the conventional view that heredity must invariably act only in gen-
eral and unspecific ways as a determinant of human behavior must be reconsidered”
(1964, 41).
7. See “Appendix: Suggested Diagnostic Check List” in Rimland 1964, 219. The
checklist included questions about gut problems; reactions to “bright lights, bright
colors, unusual sounds”; “unusual cravings” for certain foods; the possibility of loss

DESPERATE AND RATIONAL 381

of verbal skills after initial acquisition; and fine motor coordination, along with more
conventional diagnostic measures for autism, such as pronominal reversal and in-
sistence on sameness. “Form E-2,” a parent assessment of “drugs,” biomedical treat-
ments, and “special diets,” has been produced and collated by the Autism Research
Institute since 1967. They report that they have collected over 27,000 of these forms,
designed to contrast the efficacy of a variety of treatments. Also see “Parent Ratings
of Behavioral Effects of Biomedical Interventions,” available at the Autism Research
Institute website, http://www.autism.com/pro_parentratings.asp, accessed 28 July
2011.
8. Rimland maintained that his own son, now a successful illustrator, was atypical
from birth and did not appear to be vaccine injured, but he thought that this was not
the case for many younger children.
9. At one DAN! conference (fall 2002, San Diego), Rimland told a well-known
joke that fell resoundingly flat. After a moment of embarrassed silence, the audience
erupted in laughter, realizing that his inability to deliver the joke (a reference to the
tendencies toward mild “autistic” traits in parents of children with autism) was in
fact the joke itself.
10. During a talk at the Spring 2005 DAN! conference, Dr. Sidney Baker described
listening to parental testimony as an “ethos” that involved being conscious of the fact
that there are “two people in the room,” and he spoke movingly of the need to learn
to “translate” the intuitions of parents into “technical language” that the rest of the
medical community could learn to respect (April 2005, Quincy, Mass.).
11. The DAN! guide was originally referred to casually as the “DAN! Protocol,”
but following concerns about appearing to offer a standardized (or clinically tested)
protocol as opposed to a series of suggestions to be experimented with on a patient-
by-patient basis, the authors have been careful to refer to it as the “DAN! guide.”
12. The Specific Carbohydrate Diet was originally developed as a treatment for
inflammatory bowel disease by Elaine Gottschall, in the course of researching ways
to treat her daughter’s intractable case of ulcerative colitis. During the early 2000s,
parents of children with autism began experimenting with the diet to treat their chil-
dren, especially those with severe bowel symptoms. See Gottschall 1994, and for par-
ents using SCD for children with autism, see “Pecanbread.com: Kids and SCD,” avail-
able online at http://www.pecanbread.com, accessed 20 February 2008. One of the
main sites promoting the gf/cf diet is the Autism Network for Dietary Intervention,
online at http://www.autismndi.com, accessed 20 February 2008.
13. In a widely reported incident, a child with autism died while receiving an in-
fusion of a chelating agent. Investigators concluded that the doctor in the case had
ordered the wrong medication due to confusion about the names of compounds and
that the child had not been given one of the conventionally used chelation agents. See
Kane 2007.
14. Because their metabolic mechanisms can be described in conventional scien-
tific terms, community members would separate DAN! treatment methods from, for
instance, homeopathy or craniosacral therapy, although many families explore such
options alongside biomedical treatments. Within conventional medical parlance,

382 CHLOE SILVERMAN

“complementary” treatments are used alongside accepted or mainstream therapies,
and “alternative” treatments are used as a substitute for these treatments. Biomedi-
cal treatments for autism might be considered complementary, as most parents use
them alongside a behavioral treatment program. However, since no other medical
options exist (aside from psychopharmaceuticals to control extreme anxiety or anti-
psychotics such as risperdone [Risperdal] to control self-injurious behavior), and be-
cause parents using DAN! approaches see those approaches as central rather than
peripheral to their treatment program, the categories do not hold up as well as they
do for other medical conditions, such as cancer (see David Hess 2003).
15. Brenda Kerr offers an example of the Microsoft Excel spreadsheet that she
uses, on the Autism Research Institute website, http://www.autism.com/ind_track-
progress.asp, accessed 1 March 2008.
16. Of the 1,175 autism- devoted groups listed in Yahoo groups as of 25 January
2005, 46 were devoted to the discussion of “biomedical” treatments for autism,
meaning that biomedical groups comprise a little under 4 percent of the autism
groups on Yahoo—it is important to remember, however, that many of the total num-
ber of groups are region-specific support groups or are devoted to specialized topics.
Many of my comments on the types of discussions which take place among parents
in the community using biomedical treatments for autism are based on “lurking”
on the “autism biomedical discussion group,” or abmd, a Yahoo-based discussion
group, for approximately two years. Parents frequently build close relationships via
the listserv, and I have witnessed meetings at conferences between parents who
had known each other (and each other’s children, by proxy) for years, but had never
met in person. New subscribers are given a list of guidelines, including the provi-
sion that “this is a DISCUSSION list, not a SUPPORT list,” the request that “off-topic”
messages on topics such as behavioral therapies should be marked as such, and the
instruction that participants should “try to stick to the topic of biomedical factors in
autism and avoid ranting about [their] disappointment with the mainstream medical
community, the government, etc.,” along with the rule against “flaming” or written
attacks against another member. Guidelines from “File—abmd List guidelines.txt”
from abmd- [email protected].
17. The most recent (2003) edition includes an additional literature review and
discussion by Teresa Binstock, an independent researcher diagnosed with Asperger’s
Syndrome, who is active in the DAN! community and widely respected by both par-
ents and practitioners.
18. For many years, the Autism Research Institute maintained a list of DAN! doc-
tors, although they eventually abandoned the practice because of the difficulty of re-
viewing applicants and ensuring that they were reliable and had the requisite train-
ing.
19. The campaign was created in collaboration with a public-relations firm. An ex-
ample of the basic platform can be found in the congressional testimony of Bernard
Rimland (Rimland 2003). A form for reporting successful biomedical interventions
is available on a website run by the Autism Research Institute, http://legacy.autism
.com/treatable/autismistreatable.htm, accessed 3 August 2011.

DESPERATE AND RATIONAL 383

 20. Some laboratories, such as the Great Plains Laboratory and Genova Diagnos-
tics, have actively courted the autism market, while others specialize in functional
medicine and include autism among multiple disorders for which they offer work-
ups. The head of the Great Plains Laboratory has published a treatment manual that
makes use of protocols similar to the DAN! guide and contains an initial chapter
citing DAN! doctors and listing many of the hypotheses current in the DAN! commu-
nity, including concerns about vaccines. See Shaw 2001. In contrast, doctors asso-
ciated with Metametrix Clinical Laboratory (http://www.metametrix.com), which ad-
vertises itself as “Innovative Solutions for Integrative Clinicians,” have published a
manual on specialized laboratory tests for functional medicine, to encourage and
guide their use and interpretation by physicians. See Bralley and Lord 2002.
21. Susan Costen Owens, posting on St. John’s List for Autism and Developmen-
tal Delay, 6 July 1997, [email protected] (shared by and quoted with
permission of author).
22. DAN! Bridge Meeting “Save the Date” flyer, “Treatable Features of Autism: Im-
plications of New Findings in Autism Biochemistry and Immunology,” for meeting
on 15 April 2005, Quincy, Massachusetts.
23. One parent with whom I spoke compared her own research to her experience
of the “Jesus Movement” in the late 1960s “Bible Belt” states. Specifically, she re-
lated her acquisition of an ability to read and interpret scripture with the faith that
revelations would appear by tracking thematic continuities between Old and New
Testaments. Her own intensive reading of published texts in biochemistry for their
particular relevance to autism (even if their relevance, or the relationships between
adjacent fields, was not apparent to the authors themselves) seemed, to her, to have
parallels to this practice.
24. Letter from Susan Costen Owens to Jon Shestack, dated 1997 (shared by
and quoted with permission of author). The full quote reads: “You and I probably
would agree about the need for autism to become a diagnosis of biochemical cer-
tainty rather than one built around behavioral things that may change as people re-
spond to a whole host of different sorts of therapy. I think that the only thing you and
I may see differently is what may be the fastest and most effective method at getting
to a ‘physical marker’ which could replace current methods of diagnosis. I very much
feel that studying the measurable factors in the immune, endocrine and metabolic
systems would yield faster results, as opposed to looking at something as incredibly
large as the human genome, and looking at only those persons from multi-incidence
families who may not represent at all those whose autism appears without precedent
in a family.”
25. Jon Pangborn and Sidney Baker, founders of DAN!, both use the phrase “bio-
chemically unique” in talks and presentations, although they may be implicitly or
explicitly referencing the book by biochemist Roger Williams on the differences in
vitamin requirements among individuals (Williams 1956). Cited in Rimland 1976.
26. Martha Herbert, personal communication, 19 September 2010. For further
development of these concepts, see Herbert 2011.

384 CHLOE SILVERMAN

 13
MICHAEL M. J. FISCHER

LIVELY BIOTECH AND TRANSLATIONAL RESEARCH

In memoriam: Judah Folkman, teacher, healer, scientist

As children, we liked to take walks with our dad. Along the way, he would point out
trees, buildings, stop signs, and ask us, what else could those objects be? A lamppost
would be a toothpick for a giant, we’d exclaim. Or a tree could be his broccoli. Dad
called this game symbolism, showing us the world as a fascinating place of potential.
LAURA AND MARJORIE FOLKMAN, EULOGY FOR JUDAH FOLKMAN,

20 JANUARY 2008, TEMPLE ISRAEL, HARVARD MEDICAL CENTER

For the spring 2008 class, Introduction to Global Medicine, at the Harvard
Medical School, I asked Judah Folkman, pioneer and champion of the field
of angiogenesis inhibitors, to update his translational-research lecture to
focus on the angiogenesis work that his former Chinese postdocs were pur-
suing in China. (Angiogenesis is the blood flow to tumors that keeps them
growing; if one can find the right combination of angiogenesis inhibitors,
one can make the tumors regress.) Folkman was eager to add the China di-
mension. Always charismatic and a highlight of the course, he never said no.
Folkman died in 2008. Just before he died, the first textbook on angio-
genesis was published. At his funeral, the long procession of his postdocs
and lab alumni testified to a capillary network into the future, fragile, power-
ful, and lively as life itself: Folkman’s lively capital. They included leaders in
many fields, from oncology to tissue engineering and drug delivery, as well
as researchers attempting to solve the enigma of LAM (lymphangioleiomyo-
matosis), which had become one of Folkman’s concerns at the time of his
death. This chapter, which I dedicate to his memory, draws in part on his
translational-research lecture, composed in 1999, when his research had
just survived a report, which made headlines, that his results had not been
replicable at the National Institutes of Health (NIH), for reasons he outlines
in the talk. At the time of the lectures he gave in the late 1990s, he was not
yet calling the results of his research “translational,” but that buzzword dis-
seminated through the NIH system and came, by 2000, to be the way he de-
scribed these talks in which he understood perfectly the desire in our global-
medicine class to explore the social and ethical issues of the biosciences and
biotechnologies.1
In this chapter, I attempt to draw together how emergent forms of bio-
medical laboratory life fit into the series of transformations that medicine
and the life sciences are undergoing, from discovery to invention of new bi-
ologies, from “slash, burn, and poison” therapies to minimally invasive and
regenerative ones, from bounded craft science to “good hands” and “green
fingers” reaching “through” the computer screen with interactive graphics
to networked databanks.2 I am looking for new epistemic and material-
semiotic objects, sites of deep play, gearshifts between macro-, molecular,
and nanoworlds (among proteins, enzymes, polymers, and cells), shifts and
differences between in vitro and in vivo environments, and among experi-
mental systems provided by nematodes, flies, zebra fish, mice, and humans.
I am interested in shifts of scale from laboratory products to clinical-trial
prototypes to market-scale volume manufacturing with high- quality con-
trol. I am interested in the translations (and failures of communication) that
occur between fields of expertise, in the “translation” from bench to clinic,
and in the translations across medical systems, national competitive ambi-
tions, and the dances of cooperation and competition that fuel (and slow) the
global republic of science. This is a large agenda, toward which this chapter
can provide only a few immortalized cell lines to experiment with, to watch
as they might culture into robust repair systems and healthy growth (or not).
While the nodes of interest are new epistemic and material-semiotic ob-
jects, sites of deep play, and shifts of scale or frame, the substance of inter-
est is the people at these sites and their social and cultural relations. From
my perspective, as an anthropologist, a criterion of acceptability excludes
the admission, as a recent review of actor-network theory admits, that the
theory doesn’t handle personhood or culture or people very well. This is not

386 MICHAEL M. J. FISCHER

a call for journalistic “human interest” or “genius scientist” writing, but a
meditation on the mix of detailing—organizational, historical, intellectual-
genealogical, political-economic, material-technological, as well as the sin-
gularities of events, passions, and competitive bootstrapping—required to
upgrade ethnographic work on the biosciences so that it can be in conversa-
tion with the understandings of practitioners.
Lively capital might be understood to include a least four kinds of capital:
venture, corporate, or government capital; intellectual capital, in inventive
new legal “structured instruments” and safe harbors for risks of exploration;
the symbolic capital created through public-relations promissory ploys; and
scientific capital, both in institutional depth and in the play of the scientific
imagination. All four of these—financial, legal, symbolic, scientific—are
“bankable,” at least as discountable investments, and play important roles
in the flows, speed bumps, and rechannelings of biocapitalism. They are
thus central to each of the “culturings” (passages is the biological term for
separating out a few cells in a new vessel and medium to ensure continued
growth of the cell line) or translational arenas addressed here. Judah Folk-
man’s lectures on translation—ten kinds of ethical and practical problems, a
decalogue of lively dilemmas never standing still—form the hinge or center-
piece of challenges in getting anything from lab to clinic.
I then proceed to other kinds of culturings, which complement and ex-
pand the ten selected by Folkman: translations from lab skills to stable tech-
nique; multidisciplinary translations; translations between academe and the
market of small biotechs and big pharma; geographical and transnational
translations of researchers and research trajectories.
If you listen and watch carefully around the edges, in the corridors and
pubs, and between the lines of scientific reports, you can see Alice in Won-
derland other worlds beyond the residues (the numbers, models, laws, argu-
ments) by which we claim to understand what science is. These other worlds
are lively: full of quirks and rituals, superstitions and fetishizations, all-too-
human transferences, competitions, and collaborations, mentoring styles
and politicking games, translations and shifts in scale, and financial incen-
tives and other surprises. The other worlds, no less than the laws of nature,
the flow of funds, and the organization of laboratories, are what make science
work. The interplay (and incompatibilities) between the way scientists speak
and the way engineers speak runs through technoscientific exchanges; one
is improvisational, like jazz or the neutral third microtones (koron) in Per-
sian music, while the other is functional and standardizing. Their interplay
is most evident in fields like synthetic biology, where biologists and software

LIVELY BIOTECH 387

engineers must interact, the first being attuned to the lively biological world
that incessantly make experiments fail in new, surprising, often illuminat-
ing, ways, the other being intent on creating tools and building blocks that
will always work. Such counterpoint interactions are necessary throughout
the life sciences for knowledge to advance. The music of science talk is en-
chanting. Much of it is lost in translation in the writing of sociologists (who
standardize and anonymize) and journalists (who substitute metaphors for
detailed connections). It is ethnographically valuable, at least for a time, to
transcribe the songs of science, paying attention to their metalinguistics,
their jousting encounters, their impassioned bets and investments, their tac-
tile and rhythmic physical dance, their joy, and their imaginative harmonics,
not only their content.
Translation (across science fields and technological scales; from bench to
clinic, or from green fingers to stable techniques and scaleable production;
and from experimental therapy to standards of care) and capital (financial,
legal, symbolic, scientific) are the two linchpins of both the Alice in Won-
derland worlds and the indirection of scientific opportunistic development.
Both are lively, fluid, ever-moving.

The Decalogue and the Network

Translation to the clinic proceeds along a pathway strewn with obstacles and it’s actu-
ally harder than making the discovery because it involves other people, and involves
all their different views.
JUDAH FOLKMAN, 21 SEPTEMBER 1999

In a wonderfully comic but serious account of the changing sites of medi-

cal discovery, Judah Folkman lays out ten reasons, a decalogue, for why it
is nearly impossible to get discoveries from the lab into the clinic.3 He be-
gins with a quick survey of the shift from discoveries made by physicians at
the bedside in the nineteenth century and early twentieth, to the need for
laboratories and the rise of the physician-scientist often fostered by train-
ing at NIH in the mid-twentieth century, to the growing difficulties involved
in maintaining the dual career of physician-scientist and the disjunctures
caused by new discoveries coming increasingly from basic scientists with-
out much clinical experience and unaware of many important clinical clues.
It is no accident, he suggests, that angiogenesis research began in a sur-
gical laboratory (his), not in a molecular laboratory.

388 MICHAEL M. J. FISCHER

 [This is] because in a molecular laboratory cancer is studied in
a dish, and so, my very good friend and colleague Bob Weinberg
thinks all his life of cells that are flat, and I think all my life that
cells are crowded like they are in cancer, and then we talk about it
occasionally, and now he’s studying angiogenic genes. This is why
there came the development of the HST program, the M.D./Ph.D.
programs. It came from this problem of the two cultures that are
getting further and further apart, and so the attempt is, can you,
your generation, solve the problem of the disappearing physician-
scientist that was a very fruitful career but seems no longer pos-
sible. Physicians worry about leaving the whole next century just to
the pharmaceutical companies without the clinical clues going on.4

Folkman describes a series of different career paths among his colleagues

who maintain both labs and clinical practice, and the difficulties they face.5
But chief among the difficulties is “translation.” Indeed, he estimates, some
40 percent of the medical-school faculty would say their obligation is only to
do basic work in the laboratory and to publish. “They say you have no obliga-
tion to get into the problems of translating to the clinic because it is a politi-
cal morass. . . . [T]he other half of the faculty feels that if you find something
that could improve the care of patients, it would be unethical not to help in
some way guiding it into the clinic.” As his case study, Folkman uses his own
experience with

a new protein that has anti- cancer activity, that was in fact pub-
lished in Science on Friday [17 September 1999], discovered in our
lab, a very powerful internal fragment of antithrombin 3, a clot-
ting protein. The fragment itself is a potent angiogenesis inhibitor,
very powerful anti-tumor agent, no toxicity, many tests in animals,
the whole sequence is known, the genetics is known, and it’s actu-
ally being made now as recombinant in large quantity. So that was
published. So we say, well, that’s a really good protein. That should
be in the clinic. There are many patients dying of cancer—do you
know how many there are? . . . If you take out the suffering, the
death rate, which we can count, is 1,500 a day in the U.S. That’s one
a minute. If it’s melanoma, it’s one an hour. It’s 565,000 deaths per
year. The number of new patients with cancer, newly diagnosed, is
1.2 million, and in Europe twice that. The number of current cancer
patients being treated is eight million.

LIVELY BIOTECH 389

 The decalogue of obstacles includes (1) patenting, (2) the break up of
collaborations, (3) “their culture has to fit your proteins,” (4) internal com-
pany rejection (“it’s always in the cafeteria”), (5) transferring skills (the
Stradivarius problem), (6) Fridays are cancellation days, (7) clinical trials,
(8) “for your little protein, change a million dollar manufacturing process?,”
(9) physician resistance, (10) stock manipulations. (There are, of course,
more, but ten obstacles were all that could be addressed in an hour-long lec-
ture.)

1. Patenting:!“All my postdocs say, ‘I don’t want a patent on it; I just want to

publish it, and I don’t want to sit and talk with lawyers about patents.’ Why
do you have to patent it?”
A student ventured, “To exclude. If a company wants to take it, they want
to know that they can exclude everyone else from taking it.”
Folkman: “Correct. So we have ten micrograms. We have the gene. We
have the cDNA. We have all our assays. And we say to a company, in this case
Genzyme in Boston, will you make this for us? We would like ten kilos,
enough to treat a hundred patients for one year each. No problem, do you
have a patent? No patent, they won’t even talk. They hang up. They won’t
even have a meeting. So you have to have a patent.”
But that’s hardly the end of the story. Nor is it merely that an ethical shift
has to occur institutionally and professionally, but the returns (profits, bene-
fits) and risks are modulated by time.

So, the medical school and the hospitals therefore each has an office
of technology transfer staffed with patent attorneys. . . . Before 1974
the school did not have a patent policy. The policy of the school was
publish it, give it to the public domain. MIT has had a patent policy
since 1900. So when Harvard finally got a patent policy, they got
a big telegram from Jerome Wiesner who said, “Welcome to the
twentieth century.” [Laughter.] He was the Provost of MIT. The view
was that it’s not ethical for a physician to patent something be-
cause you shouldn’t be making money based on the patient’s ill-
ness. Then they found out that it was actually okay, because most
of the patents don’t make any money. In fact, nobody makes much
patents, money on these kinds of patents. And the reason is—it’s different
money, than MIT: if you patent computer software, you can make money—
and time but if you patent a drug, by the time the FDA has approved it, eight

390 MICHAEL M. J. FISCHER

 years, by the time it’s gone into the market and has been allowed to
be used, it’s fifteen years, the patents have run out. So, it’s a com-
plicated problem.

2. The Break Up of Collaborations.!The second problem comes with the as-

signment by the lawyers of one of the coauthors of a scientific paper with
the status of inventor. This assignment of legal inventorship is a classic
transition from gift economies of affluence (it is immoral to own knowl-
edge, knowledge should be public goods) to capitalized economies of scar-
city (patents need to be defended, assigning only one person the status of
inventor is a defense against weakening of exclusive claims, and property
rights are a moral foundation of society), the accent being on the ethical
transitions.

They won’t allow coauthors because they say if we put coauthors on

it, the patent is weak and somebody can challenge it and win on in-
fringement, because they can prove these other people didn’t have
anything to do with the idea. They may have helped with the chem-
istry, they may have done other things. So after the attorneys have
gotten through ruling that one of the coauthors is an inventor and
the others are not, the whole group breaks up. . . . If you had colle-
giality, it goes away in one day. . . . It’s like wedding invitations: if
you send out wedding invitations and you forget Aunt Minnie, she
never talks to you. So you have to be careful.

A student asks if there are not equivalents to prenuptial agreements. And

Folkman agrees.

Yes, exactly. So it turns out, if there is income from a patent in the

future, from licensing agreements or other things, there are, there
can be. But the philosophy of this school and other medical schools
is that the purpose of a patent is to bring something to the social
good, not to make income for the school, because it’s a poor way
to do it for a medical school. It’s a very good way for an engineer-
ing school. So it turns out that if there is possible money involved,
what can you do? What we do is explain to all the authors that we
will simply ask the attorneys to write an agreement that if there is
any money to the inventor, it will be divided equally among the co-
authors. That’s been our tradition. That actually works.

LIVELY BIOTECH 391

Another medical student is still unconvinced, “You said it would ruin the
collegiality, but why?”

Well, it’s amazing. You have four authors and you have the first
author, and the first author may not be the inventor, because there
are different rules [about authorship]. So the first author is really
upset that the inventor, who is going to get possibly all the benefits
of being the inventor, because nobody knows what they are—you
license the patent, they have to pay a licensing fee; you get into
the clinic, they have to pay a milestone fee—it goes to him. And
what he did was do the sequencing. But the first author thought of
it. But for some reason, the attorneys determined that [it was] the
sequencing that was the first demonstration of the principle—it’s
a whole different vocabulary. . . . The last one, we’ve had a ten-year
fabulous collaboration with a professor at UCSF. We have a merit
award that’s gone ten years. We worked together on the phone; we
sent things back and forth; we published together. And then they
sent us some of their cells from which we found a totally unex-
pected new protein. Harvard patented it, and we said coinventors.
The attorney said, “Nothing doing”: just because they sent you the
cells doesn’t mean they’re inventors. So it made a lot of hard feel-
ings, and we wrote out that we just would equally distribute [what-
ever proceeds if there were any].

Here the scientists are at the mercy of the attorneys, even if they want to be
amicable, and the attorneys in turn are thinking ahead about challenges to
the patents: in Folkman’s words, a patent “will always be challenged if it is
worth anything.” It is neither that Harvard is playing hardball, nor that the
attorneys are being unmindful of their clients’ egalitarian feelings. Rather,
if a patent is valuable, “It will be challenged and infringed upon, and they
will say, ‘Sue us.’” In court tests, patents show their weaknesses and can be
invalidated. For a research-group leader, these “facts of life” mean the need
always to repair relationships. “I just tell you the end result is you lose col-
leagues. You have to get them back. So a lot of my colleagues . . . refuse to
patent anything.”

3. “Their culture has to fit your protein.”!Academic scientists need compa-

nies to manufacture larger quantities than they can produce in university
laboratories and to bring it through the regulatory process.

392 MICHAEL M. J. FISCHER

 First you have to find a company that—their culture has to fit your
protein—that sounds funny. It turns out that big companies prefer
to make small molecules, and small companies prefer to make big
proteins. So the biotech company in Kendall Square—there are a
hundred twenty-nine biotech companies hanging on for their life in
Boston. They have no income. They have three more years of fund-
ing. The burn rate is going to close them in two years. They have a
fabulous new protein, a professor who invented it . . . and they are
trying to make it. And then there is Merck which has a rule—only
small molecules that you can swallow because they don’t want to
get into the problems of big molecules. So they’ll look at your pro-
tein. They’ll say “too big” or “too small.”

Because “discovery is unscheduled,” debts exert pressure to find a com-

pany whose culture fits your protein.

I’ll give you an example. In 1991 Michael Roddey in our lab discov-
ered angiostatin, an internal fragment of plasminogen, one of the
first of the angiogenesis inhibitors that could regress a tumor. All
previous ones could hold them or slow them, and we were simply
going to continue working with it after we published it, but here’s
what happens when you have a new discovery in a laboratory and
grants, you’re funded by National Cancer Institute grants. You go into debt
unscheduled right away because it is unscheduled. Suddenly you have to have
discoveries fermenters and you have to buy different equipment and you’ve got
to have new mice and you have to hire somebody who does protein
chemistry. So what you do is, you take money from all the other
grants, and immediately you write a grant and hope that in nine
months it will be funded and you’ll pay back. So we did that, but
the study section said you will never be able to purify this, it’s parts
per billion, it is so powerful. It’ll be hopelessly impossible to purify
it. So they turned the grant down. So now, nine months down the
road, we had a $250,000 deficit in a big lab, and the hospitals won’t
cover that. No one will cover that. So what they do is start turning
off your heat, light, salaries [laughter], and you can sit up there and
and debts look out the window. So what do you do next? We thought, this is a
terrific discovery, just because the peer reviewers don’t understand
it, we’ll go ahead anyway. So what would you do?

On cue, a student offers the salvationary word companies.

LIVELY BIOTECH 393

 Right. So I wrote to a whole series of companies, all of whose CEOs
networks had been my students. Skolnick, president of Merck, president of
Upjohn, president of Lilly, all Harvard Medical School. And I got
appointments right away. And they said, oh, I remember your lec-
tures and everything [laughter]. However (this is 1991), what would
we do with an angiogenesis inhibitor? Nobody understood it. Only
the scientists understood it; it had not yet permeated to the phar-
maceutical companies. So after a year of that, I went around to the
biotech companies. They understood it right away, they have the
risk- most advanced, youngest scientists; they’re not yet so conservative,
taking because they haven’t made any money. So they said, terrific idea,
and debt but we’re broke. They’re all in debt. They fear it will take resources
away from their idea. So a company is a zero-sum game.

In the case of angiostatin, there finally was one company, EntreMed, “a tiny
company, about eight people, and they had just become capitalized, nothing
to do yet. So they took on this project . . . and in the bargain we got endo-
statin and a couple of other things that were discovered because [EntreMed]
gave a grant to Children’s Hospital.”
In the case of anti-angiogenic antithrombin, the discovery reported in
Science, 17 September 1999, the match with Genzyme came about in a dif-
ferent way.

It’s a fragment of antithrombin, and when it was discovered to be

such a powerful inhibitor floating in the blood, and isolated and
purified, and we sequenced it, we looked around the world for com-
panies that make antithrombin the parent, so we could buy that
and make it from the source rather than purify it from the blood.
sourcing There are only two in the world and the biggest one is Genzyme on
match the Charles River, opposite the [Harvard] Business School. So we
went over to them, and it turns out that they’ve been making anti-
thrombin 3 for nine years and selling it in Europe, and testing it in
the U.S. It’s for people who have a deficiency of this protein. If you
don’t have enough antithrombin 3, you have free thrombin floating
around, you get clots in your head and your lungs, you get pulmo-
nary emboli in your legs. These people were always clotting, so they
are given intravenously once every two weeks a protein called anti-
thrombin 3 until their level comes up to normal. It is a sort of bou-
tique thing because there are not that many hundreds of patients.
. . . Unbelievable because, see, they make antithrombin 3 in goats

394 MICHAEL M. J. FISCHER

transgenic . . . transgenic goats. They have transgenic goats, the only ones in
goat the world. So they have taken the gene and hybridized it to casein,
factory which is the milk protein. It is a huge sterile farm, blessed by the
FDA, no viruses. Then they milk the goats and they get five hun-
dred milligrams per liter. The best fermenter is seventy-five [milli-
grams per liter] if you are lucky, with E. coli. Each goat is a factory.
So they can make any protein by this technology, and they hold all
the patents. So, they are making antithrombin 3, and they take the
milk and ship from Framingham to the Charles River [plant] where
they purify it. Now they have to pasteurize it and that gives them:
seventy-five percent of it active. But twenty-five percent is inactive
and has to be thrown out.
That’s our protein! So what they said was, our protein is fifty-
technique three kd, our technique the internal fragment, theirs is fifty-eight
match kd. The way you get there is sixty degrees heat. Match. They heat it
a little longer, add citrate, and they’ve got ninety percent. So they
said, why of course we would love to work with you! [Laughter.]
Let’s have a meeting tomorrow. There was the president: it’s his
company, he founded it.
It was a tiny company of four people, now it’s a six hundred
million dollar company. Six hundred million dollars is the danger
biotech point: that is where you can still be bought out and swallowed up
to pharma by Merck or somebody. But if you get to a billion, it is too big and
threshold you can go all the way to be a pharmaceutical firm. Like Genentech.
They made it, but most everybody else was eaten up. So he said,
hmm. . . . So it is a very good match.

4. Company cultures (“it’s always in the cafeteria”).!Getting the leadership

of a company to adopt the project is not a guarantee that the rest of the com-
pany will go along.

There are company cultures, and within the company there are
certain groups that do not want to work on that idea . . . a com-
zero-sum pany is a zero-sum game, and if the president says, oh, we’re going
games to work on this new protein, it’s as if he brought home a second
wife. They say, wait a minute! [Laughter.] The president says we’re
all going to get behind this. Oh yes, in his presence, everybody is
gung ho. But then comes the undermining. It’s extremely subtle.
It’s always in the company cafeteria. I hear it’s not working. That’s

LIVELY BIOTECH 395

 the rumor. Then they talk to the press and they say, well, it’s from
a lab, you can’t reproduce the results. It’s incredible. You have tre-
mendous, tremendous rumors. And they’re afraid that resources
will be siphoned off.

The pattern is “so common that some companies have solved it a different
way. Johnson and Johnson for example.”

If you have a new idea in Johnson and Johnson, and you wanted to
do it—[I’m speaking of ] three years ago, it’s now public. . . . What
risk they do is form a new company. They go around to all their young
shelters stars and they pick a young, brand-new vice-president and they say
how would you like to be president of this company? It’s going to be
in Belgium and you’re going to have a hundred staff and a total bud-
get for three years. And if you can make it, it’ll be sold worldwide
and you will be established in the big company. . . . And so Johnson
and Johnson has a hundred and seventy- one companies. . . . They
never started in-house.

Folkman’s experience at Bristol-Myers was a negative case example.

We went to them with angiostatin and there was a whole group

that just didn’t want to do it. They said we should make cytotoxic
chemotherapy. Taxol, Taxol. We’re making a billion and a half dol-
lars. We should not go into angiogenic therapy. The president kept
saying: have you ever read about IBM? They were making main-
frames. How long do you think we will be able to make Taxol if
these [angiostatins] come in? He kept saying we have to have this
in the company. He forced it through, but it got pretty much under-
mined. So it is really amazing what you learn from all this.

5. The Stradivarius problem: transferring skills.!Next is the classic problem,

in science, of teaching another lab or a company, problems joked about in
corridor talk and in such terms as having “good hands,” and analyzed more
fully in the chemist Michael Polanyi’s lectures on Tacit Knowledge (1966), the
sociologist of science Harry Collins’s account of physics labs (1974), and in
the historians of science Steven Shapin’s and Simon Shaffer’s account of the
seventeenth- century experiments conducted by Boyle and the Royal Society
(1985). The transfer of skills is a standard problem in scaling up from experi-
mental systems to industrial production, from systems that are still return-

396 MICHAEL M. J. FISCHER

ing knowledge through their instability and need for skill to reliable, highly
quality- controlled processes.

So now they say, gee, we’d love to work with you, bring your pro-
teins and your genes and all your technology to our lab. They have
never grown endothelial cells. No problem: we’ll teach them. It is
a big problem. It has to be idiot-proofed, because you write out the
methods and . . . they say it doesn’t work. How could that be? You
have published it. They call you up, you have given them great de-
tail; they say, we cannot reproduce your results. Other people may
call. If you are a basic scientist, Ph.D., and you get a call, we can’t
reproduce your results, it is a chilling, sleep-losing experience. It
implies that you have manipulated the data. That is the implication.
And many of them are angry and they call collect. [Laughter.] So
someone has taken that call and you see them, they’re pale white
the next morning. They’re drained, they can’t do any work. They
are worried that their theory is over. Now to a surgeon it is a source
of pride. It’s just the opposite. [Laughter.] Surgeons in the locker
room refer to this as the Stradivarius problem. Too bad about sur-
geon Jones, that his mortality is twice as high as mine. . . . They see
it as a skill problem, and most of the time that is what it is.

For example,

We said, okay, here’s how you grow endothelial cells. They had very
good gene people, they had molecular biologists, they had done tis-
sue culture. But not endothelial. And so we wrote it out exactly for
them. And they did not grow. They have grown all over the world.
There are twenty papers a week, and they did not grow at Genzyme.
And it turns out the method said, make up the media and the tryp-
sin and the gelatin coating with glass- distilled water. Deionized
distilled water kills endothelial cells slowly, so you don’t know it
for about three weeks. . . . It’s been known for twenty years. We
went down the check sheet. They said, we don’t have glass- distilled
water at Genzyme. The whole company is on deionized water, and
they could not get anybody to order a glass still. So we said, okay,
here’s a bottle of glass distilled water from our place, and we made
a CARE package and they took it to Genzyme in Framingham, and
it worked. Then there was a meeting and they decided to order glass
stills.

LIVELY BIOTECH 397

 In a second example, the process of troubleshooting generates new knowl-
edge.

Then we were trying to teach people how to inject these into mice
which have tumors growing. The tumors grow at a certain rate;
you measure them every day; then you give the inhibitor and [the
growth rate] should come down. This is now the National Cancer
Institute, and they said . . . it’s not working. Can’t reproduce your re-
sults. They also talked to the press and everybody else because they
don’t want to be at fault. . . . So we had to troubleshoot, and what
do you suppose was the problem? It didn’t work for six months,
then they came up to our place in January and it worked fine. They
stayed nine days in a hotel, came every day, injected theirs, we in-
jected ours, and it was perfect. Theirs were actually better. Now
try to troubleshoot that. You don’t know, are they coming in on
weekends? They are supposed to: they’re not supposed to miss any
days. . . . Are they having different people inject? . . . There’s a mil-
lion things. It took us about five months to out what one of the
problems was: . . . room temperature.
expensive Mice have their tumors grown on their backs so you can see
mice them. We do have mice with the tumors inside, of course, to prove
that it works, but that’s really expensive because you sacrifice one
every day to measure it, and mice are expensive. This way you just
measure. They grow on the skin and the blood vessels come from
the skin vessels. So now what do you think is the problem?
Temperature control in mice: mice cannot sweat, mice cannot
shiver. Those are your two main ways of controlling your tempera-
literature ture. . . . A group at MIT published a paper some years ago which
experiment is very striking: they built a long cage and took a copper bar that is
one meter and at one end it was zero degrees and at the other end it
was fifty degrees, and it had a complete gradient, and they put mice
in and they all ran to twenty-six degrees. They just huddled around
twenty-six degrees. [The investigators] put in a baffle and pushed
the mice to twenty- eight degrees, and the mice climbed over, and
went to twenty-six. They pushed them to twenty degrees and they
ran for twenty-six degrees. In fact, when they were forced to be at
twenty, they all huddled; they wouldn’t move, trying to save their
heat. They love twenty-six degrees. Simple experiment: no gels, no
PCR. [Laughter.] It turns out that because of that, our rooms are

398 MICHAEL M. J. FISCHER

 always at twenty-six degrees. One of the [NIH] rooms we went to
experience was at twenty degrees, and we said, we can tell this is not right, be-
cause in our rooms we sweat when we are in there for hours inject-
experiment ing mice. These rooms were air- conditioned. So we did an experi-
ment: we set one room to twenty degrees, and in the twenty- degree
room the tumors did not grow, because the animal, in order to keep
his core temperature at thirty-seven degrees, has an outer coat, and
in that outer coat the only thing he can do to save heat is to close off
theory the blood vessels, vasoconstrict [as our fingers do when they turn
blue from the cold]. . . . These animals are vasoconstricting and the
confirming tumors can’t get any blood, so they don’t grow: it is another proof
of anti-angiogenic therapy, a beautiful proof.
Now do you know what it is to get the room temperature changed
at a government facility? [Laughter.] You have to fill out a form, that
has to be taken to your supervisor, who has to get an appointment
with building maintenance, that has to go to . . . can’t just go in like
network we do in the laboratory, take off [the lid], unscrew it, and change the
temperature. MIT is the most liberal [in this regard]. Bob Langer
was a student of ours in 1975, and we were making heparinase,
because you couldn’t buy it, to try to understand the fragments of
heparin, and he had a bacteria that made it, and it was very hard and
very expensive. He discovered if you added a little bit of heparin,
that induced it to make heparinase. It was a beautiful thing. They
needed a big column that was about eighteen feet high to make
this, so they drilled a hole in a laboratory at MIT, and they had this
column, sticking up through the ceiling into another lab, making
heparin. It was a fantastic night and day thing, very exciting. The
president came by because he had heard about it, and [Bob] gave
him this talk, and he got more and more interested. He was sitting
down and asking how many liters. Finally he got up. He had come
for disciplinary purposes, [but] he said, Langer, just don’t let it hap-
pen again. So they are very liberal there. You couldn’t drill a hole
anywhere at Harvard that I could imagine.

6. Fridays are cancellation days: time-investment gambles.

Every Friday they cancel some projects in all big companies. . . . In

a large company with many competing drug candidates in the pipe-
line, they cannot have more than eight at any one time. . . . If they

LIVELY BIOTECH 399

 have some other candidate like an antibiotic or an antihypertensive
that is suddenly doing well in the clinic and is closer to market, and
if the company puts all their resources behind this other drug now,
it will be better for their balance sheet and the analysts’ sheet . . .
then the decision is to stop everything else. . . . And suddenly your
little project, which is so fantastic, is stopped for two or three years,
and there is nothing you can do about it.

In dealing with companies there are ways to write contracts and licensing
agreements.

You have to negotiate for every foreseeable possibility, which you

have to think of, because they don’t offer it. You have to say, sup-
pose you don’t make a particular milestone by two years from now.
Suppose they decide to sit on it to keep competitors out. It’s a busi-
ness decision, not a moral or any other kind of decision. Then we
get the right to take it back and there is a penalty.

In the case of negotiations with EntreMed, the company licensed angio-

statin in 1991.

Actually it’s a world-record time. They licensed it in 1991. We only

had a few micrograms, so at that time there was no gene or any-
thing. By ’94 angiostatin was published in Cell [October 1994], it
took all that time. Nobody knew how to make the recombinant. . . .
By ’96 we had the recombinant. And then they could make it. The
problem then was, what in? Yeast? E. coli ? You’ve got to try all these
things and look at stability, cost, scale-up, and that took another
year. And it turned out that endostatin, which had been discov-
ered later [Cell 1997] was easier, and will be out in the spring. So
time that’s about right. People forget. Proscar, Merck’s drug for prostate
[took] twenty- one years from the time it was discovered in the labo-
ratory to the time they could figure out how to make a structure
that was stable in a bottle. It is really complicated. That’s why those
drugs are expensive in the beginning. There is no four-year drug.
The AIDS drugs, which were done at warp speed, were eight years,
and they had everybody working on two shifts at Merck. They paid
exorbitant fees for overtime. And still there is a shortage that is
massive. They can’t keep up with it, they can’t produce it enough.
People are on waiting lists. Nobody in Europe can get it. It’s a big
lottery problem. Herceptin, the same way: there’s a lottery, a breast- cancer

400 MICHAEL M. J. FISCHER

 lottery so you can get this good drug or not. Genentech is trying to
build a factory, but they can’t make it fast enough. It takes a long
time; once they’re up and going, it’s okay.

