Submission deadline: 1st July 2020
Projected publication date: December 2020
Guest editors: Alice Street, Ann Kelly, Michelle Taylor
As the COVID-19 pandemic continues to disrupt life and livelihoods across the world, diagnostic testing has taken centre stage in debates about how best to respond. ‘Test, test, test’ implored Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. ‘Without testing you are blindfolded’. The ability to detect the SARS-CoV-2 viral pathogen has proved pivotal to the success of containment and mitigation efforts, informing public health planning, clinical triage and economic forecasting. The social, political, ethical and, critically, economic qualities of medical testing have rarely been so evident: in some countries, the vital importance of diagnosis to pandemic response and the challenges associated with scaling up testing seem to have taken politicians, journalists and citizens by surprise, generating outrage, political controversy, and thousands of lines of media commentary. Across the world, publics have been vocal in demanding access to tests, in the hope that they will provide certainty, reassurance that authorities are in control, and the reinstatement of personal freedoms.
Taking the prominence of medical testing the COVID-19 pandemic response as a provocation, we invite contributions to a special issue of MAT on the value(s) of diagnosis and medical testing in diverse social and cultural contexts.
The sheer scale of COVID-19 testing needs has exposed a diagnostic paradox. Laboratory-based diagnostic testing has occupied an axiomatic position in modern biomedicine since the early Nineteenth Century, and yet policy makers and funders across the world have systematically neglected public health laboratories and diagnostic work. For many under-resourced settings, the failure to invest in diagnostic systems is particular acute: without access to laboratory infrastructure, treating patients and public health planning ‘blind’ is the status quo not the exception. In global health circles, stand-alone devices and rapid point of care tests have been leveraged as a solution to the diagnostic gap. However, if the current COVID-19 testing impasse that has characterised the response in so many high income countries’ teaches us anything, it is that tests provide little by way of insight without comprehensive and well-integrated laboratory systems, supply chains and trained personnel to support them.
How is it that diagnosis constitutes a primary source of biomedical authority and yet, until the present crisis, has attracted so little attention and garnered so few resources from governments and global health organisations worldwide? To begin to answer this question demands nuanced interrogation of the distinct social values of diagnosis and tests and how the significance of diagnosis for patients, publics, health workers, and governments has evolved across time and place. Who is diagnostic work for and how do distinct value regimes – e.g. global biosecurity, humanitarianism, or science – shape its visibility, resourcing and practice? What role do medical testing and diagnostic technologies play in diagnostic work and what does the changing nature of this role in many settings tell us about shifting priorities and relationships in global health? How do novel diagnostic technologies transform relationships of trust and power between citizens and governments, patients and health workers, laboratory technicians and clinicians, and reconfigure our understandings of health, the human body and, increasingly, the economy? What expectations do people invest in medical testing, and how do those expectations play out over the course of test development, public health planning, clinical management, and personal biographies? How do relationships between knowing and doing, uncertainty and hope unfold in the course of diagnostic work across diverse contexts?
Medical anthropology has a singular and important contribution to make to understandings of diagnosis and medical testing in the present moment. Ethnographic work on medical testing has provided the anchor to elaborate the forms of solidarity, subjectivity, modalities of care and authority that cut across reproductive medicine (e.g., Birenbaum-Carmeli & Inhorn, 2009; Buchbinder & Timmermans, 2011; Rapp, 2004; Smith-Morris, 2005; Taylor, 2008), genetic medicine (e.g., Latimer, 2013; Konrad 2003; Nelkin 1996) and infectious disease control in global health (e.g., Biehl et al. 2001; Beisel et al 2015, Beisel, Clakin & Rottenberg, 2018; Hardon et al, 2011; Hutchinson et al, 2015, 2017; Lee & Palmer 2018; Meinert et al. 2009; Palmer et al. 2020; Street 2011, 2018). Anthropologists have long recognised the central role of diagnosis in the production of biomedical authority, the governing of biological persons, the formation of new subjectivities and solidarities, accessing care, and the structuring of relationships between patients, clinicians and the state.
In a special issue of MAT dedicated to medical testing, we take COVID-19 as an impetus to explore these questions afresh. Building on this body of work and expanding its concerns to reflect on the shifting social, political and economic trajectories of medical testing today has the potential to push scholarly debates beyond immediate practicalities to understand, at a more fundamental level, what diagnosis means to people, why it matters, and what kinds of value it generates in different places and times. Contributions can touch on the role of medical testing in any aspect of healthcare, from reproductive medicine, to non-communicable diseases, to infectious disease control and public health. We particularly welcome contributions that explore synergies and intersections between medical anthropology, medical sociology, public health, science and technology studies and geography, fields that have paid substantial attention to the development and deployment of new diagnostic technologies in recent years (e.g., Büscher, Goodwin & Mesman 2009; Jutel, 2009