7. Clinical Trials.!Clinical trials present a series of complicated ethical and

practical problems. “The entire course could be on the ethical problems in
clinical trials,” Folkman begins. There are a “whole set of medical ethical
rules,” but the set of ethical problems are not solved to everyone’s satisfac-
tion. Placebos, dose escalation, deployment of hope, selecting who gets into
trials, patient migration to higher- dose trials (so earlier trials cannot be com-
pleted), protocol violations, protecting physicians who decide who gets into
the trials, shortages, and difficulties of timely scaling up as soon as good re-
sults are assured—these all present complexities and dilemmas.6
Folkman is dramatically masterful in the way he poses an obvious solu-
tion, only to raise a question about it, and in how he laces answers with de-
tailing so vivid, listeners are unlikely to forget, not the rule, but the trade-
offs that produce the rule. Among the enticing loose ends: the ethical rules
don’t work in entirely the same way in Europe as they do in the United
States.

For example, the best scientific way to do a study of compound A is

placebos to have a placebo, because many people, as soon as you give them
a pill there is a certain improvement, and you can read that as part
of the drug you are testing. So normally half of the patients are not
treated. They are given nothing because there was nothing before,
if this is a new drug. There is no alternative. What is the problem
with that?
Female student: If the drug was a cure, all these people are dead
because they did not get it.
Folkman: Right. So if you have diseases like skin diseases and
you are trying to test a new drug for psoriasis, placebos are ethically
allowed by the FDA. So one patient can get the actual drug and the
other patient will get a paste, and then they have crossovers, so that
both patients have a chance at it. After the patient with the placebo
has had three months, they get to try the drug. And it may be that
cancer neither is working. But what about cancer?
Male student: I think it depends on how old the patient is and
how far along the cancer is and what kind of cancer.
Folkman: Right. It depends on the clock, because the clock is

LIVELY BIOTECH 401

 now ticking very fast. Different than our clock. So the point is
that when the disease is moving fast and is fatal, they generally,
the ethics say: no placebo. The reason is that by the time a cancer
patient can even be a candidate for a clinical trial, they have to have
become refractory to all conventional drugs. By that time an adult
would weigh eighty pounds, they are very sick, they have no hair,
they are vomiting, they have metatastic cancer, they have pain all
night, they cannot sleep without drugs, they are in the last year of
their life, and they cannot be on a placebo, ethically in this country.
Europe In Europe, they can, and there are placebo trials in Europe. But in
this country the Food and Drug Administration will not allow it.
You would have to make a very good case. Okay, but then, how do
you get any data?

Another student asks about angiostatin, which seems to have no side

effects versus a drug that has hard-to-tolerate side effects.7 Folkman re-
sponds with a possible conflict between law and ethics.

Okay, so angiostatin has not yet been in clinical trial, but in all the
animal studies and all the monkey studies and all the FDA studies,
there have been zero side effects with either angiostatin or endo-
statin. So therefore the FDA has said it is so safe—they have found
nothing in years of testing in monkeys—they will let it go ahead
into the clinic earlier than usual, but they still will not allow a pla-
cebo, because they feel that it may work, and some patients would
be untreated. So if a patient is going to get into a clinical trial and
be off all other drugs, they do not want a placebo. Anyhow that is
just the law, and, of course, it can be argued, but right now that is
the law and the ethics sort of disagree.

“But the worst problem,” Folkman continues, “is dose escalation,” how to
tell patients that they are not getting effective treatments, how to manage
patients cherry-picking trials, and how to protect the physician committee
making the random selections.

The FDA says, new drug, we have never tested it, yes it is safe in mice
and rabbits and monkeys, but we have never tested it in humans. So
they say, tell us the effective dose in different animals, and they figure
out the effective dose per kilogram or meter squared. And they say,
lower it fifty times and start treating patients, and every week you
may go up five percent. Dose escalation. What is the problem here?

402 MICHAEL M. J. FISCHER

 B.G.: They think they are getting treated.
Folkman: Right. So you have to tell the patient that we do not
know the dose, and the FDA does not want to start out at what you
think is an effective does for animals, because it could be a toxic
animal dose for humans, and you could have some sudden deaths. So you
models start low. You tell the patients in writing and verbally and hold-
are not ing their hand: look, you are the first in the world. We have been
human through all this before with other drugs in other trials. This is a low
models dose, but each week we are going to ramp up, and you tell us if you
have any side effects at all, keep a little diary, and when we get to
an effective dose, we will let you know, but you have to know that
we are on now what we think is not an effective dose.
Student: How do you prevent them from taking more?
Folkman: They get it intravenously in the hospital. They cannot
just go home and take it. So you have this ethical problem: you have
to tell them and they have to know it, but what you are relying on
hope is their hope that it will work for me at that dose, because they are
desperate. This is a very difficult ethical problem for a physician.
I think it is one of the worst ones. You are giving a subtherapeutic
dose and you know better. When you do it in children, it is terrible.

“An even worse problem: who do you select?” Folkman recreates the mul-
tiple building pressures.

The Dana Farber announces that on September 27 or before Octo-

ber 1, they will begin endostatin [trials]. They have enough to treat
one hundred patients for one year. It costs seven million dollars,
the first trial. If it works the price will go right down because you
can build a factory. This is all done in a pilot plant.
Student: With something like cancer that is fast and fatal, could
you scale it up faster if it seems to be . . .

Yes, Folkman responds, pointing out that there are milestones that can be
moved up if things are going well, but, he continues, “here is another inter-
esting [problem]”: patient migration to higher- dose trials.

They started in Boston on an earlier drug of ours, at very low dose.

The FDA says the tumor name does not matter: all solid tumors [can
be included] because it is not like Taxol for breast cancer. It is endo-
thelial cells. So try it on all tumors. The dose [increases] are going
slowly: after eight months, they are still not up to the effective dose,

LIVELY BIOTECH 403

 but they say it looks safe. They had their meeting, and we will open
another study in Houston. [Houston] will start [at the dose level]
where Boston left off, or where Boston is, and they will increase the
dose at a little faster rate. We will open a third trial in Wisconsin,
and a fourth . . . because it is safe. They just do not want a lot of un-
safe ones going. But then what happens these days?
It is an extraordinary new thing. All cancer patients are on the
Internet. There is a colon cancer club, a breast cancer club, a pros-
trate cancer club, and they have about a hundred thousand people
in them. So now everyone wants to be in the Houston trial, not the
Boston one.

The students are compelled by the urgency of cancer patients versus

the slowness of trials. A students asks about what would happen if some-
one “accidentally” increases a dose, especially if it works. People laugh, and
although Folkman first jokes that law is interested only in process, while
medicine is interested in the results, he proceeds to remind everyone of the
seriousness of protocol enforcement.

If you make any violation, they call it a federal citation that one of
your doctors has gone off the protocol. . . . They first stop the study
at the institution. They prevent all further studies at that institu-
tion, and they start taking away grants. Very stiff penalties. So it is
very tightly controlled. Even if you give an abstract at a meeting and
you have not gotten permission from the FDA, say ten patients were
on it and they all had complete regressions, but you didn’t check
it with the FDA and you go to a public meeting, they stop the study
because they say, if you are going to be on an FDA-approved study,
you have to follow these rules.

The students probe: what about surgery?

Surgical techniques are done on the spot if you are in a difficult

situation. However you cannot just do an experiment on somebody
because you think it is a good idea. You would lose your license,
your hospital position, and you would probably be sued. There are
very strict guidelines to keep physicians from doing that. If you
want to try something, you go and get permission, but it is a long
process. Your peers have to approve it. [In the question period, a
student posed a question about performing fake surgeries as a pla-
cebo control, raising an interesting difference between Europe

404 MICHAEL M. J. FISCHER

 and the United States, with direct implications for angiogenesis
research.]8

What about going to another country?

So they test in other countries and it gets into the New York Times:
so and so is testing on poor patients in Third World countries. It
does not look good. Many of my colleagues have suffered enor-
mously from that because they wanted to know earlier. It is a good
way to end your career.

How do you protect the physicians who select the trial patients?

When you are selecting patients, if you say, we will just take vol-
unteers, the FDA sets the end points. They say it must be patients
with any of these cancers who have become refractory to all known
therapies. So, they have had Taxol and [the cancers] have grown
through it; they have had radiation therapy, and [the cancer] is still
growing. They have had Adriamycin, Cytoxa, platinum, it is still
growing. Nothing is working and they have been given up. They
are now called terminally ill. Second, they must have an end point,
something you can measure. Their prostate-specific antigen is
going up in their blood, their CEA for colon cancer is going up, or
ovarian marker, or spots on a film that are increasing every month
that you can see. There are thousands of patients that have those,
so they all sign up.
Then a poor committee has to pick them randomly. But Profes-
sor X at Mass General has a thirty-year- old daughter—these are
true cases—with ovarian cancer, could you please take her first? A
donor who gave a chair to Harvard says could you please take his
son first? An NBC announcer, Katie Couric—this is public knowl-
edge—and Sam Donaldson, public knowledge—could you take me
first? So now you have all these problems and of course you have
to take everybody in a row and you have to take them randomly,
because the newspapers are just waiting to say that Harvard treats
only VIPs, Harvard treats only its donors. Front page, Wall Street
Journal. So the physicians on the committee that is selecting are
anonymous. They are like the FBI witness-protection program.
They’re protected from being deluged by the patients.

When time is running out, shortages exacerbate the problems.

LIVELY BIOTECH 405

 Let’s say [the clinical trial] works. Herceptin is an example. It
worked. It actually turns out to be an angiogenesis inhibitor, but it
was not known as that. It is an oncogene inhibitor: it stops breast
cancer, has some side effects, but is better than any other breast-
cancer drug we have. It was announced in May a year ago at the
American Society of Clinical Oncology. They said the clinical trials
were opened up and it worked beautifully.
The company is Genentech: their stock has doubled. They had
only enough for a thousand patients, because they cannot afford
to build a factory until it works. So they start to build it. But the
factory is not going to be producing for two more years. So there
is a waiting list. So poor breast- cancer patients are on a lottery,
a national lottery, and there they are, with their tumors growing,
time and they are terrified. And each one calls you. We get two hundred
calls a day. Once you have a fatal disease and your clock is speed-
ing up, what happens is people narrow their goals. I just want to
see my daughter married. I just want to see my son graduate. I just
want to see my first grandchild. If I could just make it to that. They
do everything they can, and they’re on every lottery, they’re every-
where, but there are shortages.
It is really horrendous, because there is no way to speed these
up. It is all economics: these are ethical and economic problems.
Physicians just hate to get into that, because our view is, we should
be able to treat anybody we want with the best there is, with any-
thing we have.
Student [urgently]: Why can’t you just bring in some venture
capital to help bring up the factories?
Folkman: Oh, you can. It comes in. As soon as it is announced
that it works, the venture capital pours in. The problem is building
it and getting production and having FDA inspections is an enor-
mous effort and cannot be done like building a high school. You
have to have fermenters and you’ve got to have quality control.
polio I’ll give you an example. Monsanto, one time, was racing to do
in the some veterinary thing and they built fermenters and suddenly all
pipes of the drug had polio virus in it. They had to pull out. It turned
out that in the pipes they built—they built these fermenters like
making beer—they were making a protein, this was twenty years
ago. They had stainless-steel piping and every month they would
flush it all off and push steam through it to sterilize it. But the

406 MICHAEL M. J. FISCHER

 pipes had angles in them and in those little dead ends, there were
pockets that didn’t get the steam. They finally figured it out and
they had to make all the pipes curved. It almost broke the company.

8. “For your little protein, change a multimillion dollar manufacturing pro-

cess?”!The eighth problem involves the manufacturing complications,
without which you do not have a therapy.

A drug can fail in the clinic for reasons that have nothing to do with
the beautiful science. The drug works: it stops endothelium, the
blood vessels stop, the tumors regress in all animals and people,
and you do everything you can, and you put it in a patient’s intra-
venous and it does not work. The tumors are growing. It takes a
while before everybody figures out that this particular protein likes
to stick to this polyvinal plastic that happens to be in the tubing and
this is a chromatography column. Now what do you do? First it took
a long time to figure that out, although with experience that is what
you go for first, but good judgment means you made a lot of bad
judgments first. So what do you do?
You can either change the protein or change the tubing. Try that.
There are only three tubing manufacturers in the country. Abbott
is the biggest. Change our tubing? Are you out of your mind? For
your little protein, we’re going to change a multimillion- dollar
manufacturing process which has plasticized this, and we worked
it out, and it is FDA approved, and we haven’t had any problems?
We’re not changing our tubing. Make your own tubing.
So change the protein so that it doesn’t stick? Should you change
FDA and the icing? If you could do it, the FDA will say it is a new protein. You
Catch- 22 have to start all over! It is like Catch-22. When I retire, I’m going
to write this book because you have got all these government agen-
cies. So, it can stick to plastic, it can precipitate into dextrose. And
you have to work all that out.

As with the polio in the pipes, details can have consequences, and again
changes tested in laboratory animal models are not good human models.

But the worst problem is that all the [laboratory] mice are identical
allergies twins and people are not. If you tested in field mice, you would be
and little fine, except it would take forever. So people get allergies that you
things could not even have predicted. So there are little things.

LIVELY BIOTECH 407

 The most dramatic event to be discussed came next, a long- standing
problem that had affected the NIH’s inability the previous year to replicate
at first Folkman’s experiments, and it got solved by a member of the class:
shipping.

Finally [in all the back and forth with the FDA, NIH, and experimen-
tal biological materials], there is the problem of shipping it. The
most amazing thing is that all proteins and drugs are shipped on
dry ice because they are stored at minus eighty, that’s the best place
to keep them, but when you ship them on dry ice—and we learned
this to our horror—that can in fact damage the protein. How could
that be? You can freeze it in the lab and get away with it, take it to
minus eighty in freezers. Up to a certain time it works fine. Dry ice
is minus seventy-five, minus eighty. You ship it and [the protein] is
dead in about four hours. It doesn’t work.
Student: Ph . . carbon dioxide . . .
Folkman: How did you know? You guessed it?
Student: I’ve heard it somewhere that it is a problem. The buffer
with the carbon dioxide.
Folkman: Right. It has been a problem for years and years. The
paper was just published the end of August in Nature Medicine. It
turns out that no matter what, first of all, people don’t put dry ice
in glass because the glass will crack when it warms up and they do
not want the drug to be contaminated. So they put it in plastic. All
plastic, carbon- dioxide gas goes right through it. So this simple ex-
periment published in Nature Medicine was: there was a company
and they were puzzled that they would send people titers of adeno-
viral vectors at ten to the minus eleven, but when it arrived it was
only ten to the fourth titer units, and they could not figure out what
the losses were. So they said something is happening with Federal
Express. They are leaving it on the dock or something. So they put
it in a Federal Express box and put it in a car and drove around for
two days, and one day, and it turns out that three hours is when it
becomes inactive. It took a long time to discover what you just said,
so I wondered if you had invented it yourself or read it. [Laughter.]
One’s genius, the other’s just a good memory. So it turns out they
put pH markers in, they put buffer, they buffered it at nine, and it
dropped to five, and that is as low as things could go in three hours.
So any protein that cannot stand that change gets agglutinated or

408 MICHAEL M. J. FISCHER

 unfolded or damaged and denatured, and that happens to a lot of
them.

Students were intrigued and began discussing solutions. To ship in liquid

nitrogen is not so easy. To temporarily ship in glass has not worked because
the screw top cannot be tight enough and the carbon dioxide goes up in
there. Gas masks work on different problems. Folkman said a number of in-
ventors had appeared since the article.

An inventor in France read the article and developed a one-square-

foot, minus-twenty, electrically driven, battery- operated thing that
you can carry and ship in, and it will hold minus twenty for about
three days. It is beautiful. We said, could you bring it to us, or we
blown up will come and see it. He said I will bring it to you. We want to buy it
in the and test it. He was arrested in Paris trying to get on the plane with
airport it because they thought it was a bomb [laughter], so they blew it up.
Honest to God! We get this call at six in the morning about three
weeks ago. This is Perletti. I am stuck in Paris and I do not have my
icebox. I’ll make another one. He’ll probably mail it next time. But
minus eighty is hard. If anybody can invent a minus-eighty ship-
ping canister that is not carbon dioxide, that would be fabulous.
So where are the MIT students? You guys and ladies ought to be
able to do that in the shower.
Female student: Will I get tenure?
Folkman: I would certainly help, I would come before the board
for you. If you solve this problem, you have solved a huge problem
for the pharmaceutical companies. The reason is, they never had
proteins this problem until they had proteins, but a lot of these proteins do
do things things the small molecules do not. They’re not toxic, they circulate
small in your blood, they’re stable, they don’t hurt you, but give Adria-
molecules mycin, the heart is damaged, the hair falls out. So that is another
don’t problem. And if you solve it, my number is 355-9661. Call me first.
[Laughter.] You patent it, we will help you develop it. You can be the
inventor, and we’ll be the coauthor.
Same student: I just want tenure.

In fact, the problem was solved by a student who came up after class that
day. Within months they had the device patented, prototyped, and ready
to go.

LIVELY BIOTECH 409

9. Physician Resistance.!A ninth problem is having to “educate physicians
when you have something really new, because they are threatened, because
it takes so long to learn how to do anything really well in the clinic.” Key ex-
amples: Ignaz Semmelweis trying to teach people in Prague to wash their
hands before delivering a baby, to prevent the transmission of streptococcus
(childbed mortality was 30 percent), and being kicked out of the hospital for
his efforts; Howard Florey, in 1941, unsuccessfully trying to persuade mili-
tary physicians in England to use penicillin for soldiers dying of streptoccal
septima, and having to come to the United States before people would lis-
ten; resistance to using Tagamet for bleeding ulcers at Massachusetts Gen-
eral Hospital, in the 1960s (when Folkman was chief resident), instead of
gastric surgery (a procedure that no one performs or knows how to do any
more); and Proscar, the prostate drug, made by Merck, that did the same for
prostatectomies, but only because Merck mounted an ad campaign show-
ing older men who insisted they would go to other doctors if their primary
physician refused to prescribe it for them.
Another minor problem is introduced by the insurance companies,
which can continue to define a treatment as experimental; as long as a drug
is considered experimental, insurance companies are not required to pay for
it. More insidious is another element of the market.

10. Stock Manipulations.!“Then, finally,” Folkman concluded, “there is a

worse problem. And that is if it is a small company like EntreMed, and it
starts to work, or they have some success, what happens to them in the busi-
ness world? There are short sellers. These are not things you learn in medi-
cal school.”

It is amazing. EntreMed is a small company. It is hanging on.

You put on the Internet under Yahoo Finance a rumor—have you
heard—you put it as a question, then the SEC cannot hurt you—
have you heard that they are having trouble manufacturing, scaling
up, or whatever. It is not a statement, it is just a question. Next guy
signs in, is that true? Thousands of hits, is that true? Is that true?
Suddenly their stock is down and they have to sell the company, or
it can be bought, or they can buy the stock and it will rise on an-
other rumor. Have you heard about this new publication that says
it is okay? And that goes on all the time and is going on now. It is
incredible. There are a lot of greedy people.

410 MICHAEL M. J. FISCHER

Skills Translations: Green Fingers,
Good Hands, Tacit Knowledge

When Folkman talks about the Stradivarius problem, he is referring to

the translations of skills across labs. Some of the difficulties of this can be
solved by material troubleshooting (relating to lab temperature, nature of
the growth medium, packaging of samples, etc.). But sometimes the prob-
lem of translating skills can be more nebulous, what crystallographers call
the “green fingers” problem.
“Green fingers” for chemists and structural biologists, like “green
thumbs” for gardeners and “good hands” for experimental physicists, or
tacit knowledge and skill in the lingo of philosophers of science, open the
doors to the Alice in Wonderland human worlds of science.9 Green fingers,
an Italian postdoctoral crystallographer says, are like cooking skills: “For one
person it crystallizes, for another it doesn’t” (interview with EP, 7 July 2005).
The same batch, the same protocol, and some manage to push the expres-
sion to a very high yield, while others cannot manage to get such high yields.
Crystallographers have their rituals of procedure which they cannot explain.
There are, the postdoc concludes, “whole layers of details pertaining to the
way people work.” It is, he repeats, like cooking, a rhythmic feeling for what
goes together in what proportions with what motions. Labs are full of people
who do not have green fingers. The postdoc continued: “I have a friend who
is an M.D.: you can tell, you know, the way he sets up his experiments, you
can tell they are not going to work.” They were talking one day about food,
and his friend said, “‘Oh, you Italians, you have a tradition of good food,’
and he asked me, do you cook? And I said yes, I like to cook. And he said oh
no, I don’t like to cook, and then it made sense. He said to me in my family
we don’t have any cultural tradition of food, you know, we don’t have, that’s
what he said to me. At that point I realized where the connection came.”
The dance of embodiment is how structural biologists teach their craft;
they speak with their bodies, folding their arms and sometimes their whole
bodies to mimic their molecules, to capture both their structural folds and
their movement over time. The structural biologist Jiahuai Wang demon-
strates with his hand (p. 412) how his team solved a key component of the
structure of human CD4, the receptor on helper T- cells for the human im-
munodeficiency virus, HIV (Wang 1990). Structural biologists are trained to
use their bodies as well as their hands to demonstrate and viscerally imagine
protein folds (Myers 2007). This works in pedagogy, in discussions among
colleagues, and most creatively in solving new protein structures by “reach-

LIVELY BIOTECH 411

 1. Jiahuai Wang, a
structural biologist,
uses body language to
demonstrate a structural
discovery regarding
human CD4. Photo by
Michael Fischer.

ing through” the computer screen and feeling how the folds must fall into
place, a “feeling for the organism,” as biologists at least since August Weis-
mann have said.
Folding the body in mimesis of the protein foldings associated with solv-
ing protein structures is a distinct skill from that of crystallizing proteins
(“having green fingers”). Not everyone with the one skill has the other. Vari-
ous imaging models are also used, including atom-by-atom balls, electron-
density maps, and cartoons such as the one on the monitor behind Wang.
The cartoons are particularly useful for describing folds. Nowadays these
are three- dimensional, rotatable models. Wang is showing where a ridge on
CD4 provides a hotspot binding site for HIV glycoprotein 120, the initial step
in viral entry leading to a fusion of viral and T- cell membranes. It involves
the key binding residue Phe43, at the top-right corner of the CD4 molecule
(highlighted on the screen), forming a mini-beta ribbon. Glycoprotein 120
competes with MHC (major histocompatibility complex), binding a thou-
sand times more strongly than MHC, covering more surface area of CD4, and
thus disabling the helper T- cell’s ability to fend off the virus. Hence the name
AIDS, acquired immune deficiency syndrome.
The Italian postdoc, with slight embarrassment, admits, “I designed a
dance based on the way that my molecule worked. Sometimes I’ll make my
friends laugh about it, because I dance the way the molecule moves.” He
points out that capturing movement or “resolving time” is a particular chal-
lenge.

There is a lot of interest in movement and film now in structural bi-

ology. Because up to now, until a few years ago crystallography gave
a very rigid picture of molecules which we know is false, because

412 MICHAEL M. J. FISCHER

 molecules in real life can be moving, and actually it is through this
movement they accomplish what they are supposed to do. In some
cases it is just vibration around an equilibrium position. . . . But
in the case of machineries, like splicers, big machines that form a
huge task, like photosynthesis . . . they have movements that are
functional. . . . It’s the movements that make these things work.

Techniques of capturing movement, of resolving time, and the software to

manipulate and simulate constraints and possibilities include fluorescent
tagging and laser-beam pulses that allow you to follow the changing confor-
mations of a molecule over time or the unfolding synthesis of a molecule,
“what we call ‘time-resolved crystallography.’ . . . Basically everything that
we normally collect by rotating the crystal can be collected in just one go.”
Imaging often requires collaboration both with wet-lab biologists to verify
the structure and with other modes of imaging. Crystallographers work with
three- dimensional models on computer screens. When crystallographers
are brought together with nuclear magnetic resonance people and their
images, “instead of ending up with a single model which is supposed to be
accurate, they come up with twenty models.”

Instead of a picture of a molecule, they have a picture of twenty

molecules that look more or less the same, but there are some areas
in which they are highly undetermined, show variations. It means
that they are either flexible, or the signal is too low for crystallog-
raphy. But it gives you a picture of the behavior of a molecule in
solution, which means more degrees of freedom for the molecule
because there is no backing constraint for the crystal. This means
more [you see more] dynamic behavior. . . . There is no single imag-
ing technique that can explain everything, so you have to go with
a combination of things, and that is why these kind of movies are
very interesting. Microscopy being combined with crystallography.
That’s beautiful.

Aesthetics, tactile skills, and complementarities across expertises and

imaging devices are among the fields of translation that are hard to write
down as simple protocols or textbook knowledge, but they are part of the
seductive joy of science when they work to produce epiphanies of intuition,
fit, sense of rightness, and even psychological (if not immediately provable)
certitude.

LIVELY BIOTECH 413

Thematic Centers, Informatics, Human
Disease, and Market Translations

People have no idea what it means to have a laboratory information lab. . . . It is a

sociological challenge . . . One of the problems is that infrastructure management is
not very fungible.
MEMBER OF THE THEMATIC CENTER FOR COMPUTATIONAL BIOLOGY,

MASSACHUSSETTS GENERAL HOSPITAL, 2004

If “translational research” was an NIH-funding catchphrase of the late

1990s, in the early twenty-first century the catchphrase was “multidisci-
plinary research,” to encourage architecturally facilitated synergies across
disciplinary silos. Massachusetts General Hospital (MGH) was one of the
first large institutions to have a chance to experiment with five new thematic
centers in a new research building built in 2004–5. The promissory notes
for the creation of these centers are bets (gambles), stakes (assets on the
table), and investments (capital) on the future course of the medical and life
sciences. Regenerative medicine, computational biology, genetics and geno-
mics, minimally invasive optical technologies, and systems biology were the
promissory names of the five thematic centers.
Academically, they grew out of a unique institutionalized leadership
for planning, the Executive Committee for Research (ECOR). Financially,
they grew from the rare, at best once-a- decade, opportunity provided by a
developer-leasing scheme to create a new research building near the hospi-
tal. Procedurally, they grew from choosing how best to fill the rental space
without huge startup costs. Space, I was repeatedly told, is more valuable
than money. After all, MGH is a national leader in raising research funds,
but space in close proximity to the hospital is hard to come by. The space
could easily have been absorbed by existing departments, or become con-
tested arenas of space wars. ECOR saw an opportunity not merely to mediate
competing demands, but to try to build new cross- disciplinary and cross-
departmental knowledge. New space can also be a huge financial burden
if revenue does not come in fast enough to pay for the large rental or con-
struction costs. MGH was well aware that Beth Israel Deaconness Medical
Center had almost ruined itself in this way. MGH itself had also had a previ-
ous near- death experience. The now extremely successful, if geographically
isolated, Charlestown laboratories had required a five-year, expensive burn
period to become fully sustainable. The trick, then, was to fill the research
building with a mix of established research groups that would be given new

414 MICHAEL M. J. FISCHER

multidisciplinary mandates as part of thematic centers, and the ability to
hire new staff or to bring in new labs with established fundraising records.
The politics of the older department heads had to be carefully negotiated
through the persuasiveness and incentives provided by ECOR.
The collaborations at issue are not just across labs, or with members of
a lab with different disciplinary expertises, but across disciplinary forma-
tions as understood in traditional medical departments. Multidisciplinarity
in this sense has a variety of models, often partially shaped by institutional
and financial conditions as much as by pragmatic needs for collaborations or
by the shifting ideologies of scientific information flow (ideally free, but full
of slowing tactics of intellectual property and competition). There was, for
instance, a period in the early history of molecular biology at Berkeley, UCSF,
and Stanford when clinical science was discounted and basic science privi-
leged, with programs such as what would become MIT’s highly successful
Health, Science, and Technology program being dismissed as not leading
to basic-science discoveries. Today, under changed government-industry-
academic relations, in a post-Bayh-Dole Act, post- Chakrabarty Supreme
Court decision, and post-venture capital era, the emphasis is on ensuring
that basic science always keeps an eye on medical therapies to relieve patient
suffering and create value.
The Computational Biology Thematic Center provides an example. Al-
though computers and molecular biology have been intimately intertwined
since the 1950s—with the needs of crystallographers, in particular, affect-
ing the early development of computer technology, which was also more
generally affected by the migration of physicists into the early formation of
molecular and structural biology—what today is called computational bi-
ology, “an algorithmic attempt to identify different kinds of determinants of
sequence effectiveness” (interview with Seed, 2004),10 has a different gene-
alogy, derived less from physics and computer science, and being rather a
development by biologists like Brian Seed, the first director of the center,
who picked up software skills, initially to interrogate DNA sequences for
gene locations and restriction enzyme sites.11 Only recently have electri-
cal engineers and computer scientists drifted into computational biology.
Seed works with computer scientists on this effort to develop postmicro-
array technologies. In 2004, Seed had about fifteen software engineers in
his lab and was interested in developing postmicroarray technologies. He
argued that there was a need at the NIH level to support an infrastructural
transition, something that required mobilizing resources beyond the con-
servative drag of the peer-review system.

LIVELY BIOTECH 415

 Toward this endeavor, the NIH simultaneously launched a series of ini-
tiatives, including two five-year grants to MIT, totaling some $19 million, for
a new computational and systems biology doctoral program (Sasha Brown
2004, 1, 5). Harvard also initiated a new Systems Biology Department, in
which Seed also spent time. The initial four students were admitted to the
MIT program in fall 2004 and were expected to help invent the field by
making rotations in research groups in the various component and adjacent
fields, rather like the rotations medical students make in becoming doc-
tors. The idea was to overcome the fragmentation of specializations. Sabrina
Spencer, one of the new graduate students, said, “It’s like zooming out as
opposed to in. If you only study biological systems using a reductionist ap-
proach and look only at very small pieces of the whole puzzle, you might
miss the larger dynamics of what is going on” (ibid. 5).
Seed’s lab is a model of this sort of zooming out and in, of focusing
neither on a single problem, nor on computation for its own sake, but on
systems biology in the sense of remaining open to the unpredictable tim-
ing and serendipity of discovery, as well as to the search for new tools, be
they found through collaborations with companies, such as NeoGenesis,
that have proprietary libraries of compounds and high-speed screening tech-
nology (size- exclusion chromatography); new “second harmonic imaging,”
as in a collaboration with Rakesh Jain’s lab, designing humanized mice more
efficiently in order to demonstrate the potentials of directed protein evo-
lution, to find new platforms for rapid prototyping of antibody-expression
systems, and to look at antigen concentrations in real time; or finding the
next generation of informatics tools that will displace microarray profiling
technologies (the revolutionary advance of the last decade), allowing com-
prehensive inventorying of the abundance of RNA in different cell types.
Seed’s research informatics group’s first project was to select seventy base
pair oligonucleotides that would uniquely identify an RNA transcript, and do
so in a more efficient way than the various competing algorithms in current
use, all of which are based on global scores of sequence similarity using
BLAST (Basic Local Alignment Sequence Tool). But much better would be if
one had an algorithm that gave the longest run of perfect complementarity,
rather than a global score that cannot distinguish perfect complementarity
from distributed complementarity. The degree of hybridization depends on
the former. Using the work he had earlier done on sequence analysis, Seed
figured out such an algorithmic analysis, and his software engineer, Seth
Shalway, “built a little engine for picking seventy base pair oligos.” They
published it, and “because we were funded by the National Heart, Lung, and

416 MICHAEL M. J. FISCHER

Blood Institute, we took that and actually made a collection of oligos,” which
are now used by other institutions (interview with Seed).
That was step one. The next step was to deal with the fact that the DNA is
still stuck on a solid surface, and so it cannot hybridize as well as if it were in
free solution, able to assume whatever conformation it needs to, and in any
case only so much can be put on a spot. In addition, the microarray facility
proves to be a lot of work.
Despite this informatics work, Seed’s focus was not on the informatics
itself, but on human healthcare, “actually making a difference.” The col-
laboration with NeoGenesis was an effort to directly target particular dis-
eases. This is another example of academe-industry collaboration, and this,
Seed mused, much like Folkman, “is an extraordinarily difficult thing to
contribute to because there are so many reasons for failure” (interview with
Seed). Seed’s own history in discovering and licensing the “protein fusion”
idea behind the injectable arthritis drug Enbrel is a model of the mix of in-
formed strategy, serendipity, and what he calls “unscheduled discovery.” As
usually told, Seed was working on “decoy” proteins to which the HIV virus
might bind and which might in this sense “fool” and disable the virus. In
1997, MGH licensed the idea of “protein fusion” to Immunex (later bought
by Amgen), which applied the concept to block a protein that causes de-
struction of the joints. Enbrel, now the leading anti-rheumatoid arthritis
drug (with revenues of $800 million a year) in 2004 was bringing in almost
half the total royalties earned by Partners Health Care (the merged MGH and
Brigham and Women’s hospital system).
But the backstage story of Enbrel is much more diverting than this sum-
mary account. It is a classic case of searching for one thing, but discovering
tools useful for many other things. The idea of using a decoy, however, was
the least of it. “The idea of using a decoy, I thought, was trite, and I wasn’t
interested in it,” says Seed. Viruses, like influenza, invade the immune sys-
tem by creating their own decoys, using dispensable residues, loops that
can be changed at will to miscue the immune system, but don’t affect the
functioning of the virus. What the virus cannot change without affecting its
own functioning is the receptor it binds to. So Seed’s idea was to turn the re-
ceptor into an antibody. It didn’t work, partly because the receptor-antibody
did not work sufficiently like an antibody, but also because the virus had
ways of defeating the immune system at a different level by blocking depo-
sition of complement, a collection of plasma cells that cause the lysis of
targeted mammalian cells. So if you have a viral infection, infected cells
express fibrous protein on their surface and an antibody binds to that. If

LIVELY BIOTECH 417

enough antibody binds, patching the surface, then complement comes and
creates a hole in the cell, causing lysis of the cell and killing it. That, rather
than just using antibodies to gum up the works, is how the body protects
against infection. So the idea was to use or enhance this mechanism.
Although it did not work to block HIV, it proved useful to have these
structures as tools in the lab to purify cell surface proteins, to interrogate
what their receptors were, “all kinds of practical purposes for these things,
just because they were good to latch onto” (shades of Levi-Strauss’s brico-
leur). “Leander Loeffler and Patricia Kendo were in the lab and they decided
to make these cytokine receptor fusions, protein fusions. Because they were
in a collaboration with Immunex, their fusions became useful” (interview
with Seed).
The search for HIV treatments continued. Again another discovery, this
time about how the T- cell receptor works.

So then we thought, fine, so then we can’t use antibodies. What if

we could take the cells’ natural cellular machinery for recognizing
infections and focus that on HIV. So the next thing we did was make
chimeric T- cell receptors, again at the same [site]: CD4 on the out-
side. It’s a transmembrane protein, CD4 on the outside and the in-
ternal apparatus T- cell receptor on the inside. We could then create
T- cells that would recognize HIV-infected cells and kill them. And
this is another kind of backward thing, it turned out to be a big ad-
vance, we actually managed to get it published in Cell, because it
was a big advance in understanding how the T- cell receptor works.
But that is not why we were doing it. We were doing it because I
wanted to try to cure AIDS. And so far, after taking three or four
swings at this one, I haven’t been able to do it at all. And actually
only three or four years ago I decided, you know what, I better start
working on cheap protease inhibitors because, you know, we are
not going to get there with a vaccine anytime soon anyway. So any-
way this began a tangent, but about two years ago, three years ago,
[we] started to create a venture in China to see what we could do
to make cheap protease inhibitors that would be distributed to the
Third World. I think that is really a missing ingredient. I mean it is
pretty easy to make reverse transcriptase inhibitors, but to have a
really effective cocktail you would like to have a pi, protease inhibi-
tor. (interview with Seed)

418 MICHAEL M. J. FISCHER

 Not only is China an emerging market with national biotechnology com-
petitive goals, but the large numbers of Chinese postdocs who have worked
in U.S. biology labs, some of whom have returned to start their own labs
in China, provide a potential collaborative platform both for scientific dis-
covery and to carry out development, translational research toward clini-
cal therapies. But in an investment market in China where high returns
can be made in real estate and other ventures, it is difficult to raise money,
and other perhaps nonprofit organizational mechanisms will need to be de-
signed.
The Enbrel story, in a quite different way from Folkman’s angiogenesis
story, underscores the difficulties and lively diversions of translation from
bench to clinic. Seed put it this way: “We’ve had a number of things that
have had what you might call spin- off potential. We were aiming to do some-
thing that was actually pretty clever, and we ended up doing something that
was substantially less smart but that was much more successful” (interview
with Seed).12

Translating Knowledge Workers and Brain Circulation

Both the Folkman and Seed labs, like many other U.S. labs, have had post-
docs who have come from China, and some have returned there. There is
a growing sense that, particularly in the mathematically dependent post-
genomics fields, with their promise of targeted clinical trials and person-
alized medicine, much new work will be done outside the First World,
in China, India, and elsewhere. Already there are both national and trans-
national initiatives, such as Biopolis in Singapore, the revitalization of an
Asian-Pacific network within the Human Genome Organization (HUGO),
and the scaling up of interests in translational medicine, drug discovery,
and genomics in India. The genetics and genomics quests, and their vari-
ous applications in agriculture and medicine, have become global, there are
cost advantages to doing work in Asia, and while brain drain remains a criti-
cal problem in many places, brain circulation is also becoming prominent.
The case of a Chinese-born geneticist working in a Massachusetts General
Hospital research lab provides one of many such trajectories across the globe,
sometimes from East to West, and increasingly now a return flow from West
to East. Unlike most scientists, who usually speak in anticipatory terms of
new worlds that genetics and genomics will reveal, this geneticist has a more
nuanced view because he is in danger of becoming a casualty of the unforgiv-
ing competition. He characterizes genomics as a speculative bubble that has

LIVELY BIOTECH 419

come and gone, leaving behind a few tools, as well as more complicated, and
more interesting, problems, and he speaks wryly of himself as a casualty of
the speculative bubble of biotechnology companies, as well as of the branch-
ing pathways of plant and human genetics, Chinese and U.S. biology. He has
a doctorate in genetics from Wisconsin, which he followed with postdoctoral
study at Stanford. He was trained to work on individual genes, including
some important human disease genes, using mouse models.
Then the Human Genome Project and genomics arrived with the vision
of working not gene by gene, but on the whole genome. “In only two or three
years, many new companies came up. . . . I think it was just two years for
the booming, . . . and then [came] the crash. . . . Only a few are still there.”13
While companies like Millennium, Incycte, and Human Genome Sciences
survived the crash, “actually even Millennium started as a genomics com-
pany, but now if you go inside and look what they are doing, genomics is
phasing out.” After Stanford, the geneticist had worked for two different
companies, one a Monsanto subsidiary (Cereon Genomics), then headed a
research group of eight at Genome Therapeutics, but both companies were
shut down. He is one of several refugees taken into the S. lab, with the idea
of retooling and pursuing ideas in an academic setting until they are suffi-
ciently developed to have a chance in the private sector.
It is a somewhat different model from traditional incubators set up by
universities, where companies are given subsidized space to get them off
the ground, but still depend on their own business models. In the after-
math of the venture- capital fueled biotech boom and bust of the 1990s, the
S. lab provides a safe haven and experimental space both for those who want
to stay in an academic environment and for those who are looking for new
technologies that are well-enough developed to launch new companies. It
is a potentially fertile environment that brings together different kinds of
experienced hands, and accommodates branching goals along the bench-to-
clinic pathways.
The geneticist has taken over a project from someone who had recently
left the S. lab to join a local biotech company down the street. He suspects
that an already existing alliance with yet another company that many mem-
bers of the lab are working on will slowly wind down. Therefore, he has
moved to the new project, on which he works alone, which has to do with
using RNAi–RNA interference, which inhibits transcription of genes and thus
their expression, in a technology developed at MGH, to find protein prod-
ucts that might help patients with red-blood- cell deficiencies. These erythro-

420 MICHAEL M. J. FISCHER

poietin (EPO) deficiencies are caused by an autoimmune reaction that causes
EPO to bind to its own antibodies instead of to the IL-4 cytokine. To create
libraries of possible variant targets, RNAi displays work more powerfully, the
geneticist says, than the older phage displays, which required one to work
with virons containing an inserted target gene that was to be amplified like a
clone, without necessarily knowing exactly what variant one was amplifying.
With the RNAi displays, one can generate a much larger library of engineered
variants of IL-4, pull out the protein along with its messenger RNA (mRNA),
and amplify the protein until one is recognized by the EPO receptors. The
idea is that one can create libraries of protein variations, experiment with
them until something works (in this case, an IL-4 that can function like EPO,
but not be recognized by its auto-antibodies), and be able to identify exactly
which ligands and receptors work.
To make headway, the geneticist hopes that the lab will support him for
three years, and if the experiments lead to successful results, perhaps he
can then acquire grant or corporate support on his own. In the early days of
biotech, many academics found relief from the treadmill of grant-writing,
university bureaucracy, and departmental politics by going to well-funded
new labs in biotech companies founded by scientists (Rabinow 1995). The
geneticist, however, understands recent corporate life to be full of meetings
and sudden project cancellations or changes of direction, while he under-
stands academia to provide more space for thinking and reflection. The ge-
neticist’s perspective is informed not only by his U.S. experience, but also
by his Chinese network. One of his roommates in graduate school in China
is now the director of the Beijing Genomics Institute, and the vice president
of the Chinese Academy of Sciences. The geneticist says, “I know they are
doing quite well, well probably on their standard. . . . Before I came to the
United States, I was working in the Chinese Academy of Sciences. I did my
masters degree in [plant] genetics.”
“On their standard” elaborates into an interesting set of observations,
rather than being merely a token of deferential politeness to an American
interlocutor or a simple evaluation. First, the geneticist notes, the institute
is associated with the Chinese human genome project, but neither owns
it nor is primarily interested in it. The institute works mainly on the rice-
genome sequences “and one percent of the human genome, something like
that.” In fact, he goes on, “biology in the United States means more about
health and medical things, [whereas] biology in China means more agricul-
ture.” But this, too, has deeper mappings. I ask him, as a geneticist, if the

LIVELY BIOTECH 421

techniques and technologies in agricultural biotechnologies and medical
biotechnologies are not very close: “Yes, close. Um. I would say it this way:
You know, the concepts, the general things, are the same. Genetics is the
same for all organisms. But for historical reasons, some organisms are used
as models, bacteria first, then fungus, C. elegans, Drosophila, and then mam-
malian cells. All this information accumulated [and so] now today the genet-
ics of the human is [known as or] more deeply than [that of ] Drosophila, than
C. elegans.” But now comes the more interesting claim, “For plants, they fall
out of this loop. . . . In the U.S., plant genetics does not attract many people.
Of course a lot of people work on [agricultural genetics], but not proportion-
ally [relative to the] whole field of biology.” I probe again, asking if this im-
pression might be a function of the fact that most agricultural biotechnology
is being done privately inside corporations such as Monsanto. In response,
the geneticist utters a telltale “Um hum”—an affirmative, but delivered in a
way that signals that the situation is more complicated than simply a ques-
tion of the corporatization of agricultural biotechnology.
Transnational translations are also about research priorities in different
contexts and the consequences of those differences.

Um hum. Actually yesterday one of my friends, an old friend, called

me. She is working—actually she was working in Monsanto, but
now she switched to another company, Simplex, something like
that, a big company that works on tomato. She has the same back-
ground [as I do]. We were classmates in college, thirty years ago,
and we are still very close. But she has been working with plants
continuously. I [took] a lot of plant courses, and was quite good at
that. But now I have moved to this [U.S.] environment, follow the
mainstream here, and so I work with the human system here. We
had a good talk on the phone, about half an hour. She tried to ask
me something about what I am doing that could be useful for her.
In her mind I am kind of one step further than what they are doing.
It’s not that she is behind, it is the area. So I told her in the mam-
malian system we do things this way. . . . For instance, I told her
about an experiment with apoptosis, and [suggested that] probably
the general principles can be used in agriculture as well.

Such crossings of agricultural and medical biotechnological skills and com-

petencies form part of the contemporary ethical plateau of multiple tech-
nologies intersecting in uneven ways. The geneticist’s situatedness was
resonant: he was about to lose another job, and his skill sets from his vari-

422 MICHAEL M. J. FISCHER

ous experiences in plant genetics, human genetics, genome companies, and
academic research would all have to be in play for his next move.
One of the 26,500 Chinese students who received doctorates in the
United States between 1985 and 2000 (twice the number of Western Euro-
peans who did so), the geneticist is part not only of the transnational net-
work, but of the disjunctions in national priorities (between the agricul-
tural work he did in China, and the biomedical work he does in the United
States), and of the struggle for secure positions among highly trained sci-
entific workers who do not yet have their own labs.14 His situatedness is
particularly useful in deconstructing and reconstructing the more abstract
hopes that reside in the logics of the technologies, business models, and sci-
entific speculative visions.

Asian Translations

The most active or interesting chapter [of the Human Genome Organization], or what-
ever you want to call it, is the Asia-Pacific.
EDISON LIU, HEAD OF THE GENOME INSTITUTE OF SINGAPORE,

FORMER DIRECTOR, DIVISION OF CLINICAL RESEARCH, U.S. NATIONAL

CANCER INSTITUTE, CURRENT PRESIDENT OF HUGO

Singapore’s Biopolis provides a concluding global node and perspective on

the emergent threads of interaction and competitive cooperation described
in this chapter, as well as a platform for reflections for future ethnographic
work and methods. Scientific labs are, of course, nodes in national competi-
tions, but they are also among the most international of institutional spaces,
especially at the postdoc and graduate-student level, as can be seen in the
indexical backgrounds in earlier parts of this chapter, but especially with a
quick perusal of the names listed in the acknowledgments included at the
end. While internal lab struggles with language and other intercultural re-
lations has not been a topic of attention here, and collaborative mentoring
lineages across national boundaries only slightly more so, the relations of
competitive collaboration have been pervasive. While cultural-studies and
immigration-policy scholars talk a lot about the positive and negative as-
pects of emergent global multiculturalism (conflicts as well as expansion of
intellectual and moral horizons), scientific laboratories are sites where such
work is actually accomplished daily.
Singapore emerged into the headlines not only with its ambitious, ten-
year, $3.5 billion initiative in biomedical development (2000–10), but also

LIVELY BIOTECH 423

with its success in luring to its state- of-the-art laboratories and informatics
infrastructure (of the sort described by Brian Seed) high-profile scientists
including Alan Colman, of Dolly- cloning fame; David and Bridget Lane,
of p53-gene fame; Edward Holms and Judith Swain, from the University
of California, San Diego; Neal Copeland; Nancy Jenkins; Edison Liu, from
NCI; and Bing Lim, from Harvard, who runs two labs simultaneously, one
at Harvard and one in Biopolis. Singapore’s array of institutes includes
direct translational research as well, including building a GMP (good-
manufacturing-practices certified, clean room, quality controlled) facility
for stem- cell-therapy production.
But it would be a mistake to underestimate the Singapore experiment
as merely a buying of talent and facilities. Central to the economic plan-
ning of Singapore is an effort to upgrade its skilled work force; outpaced by
cheaper labor markets, it can no longer compete in even the higher end of
integrated- computer- chip assembly and testing. That Pfizer’s Asian clinical-
trials division for the region is based in Singapore is another index of Singa-
pore’s positioning itself as a biotechnology development node. Singapore’s
research-granting organization A*STAR (Agency for Science, Technology,
and Research) provides student fellowships and scholarships to attract tal-
ent from China, Vietnam, and elsewhere as well. And Edison Liu considers
it his role, both in Singapore and in international organizations such as
HUGO, to create new synergies and coordination. One of the first big confer-
ences Liu convened as president of HUGO was the thirteenth global Human
Genome Meeting (in September 2008), in Hyderabad, with co-sponsorship
of India’s Council of Scientific and Industrial Research (CSIR) and with its
new director general and former director of the CSIR Institute of Genomics
and Integrative Biology, Samir K. Brahmachari.15
Edison Liu has a multitiered vision of developments and how to make
competitors into colleagues and allies, at least in fields like genetics and ge-
nomics. “Virtually every country [in Asia, and now in Latin America, emerg-
ing countries] is doing [genomics] as an economic driver.”16 There are vari-
ous reasons. “Sociologically . . . [one] reason genomics is an ideal entry point
for these countries is because their base is engineering, physics, and math.
Who are the best genomicists? Mathematicians. Eric Lander, you know, is
a mathematician. And the field is replete with physicists and mathemati-
cians. . . . Furthermore, young aggressive people can go into it and actually
make a difference by just computational fooling around.”17 But there is a
more subtle reason having to do with the fears of exploitation marking post-
colonial history and the troubling debates about marketing populations as

424 MICHAEL M. J. FISCHER

relatively homogenous or unique for data mining for genetic markers of dis-
ease and drug targets.

If you look at biological development in many of these countries,

you can ask which are the biological fields that seem to do very well
on a competitive basis. It is always the genetics-based [ones] like
population genetics, Drosophilia genetics, whatever, but genetics-
based, and the reason is, it is the mathematics. But it is also be-
cause, you know . . . recall that during postcolonial days, one of
the biggest raps on genetics . . . was fear of exploitation from First
World universities who come and take their blood and publish and
do anything they want and make claims like, oh, this society is
weaker because it has this gene more often.

Haunted by the legacy of the Nazis and this postcolonial history, and by the
fears of indigenous populations who have suffered similar exploitation at
the hands of their national governments, discussions around disease asso-
ciations can be troubling, and defensive barriers must be overcome.18 Liu
amusingly describes a meeting where another subtext, of course, is always
also the competition for the patents for the identification of the genes, both
for the glory and the results: “The Japanese were saying, give me your DNA,
and I’ll work it out for you. The Chinese were stone-faced, knowing that
sooner or later they will be able to do it all themselves and do a lot better
than the Japanese. The Koreans would nod their heads, you know, gently,
but afterwards sabotage anything the Japanese would want to do. And the
Taiwanese and Chinese wouldn’t talk to each other.”
So Liu suggested they pursue a genetics study that would not involve
disease associations, also because phenotyping disease is costly (economics
again) and there would be great disparities. “Vietnam, Cambodia, Mongo-
lia, . . . they can’t do any of this stuff, even Malaysia at one point and Thai-
land had difficulty, and Indonesia for sure. . . . So, we said, O.K., let’s remove
anything that has to do with disease and just talk about how we are related
to each other as Asians and how human migrations may have taken place.”
Beautiful: using migration studies, not just for itself, but as a tool to gen-
erate genetic knowledge and collaboration. In this context, rather than pri-
oritizing discrete populations with high rates of disease, where the bigger
the number of participants the greater the advantage, researchers focused
on cross-sections of diversity, discounting the alleged homogeneity of popu-
lations in (richer) Korea and Japan (touted earlier as advantages in seeking
distinctive genetic signatures of disease markers). The resulting study, the

LIVELY BIOTECH 425

Pan-Asian SNP initiative, with eleven countries, seventy-four ethnic groups,
and the construction of a 50K SNP chip, found that instead of the tradition-
ally hypothesized “two waves of migration,” there was really only one wave.19
Culturally and sociologically, Liu suggests, his effort is to foreground
Asian traditions of host-guest relationships. Countries enabled with tech-
nology and financial resources volunteer as hosts. Other countries choose
their hosts and bring their DNA with them, keeping the chain of custody
always with their national scientists, but sharing data. This format, together
with a policy that designates the use of surpluses generated by HUGO Asia-
Pacific meetings to help fund travel, creates a network of friends and col-
leagues, and “an operating system, you know, a social construct” for cross-
cultural, cross-national science and technology development.
All these sociological, cultural, and organizational observations and hy-
potheses are working tools for science managers such as Liu, John Parish
(the leader of MGH’s Executive Committee on Research in the founding
period of the thematic centers), Seed and other thematic- center directors,
and lab heads like Bim Lim, Judah Folkman, and Jiahuai Wang.20 Their lan-
guage, insights, and strategies provide a potential space for anthropologists
of science and technology, who help translate these worlds into worlds of
humanists, philosophers, social scientists, and various public-policy venues
for discussions of the social, ethical, and legal implications for publicly sup-
ported and nationally prioritized science and technology. As in many pro-
fessional arenas, broad generalizations and buzzwords serve as signposts
or short-hands, but it is access to details rich enough to unpack disputes,
interests, passions, and practicalities that is required for such conversations
to make a difference.

Conclusions

There are nay-sayers all over the place. It’s very interesting to watch. I’m going to pub-
lish a book on the physiology of nay-saying some day.
JUDAH FOLKMAN, 1999

In 1992, in his comments on “the aforementioned so- called human ge-

nome”—that is, right at the beginnings of the Human Genome Project—
the philosopher Jacques Derrida asks in a condensed way many of the fre-
quently raised ethical, legal, and social questions about our integration of
software and databanks, the outrunning of our legal theory of patenting,
the exceeding of the opposition between private and public by new forms

426 MICHAEL M. J. FISCHER

of ownership, the appropriation of knowledge and technical ability through
the very compilation and constitution of these databases, and the degree
to which we might foreclose the possibilities of a future system of health-
care that might privilege even further the rich over the poor.21 At issue is
whether decisions we make are made freely or are constrained under the
guise of extending old norms (what the philosopher and chairman of Presi-
dent George W. Bush’s President’s Council on Bioethics in 1997 infamously
proclaimed as the “yuck factor”), or more generally are our decisions freely
made or determined by path- dependency (by prior decisions).22 Do we know
what we are gesturing toward when we speak of the human genome: why
are we selecting certain bits of information for what is human, and if we
select differently, will the definitions change? Or, in more abstract terms, we
seem to have no clear criteria for distinguishing invention from discovery,
one of the practical problems in today’s patent competitions.
Derrida urges a stance of “decidedly keeping watch” against the appro-
priation of knowledge and power, as well as a firm defense of the ethics
of the Enlightenment and of scientific research. No simple antitechnol-
ogy romanticism here. As he says in an essay on “Nietzsche and the Ma-
chine,” “Life is a process of self-replacement, the handing down of life is a
mechanike, a form of technics. Not only, then, is technics not in opposition to
life, it also haunts it from the very beginning” (Derrida 2002, 244). If there
is an urgency to ban or permit certain lines of research, there is the counter-
vailing calming effect of knowing that science is lively and takes time, and in
that given time, while “decidedly keeping watch,” “a vast political and legal
consciousness is indisputably in the process of rising to meet this incredible
progress of knowledge” (ibid. 210).
In 1992, as Derrida pointed out, while the ability to map the genome
was not yet the ability to reliably manipulate the genome, and while often
it is difficult to distinguish inventions from discoveries, most important
is the vagueness of our understanding of what being human is, and thus
what ends our discoveries and inventions are to achieve. Like most scien-
tists, Derrida affirms the right to know as fundamental to being human:
“Purely scientific research and its breathless desire to know must not, in
principle, be opposed by any limit. . . . There is something here that is prop-
erly human. . . . There is an ethics of the Enlightenment here that must re-
main unconditional” (ibid. 202–3).
One hears here a harmonic echo of Judah Folkman’s refrain that he
planned to write a book, after retirement, about all the nay-sayers. The two
imperatives are not the same, but they are mutually supportive: Derrida’s

LIVELY BIOTECH 427

insistence that the will to know is fundamental to being human, and Judah
Folkman’s insistence on patiently working through the various obstacles to
getting new healing technologies from the bench to the clinic.
What is it to be human? asks Derrida.

Is man the being that possesses a knowledge about itself ? With the
possibility of self-fashioning? . . . There are two competing defini-
tions of man . . . one that knows its own norm, that knows itself,
that knows its normativity, its normality, and that draws the conse-
quences from this knowledge, as a scientist, techno-scientist, etc.;
whereas in another way, this being is one that at least asks itself the
question of ethics, of freedom, of responsibility, where not only a
norm and a knowledge of this kind are lacking, but further, must
be lacking . . . for a responsible decision to be made. (Ibid.)

We are, he agrees, haunted by the archives of past genocides where so- called
genetic knowledge was misused, and he contemplates the possibility that
genetic manipulation will generate social inequalities, stigma, stratification.
And yet our futures are underdetermined, open to the consequences of our
own decisions.
Debates over genetically modified foods in Europe became as heated
as those over stem- cell research in the United States, exposing religious
and other presuppositions (archives of history) that seem to ill-fit a world
transformed by new knowledges, new material-semiotic objects, new ap-
preciations of ecological, hormonal, genetic, and other flows, circuits, inter-
connectivities, interactions, disruptions, and accumulations. Indeed, Der-
rida teasingly rewrites, as it were, Mark Twain’s A Connecticut Yankee in King
Arthur’s Court, asking whether prehistoric human beings, or even sixteenth-
or seventeenth- century ones, would recognize us—“people who go to the
Moon, freeze their sperm, open a virtual space, etc.” (ibid.)—as human
beings like them.
At issue is the aporia of whether the human is what we have been or what
we will be. Crimes against humanity may be the literal killing of people, but
they also act against the freedom of knowledge, which is part of the essence
of being human. Derrida is split, he says, between two feelings: on the one
hand the anxiety about the accelerating rate of decisions about the process-
ing of the human genome, but on the other hand a “calming effect, rela-
tivizing or demystifying in some sense” (ibid.). I take this to mean that as
we learn more about our biological connections with the world, we come to
feel less estranged. He continues not merely hopefully that “a vast political

428 MICHAEL M. J. FISCHER

and legal consciousness is indisputably in the process of rising to meet this
incredible progress of knowledge,” but even more “one can and one must
resist—we must arm ourselves for this—the phantasm and the pathos of
ignorance, which ignorance and disinformation may produce or propagate”
(2002, 209–10).
The genetics and genomics quests, and their various applications in agri-
culture and medicine, have since 1992 become global, but not therefore
singular: national contexts and priorities differ; the republic of science is a
landscape full of competition and intellectual-property minefields, as well
as of sites of cooperation and complementarity.
One of the challenges for contemporary ethnographic work in high-tech
industries and sciences is finding appropriate vehicles beyond “genius scien-
tist,” laymen’s metaphors drawn from other fields, or simplistic reassurance
against fears of science and technology that fail to deepen understanding.
In this chapter, I have tried to focus attention on the different scales and
translations that are required, from the level of green fingers, tacit knowl-
edge, or “skills” in handling experiments to more stable tools; from post-
doctoral career journeys across countries, labs, and sometimes fields, to the
negotiations of lab management internally, to translation to the biotech-
development markets and into actually used therapies; and efforts to foster
multidisciplinary and cross-national synergies.
Of key or nodal interest are (1) new epistemic and material- semiotic ob-
jects (like the 50K chip of the Pan-Asian SNP project, or the genome itself as
databank object), which change the way we think and talk about the objects
and the social relationships they reconfigure; (2) sites of deep play (invest-
ments that are financial but also political, economic, organizational, public
relational, and symbolic), and ethical plateaus (where different technologies
intersect and compete, creating moral concerns about, for instance, social
welfare and the long-term restratification processes networked databanks
may create, or alternative efforts to create open-source biology databanks);
and (3) shifts of scale that these epistemic and material-semiotic objects, deep
play, and ethical plateaus foster.23 But along with these sites and objects,
strategies and symbols, the substance of interest in this chapter has been
(4) the kinds of people being created at these sites: their technological lives,
scientific arts, and cultural integrative perspectives. For increasing numbers
of people, these are our family members, our children, and our neighbors,
whose anxieties, obsessions, joys, and woes we share even when we do not
completely understand.
For Judah Folkman and Jacques Derrida this kinship relation was ex-

LIVELY BIOTECH 429

pressed through a special modality of friendship, something that Derrida
and his philosophical interlocutors, Emanuel Levinas and Hélène Cixous,
wrote extensively about in both their concrete relations with one another
and more generally as an attitude more important than any foundational
philosophies of usually quite ethnocentric ontology. Judah Folkman lived
this modality in his extraordinary commitment to answering phone calls
and in taking personal interest in thousands of pleas for help. His was not a
distanced professional career, but a life dedicated to a physician-scientist’s
calling, intimately tied up with his own family romance.24
There are many moving parts in the call for upgraded ethnographic ac-
counts of technological lives, scientific arts, and cultural rearticulations. An-
thropology over the past century has invoked many frames and metaphors
for focusing attention on such connections, both in detail and in setting (see
Fischer 2007a). Single metaphors or mapping procedures are unlikely to
succeed, as each captures only one or two facets. Some of these are complex
holism, or the obligation to see things in their historical, cultural, and social
contexts; methodological functionalism, as the obligation to ask how a change
in one element changes other elements in a material sociocultural complex;
ecological relations, as questions of sustainability, homeostasis, or threshold
transformations; constitutive multicausal conjunctures of social causes, cul-
tural logics, and psychological motives, as in Max Weber, the Annales School
of Historiography, or Talcott Parsons’s cybernetic models of social, cultural,
and psychological systems; complex models, as in the debates over surface and
deep linguistic structures generalized to culture, with relatively small num-
bers of generative rules able to produce infinite varieties of surface enuncia-
tions and patterns, and more recent variants couched in terms of algorith-
mic reproduction generating unexpected fractal, tiling, and other patterns;
and multi-locale or sited ethnographic strategies to access different scale sites in
widely distributed, differentiated, and stratified processes. One of the most
recent of these terms is assemblages (Marcus and Saka 2005), a term taken
from the philosophers Deleuze and Guattari (1987 [1980]) elaborated by de
Landa (2006), and adopted by some anthropologists (e.g., Ong and Collier
2005), where it represents a movement away from organismic metaphors
toward mechanical and engineering ones, in a pendulum movement revers-
ing that of the late nineteenth century and exemplified in today’s synthetic-
biology goals (to find standardized building blocks in biochemistry, genet-
ics, and mathematical logic with which to synthesize new life forms), rather
than in the holistic goals of systems biology (to work within the messy, wily
processes of wet biology, whole organisms, and habitats).

430 MICHAEL M. J. FISCHER

 This difference between synthetic and systems biology itself signals the
importance of keeping mapping tools multiple. The intent of the term as-
semblages is to loosen the tight coupling of elements in some of the criti-
cisms of particular metaphors or linguistic terms with multiple meanings
(such as the overly mathematical metaphor of function, where one function
is defined in a deterministic relation to another, as opposed to methodologi-
cal functionalism; or closed-systems analysis, as in thermodynamics, as op-
posed to open ecological systems). While Deleuze’s and Guattari’s usage of
assemblages draws from host-parasite coevolution, genetic exchange across
species, and rhyzomic proliferation, de Landa seems to draw from mechani-
cal engineering (exteriority of relations, mixtures of roles or functions from
material to expressive, variable ratios and degrees of boundary strength).
What I find ethnographically interesting are the sites from which these
various metaphors are taken and with which they are traded. These are not
just the organism-mechanism debates of the eighteenth and nineteenth
centuries, but articulations among different contemporary scientific sub-
fields, imaginaries, problematics, and logics. We find ourselves in a new
world of la pensée sauvage, with wondrous concrete logics and transforma-
tions. Levi-Strauss’s metaphors were those of the nebula (as it “gradually
spreads, its nucleus condenses and becomes more organized”) and germi-
nal molecules (“sequences arranged in transformation groups . . . [that] join
up with the initial group and reproduce its structure and determinative ten-
dencies. Thus is brought into being a multi- dimensional body, whose cen-
tral parts disclose a structure, while uncertainty and confusion continue to
prevail along its periphery” [1964 (1970): 3]).
Knowledge and object, discovery and invention, discursive structures and
subjectivities—these do not just mirror each other, but diffract, generate,
and recompose. This is as true for new biomedical technologies (such as the
relations between crystallography and the wet lab) and for medical science
translations into the clinic, as it is for anthropological knowledges of them.
As Judah Folkman challenged medical students, “There are four thou-
sand brain diseases we don’t know anything about. They are listed in the ad-
missions book in hospitals. We haven’t got a clue about them.”

We’re all accused of raising expectations . . . never tell a patient

that he doesn’t have any time to live . . . they go into a deep depres-
sion. What we say is, we’re worried . . . but we’ve got all this work
going on, and here’s our goal: our goal for you is, we’ve got to get
it stabilized, doing this, this, and this. You map it all out. You can

LIVELY BIOTECH 431

 make hope, and that’s what part of medicine is if you can’t treat.
There are twenty-six thousand diseases, how many do you think
we have cures for? . . . When Lewis Thomas entered Harvard Medi-
cal School in 1932, the only thing they had was digitalis, no other
drugs. . . . And they could do surgery. They could cure four dis-
eases. [1999]

Instead of nay-saying, the clinician-scientist looks for clues the oncogeneti-

cist misses, scans the experimental literature for effects of other titrations,
other interactions, other combinations. “A lamppost would be a toothpick
for a giant. A tree could be his broccoli. The world as a fascinating place of
potential.”

Notes
I gratefully thank Judah Folkman, Jiahuai Wang, Brian Seed, John Parish (the head
of ECOR in the crucial years, and of the Center for Integration of Medicine and Inno-
vative Technology [CIMIT]), Edison Liu, and the members of their respective labs and
teams for their time, generosity, tutorials, formal talks, and welcome into their labs. I
am particularly grateful to the structural biologists Azin Nezami, Rob Mjeirs, Emilio
Parisini, and Georgio Skiniotis; to Julian Banarjee, Guo-Hong Feng, Ed Fritsch, Glen
Cho, Glen Short, Summer Xuichin Wei, Jha Wolf; Daine Shao, Minh Le, Gugi Guo,
Senthil Raja; and of course my fellow anthropologists and historians in this enter-
prise, particularly Natasha Myers, Aslihan Sanal, Wen-Hua Kuo, Kim and Mike For-
tun, Chris Kelty and Hannah Landecker, Byron and Mary Jo Good, and Kaushik
Sunder Rajan. Many thanks as well to the participants of the three Lively Capital
workshops organized by Kaushik Sunder Rajan at the University of California, Irvine.
None of the above, obviously, are responsible for anything that I got wrong.
1. For over a decade now, Byron Good, Mary Jo DelVecchio Good, and I have been
teaching a class on social and ethical issues in the biosciences and biotechnologies
at the Harvard Medical School in the Joint MIT-Harvard Health Science Technology
(HST) track, fulfilling a social medicine requirement. In 2008 we transformed the
course into a global-medicine course to fulfill a new HST requirement for the HST
track in the Department of Global Health and Social Medicine.
2. See Fischer 2003, chapter 9 (305–69), for how emergent forms of biomedi-
cal laboratory life fit into the transformations from “Las Meninas” (the perspective
of a neutral observer surveying the external world) to “Ian Hunter’s Robotic Surgi-
cal Lab” (the perspective of always already being inside our means of knowing), and
Rheinberger 1997, for an argument about how the line between discovery and inven-
tion has shifted such that we now write, not merely discover, biologies. Computer-
and robot-assisted surgical systems (such as the Da Vinci Surgical System, developed
by Intuitive Surgical of Mountain View, California) provide a counterpoint to Velás-

432 MICHAEL M. J. FISCHER

quez’s early-modern painting Las Meninas. Just as Michel Foucault, Norbert Elias,
and Svetlana Alpers have used the Velasquez painting to meditate on the epistemic
transitions from the Renaissance to the modern period, so, too, we might use images
of such surgical systems to meditate on the transition into informatics-immersive
environments and networked databanks that are changing our current life worlds.
3. Unless otherwise indicated, all the quotes that follow are from Folkman’s talk.
4. For the history of the first twenty-five years of the Harvard-MIT HST program,
see Abelmann 2004.
5. See also the marvelous interview with the oncologist Irene Kuter on the chal-
lenges of being a physician-scientist (M. Good, I. Kuter, et al. 1995).
6. See also Petryna 2005; Petryna, Lakoff, and Kleinman 2006.
7. For a dramatic physician-scientist’s account of the terrors and dilemmas of
clinical trials with highly toxic, poorly tolerated, drugs, see Steven Rosenberg’s 1992
chronicle of the NIH early trials with interleukin-2 (IL-2).
8. The student asked whether it was ethical to perform a fake surgery in order to
compare. Folkman answered that it generally wasn’t considered ethical to do so, but
that it had been done in Germany and that a classic paper using the results had been
published in Circulation (February 1996), showing that when the gene for angiogenic
factor was injected into the hearts of twenty patients with severe heart disease for
which nothing more could be done, they grew new blood vessels and their angina
disppeared. The success was picked up in Boston and Atlanta. Then it turned out the
German researchers had also had twenty matched patients: they had heat-killed the
protein and randomized the patients. That, Folkman noted, would be a criminal case
in the United States. It has generated heated discussion, since it is known that some
people’s angina ceases of its own accord, so without a placebo, the trials could have
continued indefinitely. Folkman concluded, “So these are the big dilemmas. Trying
to improve medicine really has ethical pitfalls. Trying to practice it has one set of ethi-
cal dilemmas, but trying to prove [efficacy] has another.”
9. On skill and tacit knowledge in science experiments, as opposed to straight-
forward protocol- or rule- driven activity or simple rational design and replication,
see Polanyi 1966 and Collins 1974, for early reference points in a growing literature;
Shapin and Shaffer 1985, for a historical starting point in the modern European dis-
cussions on the nature of experimental proof; Rheinberger 1997 and Rheinberger
2006, for more recent approaches in a Massachusetts General Hospital molecular
biology lab and in philosophy of science discussions.
10. This and following quotations are from a series of interviews with Brian Seed
in 2004.
11. “Crystallographers were the first life scientists to make use of computers, ini-
tially [to alleviate] the massive labours they faced with calculation, [and] later [to]
reduce the physically labourious process of data collection, and only after that, for
facilitating computer graphic representation and manipulation” (Myers 2007, 12).
Myers draws on de Chadarevian 2002 and works cited therein by Francoeur and
Segal, Siler and Lindberg, as well as research in the MIT archives, including the work

LIVELY BIOTECH 433

of Cyrus Leventhal in the 1960s Project Mac with interactive graphics (“Molecular
Embodiments and The Body-Work of Interactive Molecular Graphics”).
12. On the rhetoric of smartness in a different professional field, also structured
by neoliberalism (and also powerfully structuring that neoliberalism), see the work
of Karen Ho (2009) on the recruitment and use of Harvard, Princeton, and Stanford
graduates in investment banking.
13. This and following quotes are from the interview with CS 2004.
14. Brumfiel 2005, 278; the original source of the student statistics was the Na-
tional Science Foundation. Brumfiel’s article, in Nature, is about a protest against
unfair treatment at Yale. A paired article in the following issue (1 December 2005)
reports on worries that post-9/11visa restrictions could threaten the labor pool of
graduate students and postdocs working in U.S. biology labs.
15. India’s growth and challenges in the global biotech sector since its accession
to the WTO’s intellectual-property patent regime, TRIPS, has been impressive. At the
international conference of HUGO, held in Hyderabad in 2008, there were over a
thousand participants, the vast majority Indians, including students, thanks to vig-
orous advance programming by the co-sponsoring organizations, HUGO and India’s
CSIR, and their respective leaders, Edison Liu and Samir Brahmachari. Among the
challenges for startup firms are investment needs that are below the minimum
thresholds set by large venture- capital funds to get sufficient returns. Another chal-
lenge is the recent reentry into India of multinational pharmaceutical companies’
research-and- development units, which can affect salary levels, threatening to reduce
them below the levels required to retain lead investigators (Frew et al. 2007). Shan-
tha Biotechnics (Hyderabad), founded in 1993 at Osmania University, for instance,
now supplies almost 40 percent of the global requirements of the United Nations
Children’s Fund (UNICEF) for hepatitis B vaccine (India’s first domestically produced
and marketed recombinant-DNA product). Pune-based Serum Institute of India is
said to be the world’s largest manufacturer of measles and the diphtheria, pertus-
sis, and tetanus group of vaccines for half the children immunized globally (ibid.).
As blockbuster drugs come off patent, India’s generics industry is well positioned
to garner significant market share. There is a growing field of clinical-trial contract
organizations. A number of Indian companies have established subsidiaries in the
United States to help them access capital and expertise, and, domestically, compa-
nies that originated in other fields are beginning to acquire and invest in biotech re-
search units. Entirely new product development is still in its initial stages, but inter-
est, energy, and scale will make India, like China, a global health-biotech player. The
William J. Clinton Foundation in 2003 announced it had joined with four companies
worldwide to supply anti-AIDS medicines in Africa: three of the four—Cipla, Matrix,
and Ranbaxy—were Indian companies (Bhandari 2005, 15). Also in 2003, Ranbaxy
replaced Roche as the lead partner in the private-public Medicines for Malaria Ven-
ture. Ranbaxy has acquired production units in France (RPG Aventis), the United
Kingdom, and Germany. It has a collaboration with GlaxoSmithKline in which Ran-
baxy is entrusted with discovery and early development through clinical trials of
new chemical entities. For a detailed account of the strategies, the training, and the

434 MICHAEL M. J. FISCHER

recruitment of leaders of Ranbaxy, see Bhandari 2005. Ranbaxy has now been partly
sold to a Japanese company, Daitchi Sankyo, so there are interesting emergent dy-
namics of corporate competition in this sector within Asia now.
16. Interview with Edison Liu in 2009. Following quotes unless otherwise noted
are from interviews with Liu.
17. See also Kuo (2005) on the Taiwanese cadre of biostatisticians, U.S.-trained,
and with experience in the U.S. FDA, who returned to Taiwan to help with the Taiwan
national priorities in biotechnology.
18. Not only have India and other countries introduced restrictive laws prevent-
ing samples and data from leaving the country, but researchers have been sensitized
to react negatively to using particular populations for disease studies for fear of stig-
matizing them or having them react defensively for fear of possible stigmatization.
Restrictions in Japan including strong confidentiality rules, for instance, it has been
suggested, are among the reasons that Japan is weak in epidemiology, and yet insists
on its biological uniqueness as a reason to counter European and U.S. pharmaceuti-
cal companies’ desire for global clinical trials. International organizational structures
such as the agencies of the United Nations, Liu observes, have been good venues
for working out consensus and templates for handling such ethical questions, so,
for instance, countries such as the Philippines, Indonesia, and Malaysia deal with
indigenous populations in similar ways. But these agencies tend not to be good at
operational working groups, falling into cronyism and bureaucratic involution. For
operational purposes, better to have the mix of private and public national initiatives
(“from within”) such as, he suggests, the new developments stimulated under CSIR
in India.
19. The SNP chip is a silicon wafer substrate that has DNA sequences tagged to
it, on which hybridizations can be performed to compare two sets, and “states,” of
genetic samples, to see which genes are selectively regulated in response to cer-
tain events, or predispositions to events. These events are usually biochemical inter-
actions that trigger certain genes being turned on or off, or trigger cascades of bio-
chemical interactions constituting a biological pathway. In other words, the chip
itself maps clusters of genes to provide broad views of gene expression. An SNP is
a single nucleotide polymorphism. These are single base variations in the genetic
code that occur about once every 1,000 bases along the 3-billion-base human ge-
nome. Knowing the locations of these closely spaced DNA landmarks both eases the
sequencing of the human genome and aids in the discovery of genes variably linked
to different traits.
20. See also Rabinow’s account of Tom White as a scientist-manager (Rabinow
1995).
21. “The Aforementioned So- Called Human Genome” was a set of remarks origi-
nally made at a conference in 1992; the proceedings were published in France in
1996 and translated into English in 2002. The original date is interesting, since
it reveals that the comments came relatively early in the maneuvering around the
Human Genome Project (1990–2003). The first meetings on the feasibility of such a
project were held in 1985, by the U.S. Department of Defense, in Santa Fe and at the

LIVELY BIOTECH 435

University of California, Santa Cruz; and the first initiative was started in the Depart-
ment of Energy’s national laboratories the following year. In 1988, the NIH and the
Department of Energy agreed to jointly pursue the project, and HUGO was formed to
coordinate international efforts. Derrida, however, had long been interested in the
ways in which computer programming and molecular biology were rearranging our
conceptual categories, even in his first major work, Of Grammatology (1974 [1967]).
22. Kass 1997. The issue was stem- cell research. The President’s Council was con-
vened to bolster President George W. Bush’s and the right-wing’s desire to ban or at
least not provide federal funds for stem- cell research. The best that Kass could come
up with was a peculiarly reactionary and ethnocentric gut feeling of repugnance to
whatever is new that should be treated as a moral compass. In Derrida’s more ana-
lytic terms, such a response is a binding to what we have been, rather than an open-
ness to what is essentially human: the will to know.
23. There are numerous public- domain repositories for various kinds of biological
data, though often restricted in various ways for reasons pertaining to intellectual-
property rights. On the creation of a SNP consortium agreement to create an up-
stream commons because cross-licensing was becoming burdensome to research
and innovation, see Sunder Rajan 2006. Better profits in that case could be expected
from downstream products if upstream data was freely available. In the synthetic-
biology community, there is an effort to make biobricks (biochemical building blocks,
or their algorithms) open source from the beginning. On the creation of open-source
forms more generally, see Kelty 2008; Coleman 2005.
24. He always managed to end his slideshows on his work with a picture of his
granddaughter holding a book or article about angiogenesis, and he never failed to
relate how he was the son of a Midwestern rabbi, who learned his calling while pay-
ing hospital visits with his father. The stories told at his funeral filled in many other
relationships, including his siblings’ awe at his incessant drive for exploration and
experiments in his basement lab as a child, complementing his daughter’s memories
of how he taught them to think of the world otherwise, as full of potentials different
from the given realities.

436 MICHAEL M. J. FISCHER

 KAUSHIK SUNDER RAJAN

EPILOGUE

THREADS AND ARTICULATIONS

The chapters in this volume traverse an array of empirical material (ge-

nomics, pharmaceutical marketing, intellectual property, environmental
science, clinical trials, and patient advocacy, to name but some); draw on
practices that are happening around the world (North and South America,
Europe, Africa, South and Southeast Asia are all represented); and adopt a
variety of disciplinary approaches. I wish in this brief concluding overview
to thread together some of those themes. The attempt here is not to create
a unifying framework. Indeed, I think that an attempt to do so would be an
impoverishment that would not do justice to the richness and range of em-
pirical material that the authors are contending with. Rather, I wish to high-
light some points of convergence, divergence, and distinction that mark this
collection.1 I wish to do this by working through nine specific points that
resonate for me in the chapters collected here.
These concern a series of questions that are empirical, methodological,
and political (where these three categories cannot be easily teased apart from
one another). Empirically—what are these things that we are seeing in the
world of technocapital today, and in what ways are they new or do they force
a recalibrating of the vocabulary of social theory that we have inherited?
Methodologically—how do we see these things and write about them in ways
that make meaning? And politically—what larger interventions might these
empirical and conceptual interventions have? These constitute a question of
history, a question of epistemology, and a question of praxis.2
1. The chapters in the volume raise a methodological question: how do we
make sense of the emergent present? If there is a unifying methodological
distinction (one that is certainly haunted by an ethnographic sensibility, but
is by no means a simple disciplinary mark of anthropology on the volume),
then it is the way in which each chapter is grounded in particularities, and
the attempt in bringing this collection together is to juxtapose these particu-
larities in order to get a thicker picture of the global constitution of the life
sciences and capital. There is an absolute importance to each chapter of the
cases that constitute it; larger concepts derive up from the cases, rather than
frame them in advance. In discussions at the workshop, Donna Haraway
made the following point as we concluded our conversations and thought
of outcomes and future directions: “Each paper has had a moment of pre-
cision that has given me a little whiplash. I want to ask how what I’m doing
is very different from what other people are doing. . . . I want conversations
that aren’t necessarily about the large concepts. I care about the cases. . . . I
don’t want to reduce it simply to discourses of political economies or science
studies, but the stuff of the earth under question.”3
Therefore, Travis Tanner’s chapter is not a general story of population
genomics, but a specific one, involving particularly brutal histories of in-
digenous populations. In Kris Peterson’s and Joseph Dumit’s cases, the par-
ticularities are geographic (Africa as a site of extreme dispossession in the
former, the United States as a site of extreme therapeutic marketing and
consumption in the latter). For Sheila Jasanoff, the mechanism of modernist
legal purification is not at issue as much as the outcomes of particular legal
purifications (in the United States versus in Canada, for example). The par-
ticularities in Elta Smith’s case are material and concern the sort of research
object that rice is. Tim Choy insists on a “poetics of place” in terms of the
particularities of Hong Kong, which itself is constituted by many particular
microenvironments. Wen-Hua Kuo’s particularity is Japan’s refusal to stan-
dardize its drug registration according to ICH protocols, insisting instead on
drug trials being conducted in Japan in order to be registered to market to
Japanese populations (a very different strategic resolution compared to the
particular cases of Taiwan and Singapore). The history of Lacanian psycho-
analysis grounds a particular response to psychiatric genomics in Argentina
in Andrew Lakoff ’s piece. And the particularities of autism as a disease cate-
gory are crucial to Chloe Silverman’s analysis (part of the particularity being

438 KAUSHIK SUNDER RAJAN

a consequence of the parents also often presenting as quasi-symptomatic,
thereby blurring the boundary between patient and parent advocacy).
2. A second methodological emphasis is historicist. The authors are con-
cerned with marking the historical transitions in capitalism that become
particular to biocapital. Perhaps most important is the particular salience of
speculative capital at this historical moment, which again is emphasized in
a number of the chapters.
This is not to suggest that speculation itself is new to capitalism. In-
deed, speculative capital is the central subject of analysis of volume 3 of
Capital (Marx 1974 [1894]), and Giovanni Arrighi (1994) has shown that the
speculative nature of mercantilism precedes even the Industrial Revolution.
What is crucial here is the particular salience of speculation, when it is pos-
sibly more intense and less coupled to a material basis in profit than at any
other time in the history of capitalism. It is not that abstraction replaces ma-
teriality, but rather that the abstractions that represent value are more and
more distantly coupled (ontologically and temporally) from their materialist
bases.
This leads to an interesting temporal incongruence in the chapters,
which, by virtue of their emphasis on the particular, are historicist, but
which, by virtue of tracing actors who are themselves invested in futures of
all sorts, in themselves chart a speculative terrain. The temporalities of the
emergent present are caught between the promissory futures of speculative
capital and the historical, material conditions of production that give rise to
these presents in the first place. A whole range of historical transitions in
institutional forms are traced in these chapters—for instance, the cooptation
of scientific research by the market (Smith’s chapter), or new relationships
between genome companies, hospitals, and states globally (Lakoff ). Also
marked are historical transitions within the life sciences, with genomics a
crucial focal point for a number of the contributors. The particular episte-
mic transition marked by genomics is the way in which the life sciences, in
some materially embodied way, become information sciences. Informatics,
indeed, occupies a central place in Smith’s and Kim Fortun’s chapters. In
Lakoff ’s piece, genomics is a key new epistemology, but one whose opera-
tion in the context of mental illness involves the prior definition of what
bipolar disorder is—a question that, it turns out, does not have an obvious
answer. Interdisciplinary epistemologies appear in Fischer’s chapter. There
is the emergence of new biosocialities, such as the parent-advocates who be-
come “lay” scientific practitioners, as described in Silverman’s piece.4 There
is the historicist tracing of particular conjunctures in Jasanoff ’s chapter,

EPILOGUE 439
where particular resolutions of public and private occur in response to par-
ticular historical conjunctures of biotechnology that are situated in terms
not just of the epistemology of the life sciences or the institutional contexts
within which they evolve, but also in terms of state and legal rationalities
that are not uniform even among states that subscribe to similar legal forms
and precedents. In addition to all these historical ruptures are also historical
parallels and continuities (between the dispossession of land and of genetic
material in Tanner’s piece, for instance), all of which contribute to the his-
toricist yet speculative grounding of emergent phenomena that sees expres-
sion in the volume.
3. I have alluded to three registers of history that are at play in the vol-
ume: the marking of historical ruptures, parallels, and continuities. But a
fourth historicist register looks at the historical conditions of possibility that
allow certain types of emergence to occur. These historical conditions of
possibility are invariably grounded in what David Harvey (2003) refers to as
“accumulation by dispossession,” in some kind of original violence in space
or time. Tanner shows this with respect to the original dispossessions of in-
digenous populations, and Peterson in the context of the “emptying out” of
material space of Africa. These dispossessions are ongoing—the conditions
of possibility for the functioning of speculative capital, in this sense, are not
just constituted by one- off historical events marked by violence or expro-
priation.5 In addition to this original violence—the continuous destructions
required for “the new” to come into being—is an ongoing violence of one-
sided representational politics, which is at the heart of many of these stories.
Much of the violence of capital indeed operates at the level of representation:
who controls the means of production, and who gets to speak for whom, in
technocapitalist worlds where modes of production and emergent knowl-
edge forms are increasingly entangled.
There is also the constitutive violence of intimacy that underlies the
quality of the encounter value that Haraway writes about. Haraway’s stories
of encounter value are, at their core, not simply warm and fuzzy stories of
dogs technologically inserted in new ways into human hearth and home.
The encounter value that animates decisions about dogs’ life and death are
visceral, poignant, and painful, and extend beyond the bounds of domes-
ticity into, for instance, the prison (for example, the globally disseminated
images of the role of guard dogs in Abu Ghraib). This violence is noteworthy
not simply because affective encounters, and the obligations they entail, are
inherently violent, but because, again, there is a one-sided representational
politics to these encounters—decisions about dogs’ life and death, even

440 KAUSHIK SUNDER RAJAN

when dogs are deeply inserted into human family structures, are always de-
cisions that are made only by humans. Just as, indeed, decisions about thera-
peutic consumption practices in the United States are invariably dictated by
the interests of the pharmaceutical industry; those about the bounds of en-
vironmental discourse invariably made by the security state (the democratic
potentials of the Internet notwithstanding); those about aid to Africa invari-
ably made by agents such as American governments, leading economists,
or the CEOs of large multinational software companies; and those about rice
research priorities by agribusiness or by global donor organizations with
First World research agendas in mind. Haraway’s diagnosis of the violence
constitutive to encounter value is not some simple call to consider the dog’s
“point of view” in making decisions about its life and death—such a liberal
political response, indeed, would be an absurdity. Rather, it is to show, in a
manner similar to that of many of the other contributions to this volume,
the ways in which capital is animated by complex affective processes that
are very difficult to reduce to the dynamics of an exchange mechanism, and
further, the ways in which these processes are hardly innocent, even when
they might appear to be so, if one pushes an analysis of affect in the deep,
historically, and biologically contextualized sense that it ought to be. In that
sense, Haraway’s political lesson is very similar to those that Peterson and
Tanner in particular are trying to emphasize, while pushing the boundaries
of exchange, kinship, representation, and affect into the domain of trans-
species encounters. What is at stake, in Haraway’s words, is marking the
“relationalities in companion-species worlds,” none of which are “innocent,
bloodless, or unfit for serious critical investigation.” If there is some “funda-
mental” logic of capital that persists through these stories of the multiplicity
of capitalist forms and logics, then that perhaps has to do with the consis-
tency of original and representational violence that structures them.
4. The chapters pose intriguing questions of space, perhaps most inter-
estingly asking what constitutes the “global.” For Peterson, the global takes
form in Africa, which is simultaneously the material site of dispossession
and the target of global trade, aid, and capital flows. This echoes the argu-
ments of scholars such as James Ferguson (1999), who shows how a theori-
zation of modernity must crucially account for Africa (normally diagnosed
as precisely lacking such a modernity, but in fact in the midst of a “decline”
that is symbolized by the failure of the dreams and hype of modernity that
fueled African economies in the 1960s and 1970s), or Achille Mbembe
(2001), who argues that to capture the essence of biopolitics, one needs to
look not toward advanced liberal societies that serve as the empirical start-

EPILOGUE 441
ing point of Foucault’s analyses, but toward Africa. But like capitalism,
there are multiple globalizations reflected in the volume. For instance, if
the dominant form of globalization in Africa manifests through trade with
and aid from advanced liberal societies, then the generics market there is
also constituted through the globalization of Indian pharmaceutical compa-
nies, which strategize Africa as their “global” market site.
The global is constituted still differently in the case of environmentalism
(Kim Fortun’s and Choy’s chapters), where, as a category, it implies porosity
and the ways in which the borders of the nation-state get transcended either
by information (Fortun) or by pollution (Choy). “The global,” here, is a net-
work, but not one that is seamlessly constituted. Choy shows how this net-
work is, to borrow a term from Anna Tsing (2004), frictioned, while Fortun
shows how the network is simultaneously constituted at multiple scales. In-
deed, part of the way in which globalization is frictioned is precisely through
the acts of scale-making that constantly animate it (Tsing 2000). Therefore,
Choy’s “global” story is a story of Hong Kong (itself an odd sort of locality,
one that is always already global in a number of ways), but one that has
global, regional, national, local, and sublocal scales interacting with one an-
other.
Fischer’s global is located at sites such as Harvard and MIT, or at Singa-
pore’s “Biopolis,” which, like many other technoscientific institutions, are
nodes at which “transnational ligaments of technoscience” get articulated.
Once again, questions of scaling become central—in Fischer’s stories, there
are at least at three interfaces: between lab and clinic, biology and infor-
matics, and university and market. These interfaces are also sites at which
friction is produced—the scaling up of laboratory research so that it works
in clinical settings is hardly a seamless process, as things that work in one
setting often work very differently, or not at all, in another. Similarly, the
interdisciplinary coming together of biology and informatics sees the cou-
pling of different knowledge systems and labor practices in ways that have
to be constantly worked through by those engaged in the activity of bioinfor-
matics, just as the transition of the life sciences from university settings to
market settings is not simply a cooptation of the former by the latter, but
constantly sees competing value systems at play, often manifesting in dif-
ferent incentive and normative structures.6
These scalar transitions also have to be located against global imperatives
of standardization. If the work of scale-making is always frictioned, then
constitutive to that work are impulses of homogenization. Hence Kuo’s ex-

442 KAUSHIK SUNDER RAJAN

ample of attempts at standardizing clinical-trials regulations in Asia in ac-
cordance with “global” standards, which itself sees incongruent articulations
when one compares Japan, Taiwan, and Singapore, each drawing on differ-
ent registers of nationalist sentiment, regional power plays, and global am-
bitions and imaginaries. These standardizing imperatives and epistemic at-
tempts at establishing universality are also seen in Lakoff ’s piece. If in Kuo’s
chapter standardization is difficult because of different strategic interests of
different state actors, in Lakoff ’s it is difficult because while technical prac-
tices are easy to standardize across borders, epistemology is much harder to
do so, not least because of different procedures of medical-record collection
in different places. Part of the historical transition that this speaks to is one
within the life sciences, from psychoanalysis to molecular medicine, but it
is an extremely frictioned transition. More generally, standardization im-
peratives are seen to exist in contradictory tension with the individualizing
imperatives of neoliberal capital, which is particularly marked in the U.S.
case that Dumit describes.
Many of the above conditions of the global engage conceptions of the
nation-state—most explicitly in Kuo’s case, but also in Lakoff ’s (the flow of
biology and capital between Argentina and France)—or other forms of ter-
ritory (the “city-state” of Hong Kong, the continent of Africa). But there are
flows of various sorts that are described in this volume which are not nec-
essarily mediated through the form of the nation-state or similar territorial
entity. In other words, the global is never simply a concept that is one step
up from the state—global capital is fluid at multiple scales, only some of
which are congruent with the scales at which state power is able to regu-
late it.
5. A number of the chapters are concerned with questions of property,
which also implies spatial demarcations (in this case, between public and
private). These are not binary categories, but hybrid, as shown in Smith’s
chapter. There is a relationship of the notions of public and private to the
materiality of information—a crucial question is often whether information
can or should be made public. This politics of the public domain does not
just have to do with property, but also, in Kim Fortun’s case, with security.
Property rights mediate the relationship of capital to the state in very par-
ticular ways, by bringing it into the purview of state law and rationality (as
seen most markedly in Jasanoff ’s chapter). In that sense, they reflect the ter-
ritorializing impulses of capital. As Jasanoff shows, particular state rationali-
ties in relation to intellectual property can vary greatly; what is common is

EPILOGUE 443
the formal relation between the state and capital that gets mediated through
the form of property. If property territorializes capital by locating it in land,
then the abstraction of “economic development” is that which deterritorial-
izes property, since it, in Jasanoff ’s words, “overflows the territorial limits of
land; it converts place, which sits still, into money, which moves.”
6. A common thread of praxis that weaves through the volume is the at-
tempt to denaturalize capitalism. In Sheila Jasanoff ’s chapter in particular,
naturalization and denaturalization are quite literally what are at stake. De-
termining the bounds of intellectual-property protection involves deciding
what is “natural” and what is “cultural,” a process that, as she shows, hardly
plays out in ways one would naturally expect.
If one component of the exercise in denaturalizing capitalism involves
denaturalizing the law, then another involves a denaturalization of liberal
notions of ethics that underlie the bioethical enterprise. Tanner, for in-
stance, shows the insufficiency of such an ethics in situations that are over-
determined by violent prehistories of expropriation. “Ethics,” in the case of
the Human Genome Diversity Project (HGDP), which Tanner studies, was
framed entirely in the context of informed consent, which takes individual
autonomy to be the ground on which the ethical can be conceived. Such a
particular grounding of ethics, as Tanner contends, often does not do jus-
tice, which is altogether a more complicated and indeterminate notion.7
It is through an insistence on the accumulative tendencies of capital that
Tanner critiques informed consent. For him, the issue is not the content of
consent, but its form. And so, the HGDP is not rendered problematic because
its informed consent procedures were somehow insufficient or culturally in-
sensitive; it is because informed consent, as a liberal contractual procedure,
is in itself insufficient to account for the deep historical violence that has
consistently been inflicted on indigenous populations, who were the major
opponents of the HGDP. The problem is not with the terms of the contract,
but the contract itself—a contract that, by its very existence, naturalizes rela-
tionships between the capitalist state and native populations as one between
“free” contracting agents, and in the process effaces a history of disposses-
sion that, as Tanner insists, is ongoing. Tanner therefore contrasts ethics as
the calculable, contractual, rule-governed, liberal form of interaction, to jus-
tice, which, as Jacques Derrida (1994) articulated it, is a notion that is both
deeply informed by the realities and traumas of history, and inspired by the
hopes and fears of a promissory future. It is the temporal incongruence of
the notion of justice, always already embedded in the past and the future,
that Tanner tries to capture, contrasting the hyperfuturity that genomics is

444 KAUSHIK SUNDER RAJAN

associated with to a “primitive” accumulation which itself continues into
the future.
Of course, theories of justice, too, can be grounded in liberalism, as they
most famously are by John Rawls (2005 [1971]). Indeed, the fundamental
guiding principles on which informed consent for human subjects experi-
mentation in the United States is based are provided by the 1979 Belmont
Report, which stresses respect for persons (basically, a concern with indi-
vidual autonomy and the protection of persons with reduced autonomy),
beneficence (a calculus that maximizes the ratio between benefit and harm),
and justice (defined in terms of equitable costs and benefits).8 In the calcu-
lus of liberal ethics, justice is precisely that—a calculus, something that can
be adequately represented. The Derridean ethics that pervades this volume,
and is explicated in Tanner’s and also Mike Fortun’s chapters, is in contrast
to one where justice is that which cannot be adequated. Ethics is not being
abandoned as a useful category, or even as a category of praxis (there is a be-
lief that the practice of the life sciences needs to be ethically grounded). The
attempt here, most explicit in Mike Fortun’s paper, is to recover an ethics
that is contrasted to the moralizing impulses of bioethics.
The chapters here are therefore often concerned with the insufficiency of
the very form and epistemology of liberal ethics. But they are also concerned
with the institutional manifestations of bioethics, particularly the instru-
mentality that pervades an ethical enterprise when it becomes constitutive
to corporate agendas also (as Smith shows in her chapter). Ethics is about
decisions—which research to prioritize, why, for whom? Who gets to make
those choices? There is a crucial relationship between ethical questions and
questions of representation, questions that can only be asked if the ethical
is not reduced to the moral, on the one hand, and if the ethical does not be-
come an instrument that reproduces larger social and institutional relations
of production and power hierarchies, on the other.9
7. Investment, a central notion in the volume, points to the monetary and
affective registers of value that are simultaneously at stake in a number of
the chapters. Indeed, affective and subjective dimensions of biocapital are a
central part of the analysis that this volume undertakes. Some of the affect
is because of the ways in which circuits of exchange are always embedded
within circuits and epistemologies of kinship. After all, one of the things that
genetics speaks to from the beginning is kinship, which is one of the cate-
gories whose reconfiguration therefore comes to be most at stake through
contemporary advances in the life sciences. As seen in Donna Haraway’s
analysis, kinship is marked both at such epistemic levels and at familial

EPILOGUE 445
levels, with the locus of technocapitalist interactions often being at the level
of family ties (the human- canine companionate family in Haraway’s account
being one such example).
There are other elements of affect that operate independent of an im-
mediate kinship equation. For example, there is a political economy of fear
that pharmaceutical marketing speaks to (Dumit), or that is part of the secu-
rity discourse surrounding ecological informatics (Kim Fortun).10 There are
political economies of desire, as seen in the ways in which the affective econ-
omy of the promise works through the discursive apparatus of hype (Mike
Fortun) or the sense of desire among professional scientists in Fischer
(which gets manifested not just toward the material consequences of their
research, but also toward an aesthetics of research). And there is the love
that structures stories of autism research in Silverman’s chapter, where that
love is tied into the irrationality of deep monetary and emotional investment
into disease cures in ways that seriously threaten the disinterested norms of
science, and into the necessary violence of experimentation on children that
is a necessary part of the search for a cure. These registers of affect point to
the complicated layers of obligation, commitment, and desire that lie at the
heart both of contemporary life-science research and of the mechanisms
and logics by which capital operates. A simply structural analysis of either
technoscience or capital, the chapters argue, is not enough to understand
what is emerging here. These forms of affect are hardly innocent, and con-
tain within them a necessary violence that is as integral to these forms of
biocapital as the structural violence that Tanner or Peterson describe is.
8. If lively capital is marked by structural and affective violence, it is also
marked by a series of absurdities that a number of the papers point to. The
cataloging of absurdity is central to the project of the denaturalization of
capital. Consider Dumit’s chapter, for instance. What might seem like a dys-
topian portrayal of the power of pharmaceutical marketing in shaping neo-
liberal consumption and selfhood is in fact an attempt to mark a historical
transition, with “medicine as an arm of capital” now becoming “an industry
in itself.” Central to this industry of biomedicine is the clinical trial, which
serves a function analagous to that of machinery in industrial capital. It is
through the mechanism of the clinical trial that risk thresholds become sci-
entific, factual, and authoritative. But in reality, Dumit shows, they are arbi-
trary and do not arise in any way consequent to the experimental procedures
that constitute the trial itself. Therefore, far from pointing to seamlessness,
what Dumit does is show the sheer absurdity of pharmaceutical logic. It is
logic, however, that is already real. And yet its “reality” operates in the realm

446 KAUSHIK SUNDER RAJAN

of potential, its potential to grow markets and treat diseases (both these
imperatives collapsing seamlessly on one another). Public health becomes
market opportunity, in itself an absurd proposition, and yet one that is im-
mediately naturalized and disseminated as inevitable, by physicians, by the
pharmaceutical industry, by the press, by government regulatory agencies.
It is this double effect of absolute presence and absolute absurdity, chill-
ingly Kafkaesque, that Dumit is trying to present. And that “chill” is central
to the affective politics of Dumit’s chapter, as he shows how the operation
of pharmaceutical logic can never occur through purely discursive mecha-
nisms without calling into being a series of fetishes and fears that are at the
heart of biopolitics.11
9. Finally, there is the question of praxis. If there is a certain conso-
nance in the analytic and methodological moves of the authors in the vol-
ume, some of which I have tried to thread here, then there is also a range
of political positions that they adopt. One is affective and subjective—part
of Dumit’s attempt in tracing pharmaceutical grammar in the manner that
he does is not just to diagnose the structure of fear-mongering that is con-
stitutive to that grammar, but to evoke an affect of fear in the reader. Such a
provocation of affect is precisely a part of the act of denaturalization of capi-
tal that he is engaged in; the key here is to insist that we cannot take phar-
maceutical discourses for granted. These affective encounters often demand
new epistemologies in themselves, new ways of looking at ourselves in rela-
tion to life, the life sciences, and capitalisms (for instance, the re- cognition
of trans-species encounters that Haraway calls for in her chapter).
A second is a political position against liberalism, which is articulated
through a sentiment that depends deeply on Derrida’s deconstructive read-
ing of liberal notions of ethics, and calls into account instead a sense of jus-
tice that is both promissory and incalculable. As with the affect of fear, which
Dumit simultaneously diagnoses as constitutive to the grammar of capital
and invokes as a political response to that grammar, a promissory ethics is
both diagnosed as a constitutive feature of speculative technocapital and in-
voked as a necessary political response to it. One sees this dual relationship
to promise, both critical and embracing of it, in Kim Fortun’s diagnosis of
the possible promissory futures for environmental politics that are provided
by ecological informatics. A promissory ethics is also what Mike Fortun is
trying to recover in the context of genomics, when one is deeply entangled
in the hype surrounding the technoscience in ways that make disentangling
fiction from reality in a rational manner basically impossible. And yet one
cannot dismiss the discursive apparatus of corporate genomics—one has

EPILOGUE 447
to adequately respond to the hype and make it accountable. Cynicism, or
what Fortun calls an “ethic of suspicion,” is just not an effective or engaged
enough response in this context—one needs to suspend disbelief without so
completely buying into the hype that one suspends the ability to be critical
of particular actions taken by particular people or organizations at particular
places and times.
In parallel ways, the promissory investments of parent-advocates in Sil-
verman’s piece are shown to potentially reconstitute forms and modes of
knowledge production—a political economy that parallels the corporate po-
litical economy of hype that Mike Fortun speaks of, but where the invest-
ment is in terms of the hope for a cure for autism. Fischer writes about the
promissory potential of new interdisciplinary and translational endeavors
that are entangled in hype and hope (the hype attendant to all high-profile
institutional arrangements that see this level of monetary investment; the
hope that new research agendas that transcend traditional disciplinary and
epistemic confines can emerge).
The ethical position in these chapters then becomes one of thinking
about how to keep open the promise of the life sciences and new biotech-
nologies (which, in a Derridean sense, is a “promise of justice”), while hold-
ing its promises accountable (Derrida 1994). The politics here is one that
avoids a knee-jerk technological positivism, but that deeply wishes to keep
open the promissory possibilities that technoscience provides. It is a politics
that is animated by an ethics that is at once experimental and that demands
accountability. It is deconstructive at its core, not passing judgment on new
technologies, but rather working through and opening up their experimen-
tal potential, and yet echoing Derrida’s own insistence that the ethic of the
Enlightenment is unconditional.12 There prevails in this volume a promis-
sory register, a belief that biotechnologies, if democratic, open-ended, and
made capable of realizing their experimental potential, rather than closed,
proprietary, and subjected to the dictates of hegemonic state and corporate
power structures, can in fact make the world a better place. There is also a
related sensibility that intellectual projects such as those reflected in this
volume have the potential to contribute to this betterment, by serving as
interlocutors and auditors of these new technologies and their practitioners
in more promising ways than economics or bioethics, for instance.13
The real question for most of the authors is not one of being in favor
of new biotechnologies or against them, or being an enthusiast of capital-
ism or wishing for its dissolution. Rather, it is one of how to seriously em-
brace the promise that the life sciences and biotechnologies present to us

448 KAUSHIK SUNDER RAJAN

in ways that are attentive to the histories within which the development of
such science and technology has taken shape. These are histories that have,
first, been heavily overdetermined by systems and logics of capital in recent
times. These systems and logics of capital have been multiple and particu-
lar to different places and times, making it impossible to suggest a unitary
logic of capitalism or globalization that one can grasp or hold onto. At the
same time, there have been certain fundamental aspects to capital that re-
cur—most notably, that capital constantly engages affect and therefore is
deeply subjective, and that capital, like its affective manifestations (obliga-
tion, commitment, fear, desire, or love) is necessarily violent. What becomes
crucial, then, is not the diagnosis or attribution of an essential nature to the
life sciences or to capitalism, but an exercise of cataloging the representa-
tional politics that are at play in the merger of the two. This is a politics that
is often painfully familiar and reproductive of old power hierarchies (of the
state or of corporations “taking over” the domain of biocapital), but which
also, because of the contradictions inherent to biocapital, offer possibilities
for alternative representational possibilities.
Particularity; materialism; promise; history; violence; the global; prop-
erty; ethics; investment; affect; subjectivity; absurdity; politics; praxis.
These then are some of the keywords that thread this volume together in
spite of its purposeful absence of a single topical, conceptual, or disciplinary
frame. In this brief conclusion, I have tried both to thread together and to
highlight the incongruence across the papers in this volume, as they attempt
simultaneously to describe the rapidly changing worlds of technocapital and
to intervene at multiple registers—conceptually, in debates within philoso-
phy and the human sciences; reflexively, in methodological debates within
the disciplines and interdisciplines that the authors inhabit; and perhaps in
subtle or pronounced ways in the social worlds that constitute the objects of
study for the authors here.

Notes
1. This synthesis is deeply influenced by Jean Comaroff ’s concluding remarks at
the Lively Capital workshop, for which I offer many thanks.
2. These three questions were foundational to the method of Marx’s philosophy,
which is why I would argue that even those chapters in this volume that do not ex-
plicitly engage Marx cannot escape a Marxian inheritance.
3. Donna Haraway, transcripts from Lively Capital workshop, 7 November 2004,
transcribed by Elta Smith.

EPILOGUE 449
 4. See also Gibbons and Novas 2007 for an edited collection that specifically
studies emergent biosocialities.
5. See also Sunder Rajan 2005 for an elaboration of this logic of expropriation in
the establishment of biocapital in the mill districts of Bombay.
6. The engagement with scale and friction as constitutive to global networks is
implicitly an argument with actor-network theory, which has been a powerful frame
for thinking about scientific practice within STS (for instance, Callon 1986; Latour
1987), particularly with the seamlessness that is constitutive in these accounts to
processes of knowledge production, with technoscience often getting reduced to an
instrumental act of resource generation.
7. Gail Davies (2006) provides a useful conceptualization of justice in the context
of inequities in organ transplantation in London.
8. See http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.html.
9. For the relationship between the ethical and the moral, see Michael Fortun
2000; Kleinman 1999.
10. See also Comaroff and Comaroff 2006, which shows the ways in which fear is
central to the fetish that is at the heart of the apparatus of biopolitics, using as a case
study the development and use of the police state in post-Apartheid South Africa.
11. I think here of the comedians Jon Stewart and Stephen Colbert, and their ex-
tremely effective response to media and politics in the United States by pointing to
their utter absurdity. Their mode of critique is not denunciatory, but adopts the form
of parody. Importantly, it is parody that takes the absurdities that it makes fun of at
face value and very seriously. This lets the absurdities, in a sense, speak for them-
selves. Douglas Adams, another favorite of mine, adopted precisely such a critical
posture in lampooning late-modern capitalist (in his case, British) culture and so-
ciety in the Hitchhiker’s Guide to the Galaxy series. Such critiques do not pretend to be
outside the material and ideological apparatus of capital that they critique, as denun-
ciatory critiques often do. After all, Stewart and Colbert inhabit the very world of big
media that they make fun of. It is because these are critiques that point to absurdity
from the inside, and therefore have an element of reflexivity as constitutive to them,
that they are so effective.
12. Derrida’s chapter that Fischer cites in this regard is “The Aforementioned So-
Called Human Genome” (Derrida 2002).
13. This led to an interesting, generative, and as yet unresolved tension (perhaps
one that does not have a resolution?) in discussions at the workshop, for it is in this
sensibility that the anthropology of science such as it is represented here differs from
recent work in the anthropology of finance that has also studied the liveliness of capi-
tal in interesting ways, albeit grounded in different empirical material that does not
engage emergent epistemologies of the life sciences in ways this collection does. An
important representation of that work is Bill Maurer’s (for instance, Maurer 2005),
who made the following critique at the workshop: “The question of empirical has
been troubling me all along. . . . We need to un-sunder evidence and ethics. . . . [This
is a] plea for thinking more seriously about [the] ethical form of evidence being de-
ployed. Makes me want to ask why return to Marx of Capital. Why is it so comfort-

450 KAUSHIK SUNDER RAJAN

ing? Why that now? What if we disappear the empirical—what pops up? If we liter-
ally dissolve those, what do we see? Worlds where the very question of evidence and
[the] real is already obviated? I think one of the things from anthropology of finance
and law is that . . . listening in on STS people . . . [it seems that] projects are going to
get in there and change the world with tools. If only I had the right hammer, then I
could change the world. The world follows the word. . . . For finance people, nothing
really matters because if you fail you win. You never really lose.”

EPILOGUE 451
 BIBLIOGRAPHY

Legal Cases

Diamond v. Chakrabarty, 447 U.S. 303 (1980).

Dolan v. City of Tigard, 512 U.S. 374 (1994).
Dred Scott v. Sandford, 60 U.S. (19 How.) 393, 15 L. Ed. 691 (1857).
Johnson v. Calvert, 5 Cal.4th 84 (1993).
Kelo v. City of New London, 545 U.S. 469 (2005).
Laboratory Corp. of America v. Metabolite Laboratories. 548 U.S. 124 (2006).
Linda Rubin v. deCODE Genetics, Inc, Lehman Brothers, Inc., Morgan Stanley and Co. In-
corporated, Kári Stefánsson, and Axel Nielsen, No. 01 Civ. 11219, U.S. District Court,
Southern District of New York (2001).
Lucas v. South Carolina Coastal Council, 505 U.S. 1003 (1992).
Marx v. Computer Sciences Corporation, 507 F.2d 485 (9th Cir. 1974).
Matter of Quinlan, 70 N.J. 10 (1976).
Moore v. Regents of the University of California, 793 P.2d 479 (Cal. 1990).
Nollan v. California Coastal Commission, 483 U.S. 825 (1987).
Palazzolo v. Rhode Island et al., 533 U.S. 606 (2001).
President and Fellows of Harvard College v. Canada (Commissioner of Patents) SCC 76
(2002).
SEC v. Morgan Stanley & Co. Incorporated, No. 03 Civ. 2948, U.S. District Court, South-
ern District of New York (2005).
Washington University v. Catalona, 490 F.3d 667 (8th Cir. 2007).

Abate, Tom. 2000. “Call for Access to Genome Data.” San Francisco Chronicle,
15 March.
Abelmann, Walter, ed. 2004. The Harvard-MIT Division of Health Sciences and Tech-
nology: The First Twenty-Five Years 1970–1995. Cambridge: Harvard-MIT Division
of Health Sciences and Technology.
Abraham, John. 2002. “The Pharmaceutical Industry as Political Player.” Lancet 360:
1498–1502.
Abraham, John, and Tim Reed. 2002. “Progress, Innovation and Regulatory Science
in Drug Development: The Politics of International Standard-Setting.” Social
Studies of Science 32, no.2:337–69.
Abu-Lughod, Lila. 1986. Veiled Sentiments: Honor and Poetry in a Bedouin Society.
Berkeley: University of California Press.
“Access to the Literature: The Debate Continues.” 2004. Nature Web Focus, http://
www.nature.com, accessed 12 April 2008.
ACT UP Paris. 2002. “‘Accelerating Access’ Serves Pharmaceutical Companies while
Corrupting Health Organizations.” Press release. http://www.actupny.org/re
ports/Durban-accessPR.html.
Adams, J. B., and C. Holloway. 2004. “Pilot Study of a Moderate Dose Multivitamin/
Mineral Supplement for Children with Autistic Spectrum Disorder.” Journal of
Alternative and Complementary Medicine 10, no. 6:1033–39.
Adorno, Theodor. 1991. “The Essay as Form.” Notes to Literature, vol. 1, 3–23. New
York: Columbia University Press.
Afsah, Shakeb, Benoit Laplante, and David Wheeler. 1996. “Controlling Industrial
Pollution: A New Paradigm.” Working Paper No. 1672. World Bank, Policy Re-
search Department, May.
Agamben, Giorgio. 1998. Homo Sacer: Sovereign Power and Bare Life. Stanford: Stan-
ford University Press.
Ake, Claude. 1996. Democracy and Development in Africa. Washington: Brookings
Institution.
Akiskal, Hagop S. 1996. “The Prevalent Clinical Spectrum of Bipolar Disorders: Be-
yond DSM-IV.” Journal of Clinical Psychopharmacology 16, no. 2 (supplement 1):
4–14S.
Alder, Ken. 1998. “Making Things the Same: Representation, Tolerance and the End
of the Ancien Régime in France.” Social Studies of Science 28, no. 4:499–545.
Plotkin, Hal. “All Hail Creative Commons: Professor and Author Lawrence Lessig
Plans a Legal Insurrection.” San Francisco Chronicle. 11 February 2002. http://
www.SFGate.com, accessed 24 October 2004.
Althusser, Louis. 1969 [1965]. For Marx, trans. Ben Brewster. New York: Pantheon.
———. 2006. Philosophy of the Encounter: Later Writings, 1978–87, ed. Françios
Matheron and Oliver Corpet. London: Verso.
Amani, Bita, and Rosemary J. Coombe. 2005. “The Human Genome Diversity
Project: The Politics of Patents at the Intersection of Race, Religion, and Research
Ethics.” Law and Policy 27:152–88.
American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental
Disorders: DSM- IV. Washington: American Psychiatric Association.
———. 2000. Diagnostic and Statistical Manual of Mental Disorders: DSM- IV-TR. Wash-
ington: American Psychiatric Association.
Amos, Jonathan. 2002. “Genome Dispute Touches Rice.” BBC News, 4 April. http://
news.bbc.co.uk/2/hi/science/nature/1910889.stm.

454 BIBLIOGRAPHY
Anderson, Benedict. 1983. Imagined Communities: Reflections on the Origin and Spread
of Nationalism. London: Verso.
Anderson, H. Ross, Antonio Ponce de Leon, J. Martin Bland, Jonathan S. Bower, and
David P. Strachan. 1996. “Air Pollution and Daily Mortality in London: 1987–92.”
British Medical Journal 312, no. 7032:665–69.
Andrews, Lori. 2006. “Who Owns Your Body? A Patient’s Perspective on Washing-
ton University v. Catalona.” Journal of Law, Medicine and Ethics 34, no. 2:398–407.
Andrews, Richard. 2003. “Risk-Based Decision Making.” Environmental Policy: New
Directions for the Twenty-First Century, 5th edn, ed. Norman Vig and Michael Kraft,
215–38. Washington: CQ Press.
Angst, J. 1998. “The Emerging Epidemiology of Hypomania and Bipolar II Dis-
order.” Journal of Affective Disorders 50, nos. 2–3:143–51.
Aoki, Keith. 1998. “Neocolonialism, Anticommons Property, and Biopiracy in the
(Not-So-Brave) New World Order of International Intellectual Property Protec-
tion.” Indiana Journal of Global Legal Studies 6:11.
Appadurai, Arjun. 1991. “Disjuncture and Difference in the Global Economy.” Public
Culture 2, no. 2:1–24.
———. 2001. Globalization. Durham: Duke University Press.
Applbaum, Kalman. 2006. “Educating for Global Mental Health: American Pharma-
ceutical Companies and the Adoption of SSRIs in Japan.” Global Pharmaceuticals:
Ethics, Markets, Practices, ed. Adriana Petryna, Andrew Lakoff, and Arthur Klein-
man, 85–110. Durham: Duke University Press.
Apter, Andrew. 2005. The Pan-African Nation: Oil and the Spectacle of Culture in Nige-
ria. Chicago: University of Chicago Press.
Arendt, Hannah. 1968. The Origins of Totalitarianism. New York: Harcourt.
Arnold, G., S. L. Hyman, R. A. Mooney, and R. S. Kirby. 2003. “Plasma Amino Acids
Profiles in Children with Autism: Potential Risk of Nutritional Deficiencies.”
Journal of Autism and Developmental Disorders 33, no. 4:449–54.
Arrighi, Giovanni. 1994. The Long Twentieth Century: Money, Power, and the Origins of
Our Times. New York: Verso.
Austin, J. L. 1962. How to Do Things with Words. Cambridge: Harvard University
Press.
Autism Research Institute. 2005. “Treatment Options for Mercury/Metal Toxicity
and Autism and Related Developmental Disabilities: Consensus Position Paper.”
San Diego: Autism Research Institute, http://www.autism.com, accessed 10 Janu-
ary 2008.
Badiou, Alain. 2003. Saint Paul: The Foundation of Universalism. Stanford: Stanford
University Press.
Bakhtin, Mikhail. 1984. Problems of Dostoevsky’s Poetics. Ed. and trans. Caryl Emer-
son. Minneapolis: University of Minnesota Press.
Balibar, Étienne. 1994. Masses, Classes, Ideas: Studies on Politics and Philosophy before
and after Marx. New York: Routledge.
———. 1995a. “Ambiguous Universality.” Differences 7, no. 1:48–74.
———. 1995b. The Philosophy of Marx, trans. Chris Turner. London: Verso.

BIBLIOGRAPHY 455
Barry, Andrew. 2001. Political Machines: Governing a Technological Society. London:
Athlone.
Bartfai, Tamas, and Graham V. Lees. 2006. Drug Discovery: From Bedside to Wall
Street. Amsterdam: Elsevier/Academic.
Barton, John, and Peter Berger. 2001. “Patenting Agriculture.” Issues in Science and
Technology 17, no. 4:43–50.
Barzyk, T., K. Conlon, T. Chahine, D. Hammond, V. Zartarian, and B. Schultz. 2009.
“Tools Available to Communities for Conducting Cumulative Exposure and Risk
Assessments.” Journal of Exposure Science and Environmental Epidemiology 20:371–
84.
Bateson, Gregory. 1972. Steps to an Ecology of Mind: Collected Essays in Anthropology,
Psychiatry, Evolution, and Epistemology. San Francisco: Chandler.
Battiata, Mary. 2004. “Whose Life Is It, Anyway?” Washington Post, 2 August.
Bayart, Jean-François. 1997. The Criminalization of the State in Africa. Bloomington:
Indiana University Press.
Beijing Genomics Institute. 2001. “Rice Genome Sequencing: The Science, the In-
ternational Effort, and the Chinese Contribution.” Rice GD: Genome Database of Chi-
nese Super Hybrid Rice. http://rice.genomics.org.cn/rice/index2.jsp, accessed 25
April 2008.
Bennetzen, Jeffrey. 2002. “Opening the Door to Comparative Plant Biology.” Science
296, no. 5565:60–63.
Bergel, Salvador. 1998. “Patentamiento de genes y secuencias de genes.” Revista de
Derecho y Genoma Humano 8:31–59.
Berman, Marshall. 1988. All That Is Solid Melts into Air: The Experience of Modernity.
New York: Viking Penguin.
Bernstein, Charles. 1992. A Poetics. Cambridge: Harvard University Press.
Berton, Justin. 2006. “Hotels for the Canine Carriage Trade.” San Francisco Chronicle,
13 November.
Bettelheim, Bruno. 1967. The Empty Fortress: Infantile Autism and the Birth of the Self.
New York: Free Press.
Bhabha, Homi K. 1994. The Location of Culture. New York: Routledge.
Bhandari, Bhupesh. 2005. The Ranbaxy Story: The Rise of an Indian Multinational.
New Delhi: Penguin Viking.
Biehl, João. 2001. “Vita: Life in the Zone of Social Abandonment.” Social Text 19,
no. 3 (September): 131–49.
Bloom, Floyd. 2000. “Rices, Races, and Riches.” Science 288, no. 5468:973.
Bloor, David. 1991 [1976]. Knowledge and Social Imagery. Chicago: University of Chi-
cago Press.
Blumenfeld, Marta, et al. 2002. “Genes, Proteins and Biallelic Markers Related to
Central Nervous System Disease.” U.S. Patent and Trade Office, United States
Patent Application 20020081584.
Bollier, David. 2002. Why the Public Domain Matters: The Endangered Wellspring of
Creativity, Commerce, and Democracy. Washington: New America Foundation.

456 BIBLIOGRAPHY
Bourdieu, Pierre. 1980. The Logic of Practice, trans. Richard Nice. Stanford: Stanford
University Press.
Bowker, Geoffrey. 2001. “Biodiversity Datadiversity.” Social Studies of Science 309,
no. 5:643–84.
Bowker, Geoffrey, and Susan Leigh Star. 1999 Sorting Things Out: Classification and
Its Consequences. Cambridge: MIT Press.
Boyle, James. 1996. Shamans, Software, and Spleens: Law and the Constitution of the
Information Society. Cambridge: Harvard University Press.
———. 2003. “Foreword: The Opposite of Property.” Law and Contemporary Prob-
lems 66, no. 1.
Bradbury, Jane. 2001. “Teasing Out the Genetics of Bipolar Disorder.” Lancet 357
(19 May): 1596.
Bradley, Janis. 2006. Dog Bites: Problems and Solutions. Animals and Society Institute
Policy Paper. Baltimore: Animals and Society Institute.
Bralley, Alexander, and Richard S. Lord. 2002. Laboratory Evaluations in Molecular
Medicine: Nutrients, Toxicants, and Cell Regulators. Norcross, Ga.: Institute for Ad-
vances in Molecular Medicine.
Branson, Douglas. 1998. “Securities Litigation in State Courts: Something Old,
Something New, Something Borrowed.” Washington University Law Quarterly
76:509–36.
Brayne, C., and P. Calloway. 1988. “Normal Ageing, Impaired Cognitive Function,
and Senile Dementia of the Alzheimer’s Type: A Continuum?” Lancet 1:1265–67.
Bremner, G. Alex, and David P. Y. Lung. 2003. “Spaces of Exclusion: The Signifi-
cance of Cultural Identity in the Formation of European Residential Districts in
British Hong Kong, 1877–1904.” Environment and Planning D: Society and Space
21, no. 2:223–52.
Brenner, Neil. 1999. “Globalization as Reterritorialisation: The Re-scaling of Urban
Governance in the European Union.” Urban Studies 36, no. 3:431–51.
Bright, A. O., and O. Taylor. 1999. “A Socio-Economic and Demographic Assessment
of the Extent of Self Medication in Nigeria.” West African Journal of Pharmacy 13,
no. 2:74–77.
Brotherton, Sean. 2008. “We Have to Think like Capitalists but Continue Being So-
cialists: Emergent Capital, Shifting Ideologies, and Cuba’s Changing Health Sec-
tor.” American Ethnologist 35, no. 2:259–74.
Brown, P. 1992. “Popular Epidemiology and Toxic Waste Contamination: Lay and
Professional Ways of Knowing.” Journal of Health and Social Behavior 33, no.
3:267–81.
Brown, P., et al. 2001. “A Gulf of Difference: Disputes over Gulf War-Related Ill-
nesses.” Health and Illness 42, no. 3:235–57.
Brown, Sasha. 2004. “Biology Program Launched: Computational and Systems Bi-
ology Program Is First of Its Kind in U.S.” Tech Talk 49, no. 7 (27 October): 1, 5.
Brumfiel, Geoff. 2005. “Chinese Students in the U.S.: Taking a Stand.” Nature 438,
no. 7066 (17 November): 278–79.

BIBLIOGRAPHY 457
Burchell, Graham, Colin Gordon, and Peter Miller, eds. 1991. The Foucault Effect:
Studies in Governmentality: With Two Lectures by and an Interview with Michel Fou-
cault. Chicago: University of Chicago Press.
Burr, Benjamin. 1997. “An International Collaboration to Sequence the Rice Ge-
nome.” http://web.archive.org/web/20040128094512/http://rgp.dna.affrc.go.jp/
rgp/News/Newsletter.html, accessed 25 April 2008.
———. 1999. Oryza: Newsletter for International Rice Genome Sequencing Project
(January), http://web.archive.org/web/20000817044232; http://rgp.dna.affrc.go
.jp/rgp/News/Newsletter.html, accessed 25 April 2008.
Burr, Benjamin, and Takuji Sasaki. 2002. “International Rice Genome Sequencing
Project.” http://web.archive.org/web/20061002013440/rgp.dna.affrc.go.jp/E/
IRGSP/bnl/Guidelines.html, accessed 25 April 2008.
Butler, Declan. 2002. “Geneticists Get Steamed Up over Public Access to Rice Ge-
nome. Nature 416:111–12.
Butler, Declan, and Peter Pockley. 2000. “. . . as Monsanto Makes Rice Genome Pub-
lic.” Nature 404, no. 6778:534–36.
Butler, Judith. 2000a. “Competing Universalities.” Contingency, Hegemony, Univer-
sality: Contemporary Dialogues on the Left, ed. Judith Butler, Ernesto Laclau, and
Slavoj Žižek, 136–81. London: Verso, 2000.
———. 2000b. “Dynamic Conclusions.” Contingency, Hegemony, Universality: Con-
temporary Dialogues on the Left, ed. Judith Butler, Ernesto Laclau, and Slavoj Žižek,
263–80. London: Verso.
Butler, Judith, Ernesto Laclau, and Slavoj Žižek, eds. 2000. Contingency, Hegemony,
Universality: Contemporary Dialogues on the Left. London: Verso.
Buttel, Frederick, and Jill Belsky. 1987. “Biotechnology, Plant Breeding, and Intel-
lectual Property: Social and Ethical Dimensions.” Science, Technology, and Human
Values 12, no. 1:31–49.
Caffentzis, Constantine George. 1995. “Fundamental Implications of the Debt Crisis
for Social Reproduction in Africa.” In Paying the Price: Women and the Politics of
International Economic Strategy, ed. Maria Rosa Dalla Costa and Giovanna Dalla
Costa, 15–41. London: Zed.
Callon. Michel. 1986. “Some Elements of a Sociology of Translation: Domestication
of the Scallops and the Fishermen of St. Brieuc Bay.” Power, Action, and Belief:
A New Sociology of Knowledge?, ed. John Law, 196–233. London: Routledge and
Kegan Paul.
———. 1998. “The Embeddedness of Economic Markets in Economics.” The Laws of
the Markets, ed. Michel Callon, 1–57. Oxford: Blackwell.
Callon, Michel, Yuval Millo, and Fabian Muniesa, eds. 2007. Market Devices. London:
Wiley-Blackwell.
Cantor, David. 1992. “Cortisone and the Politics of Drama, 1949–55.” Medical Inno-
vations in Historical Perspective, ed. John V. Pickstone, 165–84. New York: St.
Martin’s.
Cantrell, Ronald, and Timothy Reeves. 2002. “The Cereal of the World’s Poor Takes
Centre Stage.” Science 296:53.

458 BIBLIOGRAPHY
Carruthers, Bruce, and Arthur Stinchcombe. 1999. “The Social Structure of
Liquidity: Flexibility, Markets, and States.” Theory and Society 28, no. 3:353–82.
Castells, Manuel. 2000. The Rise of Network Society. Malden, Mass.: Blackwell.
Centers for Disease Control. 2005. “Are You the Picture of Health?” Screen for Life:
National Colorectal Cancer Action Campaign. Centers for Disease Control.
Chadarevian, Soraya de. 2002. Designs for Life: Molecular Biology after World War II.
Cambridge: Cambridge University Press.
Charan, Ram, and Noel M. Tichy. 1998. Every Business Is a Growth Business: How Your
Company Can Prosper Year after Year. New York: Three Rivers.
Cheah, Pheng, and Bruce Robbins, eds. 1998. Cosmopolitics: Thinking and Feeling Be-
yond the Nation. Minneapolis: University of Minnesota Press.
Chen, K.C. 1998. “ICH in Taiwan.” Drug Information Journal, 32:1301–7S.
Choy, Timothy K. 2005. “Articulated Knowledges: Environmental Forms after Uni-
versality’s Demise.” American Anthropologist 107, no. 1:5–18.
Clarke, Adele. 2007. “Reflections on the Reproductive Sciences in Agriculture in the
U.K. and U.S., ca. 1900–2000.” Studies in History and Philosophy of Biological and
Medical Sciences 38, no. 2:316–39.
Clifford, James, and George Marcus. 1986. Writing Culture: The Poetics and Politics of
Ethnography. Berkeley: University of California Press.
Coca- Cola Company. 1996. The Coca-Cola Company 1996 Annual Report. Atlanta:
Coca- Cola Company.
Coghlan, Andy. 1996. “Chinese Deal Sparks Eugenics Protests.” New Scientist 2056
(16 November): 4.
Cohen, Lawrence. 1998. No Aging in India: Alzheimer’s, the Bad Family, and Other
Modern Things. Berkeley: University of California Press.
———. 1999. “Where It Hurts: Indian Material for an Ethics of Organ Transplanta-
tion.” Daedelus 128:135–65.
———. 2005. “Operability, Bioavailability, and Exception.” Global Assemblages: Tech-
nology, Politics, and Ethics, ed. Aihwa Ong and Stephen J. Collier, 79–90. Malden,
Mass: Blackwell.
Cohn, Carol. 1987. “Sex and Death in the Rational World of Defense Intellectuals.”
Signs 12, no. 4:687–728.
Coleman, Gabriella. 2005. “The Social Construction of Freedom in Free and Open
Source Software: Hackers, Ethics, and the Liberal Tradition.” Ph.D. diss., Univer-
sity of Chicago, Department of Anthropology.
Collier, Stephen, and Aihwa Ong. 2005. “Global Assemblages, Anthropological
Problems.” Global Assemblages: Technology, Politics, and Ethics, ed. Aihwa Ong and
Stephen J. Collier, 3–21. Malden, Mass: Blackwell.
Collins, Harry. 1974. “The TEA Set: Tacit Knowledge and Scientific Networks.” Sci-
ence Studies 4:165–86. Reprinted in Science in Context: Readings in the Sociology of
Science, ed. Barry Barnes and David Edge, 44–64. Cambridge: MIT Press, 1982.
Comaroff, Jean, and John Comaroff. 2000. Millennial Capitalism and the Culture of
Neoliberalism. Durham: Duke University Press.

BIBLIOGRAPHY 459
Comaroff, John, and Jean Comaroff. 2006. “Figuring Crime: Quantifacts and the
Production of the Un/Real.” Public Culture 18, no. 1:209–46.
Cook, Arthur G. 2006. Forecasting for the Pharmaceutical Industry: Models for New
Product and In-Market Forecasting and How to Use Them. Aldershot: Gower.
Coombe, Rosemary. 1996. “Left Out on the Information Highway.” Oregon Law Re-
view 75, no. 237:237–48.
———. 1998. The Cultural Life of Intellectual Properties: Authorship, Appropriation, and
the Law. Durham: Duke University Press.
Cooper, Frederick. 2002. Africa since 1940: The Past of the Present. Cambridge: Cam-
bridge University Press.
Cooper, Melinda. 2008. Life as Surplus: Biopolitics in the Neo-liberal Era. Seattle: Uni-
versity of Washington Press.
Corelli, Rae, with Brian Bergman. 1997. “Getting the Call.” MacLean’s 110, no. 41
(13 October): 14.
Covello, Vincent T., and Frederick H. Allen. 1988. Seven Cardinal Rules of Risk Com-
munication. Washington: Environmental Protection Agency.
Craddock, Nick, and Ian Jones. 1999. “Genetics of Bipolar Disorder,” Journal of Medi-
cal Genetics 36, no. 8:585–94.
Creative Commons. 2007. “History.” Creative Commons Wiki, http://wiki.cre
ativecommons.org, accessed 12 April 2008.
Crenshaw, Kimberlé. 1990. “Demarginalizing the Intersection of Race and Sex: A
Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and
Antiracist Politics.” The Politics of Law: A Progressive Critique, 2d edn, ed. David
Kairys, 195–217. New York: Pantheon.
———. 1991. “Mapping the Margins: Intersectionality, Identity Politics, and Vio-
lence against Women of Color.” Stanford Law Review 34:1241–99.
Crichton, Michael. 2006. “This Essay Breaks the Law.” New York Times, 19 March,
WK-13.
Cronon, William. 1991. Nature’s Metropolis: Chicago and the Great West. New York:
W. W. Norton.
Crow, T. J. 1986. “The Continuum of Psychosis and Its Implication for the Structure
of the Gene.” British Journal of Psychiatry 149:419–29.
Curran, Laura C., et al. 2007. “Behaviors Associated with Fever in Children with Aut-
ism Spectrum Disorders.” Pediatrics 120:e1386–92.
Das, Veena. 2002. “The Practise of Organ Transplants: Networks, Documents, Trans-
lations.” Living and Working with the New Medical Technologies, ed. Margaret Lock,
Allan Young, and Alberto Cambrosio, 263–87. Cambridge: Cambridge Univer-
sity Press.
Daston, Lorraine, and Peter Galison. 1992. “The Image of Objectivity.” Representa-
tions 40:81–128.
Data Protection Act. 1998. Council Directive No. 96/9/EC of 11 March 1996. Official
Journal of the European Communities, L77, 27.3.96.
Davies, Gail. 2006. Patterning the geographies of organ transplantation: corpore-

460 BIBLIOGRAPHY
 ality, generosity and justice. Transactions of the Institute of British Geographers 31,
no. 3:257–71.
de Landa, Manuel. 2006. A New Philosophy of Society: Assemblage Theory and Social
Complexity. New York: Continuum.
Deleuze, Gilles, and Felix Guattari. 1987 [1980]. A Thousand Plateaus: Capitalism and
Schizophrenia. Translated, with a foreword by Brian Massumi. Minneapolis: Uni-
versity of Minnesota Press.
DeNicola, Lane. 2007. “Techniques of the Environmental Observer: India’s Earth Re-
mote Sensing Program in the Age of Global Information.” Ph.D. diss., Rensselaer
Polytechnic Institute, Department of Science and Technology Studies.
Derrida, Jacques. 1974 [1967]. Of Grammatology. Baltimore: John Hopkins Univer-
sity Press.
———. 1989–90. “Force of Law: The Mystical Foundation of Authority.” Cardozo
Law Review 11, nos. 5–6:920–1046.
———. 1994. Specters of Marx: The State of the Debt, the Work of Mourning, and the
New International. New York, Routedge.
———. 1998. Monolingualism of the Other: Or, The Prosthesis of Origin. Palo Alto:
Stanford University Press.
———. 2001. On Cosmopolitanism and Forgiveness. New York: Routledge.
———. 2002. Negotiations. Stanford: Stanford University Press.
Derry, Margaret. 2003. Bred for Perfection: Shorthorn Cattle, Collies, and Arabian Horses
since 1800. Baltimore: Johns Hopkins University Press.
Descola, Philippe. 1996. The Spears of Twilight: Life and Death in the Amazon Jungle.
New York: New Press.
Diawara, Manthia. 1998. “Toward a Regional Imaginary in Africa.” The Cultures of
Globalization, ed. Fredric Jameson and Masao Miyoshi, 103–24. Durham: Duke
University Press.
Dietz, Thomas, Elinor Ostrom, and Paul Stern. 2007. “The Struggle to Govern the
Commons.” Science 302:1907–12.
DiMasi, J. A., R. W. Hansen, H. G. Grabowski, and L. Lasagna. 1991. Cost of innova-
tion in the pharmaceutical industry. Journal of Health Economics (July): 107–42.
Dixon, Bernard. 1988. “Genetic Engineers Call for Regulation.” Scientist 2, no. 8
(2 May): 22.
Dodier, Nicolas. 1998. “Clinical Practice and Procedures in Occupational Medicine.”
Differences in Medicine: Unraveling Practices, Techniques, and Bodies, ed. Marc Berg
and Annemarie Mol, 53–85. Durham: Duke University Press.
Doll, John J. 1998. “The Patenting of DNA.” Science 280:689–90.
———. 2001. “Staking Claims: Talking Gene Patents.” Scientific American 285, no.
2:28.
Doull, John. 2001. “Toxicology Comes of Age.” Annual Review of Pharmacology and
Toxicology 41:1–21.
Downey, Gary Lee, and Joseph Dumit, eds. 1998. Cyborgs and Citadels: Anthropologi-
cal Interventions in Emerging Sciences and Technologies. Santa Fe: School of Ameri-
can Research.

BIBLIOGRAPHY 461
Doyle, Richard. 1997. On Beyond Living: Rhetorical Transformations of the Life Sciences.
Stanford: Stanford University Press.
———. 2003. Wetwares: Experiments in Postvital Living. Minneapolis: University of
Minnesota Press.
Dumit, Joseph. 2002. “Drugs for life.” Molecular Interventions 2 (2002): 124–27.
Dumit, Joseph. 2009a. “Normal Insecurities, Healthy Insecurities.” The Insecure
American: How We Got Here and What We Should Do about It, ed. Hugh Guster-
son and Catherine Besteman, 163–81. Berkeley: University of California Press.
———. 2009b. “Pharmaceutical Witnessing: Drugs for Life in an Era of Direct-to-
Consumer Advertising.” Technologized Images, Technologized Bodies, ed. Jeannette
Edwards, Penny Harvey, and Peter Wade, 37–84. New York: Berghahn, 2010.
Eccles, Robert G., and Sarah C. Mavrinac. 1995. “Improving the Corporate Disclo-
sure Process.” MIT Sloan Management Review, 15 July.
Edelson, Ed. 2006. “U.S. Experts Issue New Heart Disease Treatment Guidelines.”
ExpressScripts Drug Digest. http://www.drugdigest.org/wps/portal/ddigest.
Edwards, Paul. 1996. The Closed World: Computers and the Politics of Discourse in Cold
War America. Cambridge: MIT Press.
———. 1999. “Global Climate Science, Uncertainty and Politics: Data-Laden Mod-
els, Model-Filtered Data.” Science as Culture 8, no. 4:437–72.
———. 2010. A Vast Machine: Computer Models, Climate Data, and the Politics of
Global Warming. Cambridge: MIT Press.
Ehrlich, Jennifer. 2000. “A Breath of Fresh Poison.” South China Morning Post, 14 Au-
gust, 13.
Elbe, Stefan. 2005. “AIDS, Security, Biopolitics.” International Relations 19, no. 4:403–
19.
Elyachar, Julia. 2005. Markets of Dispossession: NGOs, Economic Development, and the
State in Egypt. Durham: Duke University Press.
Ember, Louis. 2007a. “Chemical Security.” Chemical and Engineering News 85, no. 21
(6 May): 8.
———. 2007b. “Securing Chemicals.” Chemical and Engineering News 85, no. 46
(12 November): 11.
Engels, Frederich. 1972 [1895]. “Engels to J. Bloch in Königsberg,” letter of 21–22 Sep-
tember 1890. Historical Materialism (Marx, Engels, Lenin), trans. Brian Baggins,
294–96. Moscow: Progress.
Enserink, Martin. 1998. “Physicians Wary of Scheme to Pool Icelanders’ Genetic
Data.” Science 281:890–91.
Environmental Defense Fund. 2003. “About Us.” Environmental Defense Fund,
http://www.edf.org, accessed 13 January 2009.
Epstein, Steven. 1996. Impure Science: AIDS, Activism, and the Politics of Knowledge.
Berkeley: University of California Press.
———. 2007. Inclusion: The Politics of Difference in Medical Research. Chicago: Uni-
versity of Chicago Press.
Erickson, C. A., et al. 2005. “Gastrointestinal Factors in Autistic Disorder: A Critical
Review.” Journal of Autism and Developmental Disorders 35, no. 6:713–27.

462 BIBLIOGRAPHY
Escamilla, Michael A., et al. 1999. “Assessing the Feasibility of Linkage Disequilib-
rium Methods for Mapping Complex Traits: An Initial Screen for Bipolar Disorder
Loci on Chromosome 18.” American Journal of Human Genetics 64:1670–78.
Espeland, Wendy, and Mitchell Stevens. 1998. “Commensuration as a Social Pro-
cess.” Annual Review of Sociology 24:314–43.
Ernst and Young. 2006. “Contract Research: Contracted for Trouble?” R&D Directions
12, no. 5 (May). http://www.pharmalive.com/magazines/randd.
Evans, Peter, Dietrich Rueschemeyer, and Theda Skocpol, eds. 1985. Bring the State
Back In. Cambridge: Cambridge University Press.
Express Scripts. 2007. 2006 Drug Trend Report. St. Louis: Express Scripts.
Fanon, Frantz. 1966. The Wretched of the Earth. New York: Grove.
Farquhar, Judith. 2002. Appetites: Food and Sex in Postsocialist China. Durham: Duke
University Press.
Fassin, Diddier. 2004. “Citizens and Humans: Competing Paradigms in the Produc-
tion of the Political Subject in South African AIDS.” Paper presented at the “Re-
framing Infectious Diseases” conference, Institute for the Humanities, Univer-
sity of Michigan, 4 December.
Feld, Steven. 1996. “Waterfalls of Song: An Acoustemology of Place Resounding in
Bosavi, Papua New Guinea.” Senses of Place, ed. Steven Feld and Keith H. Basso,
91–136. Santa Fe: School of American Research Press.
Feld, Steven, and Keith H. Basso, eds. 1996. Senses of Place. Santa Fe: School of
American Research Press.
Feldman Maryann, Alessandra Colaianni, and Connie Kang Liu. 2007. “Lessons
from the Commercialization of the Cohen-Boyer Patents: The Stanford University
Licensing Program.” Health and Agricultural Innovation: A Handbook of Best Prac-
tice, ed. Anatole Krattiger, Richard T. Mahoney, Lita Nelsen, Jennifer A. Thomson,
Alan B. Bennett, Kanikaram Satyanarayana, Gregory D. Graff, Carlos Fernandez,
and Stanley P. Kowalski, 1797–1808. Oxford: MIHR/PIPRA.
Felman, Shoshana. 2002. The Scandal of the Speaking Body: Don Juan with J. L. Austin,
or Seduction in Two Languages. Stanford: Stanford University Press.
Ferguson, James. 1999. Expectations of Modernity: Myths and Meanings of Urban Life
on the Zambian Copperbelt. Berkeley: University of California Press.
———. 2005. “Seeing like an Oil Company: Space, Security, and Global Capital in
Neoliberal Africa.” American Anthropologist 107, no. 3:377–82.
———. 2006. Global Shadows: Africa in the Neoliberal World Order. Durham: Duke
University Press.
Finegold, S. M., et al. 2002. “Gastrointestinal Microflora Studies in Late- Onset Aut-
ism.” Clinical Infectious Diseases 35 (1 September): S6–16.
Firn, David. 2000. “Takeovers Cure for German Biotechs.” Financial Times, 14 June,
http://www.ft.com, accessed 14 June 2000.
Fischer, Michael M. J. 1980. Iran: From Religious Dispute to Revolution. Cambridge:
Harvard University Press.
———. 2003. Emergent Forms of Life and the Anthropological Voice. Durham: Duke
University Press.

BIBLIOGRAPHY 463
———. 2007a. “Culture and Cultural Analysis as Experimental Systems.” Cultural
Anthropology 22, no. 1:1–64.
———. 2007b. “Four Genealogies for a Recombinant Anthropology of Science and
Technology.” Cultural Anthropology 22, no. 4:539–615.
Fisher, Jill A. 2009. Medical Research for Hire: The Political Economy of Pharmaceutical
Clinical Trials. New Brunswick, N.J.: Rutgers University Press.
Fong, Tan Shook. 1998. “Development of Clinical Trials in Singapore,” Drug Informa-
tion Journal, 32:1199–1201S.
Fortun, Kim. 2001. Advocacy after Bhopal: Environmentalism, Disaster, New Global
Orders. Chicago: University of Chicago Press.
———. 2004. “From Bhopal to the Informating of Environmental Health: Risk
Communication in Historical Perspective.” Landscapes of Exposure: Knowledge and
Illness in Modern Environments, ed. Gregg Mitman, Michelle Murphy, and Christo-
pher Sellers. Osiris 19:283–96 [special issue].
Fortun, Kim, and Michael Fortun. 2005. “Scientific Imaginaries and Ethical Plateaus
in Contemporary U.S. Toxicology.” American Anthropologist 107, no. 1 (March):
43–54.
———. 2007. “Experimenting with the Asthma Files.” Paper presented at the Ex-
perimental Systems Workshop, University of California, Irvine, 13–14 April.
Fortun, Michael. 2000. “Experiments in Ethnography and Its Performance.” Avail-
able online at www.mannvernd.is.
———. 2001. “Mediated Speculations in the Genomics Futures Markets.” New Ge-
netics and Society 20:139–56.
———. 2008. Promising Genomics: Iceland and deCODE Genetics in a World of Specula-
tion. Berkeley: University of California Press.
Fortun, Michael, and Kim Fortun. 1999. “Due Diligence and the Pursuit of Transpar-
ency: The Securities and Exchange Commission, 1996.” Paranoia within Reason:
A Casebook on Conspiracy as Explanation (Late Editions 6), ed. George Marcus,
157–93. Chicago: University of Chicago Press.
Fosket, Jennifer R. 2002. “Breast Cancer Risk and the Politics of Prevention: Analysis
of a Clinical Trial.” Ph.D. diss., University of California, San Francisco.
Foucault, Michel. 1973. The Order of Things: An Archaeology of the Human Sciences.
New York: Vintage.
———. 1977. Discipline and Punish: The Birth of the Prison, trans. Alan Sheridan. New
York: Vintage.
———. 1990 [1978]. The History of Sexuality, vol. 1. New York: Vintage.
———. 2001. Fearless Speech. Los Angeles: Semiotext(e).
Franklin, Sarah. 1997. Embodied Progress: A Cultural Account of Assisted Conception.
New York: Routledge.
———. 2007. Dolly Mixtures: The Remaking of Genealogy. Durham: Duke Univer-
sity Press.
Franklin, Sarah, and Margaret M. Lock. 2003. Remaking Life and Death: Toward an
Anthropology of the Biosciences. Santa Fe: School of American Research Press.

464 BIBLIOGRAPHY
Franklin, Sarah, and Susan MacKinnon, eds. 2002. Relative Values: Reconfiguring Kin-
ship Studies. Durham: Duke University Press.
Franklin, Sarah, and Helena Ragone, eds. 1997. Reproducing Reproduction: Kinship,
Power, and Technological Innovation. Philadelphia: University of Pennsylvania
Press.
Frew, Sarah E., et al. 2007. “India’s Health Biotech Sector at a Crossroads.” Nature
Biotechnology 25, no. 4:403–17.
Fujimura, Joan H. 2000. “Transnational Genomics: Transgressing the Boundary be-
tween the ‘Modern/West’ and the ‘Premodern/East.’” Doing Science + Culture, ed.
Roddey Reid and Sharon Traweek. 71–92. New York: Routledge.
Gaia, Vince. 2002. “Fears over Rice Genome Access.” New Scientist 18, no. 38 (19
March). http://www.newscientist.com/article/dn2061-fears- over-rice-genome-
access.html.
Galison, Peter. 1997. Image and Logic: A Material Culture of Microphysics. Chicago:
University of Chicago Press.
Gaonkar, Dilip Parameshwar, ed. 2001. Alternative Modernities. Durham: Duke Uni-
versity Press.
Geertz, Clifford. 1973. The Interpretation of Cultures. New York: Basic Books.
Gelernter, J. 1995. “Editorial: Genetics of Bipolar Affective Disorder: Time for An-
other Reinvention?” American Journal of Human Genetics 56:1762, 1766.
Gellner, Ernest. 1983. Nations and Nationalism. Ithaca: Cornell University Press.
Genetic Engineering News. 2000. July issue.
Gershon, Michael D. 1998. The Second Brain: The Scientific Basis of Gut Instinct and a
Groundbreaking New Understanding of Nervous Disorders of the Stomach and Intes-
tine. New York: Harper Collins.
Gibbons, Sahra, and Carlos Novas, eds. 2007. Making Biosociality: Biologies and Iden-
tities in Formation. New York: Routledge.
Gilder, George. 1981. Wealth and Poverty. New York: Basic Books.
Gilliland, F., et al. 2005. “Air Pollution Exposure Assessment for Epidemiologic
Studies of Pregnant Women and Children: Lessons Learned from the Centers
for Children’s Environmental Health and Disease Prevention Research.” Environ-
mental Health Perspectives 113 (October): 1447–54.
Ginsburg, Faye, and Rayna Rapp, eds. 1995. Conceiving the New World Order: The
Global Politics of Reproduction. Berkeley: University of California Press.
Golub, D. R., et al. “Molecular Classification of Cancer: Class Discovery and Class
Prediction by Gene Expression Monitoring.” Science 286:531–37.
Goobar, Walter. 1998. “De quien es esa naricita?” Siglo XXI (27 August): 66.
Good, Mary-Jo Del Vecchio, et al. 2005. “Medicine on the Edge: Conversations with
Oncologists.” Technoscientific Imaginaries: Conversations, Profiles, and Memoirs, ed.
George E. Marcus, 129–52. Chicago: University of Chicago Press.
Gordon, Avery. 2004. Keeping Good Time: Reflections on Knowledge, Power, and People.
Boulder: Paradigm.
Gottschall, Elaine. 1994. Breaking the Vicious Cycle: Intestinal Health through Diet.
Baltimore: Kirkton.

BIBLIOGRAPHY 465
Grace, Patricia. 1998. Baby No-Eyes. Honolulu: University of Hawaii Press.
Graeber, David. 2001. An Anthropological Theory of Value. London: Palgrave Macmil-
lan.
Gramsci, Antonio. 1992. Prison Notebooks, ed. Joseph Buttigeig. New York: Colum-
bia University Press.
Grefe, Edward, and Marty Linsky. 1995. The New Corporate Activism: Harnessing the
Power of Grassroots Tactics for Your Organization. New York: McGraw-Hill.
Greene, Jeremy A. 2007. Prescribing by Numbers: Drugs and the Definition of Disease.
Baltimore: Johns Hopkins University Press.
Greener, Mark. 2001. A Healthy Business: A Guide to the Global Pharmaceutical Indus-
try. London: Informa Pharmaceuticals.
Grewal, Inderpal, and Caren Kaplan. 1994. Scattered Hegemonies: Postmodernity and
Transnational Feminist Practices. Minneapolis: University of Minnesota Press.
Grove, Richard. 1995. Green Imperialism: Colonial Expansion, Tropical Island Edens and
the Origins of Environmentalism, 1600–1860. Studies in Environment and History.
Cambridge: Cambridge University Press.
Gupta, Akhil. 1998. Postcolonial Developments: Agriculture in the Making of Modern
India. Durham: Duke University Press.
Haas, Ernst B. 1990. When Knowledge Is Power: Three Models of Change in International
Organizations. Berkeley: University of California Press.
Haas, Peter M. 1990. Saving the Mediterranean: The Politics of Environmental Coopera-
tion. New York: Columbia University Press.
Hacking, Ian. 1998. Mad Travelers: Reflections on the Reality of Transient Mental Ill-
nesses. Charlottesville: University Press of Virginia.
———. 1999. The Social Construction of What? Cambridge: Harvard University
Press.
Hadden, Susan. 1994. “Citizen Participation in Environmental Policy Making.”
Learning from Disaster: Risk Management after Bhopal, ed. Sheila Jasanoff, 91–112.
Philadelphia: University of Pennsylvania Press.
Hamilton, Cindy. 2001. “The Human Genome Diversity Project and the New Biologi-
cal Imperialism.” Santa Clara Law Review 41:619–42.
Hamilton, Lynn. 2000. Facing Autism: Giving Parents Reasons for Hope and Guidance
for Help. Colorado Springs: Waterbrook.
Happe F., A. Ronald, and R. Plomin. 2006. “Time to Give Up on a Single Explanation
for Autism.” Nature Neuroscience 9, no. 10:1218–20.
Haraway, Donna. 1991. Simians, Cyborgs, and Women: The Reinvention of Nature. New
York: Routledge.
———. 1997. Modest_Witness@Second_Millennium.FemaleMan©_Meets_Onco-
Mouse™: Feminism and Technoscience. New York: Routledge.
———. 2003a. “Cloning Mutts, Saving Tigers: Ethical Emergents in Technocultural
Dog Worlds.” Remaking Life and Death: Toward an Anthropology of the Biosciences,
ed. Sarah Franklin and Margaret Lock, 293–327. Santa Fe: School of American
Research Press.

466 BIBLIOGRAPHY
———. 2003b. The Companion Species Manifesto: Dogs, People, and Significant Other-
ness. Chicago: Prickly Paradigm.
———. 2003c. “For the Love of a Good Dog: Webs of Action in the World of Dog
Genetics.” Genetic Nature/Culture: Anthropology and Science beyond the Two-Culture
Divide, ed. Alan H. Goodman, Deborah Heath, and M. Susan Lindee, 111–31.
Berkeley: University of California Press.
———. 2008. When Species Meet. Minneapolis: University of Minnesota Press.
Harbolt, Tami, and Tamara H. Ward. 2001. “Teaming Incarcerated Youth with Shel-
ter Dogs for a Second Chance.” Society and Animals 9, no. 2:177–82.
Hardin, Garrett. 1968. “The Tragedy of the Commons.” Science 162:1243–48.
Hardt, Michael, and Antonio Negri. 2000. Empire. Cambridge: Harvard University
Press.
Harris, Gardiner, and Anahad O’Connor. 2005. “On Autism’s Cause, It’s Parents vs.
Research.” New York Times, 25 June.
Hartouni, Valerie. 1997. Cultural Conceptions: On Reproductive Technologies and the Re-
making of Life. Minneapolis: University of Minnesota Press.
Harvey, David. 1996. Justice, Nature and the Geography of Difference. Cambridge,
Mass.: Blackwell.
———. 2003. The New Imperialism. Oxford: Oxford University Press.
Hayden, Cori. 2003. When Nature Goes Public: The Making and Unmaking of Biopros-
pecting in Mexico. Princeton: Princeton University Press.
Hays, Sharon. 1998. The Cultural Contradictions of Motherhood. New Haven: Yale Uni-
versity Press.
Health Gap Coalition. 2000. Questioning the UNAIDS/Pharmaceutical Industry Initia-
tive: Seven Months and Counting. http://www.healthgap.org/press_releases/00/
121300_HGAP_PS_UNAIDS.pdf.
Healy, David. 2002. The Creation of Psychopharmacology. Cambridge: Harvard Uni-
versity Press.
Helmreich, Stefan. 2003. “Trees and Seas of Information: Alien Kinship and the Bio-
politics of Gene Transfer in Marine Biology and Biotechnology.” American Eth-
nologist 30, no. 3:341–59.
———. 2008. “Species of Biocapital.” Science as Culture 17, no. 4:463–78.
Herbert, Martha R. 2004. “Complexity in Neurobiology: Autism as a Case Study
of Gene-Brain-Immune-Environment Interactions in a Changing World.” Paper
presented at the Second Biennial International Seminar on the Philosophical,
Epistemological and Methodological Implications of Complexity Theory, Havana,
January.
———. 2005a. “Autism: A Brain Disorder, or a Disorder That Affects the Brain?”
Clinical Neuropsychiatry 2, no. 6:354–79.
———. 2005b. “Is the Brain ‘Downstream’? Implications of Biomedical Findings in
Autism.” Presentation at the spring 2005 DAN! Conference, Boston, 14–17 April.
———. 2011. “A Whole Body Systems Approach to ASD.” The Neuropsychology of Aut-
ism, ed. Deborah A. Fein, 499–510. Oxford: Oxford University Press.

BIBLIOGRAPHY 467
Herrera, Stephan. 2001. “The Biotech Boom: Revenge of the Neurons.” Red Herring,
1 October.
Hess, Charlotte, and Elinor Ostrom. 2003. “Ideas, Artifacts, and Facilities: Infor-
mation as a Common-Pool Resource.” Law and Contemporary Problems 66, nos.
1–2:111–45.
Hess, David. 2003. “CAM Cancer Therapies in Twentieth- Century North America: Ex-
amining Continuities and Change.” The Politics of Healing, ed. Robert Johnston,
218–30. New York: Routledge.
Hilgartner, Stephen. 2004. “Mapping Systems and Moral Order: Constituting Prop-
erty in Genome Laboratories.” States of Knowledge: The Co-production of Science and
Social Order, ed. Sheila Jasanoff, 131–41. New York: Routledge.
Hind, Rick, and David Halperin. 2004. “Lots of Chemicals, Little Reaction.” New York
Times, 22 September, §eA , 31.
Hirakawa, Mika, T. Tanaka, Y. Hashimoto, M. Kuroda, T. Takagi, and Y. Nakamura.
2002. “JSNP: A Database of Common Gene Variations in the Japanese Popula-
tion.” Nucleic Acids Research 30, no. 1:158–62.
Hirsch, Eric, and Marilyn Strathern, eds. 2005. Transactions and Creations: Property
Debates and the Stimulus of Melanesia. New York: Berghahn.
Ho, Karen. 2009. Liquidated: An Ethnography of Wall Street. Durham: Duke Univer-
sity Press.
Ho, Louise. 2000 [1997]. “Storm.” New Ends, Old Beginnings, 54. Hong Kong: Asia
2000.
Ho, Mae-Wan. 2001. “Breaching the Knowledge Monopoly: China Trumps the West
in Sequencing Rice Genome.” Rice GD: Genome Database of Chinese Super Hy-
brid Rice, http://btn.genomics.org.cn: 8080/rice/new3.php, accessed 25 April
2008.
Hogle, Linda. 1995. “Standardization across Non-Standard Domains: The Case of
Organ Procurement.” Science, Technology and Human Values 20, no. 4:482–500.
———. 2001. “Chemoprevention for Healthy Women: Harbinger of Things to
Come?” Health 5:311–33.
Holden, Kerry, and David Demeritt. 2008. “Democratising Science? The Politics of
Promoting Biomedicine in Singapore’s Developmental State.” Environment and
Planning D: Society and Space 26, no. 1:68–86.
Holmes, Douglas, and George Marcus. 2005. “Cultures of Expertise and the Manage-
ment of Globalization: Toward the Refunctioning of Ethnography.” Global Assem-
blages: Technology, Politics, and Ethics as Anthropological Problems, ed. Aihwa Ong
and Stephen Collier, 235–52. Oxford: Blackwell.
Hong Yun- Chul, Jong-Han Leem, Eun-Hee Ha, and David C. Christiani. 1999. “PM₁₀
Exposure, Gaseous Pollutants, and Daily Mortality in Inchon, South Korea.” En-
vironmental Health Perspectives 54:108–16.
Huber, Peter. 1993. Galileo’s Revenge: Junk Science in the Courtroom. New York: Basic
Books.
———. 1998. “Saving the Environment from the Environmentalists.” Commentary
105, no. 4 (April): 25–30.

468 BIBLIOGRAPHY
———. 2000. Hard Green: Saving the Environment from the Environmentalists: A Con-
servative Manifesto. New York: Basic Books.
Hughes, Sally. 2001. “Making Dollars out of DNA: The First Major Biotechnology
Patent and the Commercialization of Molecular Biology, 1974–1980.” Isis 92:541–
75.
Hwang, Woo-suk, et al. 2005. “Dogs Cloned from Adult Somatic Cells.” Nature 436,
no. 7051 (4 August): 641.
Ingram, Alan. 2007. “HIV/AIDS, Security and the Geopolitics of U.S.-Nigerian Rela-
tions.” Review of International Political Economy 14, no. 3:510–34.
International Conference on Harmonisation of Technical Requirements for Regis-
tration of Pharmaceuticals for Human Use. 1997. “The Future of the ICH: Con-
ference Statement by the ICH Steering Committee on the Occasion of the Fourth
International Conference on Harmonisation.”
International Rice Genome Sequencing Project. 2008. http://rgp.dna.affrc.go.jp, ac-
cessed 25 June 2011.
Jacob, François. 1982. The Possible and the Actual. Seattle: University of Washington
Press.
———. 1988. The Statute Within. New York: Basic Books.
———. 1993 [1973]. The Logic of Life: A History of Heredity. Princeton: Princeton Uni-
versity Press.
Jain, Sarah Lochlann. 2007. “Living in Prognosis: Toward an Elegiac Politics.” Repre-
sentations 98, no. 1:77–92.
James, S. J., et al. 2004. “Metabolic Biomarkers of Increased Oxidative Stress and
Impaired Methylation Capacity in Children with Autism.” American Journal of
Clinical Nutrition 80:1161–67.
Jameson, Fredric, and Masao Miyoshi. 1998. The Cultures of Globalization. Durham:
Duke University Press.
Jamison, Kay Redfield. 1997. An Unquiet Mind. New York: Random House.
Jasanoff, Sheila. 1992. “Science, Politics and the Renegotiation of Expertise at EPA.”
Osiris 7:195–217.
———. 1995. Science at the Bar: Law, Science, and Technology in America. Cambridge:
Harvard University Press.
———. 2004. “Ordering Knowledge, Ordering Society.” States of Knowledge: The Co-
production of Science and Social Order, ed. Sheila Jasanoff, 13–45. New York: Rout-
ledge.
———. 2005a. Designs on Nature: Science and Democracy in Europe and the United
States. Princeton: Princeton University Press.
———. 2005b. “Let Them Eat Cake: GM Foods and the Democratic Imagination.”
Science and Citizens, ed. Melissa Leach, Ian Scoones, and Brian Wynne, 183–99.
London: Zed.
Jones, Arthur F. 1934. “Erin’s Famous Hounds Finding Greater Glory at Rathmullan.”
American Kennel Gazette 5, no. 5 (31 May).
Juma, Calestous. 1989. The Gene Hunters: Biotechnology and the Scramble for Seeds.
Princeton: Princeton University Press.

BIBLIOGRAPHY 469
Jyonouchi, H., S. Sun, and H. Le. 2001. “Proinflammatory and Regulatory Cytokine
Production Associated with Innate and Adaptive Immune Responses in Chil-
dren with Autism Spectrum Disorders and Developmental Regression.” Journal
of Neuroimmunology 120:170–79.
Kahn, Joan Y. 1978. “A Diagnostic Semiotic.” Semiotica 22:75–106.
Kahn, Jonathan. 2006. “Harmonizing Race: Competing Regulatory Paradigms of
Racial Categorization International Drug Development.” Santa Clara Journal of
International Law 1:34–56.
Kane, Karen. “Drug Error, Not Chelation Therapy, Killed Boy, Expert Says.” Pittsburgh
Post-Gazette, 18 January 2006, http://www.post-gazette.com, accessed 4 August
2007.
Kanner, Leo. 1943. “Autistic Disturbances of Affective Contact.” Nervous Child 10:
217–50.
Kass, Leon. 1997. “The Wisdom of Repugnance.” New Republic 216, no. 22:17–26.
Kassirer, Jerome P. 2005. On the Take: How America’s Complicity with Big Business Can
Endanger Your Health. New York: Oxford University Press.
Kay, Lily. 1996. The Molecular Vision of Life: Caltech, the Rockefeller Foundation, and the
Rise of the New Biology. Oxford: Oxford University Press.
———. 2000. Who Wrote the Book of Life? A History of the Genetic Code. Stanford:
Stanford University Press.
Keating, Peter, and Alberto Cambrosio. 2000. “Biomedical Platforms.” Configura-
tions 8:337–87.
Keller, Evelyn Fox. 1984. A Feeling for the Organism: The Life and Work of Barbara
McClintock. New York: Times Books.
———. 1992. Secrets of Life, Secrets of Death. New York: Routledge.
———. 1995. Refiguring Life: Metaphors of Twentieth-Century Biology. New York:
Columbia University Press.
———. 2002a. The Century of the Gene. Cambridge: Harvard University Press.
———. 2002b. Making Sense of Life: Explaining Biological Development with Models,
Metaphors, and Machines. Cambridge: Harvard University Press.
Kelty, Christopher M. 2004. “Punt to Culture.” Anthropological Quarterly 77, no. 3:
547–58.
———. 2008. Two Bits: The Cultural Significance of Free Software. Durham: Duke
University Press.
Kennedy, Donald. 2002. “The Importance of Rice.” Science 296:13.
Keown, Michelle. 2005. Postcolonial Pacific Writing. New York: Routledge.
Kessler, R. C., et al. 1997. “The Epidemiology of DSM- III- R Bipolar I Disorder in a
General Population Survey.” Psychological Medicine 27, no. 5:1079–90.
Kim, Hyung-Jin. 2008. “South Korean Firm Delivers Commercial Dog Clones.” USA
Today, 5 August.
Kinney, P., S. N. Chillrud, S. Ramstrom, J. Ross, and J. D. Spengler. 2002. “Expo-
sures to Multiple Air Toxics in New York City.” Environmental Health Perspectives
110, no. 4 (August): 539–46.
Kitcher, Philip. 2001. Science, Truth, and Democracy. Oxford: Oxford University Press.

470 BIBLIOGRAPHY
Kittay, Eva Feder. 1999. Love’s Labor: Essays on Women, Equality, and Dependency. New
York: Routledge.
———. 2001. “When Caring Is Just and Justice Is Caring: Justice and Mental Retar-
dation.” Public Culture 13, no. 3:557–79.
Klein, D. F., et al. 2002. “Improving Clinical Trials: American Society of Clinical
Psychopharmacology Recommendations.” Archives of General Psychiatry 59:272–
78.
Kleinman, Arthur. 1999. “Moral Experience and Ethical Reflection: Can Ethnog-
raphy Reconcile Them? ‘A Quandary for the New Bioethics.’” Bioethics and Be-
yond, ed. Arthur Kleinman, Renée C. Fox, and Allan M. Brandt. Daedalus 128, no.
4:68–97 [special issue].
Knorr- Cetina, Karin, and Aaron Victor Cicourel, eds. 1981. Advances in Social Theory
and Methodology: Toward an Integration of Micro and Macro Level Sociology. Boston:
Routledge and Kegan Paul.
Koerner, Brendan. 2003. “That Pudgy Pooch is an Industry’s Best Friend.” New York
Times. 30 November 2003.
Kohn, Eduardo. 2007. “How Dogs Dream: Amazonian Natures and the Politics of
Transspecies Engagement.” American Ethnologist 34, no. 1:3–24.
Kolata, Gina. 2001. “U.S. Panel Backs Broader Steps to Reduce Risk of Heart At-
tacks.” New York Times, 16 May, §eA , 1.
———. 2003. “The Cholesterol Challenge: Just How Low Can You Go?” New York
Times, 2 December 2003.
———. 2005. “Beating Hurdles, Scientists Clone a Dog for a First.” New York Times,
4 August, §eA , 1, 10.
Kopnisky, Kathy L., and Steven Hyman. 2002. “Psychiatry in the Postgenomic Era.”
TEN 4, no. 1:27–31.
Kraepelin, Emil. 1904. “Mixed Conditions of Maniacal-Depressive Insanity.” Lectures
on Clinical Psychiatry, ed. Thomas Johnstone, 69–78. London: Bailliere, Tindall
and Cox.
Kramer, Peter. 1993. Listening to Prozac. New York: Penguin.
Kremer, Michael, and Christopher M. Snyder. 2003. “Why Are Drugs More Profit-
able Than Vaccines?” National Bureau of Economic Research Working Paper No.
9833. New York: William Wood.
Krigsman, A. 2007. “Gastrointestinal Pathology in Autism: Description and Treat-
ment.” Medical Veritas 4:1528–36.
Kroll-Smith, Stephen, and H. Hugh Floyd. 1997. Bodies in Protest: Environmental Ill-
ness and the Struggle over Medical Knowledge. New York: New York University Press.
Krupp, F. 1999. “A Letter from EDF’s Executive Director.” Scorecard, http://scorecard
.goodguide.com, accessed July 2002.
Kuo, Wen-Hua. 2005. “Japan and Taiwan in the Wake of Bioglobalization: Drugs,
Race and Standards.” Ph.D. diss., Massachusetts Institute of Technology.
Kuo, Wen-Hua. 2008. “Understanding Race at the Frontier of Pharmaceutical Regu-
lation: An Analysis of the Racial Difference Debate at the ICH.” Journal of Law,
Medicine, and Ethics, 36, no. 3:498–505.

BIBLIOGRAPHY 471
Kuriyama, Shigehisa. 1999. The Expressiveness of the Body and the Divergence of Greek
and Chinese Medicine. New York: Zone.
Kushak, Rafail I., Harland S. Winter, Nathan S. Farber, and Timothy M. Buie. 2005.
“Gastrointestinal Symptoms and Intestinal Disaccharidase Activities in Children
with Autism: 49.” Abstracts: North American Society of Pediatric Gastroenterol-
ogy, Hepatology, and Nutrition Annual Meeting, 20–22 October, Salt Lake City.
Journal of Pediatric Gastroenterology and Nutrition 41, no. 4:508.
La Feria, Ruth. 2006. “Woman’s Best Friend, or Accessory?” New York Times,
7 December, §eE , 4, 7.
Laclau, Ernesto. 2000. “Identity and Hegemony: The Role of Universality in the Con-
stitution of Political Logics.” Contingency, Hegemony, Universality: Contemporary
Dialogues on the Left, ed. Judith Butler, Ernesto Laclau, and Slavoj Žižek, 44–89.
London: Verso.
Laidler, James R. 2004. “Through the Looking Glass: My Involvement with Aut-
ism Quackery.” http://www.autism-watch.org/about/bio2.shtml, accessed 28 July
2011.
Lakoff, Andrew. 2000. “Adaptive Will: The Evolution of Attention Deficit Disorder.”
Journal of the History of the Behavioral Sciences 36, no. 2 (spring): 149–69.
———. 2006. Pharmaceutical Reason: Knowledge and Value in Global Psychiatry. Cam-
bridge: Cambridge University Press.
Lalli, Frank. 1995. “Now Only Clinton Can Stop Congress from Hurting Small In-
vestors Like You.” Money, 1 December. http://money.cnn.com/magazines/money
mag/moneymag_archive/1995/12/01/207589/index.htm.
Landecker, Hannah. 2007. Culturing Life: How Cells Became Technologies. Cambridge:
Harvard University Press.
Landes, William, and Richard Posner. 2003. The Economic Structure of Intellectual
Property Law. Cambridge: Harvard University Press.
Landow, George P. 1992. Hypertext: The Convergence of Contemporary Critical Theory
and Technology. Baltimore: Johns Hopkins University Press.
Lang, Martha Elizabeth. 1998. “Welcome to the Plastic City: Community Responses
to the Leominster Autism Cluster.” Ph.D. diss., Brown University, Department
of Sociology.
Latham, A. J. H. 1998. Rice: The Primary Commodity. New York: Routledge.
Latour, Bruno. 1987. Science in Action. Cambridge: Harvard University Press.
———. 1988. The Pasteurization of France, trans. Alan Sheridan and John Law. Cam-
bridge: Harvard University Press.
———. 1992. “Where Are the Missing Masses? The Sociology of a Few Mundane
Artifacts.” Shaping Technology / Building Society: Studies in Sociotechnical Change,
ed. Wiebe E. Bijker and John Law, 225–58. Cambridge: MIT Press.
———. 1993. We Have Never Been Modern. Cambridge: Harvard University Press.
———. 1999. Pandora’s Hope: Essays on the Reality of Science Studies. Cambridge:
Harvard University Press.
Latour, Bruno, and Steve Woolgar. 1986 [1979]. Laboratory Life: The Construction of
Scientific Facts. Princeton: Princeton University Press.

472 BIBLIOGRAPHY
Lavery, Brian. 2004. “For Dogs in New York, a Glossy Look at Life.” New York Times,
16 August, §eC , 8.
Leboyer, Marion, et al. 1998. “Psychiatric Genetics: Search for Phenotypes.” Trends
in Neurosciences 21, no. 3:102–5.
Lee, Benjamin, and Edward LiPuma. 2002. “Cultures of Circulation: The Imagina-
tions of Modernity.” Public Culture 14, no. 1:191–213.
Lepkowski, Wil. 1984. “Bhopal Disaster Spotlights Chemical Hazard Issues.” Chemi-
cal and Engineering News 62, no. 52 (24 December): 19–20.
———. 1994. “The Restructuring of Union Carbide.” Learning from Disaster: Risk
Management after Bhopal, ed. Sheila Jasanoff, 22–43. Philadelphia: University of
Pennsylvania Press.
Lerach, William S. 1998. “The Private Securities Litigation Reform Act of 1995—
27 Months Later: Securities Class Action Litigation under the Private Securities
Litigation Reform Act’s Brave New World.” Washington University Law Quarterly
76:597–644.
Lessig, Lawrence. 2004. Free Culture: How Big Media Uses Technology and the Law to
Lock Down Culture and Control Creativity. New York: Penguin.
Lévi-Strauss, Claude. 1962. The Savage Mind. Chicago: University of Chicago Press.
———. 1970 [1964]. The Raw and the Cooked, trans. John Weightman and Doreen
Weightman. London: Jonathan Cape.
Levitz, Jennifer. 2005. “Desperate Parents Seek Autism’s Cure.” Providence Journal,
27 August, 1.
Levy, S. E., et al. 2003. “Use of Complementary and Alternative Medicine among
Children Recently Diagnosed with Autistic Spectrum Disorder.” Journal of De-
velopmental and Behavioral Pediatrics 24, no. 6:418–23.
Levy, S. E., and S. L. Hyman. 2003. “Use of Complementary and Alternative Treat-
ments for Children with Autistic Spectrum Disorders Is Increasing.” Pediatric
Annals 32, no. 10:685–91.
Lewis, Lisa S. 1998. Special Diets for Special Kids: Understanding and Implementing
Special Diets to Aid in the Treatment of Autism and Related Developmental Disorders.
Arlington, Texas: Future Horizons.
Lewis, Michael. 1999. The New New Thing: A Silicon Valley Story. New York: W. W.
Norton.
Licking, Ellen, et al. 2000. “Move Over, Dot- Coms: Biotech Is Back.” Businessweek,
26 March. http://www.businessweek.com/2000/00_10/b3671142.htm, accessed
26 March 2000.
Lin, Marie, C. C. Chu, S. L. Chang, H. L. Lee, J.-H. Loo, T. Akaza, T. Juji, J. Ohashi,
and K. Tokunaga. 2001. “The Origin of Minnan and Hakka, the So- called ‘Taiwan-
ese,’ Inferred by HLA Study.” Tissue Antigen 57:192–99.
Lin, Yeong-Liang, Herng-Der Chern, and Mong-Ling Chu. 2003. “Taiwan’s Experi-
ence with the Assessment of the Acceptability of the Extrapolation of Foreign
Clinical Data for Registration Purposes.” Drug Information Journal, 37:143–45.
Lindblad-Toh, Kerstin, et al. 2005. “Genome Sequence, Comparative Analysis, and
Haplotype Structure of the Domestic Dog.” Nature 438:803–19.

BIBLIOGRAPHY 473
Litman, Jessica. 1990. “The Public Domain.” Emory Law Journal 39:965–1024.
Lock, Margaret, Allan Young, and Alberto Cambrosio, eds. 2000. Living and Working
with the New Medical Technologies: Intersections of Inquiry. Cambridge: Cambridge
University Press.
London, Eric, and Rush Etzel. 2000. “The Environment as an Etiologic Factor in Aut-
ism: A New Direction in Research.” Environmental Health Perspectives Supplements
108, no. S3 (June): 401–4.
Long, Janice, and David Hanson. 1985. “Bhopal Triggers Massive Response from
Congress, the Administration.” Chemical and Engineering News 63, no. 6 (11 Feb-
ruary): 53–60.
Lopate, Phillip. 1995. The Art of the Personal Essay: An Anthology from the Classical Era
to the Present. New York: Anchor.
Lord, C., et al. 2000. “The Autism Diagnostic Observation Schedule—Generic: A
Standard Measure of Social and Communication Deficits Associated with the
Spectrum of Autism. Journal of Autism and Developmental Disorders 30, no. 3:205–
23.
Lord, C., M. Rutter, and A. LeCouteur. 1994. “Autism Diagnostic Interview—
Revised: A Revised Version of a Diagnostic Interview for Caregivers of Individu-
als with Possible Pervasive Developmental Disorders.” Journal of Autism and De-
velopment Disorders 24, no. 5:659–85.
Luhrmann, Tanya. 2000. Of Two Minds: The Growing Disorder in American Psychiatry.
New York: Alfred A. Knopf.
Luxemburg, Rosa. 1968. The Accumulation of Capital, trans. Agnes Schwarzschild.
New York: Monthly Review.
MacKenzie, Donald, Fabian Muniesa, and Lucia Siu, eds. 2008. Do Economists Make
Markets? On the Performativity of Economics. Princeton: Princeton University
Press.
Mackenzie, Michael, Peter Keating, and Alberto Cambrosio. 1990. “Patents and Free
Scientific Information in Biotechnology: Making Monoclonal Antibodies Propri-
etary.” Science, Technology, and Human Values 15, no. 1:65–83.
Mackey, Nathaniel. 1992. “Other: From Noun to Verb.” Representations 39 (summer):
51–70.
MacKinnon, Dean F., Kay Redfield Jamison, and J. Raymond DePaulo. 1997. “Genet-
ics of Manic Depressive Illness.” Annual Review of Neuroscience 20, no. 1:355–74.
Maiwada, Jude. 2004. “70% of Nigerians Patronize Traditional Medicine Practition-
ers.” Nigerian Newsday, 11 August. http://www.nasarawastate.org/newsday/news/
culture/10811174558.html.
Mander, Jerry, and Victoria Tauli- Corpuz, eds. 2006. Paradigm Wars: Indigenous
People’s Resistance to Globalization. Berkeley: University of California Press.
Manuel, D. G., et al. 2006. “Effectiveness and Efficiency of Different Guidelines on
Statin Treatment for Preventing Deaths from Coronary Heart Disease: Modeling
Study.” British Medical Journal 332:1419.
Marcus, George E. 1995a. “Ethnography in/of the World System: The Emergence of
Multi-Sited Ethnography.” Annual Review of Anthropology 24:95–117.

474 BIBLIOGRAPHY
———, ed. 1995b. Technoscientific Imaginaries: Conversations, Profiles, and Memoirs.
Chicago: University of Chicago Press.
———. 2005. “Multi-Sited Ethnography: Five or Six Things I Know about It Now.”
Paper presented at workshop on “Problems and Possibilities of Multi-Sited
Ethnography,” University of Sussex, 27 June.
———. 2007. “Ethnography Two Decades after Writing Culture: From the Experi-
mental to the Baroque.” Anthropological Quarterly 80, no. 4:1127–45.
Marcus, George E., and Michael M. J. Fischer. 1986. Anthropology as Cultural Cri-
tique: An Experimental Moment in the Human Sciences. Chicago: University of Chi-
cago Press.
Marcus, George E., and Erkan Saka. 2005. “Assemblages.” Theory Culture and Society
23, nos. 2–3:107–8.
Marks, Harry M. 1992. “Cortisone, 1949: A Year in the Political Life of a Drug.” Bul-
letin of the History of Medicine 66:419–39.
———. 1997. The Progress of Experiment: Science and Therapeutic Reform in the United
States, 1900–1990. Cambridge: Cambridge University Press.
Marshall, Eliot. 2002. “A Deal for the Rice Genome.” Science 296, no. 5565:34–36.
Martin, Emily. 1991. “The Egg and the Sperm: How Science has Constructed a Ro-
mance Based on Stereotypical Male-Female Roles.” Signs 16, no. 3:485–501.
———. 1995. Flexible Bodies: The Role of Immunity in American Culture from the Days
of Polio to the Age of AIDS. Boston: Beacon.
———. 1998. “Anthropology and the Cultural Study of Science.” Science, Technology
and Human Values 23, no. 1:24–44.
———. 1999. “Toward an Anthropology of Immunity: The Body as Nation State.”
The Science Studies Reader, ed. Mario Biagioli, 358–71. New York: Routledge.
———. 2007. Bipolar Expeditions: Mania and Depression in American Culture. Prince-
ton: Princeton University Press.
Marx, Karl. 1959. Capital: A Critical Analysis of Capitalist Production. Trans. from the
3d German edn by Samuel Moore and Edward Aveling, ed. Friedrich Engels. Mos-
cow: Foreign Languages.
———. 1974 [1894]. Capital: A Critique of Political Economy, vol. 3, ed. Frederick
Engels. Moscow: Progress.
———. 1976 [1867]. Capital: A Critique of Political Economy, vol. 1, trans. Ben Fowkes.
London: Penguin.
———. 1977 [1852]. The Eighteenth Brumaire of Louis Bonaparte. Moscow: Progress.
———. 1978a [1867]. “The Communist Manifesto.” The Marx-Engels Reader, vol. 1,
ed. Robert Tucker, 496–500. New York: W. W. Norton.
———. 1978b [1867]. “Speech at the Anniversary of the People’s Paper.” The Marx-
Engels Reader, vol. 1, ed. Robert Tucker, 577–78. New York: W. W. Norton.
———. 1993 [1857]. Grundrisse: Foundations of a Critique of Political Economy, trans.
Martin Nicolaus. London: Penguin.
———. 2009 [1858]. A Contribution to a Critique of Political Economy. General Books
Club, http://generalbooksclub.com.

BIBLIOGRAPHY 475
Marx, Karl, and Frederick Engels. 1963 [1845]. The German Ideology. New York: Inter-
national.
Maurer, Bill. 2005. Mutual Life, Limited: Islamic Banking, Alternative Currencies, Lat-
eral Reason. Princeton: Princeton University Press.
Mbembe, Achille. 2001. On the Postcolony. Berkeley: University of California Press.
McCaffery, Richard. 2001. “The Reason to Avoid Biotech Stocks.” The Motley Fool,
5 April, accessed 5 April 2001.
McCaig, Donald. 1992 [1984]. Nop’s Trials. Guilford, Del.: Lyons.
———. 1998a. Eminent Dogs, Dangerous Me. Guilford, Del.: Lyons.
———. 1998b. Nop’s Hope. Guilford, Del.: Lyons.
McCandless, Jacquelyn. 2003. “Children with Starving Brains: A Medical Treatment
Guide for Autism Spectrum Disorder.” 2d edn. Putney, Vt.: Bramble.
McGinn, Anne Platt. 2002. “From Rio to Johannesburg: Reducing the Use of Toxic
Chemicals Advances Health and Sustainable Development.” World Summit Policy
Briefs (WorldWatch Institute, 25 June): 3.
McGovern, Cammie. “Autism’s Parent Trap,” New York Times, 5 June 2006, 3.
McInnes, L. Alison, et al. 1999. “Mapping Genes for Psychiatric Disorders and Be-
havioral Traits.” Current Opinion in Genetics and Development 8:287–92.
McMichael, A. J., H. R. Anderson, B. Brunekreef, and A. J. Cohen. 1998. “Inappro-
priate Use of Daily Mortality Analyses to Estimate Longer-Term Mortality Effects
of Air Pollution.” International Journal of Epidemiology 27, no. 3:450–53.
McPherson, James M. 1990. Battle Cry of Freedom: The American Civil War. New York:
Penguin.
Meek, James. 2000. “Why You Are First in the Great Gene Race.” Guardian, 15
November, 4.
———. 2002. “Decode Was Meant to Save Lives . . . Now It’s Destroying Them.”
Guardian, 13 October, 2.2.
Melucci, Albert. 1996. Challenging Codes: Collective Action in the Information Age.
Cambridge: Cambridge University Press.
Merton, Robert. 1942. “The Normative Structure of Science.” The Sociology of Science.
267–78. Chicago: University of Chicago Press.
Mol, Annemarie, and John Law. 1994. “Regions, Networks and Fluids: Anaemia and
Social Topology.” Social Studies of Science 24:641–71.
Monod, Jacques. 1971. Chance and Necessity. New York: Alfred A. Knopf.
Monsanto. 2010. http://www.monsanto.com, accessed 25 June 2011.
Moolgavkar, Suresh H., George E. Luebeck, Thomas A. Hall, Elizabeth L. Ander-
son. 1995. “Air Pollution and Daily Mortality in Philadelphia.” Epidemiology 6,
no. 5:476–84.
Moore, Donald S. 2005. Suffering for Territory: Race, Place, and Power in Zimbabwe.
Durham: Duke University Press.
Morey, Darcy. 2006. “Burying Key Evidence: The Social Bond between Dogs and
People.” Journal of Archeological Science 33:158–75.
Morgan, Steve, Morris Barer, and Robert Evans. 2000. “Health Economists Meet the

476 BIBLIOGRAPHY
 Fourth Tempter: Drug Dependency and Scientific Discourse.” Health Economics
9:659–67.
Moss, Giles D. 2007. Pharmaceuticals—Where’s the Brand Logic? Branding Lessons and
Strategy. New York: Pharmaceutical Products Press.
Mulkay, Michael. 1976. “The Mediating Role of the Scientific Elite.” Social Studies of
Science 6, nos. 3–4:445–71.
Mullin, Molly H. 2001. Culture in the Marketplace: Gender, Art, and Value in the Ameri-
can Southwest. Durham: Duke University Press.
Murakami, Yoichiro. 1998. Anzengaku [On security]. Tokyo: Seitosha.
Murch, S. H., et al. 2004. “Retraction of an Interpretation.” Lancet 363, no. 9411:750.
Murphy, Michelle. 2000. “The ‘Elsewhere within Here,’ and Environmental Illness:
Or, How to Build Yourself a Body in a Safe Space.” Configurations 8:87–120.
Myers, Natasha. 2006. “Animating Mechanism: Animation and the Propagation of
Affect in the Lively Arts of Protein Modeling.” Science Studies 19, no. 2:6–30.
———. 2007. “Modeling Proteins, Making Scientists: An Ethnography of Pedagogy
and Visual Culture in Contemporary Structural Biology.” Ph.D. diss., Massachu-
setts Institute of Technology, Science and Technology Studies.
Naanen, Ben. 2004. “The Political Economy of Oil and Violence in the Niger Delta.”
ACAS Bulletin: The Warri Crisis, the Niger Delta, and the Nigerian State, no. 68 (fall):
4–9.
Nash, Roderick. 1982. Wilderness and the American Mind. New Haven: Yale Univer-
sity Press.
National Center for Biotechnology Information. 2008. “GenBank Overview.” http://
www.ncbi.nlm.nih.gov, accessed 3 May 2011.
National Health Research Institutes. 2003. Proceedings of 2003 Symposium on Statisti-
cal Methodology for Evaluation of Bridging Evidence. Nankang, Taipei.
Navarra, Gabriela. 1998. “De la euforia a la depression.” La Nación, 22 July, §e6, 4.
Neal, Andrea. 2005. “Trained Dogs Transforming Lives: A Service Program to Bene-
fit People with Disabilities Is Also Helping U.S. Prison Inmates Develop a Pur-
pose for Their Lives.” Saturday Evening Post 277, no. 5 (1 September): 64–65.
Nelkin, Dorothy, and Laurence Tancredi. 1989. Dangerous Diagnostics: The Social
Power of Biological Information. New York: Basic Books.
Nestle, Marion. 2008. Pet Food Politics: The Chihuahua in the Coal Mine. Berkeley:
University of California Press.
Nguyen, Vinh-Kim. 2004. “Antiretroviral Globalism, Biopolitics, and Therapeutic
Citizenship.” Global Assemblages: Technology, Politics, and Ethics as Anthropological
Problems, ed. Aihwa Ong and Stephen Collier, 124–44. Oxford: Blackwell.
———. 2007. “Experimentality: Massive AIDS Intervention in Africa as Military
Therapeutic Complex.” Paper presented at the Experimental Systems Confer-
ence, University of California, Irvine, 13–14 April.
Noble, David. 1979. America by Design: Science, Technology, and the Rise of Corporate
Capitalism. Oxford: Oxford University Press.
Normile, Dennis. 2002. “Syngenta Agrees to Wider Release.” Science 296, no. 5574
(7 June): 1785–87.

BIBLIOGRAPHY 477
Normile, Dennis, and Elizabeth Pennisi. 2002. “Rice Boiled Down to Bare Essen-
tials.” Science 296, no. 5565 (7 June): 32–36.
Novas, Carlos, and Nikolas Rose. 2004. “Biological Citizenship.” Global Assemblages:
Technology, Politics, and Ethics as Anthropological Problems, ed. Aihwa Ong and
Stephen Collier, 439–63. Oxford: Blackwell.
Nutley, Caroline ed. 2000. The Value and Benefits of ICH to Industry. http://www
.ich.org/ichnews/publications/browse/article/the-values-and-benefits- of-ich-to-
industry.html, last accessed on 18 July 2011.
Okonta, Ike. 2004. “Death-Agony of a Malformed Political Order.” ACAS Bulletin: The
Warri Crisis, the Niger Delta, and the Nigerian State, no. 68 (fall): 23–29.
Okonta, Ike, and Oronto Douglass. 2003. Where Vultures Feast. London: Verso.
Ong, Aihwa. 2000. “Graduated Sovereignty in Southeast Asia.” Theory, Culture, and
Society 17, no. 4:55–75.
Ong, Aihwa. 2006. Neoliberalism as Exception: Mutations in Citizenship and Sover-
eignty. Durham: Duke University Press.
Ong, Aihwa, and Stephen Collier, eds. 2005. Global Assemblages: Technology, Politics,
and Ethics as Anthropological Problems. Oxford: Blackwell.
Orum, Paul. 2008. Chemical Security 101: What You Don’t Have Can’t Leak or Be Blown
Up by Terrorists. Washington: Center for American Progress.
Ostrom, Elinor, Joanna Burger, Christopher Field, Richard Norgaard, and David Poli-
cansky. 1999. “Revisiting the Commons: Local Lessons, Global Challenges.” Sci-
ence 284, no. 5412:278–82.
Ovbiagele, Godwin. 2000. “Decorous Drug Distribution Channels: Challenges of the
Democratic Dispensation.” EKO Pharmacist (November): 19–38.
“Override the Securities Bill Veto.” 1995. Washington Post, 22 December, §eA , 18.
Palsson, Gisli, and Paul Rabinow. 1999. “Iceland: The Case of a National Human
Genome Project.” Anthropology Today 15, no. 5:14–18.
Page, Theodore. 2000. “Metabolic Approaches to the Treatment of Autism Spectrum
Disorders.” Journal of Autism and Developmental Disorders 30, no. 5:463–69.
Pangborn, Jon, and Sidney Baker. 2005. Autism: Effective Biomedical Treatments: Have
We Done Everything We Can for This Child? Individuality in an Epidemic. San Diego:
Autism Research Institute.
Paoloni, M. C., C. Mazcko, E. Fox, T. Fan, S. Lana, et al. 2010. “Rapamycin Pharmaco-
kinetic and Pharmacodynamic Relationships in Osteosarcoma: A Comparative
Oncology Study in Dogs,” PLoS ONE 5, no. 6:e11013.
Patel, Molini, and Rachel Miller. 2009. “Air Pollution and Childhood Asthma: Re-
cent Advances and Future Directions.” Current Opinion in Pediatrics 21, no. 2
(April): 235–42.
Paul, Diana. 1998. The Politics of Heredity: Essays on Eugenics, Biomedicine, and the
Nature-Nurture Debate. Albany: State University of New York Press.
Pemberton, Stephen. 2004. “Canine Technologies, Model Patients: The Historical
Production of Hemophiliac Dogs in American Biomedicine.” Industrializing Or-
ganism: Introducing Evolutionary History, ed. Susan R. Schrepfer and Philip Scran-
ton, 191–213. New York: Routledge.

478 BIBLIOGRAPHY
Pennisi, Elizabeth. 2000. “Stealth Genome Rocks Rice Researchers.” Science 288:
239–41.
Perino, Michael A. 1997. “What We Know and Don’t Know about the Private Secu-
rities Litigation Reform Act of 1995.” Testimony before the Subcommittee on
Finance and Hazardous Materials of the Committee on Commerce, U.S. House
of Representatives, 21 October. Securities Class Action Clearinghouse, http://secu
rities.stanford.edu.
Perkins, Greg. 2002. “Principles of Product Research and Development.” Pharma-
ceutical Marketing: Principles, Environment, and Practice, ed. Mickey C. Smith,
E. M. “Mick” Kolassa, Greg Perkins, and Bruce Siecker, 103–42. New York: Phar-
maceutical Products Press.
Peterson, Kristin. 2005. “The Tenofovir Trials in Nigeria: Agency, Knowledge and
Science.” Paper presented at the Michigan State University Center for Ethics and
Humanities in the Life Sciences, 23 February.
Petkova, Elena, with Peter Veit. 2000. “Environmental Accountability beyond the
Nation-State: The Implications of the Aarhus Convention.” Washington: World
Resources Institute.
Petryna, Adriana. 2002. Life Exposed: Biological Citizens after Chernobyl. Princeton:
Princeton University Press.
———. 2005. “Ethical Variability: Drug Development and Globalizing Clinical
Trials.” American Ethnologist 32, no. 2:183–97.
Petryna, Adriana. 2006. “Globalizing Human Subjects Research.” Global Pharmaceu-
ticals: Ethics, Markets, Practices, ed. Adriana Petryna, Andrew Lakoff, and Arthur
Kleinman, 33–60. Durham: Duke University Press.
Petryna, Adriana, Andrew Lakoff, and Arthur Kleinman, eds. 2006. Global Pharma-
ceuticals: Ethics, Markets, Practices. Durham: Duke University Press.
“Pets Contribute to China’s Economy.” 2005. China Daily, 14 February, http://www
.chinadaily.com.cn/english. Accessed 17 August 2008.
Pharmaceuticals Manufacturing Group, Manufacturing Association of Nigeria (PMG-
MAN), 2001. “Dangers Posed to Life and the Economy by Drugs and Medicines
from Illegal Sources.” Presentation at the Public Hearing of the Health and Social
Services Committee, Federal House of Representatives, National Assembly, Nige-
ria, March.
Pharmaceutical Research and Manufacturers of America (PhRMA). 2000. “Why Do
Prescription Drugs Cost So Much . . . and Other Questions about Your Medi-
cines.” http://www.phrma.org/publications, accessed 11 August 2006.
Pharmaceutical Research and Manufacturers of America (PhRMA). 2006. Pharma-
ceutical Industry Profile 2006. Washington: PhRMA.
Pharmacists Council of Nigeria (PCN). 2007. PCN List of Registered Pharmacies. Lagos:
Pharmacists Council of Nigeria.
Piasecki, Bruce. 1995. Corporate Environmental Strategy: The Avalanche of Change since
Bhopal. New York: John Wiley and Sons.
Pickering, G. W. 1968. High Blood Pressure, 2d edn. London: Churchill.

BIBLIOGRAPHY 479
Plotkin, Mariano. 2000. Freud in the Pampas: The Emergence and Development of a
Psychoanalytic Culture in Argentina. Stanford: Stanford University Press.
“PMDA Challenges for Global Drug Development including Japan.” Session 281 at
the Forty-third Annual Meeting of the Drug Information Association, Atlanta,
17–21 June.
Polanyi, Michael. 1962. “The Republic of Science, Its Political and Economic Theory.”
Lecture delivered at Roosevelt University, 11 January.
———. 1966. The Tacit Dimension. New York: Doubleday.
Pollack, Andrew. 2006. “In Trials for New Cancer Drugs, Family Pets Are Benefiting,
Too.” New York Times, 24 November, §eA , 1.
Pomfret, Johan, and Deborah Nelson. 2000. “In Rural China, a Genetic Mother
Lode.” Washington Post, 20 December, §eA , 1.
Postone, Moishe. 1993. Time, Labor, and Social Domination: A Reinterpretation of
Marx’s Critical Theory. Cambridge: Cambridge University Press.
Potrykis, Ingo. 2001. “Golden Rice and Beyond.” Plant Physiology 125 (March): 1157–
61.
Public Citizen. 2001. “R x R&D Myths: The Case against the Drug Industry’s R&D
‘Scare Card.’” Available at http://www.citizen.org/documents/ACFDC.pdf, last ac-
cessed on 18 July 2011.
Rabinow, Paul. 1992. “Artificiality and Enlightenment: From Sociobiology to Bio-
sociality.” Zone 6: Incorporations, ed. Jonathan Crary, 234–52. New York: Zone.
———. 1995. Making PCR: A Story of Biotechnology. Chicago: University of Chicago
Press.
———. 1996. Essays on the Anthropology of Reason. Princeton: Princeton University
Press.
———. 1999. “Artificiality and Enlightenment: From Sociobiology to Biosociality.”
The Science Studies Reader, ed. Mario Biagioli, 407–16. New York: Routledge.
———. 2003. Anthropos Today: Reflections on Modern Equipment. Princeton: Prince-
ton University Press.
———. 2004. “Midst Anthropology’s Problems.” Global Assemblages: Rationality,
Technology, Ethics, ed. Aihwa Ong and Stephen J. Collier, 4–54. Malden, Mass.:
Blackwell.
Raffles, Hugh. 2002. In Amazonia: A Natural History. Princeton: Princeton Univer-
sity Press.
Rai, Arti, and Rebecca Eisenberg. 2003. “Bayh-Dole Reform and the Progress of Bio-
medicine.” Law and Contemporary Problems 66, nos. 1–2 (winter–spring): 289–
314.
Rapp, Rayna. 2000a. “Extra Chromosomes and Blue Tulips: Medico-Familial Inter-
pretations.” Living and Working with the New Medical Technologies: Intersections of
Inquiry, ed. Margaret Lock, Allan Young, and Alberto Cambrosio, 184–208. Cam-
bridge: Cambridge University Press.
———. 2000b. Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in
America. New York: Routledge.

480 BIBLIOGRAPHY
Rapp, Rayna, and Faye Ginsburg. 2001. “Enabling Disability: Rewriting Kinship, Re-
imagining Citizenship.” Public Culture 13, no. 3:533–56.
Rawls, John. 2005 [1971]. A Theory of Justice. Cambridge: Belknap.
Read, Jason. 2003. The Micro-Politics of Capital: Marx and the Pre-History of the Present.
Albany: State University of New York Press.
Reardon, Jenny. 2001. “The Human Genome Diversity Project: A Case Study in Co-
production.” Social Studies of Science 31:357–88.
———. 2004. Race to the Finish: Identity and Governance in an Age of Genomics.
Princeton: Princeton University Press.
Regalado, Antonio. 1999. “Inventing the Pharmacogenomics Business.” American
Journal of Health System Pharmacy 56, no. 1:40–50.
Rheinberger, Hans-Jörg. 1997. Toward a History of Epistemic Things: Synthesizing Pro-
teins in the Test Tube. Stanford: Stanford University Press.
———. 1998. “Experimental Systems, Graphematic Spaces.” Inscribing Science: Sci-
entific Texts and the Materiality of Communication, ed. Timothy Lenoir, 285–303.
Stanford: Stanford University Press.
———. 2006. Epistemologie des Konkreten: Studien zur Geschichte der moderne Biolo-
gie. Frankfurt am Main: Suhrkamp.
Rice Information System. 2003. “About RISe.” Beijing Genomics Institute, http://
rise.genomics.org.cn, accessed 2008.
Richler, J., et al. 2006. “Is There a ‘Regressive Phenotype’ of Autism Spectrum Dis-
order Associated with the Measles-Mumps-Rubella Vaccine? A CPEA Study.” Jour-
nal of Autism and Developmental Disorders 36, no. 3:299–316.
Rimland, Bernard. 1964. Infantile Autism: The Syndrome and Its Implications for a Neu-
ral Theory of Behavior. Des Moines: Meredith.
———. 1973. “The Effect of High Dosage Levels of Certain Vitamins on the Behav-
ior of Children with Severe Mental Disorders.” Orthomolecular Psychiatry: Treat-
ment of Schizophrenia, ed. David R. Hawkins and Linus Pauling. San Francisco:
W. H. Freeman.
———. 1976. “Psychological Treatment versus Megavitamin Therapy.” Modern
Therapies: Noted Practitioners Describe Twelve Different Types of Therapy and the Prob-
lems Each Can Help You Solve, ed. Virginia Binder, Arnold Binder, and Bernard
Rimland, 194–211. Englewood Cliffs, N.J.: Prentice-Hall.
______. 2003. “Autism Is Treatable: Congressional Testimony of Bernard Rimland,
Ph.D., November 19, 2003.” San Diego: Autism Research Institute.
Rimland, Bernard, and Stephen M. Edelson. 2003. Treating Autism: Parent Stories of
Hope and Success. San Diego: Autism Research Institute.
Risch, Neil J. 2000. “Searching for Genetic Determinants in the New Millennium.”
Nature 405:847–56.
Risch, Neil, and David Botstein. 1996. “A Manic Depressive History.” Nature Genet-
ics 12, no. 4:351–53.
Robbins-Roth, Cynthia. 2000. From Alchemy to IPO: The Business of Biotechnology.
Cambridge, Mass.: Perseus.

BIBLIOGRAPHY 481
Robertson, A. P. N. D. “Corruption, ‘Shadow Revenues’ and Capital Flight.” Unpub-
lished manuscript.
Robinson, Cedric. 2001. The Anthropology of Marxism. London: Ashgate.
Rodman, Margaret. 1992. “Empowering Place: Multilocality and Multivocality.”
American Anthropologist 94:640–56.
Roitman, Janet. 2005. Fiscal Disobedience: An Anthropology of Economic Regulation in
Central Africa. Princeton: Princeton University Press.
Ronell, Avital. 2005. The Test Drive. Urbana: University of Illinois Press.
Rose, Carol. 1986. “The Comedy of the Commons: Custom, Commerce, and Inher-
ently Public Property.” University of Chicago Law Review 53, no. 3:711–81.
Rose, Deborah Bird. 2006. “What If the Angel of History Were a Dog?” Cultural
Studies Review 12, no. 1:67–78.
Rose, G. A., Kay-Tee Khaw, and Michael G. Marmot. 2008. Rose’s Strategy of Preventive
Medicine: The Complete Original Text, new edn. Oxford: Oxford University Press.
Rosen, Richard A. 1998. “The Statutory Safe Harbor for Forward-Looking State-
ments after Two and a Half Years: Has It Changed the Law? Has It Achieved What
Congress Intended?” Washington University Law Quarterly 76:645–80.
Rosenberg, Charles. 2002. “The Tyranny of Diagnosis: Specific Entities and Indi-
vidual Experience.” Milbank Quarterly 80:237–60.
Rosenwald, Andreas, George Wright, Wing C. Chan, Joseph M. Connors, Elias Campo,
Richard I. Fisher, Randy D. Gascoyne, H. Konrad Muller-Hermelink, Erlend B.
Smeland, Jena M. Giltnane, Elaine M. Hurt, Hong Zhao, Lauren Averett, Liming
Yang, Wyndham H. Wilson, Elaine S. Jaffe, Richard Simon, Richard D. Klausner,
John Powell, Patricia L. Duffey, Dan L. Longo, Timothy C. Greiner, Dennis D.
Weisenburger, Warren G. Sanger, Bhavana J. Dave, James C. Lynch, Julie Vose,
James O. Armitage, Emilio Montserrat, Armando López- Guillermo, Thomas M.
Grogan, Thomas P. Miller, Michel LeBlanc, German Ott, Stein Kvaloy, Jan De-
labie, Harald Holte, Peter Krajci, Trond Stokke, and Louis M. Staudt. 2002. “The
Use of Molecular Profiling to Predict Survival after Chemotherapy for Diffuse
Large-B- Cell Lymphoma.” New England Journal of Medicine 346, no. 25:1937–47.
Roy, Arundhati. 2005. “People vs. Empire.” In These Times, 3 January, 16–19.
Russell, Edmund. 2004. “The Garden in the Machine: Toward an Evolutionary His-
tory of Technology.” Industrializing Organisms: Introducing Evolutionary History,
ed. Susan R. Schrepfer and Philip Scranton, 1–16. New York: Routledge.
Sacks, Harvey, and Gail Jefferson. 1992. Lectures on Conversation. Oxford: Blackwell.
Salako, Lateef. 1997. “Health for All Nigerians—So Far, So What?” Nigerian Quarterly
Journal of Hospital Medicine 7, no. 3:199–206.
Samba, Ebrahim Malick. 2004. “African Health Care Systems: What Went Wrong?”
News-Medical.Net, 8 December, http://www.news-medical.net.
Sanal, Aslihan. 2005. “Flesh Yours, Bones Mine: The Making of the Biomedical Body
in Turkey.” Ph.D. diss., Massachusetts Institute of Technology.
Sandler, R. H., et al. 2000. “Short-Term Benefit from Oral Vancomycin Treatment of
Regressive- Onset Autism.” Journal of Child Neurology 15, no. 7:429–35.

482 BIBLIOGRAPHY
Santora, Marc. 2005. “U.S. Praises Program in City for Children with Asthma.” New
York Times, 14 January, New York Region, 1.
Sarewitz, Daniel, Roger Pielke Jr., and Radford Byerly Jr., eds. 2000. Prediction: Sci-
ence, Decision-making and the Future of Nature. Washington: Island.
Sasich, Larry. 2000. “Public Citizen’s Health Research Group: Comments.” Presen-
tation at the FDA’s Meeting on the Prescription Drug User Fee Act, 15 September.
Sassen, Saskia. 2000. “Spatialities and Temporalities of the Global: Elements for a
Theorization.” Public Culture 12, no. 1:215–32.
———. 2001. The Global City: New York, London, Tokyo. Princeton: Princeton Uni-
versity Press.
Schacter, Bernice Z. 2006. The New Medicines: How Drugs Are Created, Approved, Mar-
keted, and Sold. Westport, Conn.: Praeger.
Scheper-Hughes, Nancy. 1992. Death without Weeping: The Violence of Everyday Life in
Brazil. Berkeley: University of California Press.
Schiebinger, Londa. 1991. “The Mind Has No Sex? Women in the Origins of Modern
Science.” Cambridge: Harvard University Press.
Schienke, Erich. 2006. “Greening the Dragon: Environmental Imaginaries in the
Science, Technology and Governance of Contemporary China.” Ph.D. diss., Rens-
selaer Polytechnic Institute, Department of Science and Technology Studies.
Schofeld, Ian. 2006. “Developing Countries and Growing Threats.” The Scrip 100,
26–27.
Schwartz, Joel. 1991. “Particulate Air Pollution and Daily Mortality in Detroit.” Envi-
ronmental Research 56, no. 2:204–13.
Schwartz, Joel, and Douglas W. Dockery. 1992. “Particulate Air Pollution and Daily
Mortality in Steubenville, Ohio.” American Journal of Epidemiology 135, no. 1:12–
19.
ScienceDaily. 2007. “As Autism Diagnoses Grow, So Do Number of Fad Treatments,
Researchers Say.” ScienceDaily, 21 August, http://www.sciencedaily.com, ac-
cessed 21 August 2007.
Scott, John Paul, and J. H. Fuller. 1965. Genetics and the Social Behavior of the Dog.
Chicago: University of Chicago Press.
Scrip 100: The Analysis of the Pharmaceutical Industry’s Performance and Prospects. Lon-
don: Infoma UK, 2006.
Sedgwick, Eve Kosofsky. 2003. Touching Feeling: Affect, Pedagogy, Performativity. Dur-
ham: Duke University Press.
Seroussi, Karen. 2003 [2000]. Unraveling the Mystery of Autism and Pervasive Develop-
mental Disorder: A Mother’s Story of Research and Recovery. New York: Broadway.
Shalo, Sibyl. 2004. “Built for Speed.” Pharmaceutical Executive 24, no. 2:40–53.
Shapin, Steven. 1999. “The House of Experiment in Seventeenth- Century England.”
The Science Studies Reader, ed. Mario Biagioli, 479–504. New York: Routledge.
Shapin, Steven, and Simon Shaffer. 1985. The Leviathan and the Air Pump: Hobbes,
Boyle, and the Experimental Life. Princeton: Princeton University Press.
Shartin, Emily. 2004. “Difficult Choices Variety of Treatments Face Parents of Autis-
tic Children.” Boston Globe, 25 January, §eA , 1.

BIBLIOGRAPHY 483
Shaw, William. 2001. Biological Treatments for Autism and PDD, 2d rev. edn. Lenexa,
Kan.: Great Plains Laboratory.
Shieve, L., et al. 2006. “Mental Health in the United States: Parental Report of Diag-
nosed Autism in Children Aged 4–17 Years, United States, 2003–2004.” Mor-
bidity and Mortality Weekly Report 55, no. 17:481–86.
Shotwell, Alexis. 2006. “Implicit Understanding and Political Transformation.”
Ph.D. diss., University of California, Santa Cruz.
Sieber, Renee E. 1997. “Computers in the Grassroots: Environmentalists, GIS and
Public Policy.” Ph.D. diss., Rutgers University.
Sigurdsson, Skuli. 2001. “Yin-Yang Genetics, or the HSD deCODE Controversy.” New
Genetics and Society 20, no. 2:103–17.
Silverman, Chloe. 2011. Understanding Autism: Parents, Doctors, and the History of a
Disorder. Princeton: Princeton University Press.
Silverstein, Ken. 1999. “Millions for Viagra, Pennies for Diseases of the Poor.” Na-
tion, 19 July, 13–19.
Sinclair, Jim. 1993. “Don’t Mourn for Us,” originally published in the Autism Net-
work International newsletter, Our Voice 1, no. 3 (1993), based on a presentation
given at the International Conference on Autism, Toronto (1993). http://www.au
treat.com/dont_mourn.html, accessed 28 July 2011.
Singer, Joseph William. 2000. Entitlement: The Paradoxes of Property. New Haven:
Yale University Press.
Smith, Mickey C. 1991. Pharmaceutical Marketing: Strategy and Cases. New York: Phar-
maceutical Products Press.
Smith, Mickey C., E. M. “Mick” Kolassa, Greg Perkins, and Bruce Siecker. 2002.
Pharmaceutical Marketing: Principles, Environment, and Practice. New York: Phar-
maceutical Products Press.
Smith, Wayne, and Robert Dilday, eds. 2003. Rice: Origin, History, Technology, and
Production. Hoboken, N.J.: John Wiley and Sons.
Sokoloff, Alex. 2006. “Informating Greenpeace: Material Practice, Work Culture and
Global Organization.” Ph.D. diss., Rensselaer Polytechnic Institute, Department
of Science and Technology Studies.
Southern Poverty Law Center. 2001. “Woman’s Death Exposes Seamy Prison Scam:
Aryan Brotherhood.” Intelligence Report 102 (summer), http://www.splcenter.org.
Sozialistisches Patientenkollektiv. 1993. SPK—Turn Illness into a Weapon: For Agita-
tion by the Socialist Patients’ Collective at the University of Heidelberg. Heidelberg:
Krrim.
Sperling, Stefan. 2006. “Science and Conscience: Bioethics, Stem Cells and Citizen-
ship in Germany.” Ph.D. diss., Princeton University.
Spilker, Bert. 1989. Multinational Drug Companies: Issues in Drug Discovery and De-
velopment. New York: Raven.
Spitzer, R. L., J. Endicott, and E. Robins. 1978. “Research Diagnostic Criteria: Ratio-
nale and Reliability.” Archives of General Psychiatry 35, no. 6:773–82.
Spivak, Gayatri Chakravorty. 1987. In Other Worlds: Essays in Cultural Politics. New
York: Methuen.

484 BIBLIOGRAPHY
Stark, Gregor, and E. Catherine Rayne. 1998. El Delirio: The Santa Fe World of Eliza-
beth White. Santa Fe: School of American Research.
Starr, Paul. 1982. The Social Transformation of American Medicine: The Rise of a Sover-
eign Profession and the Making of a Vast Industry. New York: Basic Books.
Stein, Mike. 2001. “Environmental Defense: From Brochureware to Actionware.”
Interview with Bill Pease. Benton Foundation, 11 April, http://www.benton.org,
accessed 1 July 2001.
Stern, Rachel. 2003. “Hong Kong Haze: Air Pollution as a Social Class Issue.” Asian
Survey 43, no. 5:780–800.
Stewart, James B. 1984. The Partners: Inside America’s Most Powerful Law Firms. New
York: Simon and Schuster.
Stolberg, Sheryl Gay. 2005. “In Rare Threat, Bush Vows Veto of Stem Cell Bill.” New
York Times, 21 May, §eA , 1.
Strange, Susan. 1996. The Retreat of the State: The Diffusion of Power in the World Econ-
omy. Cambridge: Cambridge University Press.
Strathern, Marilyn. 1992a. After Nature: English Kinship in the Late Twentieth Century.
Cambridge: Cambridge University Press.
———. 1992b. Reproducing the Future: Essays on Anthropology, Kinship, and the New
Reproductive Technologies. New York: Routledge.
———. 2005. Kinship, Law and the Unexpected: Relatives Are Always a Surprise. Cam-
bridge: Cambridge University Press.
Strathern, Marilyn, and Eric Hirsch, eds. 2004. Transactions and Creations. Oxford:
Berghahn.
Sturdy, Steve. 1998. “Reflections: Molecularization, Standardization and the His-
tory of Science.” Molecularizing Biology and Medicine: New Practices and Alliances,
1910s–1970s, ed. Soraya de Chadarevian and Harmke Kamminga, 273–89. Am-
sterdam: Harwood.
Sunder Rajan, Kaushik. 2002. “Biocapital: The Constitution of Postgenomic Life.”
Ph.D. diss., Massachusetts Institute of Technology.
———. 2003. “Genomic Capital: Public Cultures and Market Logics of Corporate
Biotechnology.” Science as Culture 12, no. 1:87–121.
———. 2005. “Subjects of Speculation: Emergent Life Sciences and Market Logics
in the U.S. and India.” American Anthropologist 107, no. 1:19–30.
———. 2006. Biocapital: The Constitution of Postgenomic Life. Durham: Duke Uni-
versity Press.
———. 2007. “Experimental Values: Indian Clinical Trials and Surplus Health.” New
Left Review 45:67–88.
Sunyer, J., J. Castellsague, and M. Saez. 1996. “Air Pollution and Mortality in Barce-
lona.” Journal of Epidemiology and Community Health 50 (supplement 1): S76–80.
Supreme Court of the United States. 1979a. Brief on Behalf of Genentech, Inc., Ami-
cus Curiae. October Term, No. 79-136.
———. 1979b. Brief on Behalf of the Peoples Business Commission, Amicus Curiae.
October Term, No. 79-136.

BIBLIOGRAPHY 485
———. 2005. Brief for the United States, Amicus Curiae, Homan McFarling v. Mon-
santo Company. May Term, No. 04-31.
Syngenta. 2011. http://www.syngenta.com, accessed 25 June 2011.
Takeuchi, Masahiro. 2003. “Variance Components Testing in Mixed Effects Models
in Bridging Studies.” Presentation at the 2003 APEC symposium on statistical
methodology, Nankang, Taipei, 15 November.
TallBear, Kimberly. 2005. “Native American DNA.” Ph.D. diss., University of Califor-
nia, Santa Cruz.
Taylor, O. 1998. “Dispensing Practices in Private and Government Health Facilities
in Lagos State.” Nigerian Journal of Pharmacy 29, no. 1:63–67.
Taylor, R. B., et al. 2001. “Pharmacopoeial Quality of Drugs Supplied by Nigerian
Pharmacies.” Lancet 357, no. 9272 (16 June): 1933–36.
Tennant, Raymond W. 2002. “The National Center for Toxicogenomics: Using New
Technologies to Inform Mechanistic Toxicology.” Environmental Health Perspec-
tives 110, no. 1: A8–10.
“Texas City Blast of 1947.” 2010. Houston Chronicle, 14 April, http://www.chron.com.
Thompson, Charis. 2005. Making Parents: The Ontological Choreography of Reproduc-
tive Technologies. Cambridge: MIT Press.
Tietenber, Tom, and David Wheeler. 1998. “Empowering the Community: Informa-
tion Strategies for Pollution Control.” Paper presented at Frontiers of Environ-
mental Economics Conference, Airlie House, Va., 23–25 October.
Timmermans, Stefan, and Marc Berg. 1997. “Standardization in Action: Achieving
Local Universality through Medical Protocols.” Social Studies of Science 27, no.
2:273–305.
———. 2003. The Gold Standard: The Challenge of Evidence-Based Medicine and Stan-
dardization in Health Care. Philadelphia: Temple University Press.
Tinnell, Robert, and Craig Taillefer. 2007a. The Chelation Kid: Episode 129. Webcomics
Nation, 13 September, http://www.webcomicsnation.com, accessed 12 January
2008.
———. 2007b. The Chelation Kid: Episode 135. Webcomics Nation, 21 September,
http://www.webcomicsnation.com, accessed 12 January 2008.
Toobin, Jeffrey. 2002. “The Man Chasing Enron.” New Yorker, 9 September, 86–96.
Torrey Mesa Research Institute. 2004. “Accessing Torrey Mesa Research Institute
(TMRI) Rice Genome Data.” http://www.sciencemag.org/content/suppl/2002/
04/04/296.5565.92.DC1/Goffweb2.pdf, accessed 1 January 2004.
Touloumi, G., E. Samoli, and K. Katsouyanni. 1996. “Daily Mortality and ‘Winter
Type’ Air Pollution in Athens, Greece: A Time Series Analysis within the APHEA
Project.” Journal of Epidemiology and Community Health 50 (supplement 1): S47–
51.
Traweek, Sharon. 1988. Beamtimes and Lifetimes: The World of High Energy Physicists.
Cambridge: Harvard University Press.
Tsing, Anna Lowenhaupt. 2000. “Inside the Economy of Appearances.” Public Cul-
ture 12, no. 1:115–44.

486 BIBLIOGRAPHY
———. 2004. Friction: An Ethnography of Global Connection. Princeton: Princeton
University Press.
Tucker, Robert, ed. 1978. The Marx-Engels Reader, 2d edn. New York: W. W. Norton.
University of California, Office of the President. 2003. “Patent Survey Reveals AG
Biotech Intellectual Property Ownership.” Press release. University of Califor-
nia, Office of the President, 9 September, http://www.universityofcalifornia.edu/
news/article/5709.
U.S. Department of Energy. 2008. “Facts about Genome Sequencing.” Human Ge-
nome Project Information, http://www.ornl.gov, accessed 25 June 2011.
U.S. Environmental Protection Agency. 1998. Chemical Hazard Data Availability
Study: What Do We Really Know about the Safety of High Production Volume Chemi-
cals? Washington: U.S. Environmental Protection Agency.
———. 2003. “America’s Children and the Environment: Measures of Contami-
nants, Body Burdens and Illnesses,” 2d edn. Washington: Environmental Pro-
tection Agency, EPA 240-R-03-001, http://www.epa.gov, accessed 30 September
2004.
U.S. General Accounting Office. 2001. Major Management Challenges and Program
Risks: Environmental Protection Agency. Report No. GAO-01-257. Washington: Gen-
eral Accounting Office.
U.S. Patent and Trademark Office. 2001. “Utility Examination Guidelines.” Federal
Register 66, no. 4 (5 January): 1092–99.
U.S. Securities and Exchange Commission. 1994a. “Concept Release and Notice of
Hearing: Safe Harbor for Forward-Looking Statements.” Release Nos. 33-7101;
34-34831; 35-26141; 39-2324; IC-20613; File No. S7-29-94. Washington: Securities
and Exchange Commission.
———. 1994b. “Concept Release and Notice of Hearing: Safe Harbor for Forward-
Looking Statements.” Release Nos. 33-7101; 34-34831; 35-26141; 39-2324; IC-
20613; File No. S7-29-94. Washington: Securities and Exchange Commission.
———. 2005. “SEC Sues Morgan Stanley and Goldman Sachs for Unlawful IPO
Allocation Practices.” Press Release. U.S. Securities and Exchange Commission,
25 January, http://www.sec.gov/news/press/2005-10.htm, accessed July 2006.
Uyama, Y., T. Shibata, N. Nagai, H. Hanaoka, S. Toyoshima, and K. Mori. 2005. “Suc-
cessful Bridging Strategy Based on ICH E5 Guideline for Drugs Approved in
Japan.” Clinical Pharmacology and Therapeutics 78, no. 2:102–13.
Vaidhyanathan, Siva. 2003 [2001]. Copyrights and Copywrongs: The Rise of Intellectual
Property and How It Threatens Creativity. New York: New York University Press.
Vanelli, Mark, et al. 2002. “Moving beyond Market Share.” In Vivo: The Business and
Medicine Report 20, no. 3:1–6.
Vargas, D. L., et al. 2005. “Neuroglial Activation and Neuroinflammation in the Brain
of Patients with Autism.” Annals of Neurology 57, no. 1 (January): 67–81.
Vezzetti, Hugo. 1996. Aventuras de Freud en el país de los argentinos: De José Ingenieros
a Enrique Pichon-Rivière. Buenos Aires: Paidós.
Visiongain. 2006. Japanese Pharmaceutical Market, 2006–2011. London: Visiongain.

BIBLIOGRAPHY 487
Wakefield, A. J., et al. 1998. “Ileal-Lymphoid-Nodular Hyperplasia, Non-specific
Colitis, and Pervasive Developmental Disorder in Children.” Lancet 351, no.
9103:637–41.
Wald, N., and M. Law. 2003. “A Strategy to Reduce Cardiovascular Disease by More
Than 80%.” British Medical Journal 326:1419–24.
Waldby, Catherine, and Rob Mitchell. 2006. Tissue Economies: Blood, Organs, and Cell
Lines in Late Capitalism. Durham: Duke University Press.
Walgate, Robert. 2001. “Syngenta Claims Ownership of Rice but Will Give Data
Away.” Scientist, 1 February.
Wang, Horng-Luen. 2000. “Rethinking the Global and the National: Reflections on
National Imaginations in Taiwan.” Theory, Culture and Society 17, no. 4:93–117.
Wang, Jia-Huai, Y. Yan, T. Garrett, J. Liu, D. Rodgers, R. L. Garlick, G. E. Tarr,
Y. Husain, E. L. Reinherz, and S. C. Harrison. 1990. “Atomic Structure of a Frag-
ment of Human CD4 Containing Two Immunoglobulin-like Domains.” Nature
348 (29 November): 411–18.
Waters, M., et al. 2003. “Systems Toxicology and the CEBS Knowledge Base.” EHP
Toxicogenomics 111 (1T): 15–20.
Watts, Michael. 2001. “Petro-Violence: Community, Extraction, and Political Ecology
of a Mythic Commodity.” Violent Environments, ed. Nancy Lee Peluso and Michael
Watts, 189–212. Ithaca: Cornell University Press.
———. 2004. “Resource Curse? Governmentality, Oil and Power in the Niger Delta,
Nigeria.” Geopolitics 9, no. 1:50–80 [special issue].
Weber, Leonard J. 2006. Profits before People? Ethical Standards and the Marketing of
Prescription Drugs (Bioethics and the Humanities). Bloomington: Indiana Univer-
sity Press.
Weber, Max. 1978. Weber: Selections in Translation, ed. Walter Garrison Runciman.
Cambridge: Cambridge University Press.
———. 2008. The Protestant Ethic and the Spirit of Capitalism. Miami: BN Publishing.
Weber, W., and S. Newmark. 2007. “Complementary and Alternative Medical Thera-
pies for Attention-Deficit/Hyperactivity Disorder and Autism.” Pediatric Clinics of
North America 54:983–1006.
Weiner, Charles. 1987. “Patenting and Academic Research: Historical Case Studies.”
Science, Technology and Human Values 12, no. 1:50–62.
Weiss, Elliot J., and Janet E. Moser. 1998. “Enter Yossarian: How to Resolve the Pro-
cedural Catch-22 that the Private Securities Litigation Reform Act Creates.” Wash-
ington University Law Quarterly 76:457–507.
Wellman, Carl. 1998. The Proliferation of Rights: Moral Progress or Empty Rhetoric?
Boulder: Westview.
Werner, Emily, and Geraldine Dawson. 2005. “Validation of the Phenomenon of
Autistic Regression Using Home Videotapes.” Archives of General Psychiatry 62:
889–95.
White, J. F. 2003. “Minireview: Intestinal Pathophysiology in Autism.” Experimental
Biology and Medicine 228, no. 6:639–49.
Wilde, Oscar. 1990. Complete Fairy Tales of Oscar Wilde. New York: Signet Classics.

488 BIBLIOGRAPHY
Wildenauer, Dieter B., et al. 1999. “Do Schizophrenia and Affective Disorder Share
Susceptibility Genes?” Schizophrenia Research 39:107–11.
Williams, Roger J. 1956. Biochemical Individuality. New York: John Wiley and Sons.
Winner, Langdon. 1978. Autonomous Technology: Technics- out- of-Control as a Theme in
Political Thought. Cambridge: MIT Press.
———. 1988. The Whale and the Reactor: A Search for Limits in an Age of High Tech-
nology. Chicago: University of Chicago Press.
Winslow, Ron. 2004. “For Bristol-Myers, Challenging Pfizer Was a Big Mistake: In
Rare Head-to-Head Study, Lipitor Beats Pravachol at Reducing Heart Risk: A New
Push on Cholesterol.” Wall Street Journal, 9 March, §eA , 1.
Wolpe, Paul R. 1990. “The Holistic Heresy: Strategies of Ideological Challenge in the
Medical Profession.” Social Science and Medicine 31, no. 8:913–23.
———. 1994. “The Dynamics of Heresy in a Profession.” Social Science and Medicine
39, no. 9:1133–48.
Wong, Chit-Ming, Stefan Ma, A. J. Hedley, and T. H. Lam. 2001. “Effect of Air Pol-
lution on Daily Mortality in Hong Kong.” Environmental Health Perspectives 109,
no. 4:335–40.
Wong, Ellick. 2003. “The Regulatory Environment and Clinical Trials in Southeast
Asia.” Drug Information Journal 37:155–63S.
Wong, Gerard B. N., and John C. W. Lim. 2003. “Drug Regulation by Singapore’s
Health Sciences Authority: The Role of the Centre for Drug Evaluation.” Drug In-
formation Journal 37, no. 4:15–25S.
Wong, Helen H. L., and Ronald G. Smith. 2006. “Patterns of Complementary and
Alternative Medical Therapy Use in Children Diagnosed with Autism Spectrum
Disorders.” Journal of Autism and Developmental Disorders 36, no. 7 (October):
901–9.
Wong, Nadine. 2000. “Judgment Day Is Here for Biotechs.” The Worldly Investor,
http://www.worldlyinvestor.com, accessed 20 July 2000.
Wong, T. W., W. S. Tam, T. S. Yu, and A. H. S. Wong. 2002. “Associations between
Daily Mortalities from Respiratory and Cardiovascular Diseases and Air Pollution
in Hong Kong, China.” Occupational and Environmental Medicine 59, no. 1:30–35.
World Bank. 2004. World Bank Annual Report. Washington: World Bank.
World Health Organization. World Health Report. Geneva: World Health Organiza-
tion.
World Health Organization Statistical Information System. 2001. Statistics by Coun-
try: Nigeria. Geneva: World Health Organization.
Xi, Xi. 1997. Marvels of a Floating City and Other Stories: An Authorized Collection,
trans. Eva Hung. Hong Kong: Renditions Paperbacks.
Xu, X. P., D. W. Dockery, and J. Gao. 1994. “Air Pollution and Daily Mortality in
Residential Areas of Beijing, China.” Archives of Environmental Health 49:216–22.
Yakujinippo [pharmaceutical news], 1 January 2001.
Young, Allan. 1996. The Harmony of Illusions: Inventing Post-traumatic Stress Disorder.
Princeton: Princeton University Press.
Young, John. 1994. “Using Computers for the Environment.” State of the World 1994:

BIBLIOGRAPHY 489
 A WorldWatch Institute Report on Progress toward a Sustainable Society, ed. Lester R.
Brown et al., 999–116. New York: W. W. Norton.
“Your Company’s Most Important Asset: Intellectual Capital.” 1994. Fortune, 3 Octo-
ber, 68–74.
Zalik, Anna. 2004. “The Niger Delta: ‘Petro Violence’ and ‘Partnership Develop-
ment.’” Review of African Political Economy, no. 101:401–24.
Zimmerman, Jack. 2003. Preface, Children with Starving Brains: A Medical Treat-
ment Guide for Autism Spectrum Disorder, by Jacquelyn McCandless. Putney, Vt.:
Bramble.
Žižek, Slavoj. 1994. “How Did Marx Invent the Symptom?” Mapping Ideology, 296–
332. London: Verso.
———. 2004. “The Ongoing ‘Soft Revolution.’” Critical Inquiry 30, no. 2:292–323.

490 BIBLIOGRAPHY
 ABOUT THE CONTRIBUTORS

TIMOTHY CHOY is an associate professor of anthropology and of science and tech-

nology studies at the University of California, Davis. He is the author of Ecologies of
Comparison: An Ethnography of Endangerment in Hong Kong (2011). His next project is
on the politics of atmosphere.

JOSEPH DUMIT is the director of the program in science and technology studies and
a professor in the department of anthropology at the University of California, Davis.
His research focuses on the anthropology of science, technology, medicine, and
media. He is the author of Picturing Personhood: Brain Scans and Biomedical Identity
(2004) and the coeditor of Cyborgs and Citadels: Anthropological Interventions in Emerg-
ing Sciences and Technologies (with Gary L. Downey, 1997), Cyborg Babies: From Techno-
Sex to Techno-Tots (with Robbie Davis-Floyd, 1998), and Biomedicine as Culture: Instru-
mental Practices, Technoscientific Knowledge, and New Modes of Life (with Regula Burri,
2007). He was associate editor of Culture, Medicine and Psychiatry for ten years. He
is currently finishing a book on pharmaceutical marketing and clinical trials called
Drugs for Life. He has begun work on new projects on the history of flowcharts and
psychotic computers, geologists and 3D immersive visualization environments, and
comparative anatomies across therapeutic massage modalities.

MICHAEL M. J. FISCHER is Andrew W. Mellon Professor in the Humanities and a pro-

fessor of anthropology and of science and technology studies at MIT; he is also a lec-
turer in the department of global health and social medicine at the Harvard Medical
School. He recently coedited A Medical Anthropology Reader: Theoretical Trajectories
and Emergent Realities (with Byron Good, Sarah Willen, and Mary Jo DelVecchio
Good, 2010). He is the author of Anthropological Futures (2009), Mute Dreams, Blind
Owls and Dispersed Knowledges: Persian Poesis in the Transnational Circuitry (2004),
Emergent Forms of Life and the Anthropological Voice (2003), Debating Muslims: Cul-
tural Dialogues in Postmodernity and Tradition (with Mehdi Abedi, 1990), Anthropology
as Cultural Critique: An Experimental Moment in the Human Sciences (with George
Marcus, 1986), and Iran: From Religious Dispute to Revolution (1980). He is currently
working on multiple projects relating to the growth of the biosciences, biotechnolo-
gies, and translational medicine in Asia.

KIM FORTUN, a professor in the department of science and technology studies at Rens-
selaer Polytechnic Institute, is an anthropologist of science and environmentalism.
She is the author of Advocacy After Bhopal: Environmentalism, Disaster, New Global
Orders (2001). Her more recent work analyzes developments in toxicology, expo-
sure science, and other environmental-health sciences in the United States. Fortun
also contributes to The Asthma Files, a collaborative and experimental digital ethno-
graphic project.

MIKE FORTUN is an associate professor in the department of science and technology

studies at Rensselaer Polytechnic Institute. A historian and anthropologist of the
life sciences, he has covered the policy, scientific, and social history of the Human
Genome Project in the United States, the history of biotechnology, and the growth of
commercial genomics and bioinformatics in the speculative economies of the 1990s.
His current research focuses on the genomics of asthma, and he contributes to The
Asthma Files, a collaborative and experimental digital ethnographic project. He is also
researching the truth- and subject-producing practices in contemporary genomics,
which he calls the “care of the data.” His most recent book is Promising Genomics: Ice-
land and deCODE Genetics in a World of Speculation (2008).

DONNA J. HARAWAY is a professor in the history of consciousness department at the

University of California, Santa Cruz, where she teaches feminist theory, science
studies, and animal studies. Her books include Crystals, Fabrics, and Fields: Metaphors
that Shape Embryos (1976), Primate Visions: Gender, Race, and Nature in the World of
Modern Science (1989), Simians, Cyborgs, and Women: The Reinvention of Nature (1991),
Modest_Witness@Second_Millennium.FemaleMan©_Meets_OncoMouse™: Feminism
and Technoscience (1997); and The Companion Species Manifesto: Dogs, People, and Sig-
nificant Otherness (2003). Under the title “Staying with the Trouble,” her current work
inhabits the relational labor of human and nonhuman animals in urban and peri-
urban agriculture.

SHEILA JASANOFF is Pforzheimer Professor of Science and Technology Studies at Har-

vard University’s John F. Kennedy School of Government. Her work explores the role
of science and technology in the law, politics, and policy of modern democracies.
Among her books are The Fifth Branch: Science Advisers as Policymakers (1990), Sci-
ence at the Bar: Law, Science, and Technology in America (1995), and Designs on Nature:
Science and Democracy in Europe and the United States (2005). She was founding chair
of the department of science and technology studies at Cornell University and has
held distinguished visiting appointments at numerous institutions, including MIT,
the University of Cambridge, Kyoto University, the University of Vienna, and the
Wissenschaftskolleg Berlin.

492 ABOUT THE CONTRIBUTORS

WEN- HUA KUO is an associate professor at National Yang-Ming University, Taiwan,
where he holds joint appointments at the Institute of Science, Technology and So-
ciety and the Institute of Public Health. His research concerns health governance in
the transformation of East Asian states, with thematic focuses on Cold War epidemic
control and debates on the harmonization of clinical-trial regulations. His publica-
tions include “The Voice on the Bridge: Taiwan’s Regulatory Engagement with Global
Pharmaceuticals” (2009), which won the David Edge Prize of the Society for Social
Studies of Science.

ANDREW LAKOFF is an associate professor of anthropology, sociology, and communi-

cation at the University of Southern California. He is the author of Pharmaceutical
Reason: Knowledge and Value in Global Psychiatry (2005) and coeditor of Global Phar-
maceuticals: Ethics, Markets, Practices (with Arthur Kleinman and Adriana Petryna,
2006) and Biosecurity Interventions: Global Health and Security in Question (with
Stephen Collier, 2008). His current research concerns the articulation of public-
health and national-security expertise around the problem of emerging infectious
disease.

KRISTIN PETERSON is an assistant professor of anthropology at the University of Cali-

fornia, Irvine. Her work broadly concerns science, political economy, and Africa. She
is currently pursuing several projects: a study on the relationship between global
drug marketing and pharmaceutical markets in Nigeria; health and security logics
as they relate to AIDS policies and politics; and a collaborative study (with Morenike
Ukpong), analyzing the ethics, structural inequities, and biosocialities of HIV-related
clinical trials in Nigeria and Malawi.

CHLOE SILVERMAN is an assistant professor of science, technology, and society at Penn-

sylvania State University. She is the author of Understanding Autism: Parents, Doctors,
and the History of a Disorder (2011). Her work describes the role of affect in scientific
knowledge production, with a focus on biomedical social movements and the re-
lationships between scientists and their research subjects.

ELTA SMITH is a senior consultant at GHK, London. She received her doctorate in pub-
lic policy from the John F. Kennedy School of Government, at Harvard University,
specializing in the political economy of agricultural biotechnology. She works on
agriculture, food- chain, and sustainability-related projects primarily for the British
Government and the European Commission.

KAUSHIK SUNDER RAJAN is an associate professor of anthropology at the University of

Chicago. He is the author of Biocapital: The Constitution of Postgenomic Life (2006).
His work explores the relationships between the life sciences and global capital, with
a specific empirical focus on the United States and India. He is currently working on
a number of projects relating to various aspects of pharmaceutical development in

ABOUT THE CONTRIBUTORS 493

the Indian context, such as global clinical trials, intellectual-property regimes, and
translational research.

TRAVIS J. TANNER is a postdoctoral teaching fellow in the department of English at

Tulane University. He received his doctorate in comparative literature from the Uni-
versity of Califonia, Irvine, specializing in Native American literature and critical
theory. He has published an essay on the Acoma poet Simon Ortiz in The Kenyon Re-
view, and is revising his manuscript “X- Communicated Subjects in Native American
Literature” for publication. His work explores how literature reconfigures modes of
subjectivity and politics in situations of postcolonial subjection.

494 ABOUT THE CONTRIBUTORS

 INDEX

Abbott Pharmaceuticals, 234, 257–58, Air Pollution Index (API), 144–46, 151
407 alcoholism, 262
Abu Ghraib, 440 allopathic medicine, 368
academe–industry collaboration, 417 Althingi, 330, 336, 347
Academia Sinica Plant Genome Centre, Alzheimer’s disease, 79, 264, 329
209 American Chamber of Commerce, 123,
accumulation by dispossession, 30, 41, 141
230–31, 440 American Kennel and Boarding Associa-
Action Group on Erosion, Technology tion, 100
and Concentration, 227 American Pet Products Manufacturing
Actor-Network Theory (ANT), 20, 39–40, Association, 96, 115
161, 182, 386, 450 American Psychiatric Association, 258,
ACT UP Paris, 242 264–65, 268
Adriamycin, 405, 409 American Society of Clinical Oncology,
advanced liberalism, advanced liberal 406
societies, 27, 41, 441–42 American Type Culture Collection, 166
Advanced Life Science Information Amgen, 417
System (ALIS), 291 angiogenesis, 36, 388, 405, 419, 436;
Affymetrix DNA chip, 40 inhibitors, 385, 389, 393–94, 406
Afghanistan, 241 angiostatin, 393–94, 396, 400, 402
Africa, 195, 228–29, 231, 234, 237–38, animals: as models, 403, 407; rights of,
241–42, 245, 301, 434, 438, 440–43 110, 113, 173
agribusiness, 100–104, 109, 441 Annales School of Historiography, 430
Agricultural Bank, 347 anthropology, anthropologists, 20–22,
agricultural biotechnology, 37, 166, 205, 39, 100, 139, 144, 187, 275, 324, 426,
422 430–31, 438, 450–51; anthropological
AIDS, 30, 41, 75, 228–33, 236, 239–46, problems and, 38, 40; anthropologi-
262, 400, 411–12, 417–18, 434 cal voice and, 295–96; of contempo-
air pollution, 123–24, 128–34, 147, 149, rary, 8, 38
151, 306, 316, 324–25 anti-angiogenic therapy, 399
antibiotics, 60, 380, 400 Babandiga, Ibrahim, 245
antidepressants, 46, 260, 285 Bank of Iceland, 347
antihypertensive, 400 BASF, 309, 323
antipsychotics, 267, 368, 383 Basic Local Alignment Sequence Tool
antiretrovirals, 239, 244 (BLAST), 416
antithrombin 3, 389, 393, 395 basic research, 204, 208, 415
antitrust law, 170 Baton Rouge, 315
anti-tumor agent, 389 Bayh-Dole Act, 2–3, 37, 196, 415
Applied Behavioral Analysis (ABA), 361 behavioral genetics, 105, 118–19; thera-
Argentina, 31, 150, 252–56, 259–64, 267, pies of, 378, 383
270–78, 438, 443 Beijing Genomics Institute (BGI), 201–2,
Arizona Genomics Institute, 209 206, 210, 421
arthritis, 417 Belgium, 396
Asia, 129, 143, 201, 209, 281–82, 285– Belmont Report, 445
89, 292–97, 301–5, 419, 423–26, 435, bench to clinic, 420
443 benign prostatic hypertrophy, 75
Asian Pacific region, 132, 423, 426 Bermuda Principles, 198–99, 210
Asia-Pacific Economic Cooperation Berne Convention, 208
(APEC), 288–89, 291, 294, 302–5 Beth Israel Deaconess Medical Center,
Asperger’s Syndrome, 383 414
assemblage, 38, 104, 133, 182, 252, 274, Bettelheim, Bruno, 355, 361
430–31 Bhopal, 306, 313, 315–16, 323
Association of Southeast Asian Nations Bidil, 298
(ASEAN), 289, 294, 304 Bight of Benin, 241
asthma, 72, 262, 275, 316–19, 325 bioavailability, 82, 91
AstraZeneca, 302 biobricks, 436
Atlanta, 433 biocapital, 23–24, 29, 39, 90, 94–95,
Atlas Ventures, 336 102, 114, 387, 439, 445–46, 449–50
attention- deficit disorder, 277 biochemistry, 365, 369, 378, 384
Austin, J. L., 331–33, 341, 350 biocolonialism, 214
Australia, 73, 132, 144, 301; Therapeutic biodiversity, 322, 324
Goods Administration in, 304 bioethics, 29, 102, 182, 261, 276, 326,
authorship, 392 444–45, 448
autism, 35–36, 354–71, 373–84, 438, 446, Biogen, 335
448 bioinformatics, 253, 258, 442
Autism Biomedical Discussion Group, biomarkers, 56–57, 74, 79, 85, 88, 146,
366, 383 371
Autism Network for Dietary Interven- BioMarx, 50–53, 55, 57, 61–63, 69, 76,
tion, 382 79, 81–88, 92, 152
Autism One, 361, 381 biomedical mode of reproduction, 112
Autism Research Institute, 361–62, 366, biomedical platform, 277
368, 382–83; conferences, 381 Biopolis, 115, 305, 419, 423–24, 442
Autism Society of America, 361 biopolitics, biopolitical, 18, 26, 33, 41, 91,
autistic enterocolitis, 372 108–9, 231, 280, 306, 311, 323, 326,
automated sequencing technologies, 193, 441, 447, 450
209 biopower, 94, 107

496 INDEX
biorepository, 169 405; prostate, 47, 54, 169, 404; war
biosociality, biosocialities, 278, 439, 450 on, 2
biostatistics (tician), 303, 435 Canine Genome Project. See dog genome
biotechnology industry, 2, 5, 172 projects
Biotek Invest, 348 capital: fixed, 62; flexible, 126, 228; flight
bipolar disorder, 150, 252–60, 263–78, of, 233, 246; markets of, 342
439 Capital (Marx), 90; Vol. 1, 12–13, 24, 48–
black market, 234 53, 58, 65, 76, 213, 217, 219, 221, 450;
Blair, Tony, 184 Vol. 3, 439
blockbuster drugs, 64, 81, 434 carcinogens, 310
Boehringer-Ingelheim, 247 Catholic Church, 277
Bombay, 450 cDNA library, 256
Boston, 390, 393, 403–4, 433 Celebrex, 61
Boyer, Herbert, 2–3, 5, 37 Celera Genomics, 203, 337, 339
Brahmachari, Samir, 424, 434 Cell, 400, 418
brain drain, 419 cell dogs, 110, 112
Brazil, 198, 209 cell line, 160, 169, 181, 386–87
Brazilian Rice Genome Initiative, 209 cellular signaling, 371
breathers, 128, 142 Center for Autism and Related Dis-
breedwealth, 102, 113 orders, 381
bridging studies, 287–93, 296, 302–3 Center for Drug Development, Tufts
Brigham and Women’s Hospital, 417 University, 283, 299
Bristol-Myers Squibb, 247, 302, 396 Central Bank of Iceland, 345
British Medical Journal, 72, 85 central dogma of molecular biology, 39
British Petroleum (BP), 323 Cereon, 420
Broad Institute, 105 Chad Basin, 245
Buenos Aires, 252, 256–62, 270, 274–76 chelating agents, 364, 382
Burroughs Wellcome, 68 chelation, 364–65
Bush, George W., 159–60, 175, 427, 436; chemical, chemicals: industry, 314; secu-
administration of, 239, 241 rity of, 314–15, 325; toxicity of, 321
Business Communications Company, Chemical Week, 311
96, 98 chemotherapy, 396
Chernobyl, 152
California, 135–36, 145–46, 342, 362, 432; Children’s Hospital, 394
Supreme Court of, 168, 171 Chile, 262
Cambodia, 425 China, 32, 61, 114–15, 124, 129, 132, 142–
Campomar Institute, 257, 260 44, 147, 195, 198, 201–2, 209–10, 253,
Canada, 73, 140, 173, 176, 182, 262, 438; 275, 295, 324, 385, 418–25, 434
parliament of, 180; Patent Act of, 173, Chinese Academy of Sciences, 209, 421
183; Supreme Court of, 27, 158, 173, Chinese University of Hong Kong
176, 178–81, 183 (CUHK), 129, 150
cancer, 99, 104, 108–9, 118–19, 172, 177, cholesterol, 46–47, 52–58, 69–73, 88,
307–10, 316, 321, 330, 383, 389, 401–5; 90–91
breast, 56, 329, 400, 403–4, 406; chronic diarrhea, 372–73
colon and colorectal, 56, 90, 329, chronic illness, 80–82, 359, 357
404–5; genomics and, 119; ovarian, Cipla, 239, 434

INDEX 497
Circulation, 433 compulsory licensing, 241
citizenship, 16, 164, 182, 305 computational biology, 414, 416
civic epistemology, 162 computer science, 415
civil society, 240 concept work, 38
Civil War, 163 consent form, 260–61, 271
Cixous, Hélène, 430 constitutionalism, 326
class-action suit, 349 Consumer Project on Technology, 243
classification systems, 322 contiguous mapping, 198
Clemson University Genomics Institute, contingents, contingency, 7–9, 11, 16, 38,
195, 209 149, 160, 182, 207, 217, 256, 266, 274
climate change, 322, 324 copyright, 190, 192, 194, 208; law, 188
clinical research, 68–69, 280, 285, 291– Cornell University, 317
98, 381 coronary heart disease, 47, 69–70, 73, 90
clinical trials, 32, 46–50, 52, 56–65, corporate culture, 87
68–75, 79–83, 87–91, 265, 267, 277, corporate social responsibility. See social
280, 286–87, 290–99, 301–3, 356, responsibility
360–61, 378, 386, 390, 401–2, 406, corporatization of life sciences, 3–4
419, 424, 433–35, 438, 443, 446; cortisone, 60
phases 1–3, 301; phase 4, 60 cosmopolitanism, 228, 245
clinician-scientist. See physician-scientist counterfeit drugs, 232, 235, 237–38, 239
Clinton, Bill, 184, 240, 313, 342, 349 Couric, Katie, 405
cloning, 102, 160, 277 Court of Appeals for the Federal Circuit,
co-production, 2, 8–9, 15–19, 38, 103, 170–71
139, 161, 227, 297 craft knowledge, 366
Coca- Cola, 45, 49, 77, 82, 86 craniosacral therapy, 382
Cohen, Daniel, 261 Creative Commons, 188, 190, 192–93,
Cohen, Stanley, 2–3, 6, 37 207; license, 191
Cohen-Boyer patent. See recombinant critical legal studies, 187
DNA patents critical theory, 325
Cold Spring Harbor Laboratory, 209 crystallography, 411–13, 415, 431, 433
colonialism, 214, 216, 222; colonial state Cuba, 246
and, 229 cultural studies, 423
Columbia University, 317; Center for culture, 155, 158–59, 162, 171, 180, 182,
Children’s Environmental Health at, 229, 232, 244–45, 282, 291, 295–96,
325 299, 311–13, 322, 325, 334, 356, 386,
Commercial Law Development Program 389–90, 392–93, 395, 411, 426, 429–
(CLDP), 242–43 30, 444, 450
commodity, commodities: fetishism of, cybernetics, 22, 430
12–13; form of, 112 Cytoxa, 405
common law, 180
commons, 158, 187–90, 193, 205–8, 213, Daitchi Sankyo, 435
436; tragedy of, 189 Dana Farber Cancer Institute, 403
companion, companions: animals as, data, 23, 40, 46, 57, 76, 78, 101–2, 105,
99–100, 117; species as, 94, 96, 130–34, 144, 146, 185, 187, 197–210,
113–14, 441 253, 263, 281, 286–92, 295, 298, 300,
comparative oncology, 119 304–7, 313, 317, 321–24, 330, 369, 373,

498 INDEX
 397, 402, 426, 433–36; exclusivity, double binds, 133, 331, 335
243; management, 22, 299; min- Dred Scott v. Sandford, 163–64, 182
ing, 22, 425; sharing, agreements for, drugs: delivery of, 386; distribution sys-
196–97, 205 tems for, 234; labeling for, 232; manu-
databanks, 291, 386, 426, 429, 433 facturing of, 229–30, 232–33, 245;
databases, 105, 191–206, 210, 242, 253– markets for, 232–38, 242
54, 257, 276–77, 309, 311, 316, 320, DSM, 266, 274, 277
324, 338–39, 345, 427 DSM-III, 265, 271
Da Vinci Surgical System, 432 DSM-IV, 268
debt-worthiness, 246 due diligence, 344–45
Declaration of Independence, 164 Duke University, 188
DeCode Genetics, 34, 253, 263, 276–77,
330–31, 335–39, 346–50, 352 East Asia, 151, 281, 293, 302
deconstruction, 220 economic crisis, 234, 238
deep play, 296, 386, 429 Edinburgh School, 20
deep venous thrombosis (DVT), 77–78 Egypt, 245
Defeat Autism Now! (DAN!), 361–70, Eighth Circuit Court of Appeals, 169
372–76, 378, 381–84 Eisner, Michael, 122–23, 129
Delaware, 337 electrical engineers, electrical engineer-
Deleuze, Gilles, 430–31 ing, 415
Democratic Party, 173 Eli Lilly, 54, 302, 394
depression, 54, 56 embodiment, 55
Derrida, Jacques, 151, 312, 326, 331–33, eminent domain, 155–56
426–30, 436, 444–50 Enbrel, 417, 419
determination, determinations, 2, 9, 11, enclosure movement, 13
15; in last instance, 10, 39; multiple, encounter value, 25, 95, 109–10, 112, 379,
18; over-, 10, 19, 449 440–41
diabetes, 106, 264, 329 endocrine system, 370, 384
Diamond v. Chakrabarty, 3, 37, 167, 172– endostatin, 394, 400, 402–3
74, 176–81, 196, 415 Engels, Frederich, 10–11, 38
differential reproduction, 351 Enlightenment, 17, 427, 448
digitalis, 432 Enron, 349
diphtheria, pertussis, and tetanus vac- EntreMed, 394, 400, 410
cine, 434 entrepreneurial university, 3–4, 6
direct-to- consumer advertising, 54 Environmental Defense, 311, 319, 323
Disney. See Walt Disney Corporation environmentalists, environmentalism,
dispossession, 16, 29–30, 36, 213–14, 17, 33–34, 306, 311, 442; activists and,
224, 228–33, 238–39, 244–45, 438– 123; burdens of, 309; economics of,
41, 444 128; ethics of, 321, 325–26; infor-
DNA Databank of Japan (DDBJ), 199, 202, matics and, 131, 146; information
210 systems and, 311, 313, 321–22, 324–25;
DNA sequence, sequencing, 197, 199, 210; justice and, 306, 317–18; medicine
technology of, 253 and, 364; politics and, 313, 321–22,
dog genome projects, 105, 118 447; regulations of, 311; risk and, 313–
Dolly, 102–3, 118, 160, 176, 277, 424 15; science and, 437; scientists and,
dot- coms, 338 320; toxins and, 376

INDEX 499
epidemiology, 57–58, 75–81, 133, 254, feminists, feminism, 20–21, 25, 39
264–66, 271, 435 fetishism, 221
epigenetics, 94 finance capital, 228
epistemology, epistemologies, 7–9, 13, 15, financial markets, 245, 331
17, 31–36, 47, 133, 194, 225, 252, 265, fluorescent tagging, 413
267, 271, 274, 358, 361, 365, 379–80, Folkman, Judah, 36, 385–92, 396, 401–4,
438–40, 443, 445, 447, 450 408–9, 411, 417, 419, 426–31, 433
erythropoietin (EPO), 421 food: riots for, 234; security of, 28–29,
ethical plateaus, 422, 429 183, 185
ethnography, 124, 150, 211, 298, 333, 430, Forbes, 82
438 foreign direct investment, 232, 246
eugenics, 101, 261 foreign exchange, 245
Europe, Europeans, 61, 66, 73, 77, 131, forward-looking statements, 34, 335,
173, 145, 209, 242–43, 253–54, 262– 339–44
63, 274–75, 292, 389, 394, 400–404, Foucault, Michel, 17–18, 41, 91, 107–8,
423, 428, 433, 435, 438 280, 295, 433, 442
European Agency for the Evaluation of Framingham Heart Study, 57
Medicinal Products, 304 France, 145, 174, 198, 209–10, 276, 409,
European Community, 300 434, 443
European Economic Area, 345 Frankfurt School, 325
European Federation of Pharmaceutical Fred Hutchinson Cancer Research Cen-
Industries and Associations, 300 ter, 119
European Free Trade Association, 300 Freeport, 309
European Institute of Bioinformatics, 201 free-trade agreements, 229, 243
European Molecular Biology Organiza- Freud, Sigmund, 11
tion, 199, 202 functional medicine, 363–64, 377–78,
European Union, 280, 286–87 380, 384
evangelical Christianity, 363 Fundación Bipolares de Argentina
evidence-based medicine, 274 (FUBIPA), 260, 276
exchange value, 25, 54, 93, 95, 97, 112 futures markets, 255, 345
Executive Committee for Research
(ECOR), 414–15 Gabon, 262
experiential knowledge, 358 Galveston County, Texas, 306–9, 321
experimentality, 240 gastroenterology, 374
experimental psychology, 363 gastrointenstinal pathologies, 365
experimental subjects, 61 GenBank, 197, 199–204, 210
experimental systems, 23, 324, 326, 351, gene-expression studies, 39
386, 396 Genentech, 174–79, 330, 352, 395, 401,
exploitation, 79, 213–14, 219, 221, 223 406
Express Scripts, 80, 82 gene patents, gene patenting, 38, 184,
expropriation, 24, 213, 216, 440, 444, 263
450 General Electric, 77, 167
general public license (GPL), 208
factory farming, 97 generic drugs, 233, 244, 289; industry,
Fanon, Frantz, 232 229–30, 239, 242–43, 434; market
felt-illness, 53, 56–59 for, 442

500 INDEX
gene sequencing. See genome sequencing glutathione transferase, 365
genetically modified foods, 428 gluten-freeh/hcasein-free (gf/cf ) diet, 364
genetic code, 177 Goizueta, Robert, 45–46, 49, 77, 82, 86
genetic diseases and disorders, 348, 376, Golden Rice, 166–67, 183
380 good clinical practice (GCP), 288, 302
genetic homogeneity, 335 good manufacturing practice (GMP), 424
genetics, 17, 101, 329 governmentality, 41, 240
Genetic Savings and Clone, 117–18 Grace, Patricia, 211–17, 221–22, 225–26
genetic tests, 55 Gramsci, Antonio, 227, 322, 326
Geneva, 244 gray market, 345–48
Genographic Project, 227 Great Plains Laboratories, 384
Genome Institute of Singapore, 423 Green Media Toolshed, 323
genome mapping, 193 Greenpeace, 138, 151, 311, 313–16, 324–25
genome sequencing, 195, 258, 264 Green Revolution, 199
Genome Therapeutics, 420 gross domestic product (GDP), 245
genomic rice, 193, 202, 205 Grundrisse, 13, 26
genomics, 22, 28, 32, 34, 39, 116, 119, Guattari, Felix, 430–31
184–87, 193–94, 199, 201–10, 219, gut microbiology, 380
223, 251–54, 256–63, 267, 271–72,
275–76, 289–98, 329–31, 334–39, HapMap Project, 303
343, 351, 358, 378, 414, 419–20, 424, Harlem, 325
429, 437, 444, 447 Harvard University, 36, 105, 188, 275,
genomic statistics, 291 390, 392, 399, 405, 416, 424, 434,
Genoscope, 209 442; Department of Global Health
Genova Diagnostics, 384 and Social Medicine at, 432; Harvard
Genset, 31, 252–68, 271–72, 274–77 Business School, 352, 394; Harvard
Genzyme, 390, 393, 397 Medical School, 385, 394, 432. See also
geographic information systems (GIS), MITh/hHarvard Health, Science, and
324 Technology (HST) program; Onco-
German Ideology, The (Marx and Engels), Mouse
13 hazardous air pollutants (HAPS), 307–9
Germany, 162, 182, 330, 433–34 Health Canada, 300, 304
gift economy, 391 Health Gap Coalition, 242
Gilbert, Walter, 335 Health Sector Database, 330, 336, 345
Gingrich, Newt, 339, 345 heart disease, 47, 69–70, 73, 90
GlaxoSmithKline, 302, 434 heavy-metal poisoning, 364, 368
GlaxoWellcome, 234, 247 Hegel, G. W. F., 149
global aid, 31, 229, 231 hegemony, 323, 326
global cities, 228–29, 245 hemophilia, 106, 110
Global Information, Inc., 96 Henry M. Jackson Foundation, 240
globalization, 23, 30, 218, 228–29, 237, heparinase, 399
242, 245, 251, 279, 282, 286–97, 304, hepatitis B vaccine, 434
442, 449 herceptin, 400, 406
global markets, 232 hereditary disability and disorder, 355
global medicine, 386, 432 heredity, 381
global pharmaceuticals, 279–82, 297–98 high-throughput, 40

INDEX 501
history of science, 22 Icelandic Stock Exchange (ICEX), 345
history of technology, 20, 22, 103 ideal type, 10, 38
HIV. See AIDS IDEC Pharmaceuticals, 330
Hoffman-la Roche, 6–7, 51, 234, 246, identity politics, 326
277, 330, 336–37, 345, 352, 434 ideology, 11–13, 17, 19, 39, 111, 118, 211,
homeland security, 232, 240, 316 218, 227, 357, 364, 450
homeopathy, 382 immune response, 365, 368; system, 370,
Hong Kong, 26, 121–25, 127–49, 438, 384, 417
442–43; Environmental Protection Immunex, 417–18
Department of, 150–51; Legislative immunology, immunologists, 374, 384
Council of, 152 imperialism, 95
Hood, Leroy, 194, 209 import license, 234
Houston, 404 IMS Health, 76–77, 301
human embryonic stem cell, 102, 118, Incyte Pharmaceuticals, 335, 420
160 Independence Party, 345
human genome, 203–4, 214, 384, 421, India, 61, 133, 198, 209–10, 239–40,
427–28, 450 247, 278, 295, 299, 322, 324, 419,
Human Genome Diversity Project 424, 442; Council for Scientific
(HGDP), 29, 214–16, 224, 227, 304, and Industrial Research of, 424,
426, 444 434–35
Human Genome Organization (HUGO), Indian Initiative for Rice Genome
419, 423, 426, 434, 436 Sequencing, 209
Human Genome Project (HGP), 185, 253– indigeneity: indigenous communities
54, 257, 261, 291, 335, 420, 435 and, 219; indigenous knowledge sys-
Human Genome Sciences (HGS), 335, 337, tems and, 216; indigenous literature
339, 420 and, 211–12; indigenous peoples and,
humanitarianism, 241, 244; humani- 214–15, 223, 225, 425, 435, 440, 444
tarian organizations and, 231, 240 Indigenous Peoples Council on Bio-
humanized mice, 416 colonialism, 227
Human Organized Whole Genome Data- Indonesia, 425, 435; National Agency of
base, 303 Drug and Food Control, 302
human rights, 110, 212 industrial capitalism, 11, 13, 446
human subjects, 280, 445 industrialism, 324
Hungary, 77 industrial revolution, 7, 439
Hwang Woo-Suk, 102–3, 118 infectious diseases, 57, 240
hybrid properties, 186–88, 193–95, 202, inflammatory bowel disease, 382
204–8 informatics, 22, 33–34, 40, 152, 312, 316,
Hyderabad, 434 414–17, 424, 433, 439, 442, 446–47
hype, 19, 24, 34–35, 346, 359, 446–48 informating, 306, 311, 321, 323
hypertension, 58, 76 information, 17, 22–23, 28, 31, 40, 51,
55–56, 64, 74, 77, 131–32, 150, 185–
IBM, 227, 396 89, 192–210, 215, 226, 237, 251–60,
Iceland, 35, 253, 262–63, 276–77, 330– 263, 275, 280–81, 291–92, 304, 307,
31, 334–39, 347–48, 352; Ministry of 310–15, 321–25, 335–45, 362, 366,
Commerce of, 345–46 369, 374, 377–78, 414–15, 442–43;
Icelandic Heart Association, 338 economy of, 274; politics of, 322; pro-

502 INDEX
 cessing of, 324; sciences of, 17, 439; in vitro fertilization, 160
technology of, 258, 311 Iraq, 109, 241
informationalism, 310, 312, 324
informed consent, 18, 31, 168, 444–45 Janssen Pharmaceuticals, 257
initial public offering (IPO), 336, 339, 343, Japan, 32, 77, 173, 195, 198, 201–2, 209,
345, 348–50, 352 280–81, 285–87, 297, 300–304, 425,
innovation, 8, 33, 36, 101–2, 132, 161, 165, 435, 438, 443; Ministry of Health,
179, 182, 188–91, 196, 203, 253–54, Labor and Welfare of, 286, 291, 300;
264, 284, 297, 436 Pharmaceuticals Manufacturing Asso-
Institute for Child Behavior Research, ciation of, 300; Science and Tech-
362 nology Agency of, 291
Institute of Genomics and Integrative Japanese Single Nucleotide Polymor-
Biology, 424 phism, 291, 303
Institute of the Society for Techno- Jefferson, Thomas, 165, 178
innovation of Agriculture, Forestry John Innes Center, 209
and Fisheries, 209 Johnson and Johnson, 396
insurance companies, 369 Journal of the American Medical Associa-
intellectual capital, 341, 352, 387 tion, 64
intellectual property, 2, 5–7, 23, 27–30, justice, 444–45, 447–48, 450
157–58, 164–66, 182–93, 198–200,
238–39, 242–44, 251–54, 262, 415, Kanner, Leo, 355, 362, 381
429, 434–37, 443–44; law, 230, 239, Kass, Leon, 159, 175, 436
241–43 Kendall Square, 393
interdisciplinary, 22–23, 36, 119, 439, Kenya, 247
442, 448 kinship, 16, 25, 35, 225, 245, 360, 429,
interleukin-2 (IL-2), 433 441, 445–46
International Conference on Drug Regu- Kitasato University, 291, 303
latory Authorities (ICDRA), 299 Korea, South, 118, 130, 132, 198, 209–10,
International Conference on Harmoniza- 295, 302, 425
tion (ICH), 32, 280–90, 294, 296, Korea Rice Genome Research Program,
298–303, 305, 438 209
International Federation of Pharma- Kuehne Chemical Company, 315
ceutical Manufacturing Associations,
300 LabCorp, 172
International Monetary Fund (IMF), 30, labor: power of, 12, 14, 25, 51, 62, 65,
230–34, 238, 244–45; Support Policy 93–94, 114, 220; theory of value of,
Instrument and, 246 25, 65, 218–19; time and, 48, 62, 218
International Rice Genome Sequencing Lacanian analysis, 150, 271, 438
Project, 196–202, 204, 206, 210 Lagos, 235, 237
International Rice Research Institute landed property, 187
(IRRI), 205 land rights, 213, 227
intestinal dysbiosis, 364 Las Meninas, 432–33
intra-action, 114 Latin America, 424
Intuitive Surgical, 432 law of takings, 27
inventorship, 391 Lehman Brothers, 349–50, 352
investment banking, 434 Lessig, Lawrence, 188, 200

INDEX 503
Levinas, Emanuel, 430 Matrix, 434
Lévi-Strauss, Claude, 418, 431 means of production, 82, 440
liberalism, 445, 447 measles-mumps-rubella vaccine, 372, 434
licensing: agreements for, 197, 391; fees measured-illness, 53, 57
for, 392 Médecins Sans Frontières (MSF), 243
Lilly-NUS Center for Clinical Pharma- medical anthropology, 45
cology, 302 medical histories, 374
Lincoln, Abraham, 164, 182 medical pluralism, 233, 238
linkage analysis, 329 Medicines and Healthcare Products
Lipitor, 57, 97 Regulatory Agency, 304
Liu, Edison, 423–26, 434–35 Medicines for Malaria Venture, 434
London, 450 megavitamin therapy, 362
Los Angeles, 122–23, 129 melanoma, 389
Louisiana, 323, 373 Mendelian diseases, 329
Lundbeck, 303 mental illness, 84, 150, 251–52, 257–58,
Luxembourg, 348 261–65, 267, 270, 273, 278, 439
lymphangioleiomyomatosis, 386 mercantilism, 439
Merck, 68, 73, 246, 302, 393–95, 400,
machinery, 51–52, 61, 64–67, 69, 71, 410
75–76, 82–83, 87, 446 Mertonian norms of science, 6, 38–39,
magnesium, 371 203
malaria, 68, 233 metabolic system, 370, 384
Malaysia, 294, 425, 435; Drug Control metabolism, 365–66
Authority of, 302 Metabolite Laboratories, 172
Manhattan, 317, 319 Metametrix Clinical Laboratory, 384
manufacturing capital, 228 methionine synthase, 365
Maori, 215, 220, 224–26; cosmology of, methylation, 364–65
213–14; subjectivity of, 213, 221 methyl-B12, 372
Marathon Oil, 306 me-too drugs, 65
market logics, 5, 7–8 Mevacor, 73
Marx, Karl, 7–15, 23–26, 29, 33, 40, Mexico, 144
48–55, 58, 62, 65–69, 82–87, 93–97, microarrays, 324, 416–17
112, 114, 125–27, 149, 211–22, 227, micropolitics, 245
230, 449–50 microscopy, 413
Massachusetts General Hospital, 410, migration studies, 425
417, 419–20, 426, 433; Charlestown Milberg Weiss, 349
laboratories and, 414; Thematic Cen- milestone payments, 345
ter for Computational Biology at, militarism, 245
414–15 Millennium Pharmaceuticals, 275, 335,
Massachusetts Institute of Technology 337, 339, 420
(MIT), 105, 188, 298, 320, 325, 390, MindBranch, Inc., 116
398–99, 409, 415, 433, 442 Mississippi River, 316
materialism, 39, 449 Missyplicity Project, 102, 117
material-semiotic (objects), 161, 386, MITh/hHarvard Health, Science, and Tech-
428–29 nology (HST) program, 389, 415,
material-transfer agreements (MTAs), 191 432–33

504 INDEX
model animal. See model organism National Heart, Lung and Blood Insti-
model cereal, 198, 205 tute, 46, 416–17
model organism, 28, 192 National Human Genome Research Insti-
modernity, 125, 213, 222, 227, 299, 441 tute (NHGRI), 105, 119
modes of production, 125, 213, 312, 360, National Institute of Agrobiological Sci-
440 ences, 209
molecular biology, 22, 269, 415, 433, National Institutes of Health (NIH), 2,
436 192, 199, 210, 386, 388, 399, 414–16,
molecular genetics, 32, 269 433, 436
molecular medicine, 443 nationalism, nationalisms, 116, 282, 296,
molecular profiling, 291 298–99
Mongolia, 425 National Science Foundation, 434
monopoly rights, 166, 254 national security, 232, 240, 316
Monsanto, 170–71, 181, 194–98, 201, National Society for Autistic Children,
206, 406, 420, 422 361–62
moral economy, 158, 350 nation-states, 78, 237–38, 295, 299, 301,
Morgan Stanley, 349–50, 352–53 336, 442–43
Mount Sinai Hospital, 317 Nature, 160, 210, 434
mouse genome, 210 Nature Medicine, 408
mouse models, 420 NeoGenesis, 416–17
multi-locale ethnographic strategy. neoliberalism, 23, 30, 32, 126, 212, 218,
See multisited ethnography 230, 238, 244–46, 271, 434, 443, 446;
multiculturalism, 423 economics of, 7, 9
multidisciplinary, 387, 414–15, 429 neuroinflammation, 365
multilateral organizations, 243 neurology, 374
multinational corporations, 237; pharma- New Deal, 340
ceutical companies as, 38, 241, 262, New Jersey, 315, 337
434; software companies as, 441 New Orleans, 315
multiple chemical sensitivity, 357 New Testament, 384
multisited ethnography, 21, 430 New York City, 318
multispecies, 94, 97, 99, 106, 114 New York State: Department of Health
Myriad Genetics, 195 of, 317; Metropolitan Transportation
Authority of, 317
Nader, Ralph, 243 New York Times, 172, 314, 325, 359, 405
NASDAQ, 336, 345, 348–49 New Zealand, 29, 73–74, 211, 213, 223
National Autism Association, 361 Nigeria, 30–31, 228–35, 239–47; civil war
National Bank of Iceland, 347 in, 234; Intellectual Property Law
National Cancer Institute (NCI), 37, 108, Association in, 242; National Agency
119, 393, 398, 423–24 for Drug Administration and Control
National Center for Biotechnology Infor- in, 234–35, 238; National Drug Policy
mation, 210 of, 234; Patent Office of, 242; pharma-
National Center for Gene Research, 209 ceutical industry in, 238
National Center for Genetic Engineering nonexclusive licensing, 4–5
and Biotechnology, 209 non-governmental organizations (NGOs),
National Geographic Society, 227 240, 243, 313, 324
National Health Service (NHS), 74 non-tariff barrier, 281, 302

INDEX 505
North America, 158, 178, 209, 253–54, parallel importation, 241
259, 263, 271–72, 274, 438 parent advocacy and advocates, 361, 439,
Northwestern University, 169 448
Novartis, 195, 302 parent-scientists, 365
Novo Nordisk, 302 Paris Club, 231, 246
NSAIDS, 61 Parsons, Talcott, 430
nuclear magnetic resonance, 413 partial perspective, 360
number needed to treat (NNT), 59, 70–71, particularity, particularities, particular-
73, 76, 80, 85 ism, 125, 127, 131, 148–50, 438, 449
nutritional biochemistry, 363 Partners Health Care, 417
Pasteur, Louis, 168
Obama administration, 241 Pasteur Institute, 257
obesity, 47, 97, 262 patent, patents, patenting, 3–5, 27–28,
objectivity, 360, 376–77 38, 41, 66, 71, 85, 89, 108, 158, 166–
obligatory point of passage, 11 82, 185–88, 190, 192, 194–200,
off-label uses, 366 202–6, 210, 214, 242, 252–54, 257,
Oil, Chemical and Atomic Workers 261–63, 277, 283, 330, 336, 390, 392,
union, 323 395, 409, 425–27, 434
oil extraction, 231, 241, 246 patent attorneys and law, 158, 166, 170–
Old Testament, 384 71, 178, 180, 182, 390
oncogene, 177–78, 406 patient advocacy, 38, 437, 439
oncology, 386 patients-in-waiting, 47, 56, 78
OncoMouse, 27–28, 172–73, 177, 179, 181 Pauling, Linus, 362
ontological choreography, 114 penicillin, 410
ontological surgery, 162 People’s Business Commission (PBC),
open-access publication, 189, 208 174–76, 179
open-source forms, 436 peopling of technoscience, 36
open-source software, 189, 311 performativity, 55, 331–33, 335, 339
oppression, 232 Perry, Rick, 307
optical technology, 414 personalized medicine, 119, 419
organs: donation of, 276; trade of, 275; pet-food market, 97
transplantation of, 450 Pfizer, 56, 234, 302, 424
orphan drug laws, 89 pharmaceutical capital, 229, 238
orthomolecular medicine, 362–63 pharmaceutical industry, 45, 49, 51–52,
orthomolecular psychiatry, 363 61–67, 75, 88–89, 229, 241–42, 247,
Osmania University, 434 280, 283, 294, 299, 441, 447; manu-
osteoporosis, 79 facturing and, 233
overdetermination, 10, 15, 19, 449. See pharmaceutical marketing, 34, 45, 49, 52,
also determination, determinations 74, 78, 146, 438, 446
ownership, 132, 155–56, 169, 175, 182, Pharmaceutical Research and Manufac-
186–90, 193, 197, 200, 205, 207, 427 turers of America (PhRMA), 299–302
oxidative stress, 364–65 Pharmaceuticals and Medical Devices
Agency (PMDA), 304
Panama, 348 Pharmacists Council of Nigeria, 236
Pan-Asian SNP initiative, 426, 429 pharmacoeconomics, 68
panopticon, 24 pharmacogenomics, 251, 291, 293

506 INDEX
pharmacokinetics, 286, 301 prior art, 165
pharmacy, pharmacies, 229–30, 232–33, Prison Dog Project, 120
235–36, 246 prison-industrial complex, 111
Philippines, 435; Bureau of Food and Private Securities Litigation Reform Act,
Drugs of, 302 339, 342–44, 349, 352
philosophy of science, 433 property law and rights, 6, 27, 38, 157,
physician-scientist, 388–89, 430, 432–33 167–71, 178, 182, 185–96, 199, 207–
physiology, 373 8, 239, 254, 391, 436, 443
Pillsbury Madison and Sutro, 342–43, 352 property regime, 5, 13, 24, 187, 203, 205,
placebo, placebos, 367, 401–2, 404, 433 208, 251–54
plant genetics, 421–23 proprietary drugs, 238–39, 280
plasminogen, 393 Proscar, 400, 410
platform technology, 5 prostate-specific antigen, 405
platinum, 405 protease inhibitors, 418
Polaris Ventures, 336 protectionism, 231–32, 286
polio, 406–7 protein fusion, 417–18
political culture, 282, 284 Prozac, 54, 107–8, 273
political economy, 13–17, 19, 21, 23, 40, psoriasis, 401
51, 144, 147, 216, 229, 244, 387, 438, psychiatric disorders. See mental illness
446, 448; of hope, 35 psychiatric genomics, 266, 269, 438
Polymerase Chain Reaction (PCR), 6, 398 psychiatry, 87, 150, 256, 265–74, 277,
polypill, 85, 88 355, 366
population genetics, population geneti- psychoanalysis, psychoanalysts, 10, 21,
cists, 214, 425, 438 32, 261, 267, 272, 278, 333, 443
population health and illness, 58, 59, 88 psychology, 361
population medicine, 74 psychopathology, 259, 271
positional cloning, 329 psychopharmaceuticals, 267, 383
postcolonialism, 124, 147, 151, 424–25; psychopharmacology, 277, 355, 368, 378
postcolonial state and, 230 public domain, 18, 28–29, 33, 165–66,
postgenomics, 108–9, 266, 419 185–90, 194, 197–207, 210, 243, 314,
postmicroarray technology, 415 436, 443
postmodernism, 126, 238 public good, 8, 27–28, 157, 174, 188, 191,
poststructuralism, 21 390–91
Potrykis, Ingo, 167 public health, 47, 56–59, 76, 132, 183,
praxis, 438, 444–45, 447, 449 232, 238, 244, 253, 259, 283, 300,
prescription, prescriptions, 45–49, 62– 447
65, 75–84, 90, 239 public interest, 91, 178
prescription drugs, 46, 279 public knowledge, 162
President’s Council on Bioethics, 159, public property, 190
427, 436 public relations, 241, 368, 383
presumed consent, 335 public takings, 156, 181
preventive health, 57, 74 Pune, 434
preventive medicine, 59–60, 74
primitive accumulation, 13, 213, 216–17, Ranbaxy, 239, 434–35
221, 230, 445 randomized controlled trials. See clini-
Princeton University, 434 cal trials

INDEX 507
Reagan, Ronald, 7 Santa Fe, 435
recombinant DNA patents, 37 scale-making, 442
recombinant DNA technology (RDT), 2–5, Schering AG, 303
8, 38–39 Schering-Plough, 303
regenerative medicine, 414 Schiavo, Terri, 26, 159–60
relations of production, 125, 445 schizophrenia, 257, 263–64, 267–68,
Renaissance, 433 270, 277
representation, representations, 18, 30, School of American Research (SAR), 117
182, 223, 227, 229, 357, 433, 440–41, Science, 102, 185, 196–97, 202–10, 389,
445, 449–50 393
reproductive labor, 101 Science and Technology Studies (STS), 16,
reproductive technologies, 160–61 18, 20–22, 39, 103, 187, 450–51
Republican Party, 173, 339, 345, 349 Science Commons, 191–93
research and development (R&D), 64, scientific capital, 387
67–68, 162, 167, 181, 286, 434 Scorecard.org, 306, 310–11, 319, 321–23,
Research Diagnostic Criteria (RDC), 265 325
respirable suspended particulate (RSP), Scripps Research Institute, 51
128, 144, 146, 149 securities fraud, 349
restriction enzymes, 415 Securities Litigation Reform Coalition,
return on investment, 66–67, 73, 81, 83 342
reverse transcriptase inhibitors, 418 Securities Litigation Uniform Standards
rheumatoid arthritis, 79 Act, 352
Rice Genome Research Program, 209– securities market, 341, 345–46
10 security, securitization, 229, 232, 240–
rice genomes, 184, 186, 198–200, 203, 41, 244–45, 279, 314, 441, 443, 446
208, 421; projects for, 185, 187, 194– Selective Serotonin Reuptake Inhibitor
95, 205, 207, 209 (SSRI), 285
Riemers, Niels, 3 self-medication, 232, 236, 246
right to health, 98, 100 Seoul National University (SNU), 102
Rimland, Bernard, 361–63, 377, 381–83 Serum Institute of India, 434
risk threshold, 24–25, 34, 146, 446 Shantha Biotechnics, 434
risperdone, 383 shareholders, 64, 67, 89, 342–45
RNA interference (RNAi), 420–21 side effects, 76, 236, 402–3, 406
Roslin Institute, 160 Silicon Valley, 3, 6, 342
Roundup Ready, 170–71 Singapore, 32, 281, 286–89, 293–97,
Royal Society, 396 302–5, 419, 423–24, 438, 442–43;
RPG Aventis, 434 Agency for Science, Technology and
Rural Advancement Foundation Interna- Research of, 424; Center for Drug Ad-
tional, 227 ministration of, 304; Center for Drug
Russia, 61, 253 Evaluation of, 293–94, 302, 304;
Rutgers University Plant Genome Initia- Center for Pharmaceutical Adminis-
tive, 209 tration of, 302, 304; General Hospital
in, 288; Health Sciences Authority of,
safe-harbor provisions, 34, 339, 341–44 288, 294, 302–5; Ministry of Health
San Diego, 361–62, 382 of, 288; National Science and Tech-
Sanofi-Aventis, 76, 302–3 nology Board of, 288

508 INDEX
single nucleotide polymorphism (SNP), Subaltern Studies Collective, 217, 310
258, 276–77, 291, 303, 435; chip, 426, subjectivity, subjectivities, 32, 40, 220,
435; consortium, 276, 436 230, 240, 311, 449
situated knowledge, 357 subsumption, 127, 217–18
Snuppy, 102–3, 105, 118 superstructure, 11
social capital, 122 supplementarity, 312
social contract, 230 surplus health, 24, 45, 49, 52, 69, 71, 76,
social medicine, 432 84–86
social responsibility, 195, 207 surplus labor, 24–25, 51, 62, 82–83
social theory, 20, 438 surplus population, 65
Sociology of Scientific Knowledge (SSK), surplus value, 13–14, 24, 62, 66, 71, 103,
20, 39 126, 218–19, 221; absolute, 12; rela-
software company, 325 tive, 12
somatic cell nuclear transfer cloning, surrogacy, 171
102, 118 Swiss Federal Institute of Technology,
South Africa, 450; Medicines Act in, 167
241 Switzerland, 194, 337
South America, 209, 438 symbolic capital, 387
South Asia, 438 symptom fetishism, 52, 57
South China Morning Post, 140 symptoms, 53–57, 74, 81, 83, 86, 152, 237,
Southeast Asia, 151, 294, 297, 302, 305, 356, 359, 364, 367–68, 372–73, 376,
438 380
Southern California, 77 Syngenta, 185, 194–97, 201–4, 206, 210
South Korea, 118, 130, 132, 198, 209–10, synthetic biology, 387, 430–31, 436
295, 302, 425 systems biology, 414, 416, 430–31
sovereignty, 124
Specific Carbohydrate Diet (SCD), 365, tacit knowledge, 411, 429, 433
382 Tagamet, 410
speculative capital, 34, 439–40 Taiwan, 32, 198, 209–10, 281, 286–89,
speculative economy, 330 292–97, 301–5, 425, 435, 438, 443;
speech acts, 331–32 Bureau of Pharmaceutical Affairs of,
Stanford University, 3–8, 37–38, 269, 415, 301; Center for Drug Evaluation of,
420, 434 287–88, 292, 297, 302, 304; Depart-
state privatization, 238 ment of Health of, 302
statin, 25, 47, 74, 86, 97 Tanzania, 247
Stefansson, Kari, 336, 349, 352 Taxol, 396, 403, 405
stem- cell (research/therapy), 102–5, 118, T- cells, 411–12; T- cell receptors and, 418
304, 424, 428, 436 technology: licensing office for, 3–4, 6;
Sterling Chemicals, 309 transfer of, 6, 390
stock market, 64 terra nullius, 229
streptococcus, 410 testing device, 324
Structural Adjustment Programs (SAPs), Texas, 306–7, 309
30, 230–34, 237, 239, 245–46 Texas City, 306, 309–10, 320–21, 323
structural biology, structural biologists, Thailand, 198, 209–10, 294, 425; Food
411–12, 415 and Drug Administration of, 302
structure, 12–13 thalidomide, 283

INDEX 509
The Institute for Genomic Research 123, 144, 146, 156, 158, 162–65, 168–
(TIGR), 198, 209 73, 176–82, 185, 192–95, 198–202,
thematic centers, 414–15, 426 209, 231–32, 239–44, 247, 254, 262–
therapeutic economy, 233 64, 272, 276, 278, 280–81, 285–87,
therapeutic marketing. See pharmaceuti- 292, 298, 303, 306–7, 310–12, 321,
cal marketing 334, 337, 345–46, 355, 389, 394, 401,
Thoughtful House, 381 405, 410, 419–23, 428, 433–35, 438,
tissue engineering, 386 441, 443, 445, 450; Africa Command
Torrey Mesa Research Institute (TMRI), (AFRICOM), 240; Agency for Interna-
194–95 tional Development, 240, 242–43;
toxicogenomics, 324 Census, 317; Center for Disease Con-
Toxic Release Inventory (TRI), 309–10, trol and Prevention, 90, 317; Chemi-
321 cal Safety and Hazard Investigation
trade barriers, 294 Board, 323; Chemical Safety Informa-
Trade Related Aspects of Intellectual tion, Site Security and Fuels Regula-
Property Rights, 208, 242, 244, 434 tory Act, 313–14; Clean Air Act, 307,
trade secrets, 185, 188, 194, 196–97, 313–14; Community Right-to-Know
202–6 Act, 313, 325; Constitution, 155, 163–
trading zones, 298 65, 180; Department of Commerce,
Traditional Chinese Medicine (TCM), 242; Department of Defense, 240,
135–36 247, 435; Department of Energy, 196,
traditional medicine, 233 436; Department of Homeland Secu-
transgenic goats, 395 rity, 314; Department of State, 240;
translational research, 36–37, 385–86, Department of Transportation, 317;
414, 419, 424 Environmental Protection Agency,
transnationalism, 245; transnational 307–9, 311, 314–16, 323, 325; Global
capital and, 244 AIDS Coordinator, 240; National
trans-species, 94–95, 441, 447 Library of Medicine, 323; Occupa-
treatment maximization, 51 tional Safety and Health Administra-
Tristan da Cunha, 262 tion, 323; Patent Act, 165–66, 178,
tropical medicines, 67 180; Patent and Trademark Office,
tuberculosis, 68 168, 172–73, 183, 196, 243, 263; Plant
Patent Act, 166, 196; Plant Variety
ulcerative colitis, 382 Protection Act, 166, 196; President’s
UNESCO, 276 Emergency Program for HIV/AIDS
Union Carbide, 306, 309–10, 320–21 Relief, 231, 239–41, 247; Secretary of
United Kingdom, 65, 73, 160, 185, 192, State, 240; Securities and Exchange
198, 209–10, 410, 434; Parliament, Commission, 17, 34–35, 335–41, 343,
161 345, 347–53, 410; Superfund Amend-
United Nations, 208, 284, 435; Accel- ments and Reauthorization Act, 313;
erated Access Initiative (AAI), 241– trade representative, 301–2
42; Children’s Fund (UNICEF), 434; U.S. Congress, 160, 163, 175, 178–79,
Program on HIV/AIDS (UNAIDS), 309, 335, 342–45, 349; House of Rep-
241–42 resentatives, 339
United States, 46, 60–61, 66, 73–74, 77, U.S. Food and Drug Administration
89, 91, 94–97, 102–5, 109, 114–17, (FDA), 59, 65–66, 265, 277, 287,

510 INDEX
 298–300, 303–4, 390, 395, 401–8, Viagra, 66
435; Center for Drug Evaluation and Vietnam, 424–25
Research, 61 Villanova University, 188
U.S. Supreme Court, 3, 156, 158, 167, 170, Vioxx, 61
172, 174, 179–81, 196, 263, 415 Virginia, 166
universality, universalism, 125–27, 148– vitamin B6, 371
50
University of Arizona, 209 wage labor, wage laborers, 86, 113, 232
University of California, Berkeley, 415 Waitts Foundation, 227
University of California, Davis, 99 Wall Street Journal, 405
University of California, M.I.N.D. Insti- Walt Disney Corporation, 122–24, 141,
tute, 381; Los Angeles, 168–69 146
University of California, San Diego, 424 Washington University, 169, 209
University of California, San Francisco, wealth extraction, 229–30, 233
269, 392, 415 Weber, Max, 9–11, 38, 430
University of California, Santa Cruz, 119, Weissman, August, 412
436 welfare state, 271
University of California, School of Veteri- Wellcome Trust, 210, 276–77
nary Medicine, 105 Wellington Public Hospital, 213
University of California system, 37, 51 West Africa, 237, 241
University of Detroit, Mercy, 64 West Harlem Environmental Action
University of Hong Kong (HKU), 129–30, (We Act), 316–17, 320
132–33, 150 Wheat Commission, 340
University of North Carolina, Chapel White House, 342
Hill, 106 whole genome shotgun [sequencing],
University of Pittsburgh, 102 195, 201
University of Washington, 194 William J. Clinton Foundation, 434
University of Wisconsin, 209, 420 Wisconsin, 404
use value, 25, 54, 93, 95, 97, 112 Wistar Institute, 276
utopian socialists, 10 World Bank, 30, 231, 246
World Health Organization (WHO), 146,
vaccine, vaccines, 364, 376, 382, 384 152, 241–42, 264–65, 284, 299–300
value, 5–8, 12–15, 19, 24–29, 34, 48, 52, World Intellectual Property Organiza-
59, 62–64, 67–72, 75, 77, 80–83, 87, tion, 208
91, 93, 95, 99–100, 103–4, 108–9, World Trade Organization (WTO), 208,
114, 117, 124, 126, 143, 156–58, 166, 229, 238, 241–42, 434
169, 177–81, 190, 198, 212–14, 217– worst- case scenarios, 313–14, 325
20, 226, 252–58, 262–63, 275–76,
279, 297, 304, 325, 332, 337, 373, 375, xenotransplantation, 177
379, 415, 439, 442, 445, 450
vancomycin, 380 Yahoo, 383
variable capital, 62 Yahoo Finance, 410
Velasquez, 432–33 Yale University, 434
venture capital, venture capitalists, 2, 17, Young Hegelians, 10
89, 264, 335–37, 352, 387, 406, 415,
420, 434 Zimbabwe, 245

INDEX 511
Donna Haraway’s chapter originally appeared as
“Value-Added Dogs and Lively Capital” in When
Species Meet. Copyright © 2008 Donna J. Haraway.
Reprinted with the permission of the University of
Minnesota Press.

Andrew Lakoff ’s chapter originally appeared as

“Diagnostic Liquidity” in Pharmaceutical Reason:
Knowledge and Value in Global Psychiatry. Copyright
© 2004 Andrew Lakoff. Reprinted with the
permission of Cambridge University Press.

Library of Congress Cataloging-in-Publication Data

Lively capital : biotechnologies, ethics, and
governance in global markets /
Kaushik Sunder Rajan, ed.
p. cm. — (Experimental futures)
Includes bibliographical references and index.
ISBN 978-0-8223-4820-7 (cloth : alk. paper)
ISBN 978-0-8223-4831-3 (pbk. : alk. paper)
1. Biotechnology—Social aspects. 2. Biotechnology—
Political aspects. 3. Biotechnology industries—
Finance. I. Sunder Rajan, Kaushik. II. Series:
Experimental futures.
TP248.23.L58 2012
660.6—dc23!2011027558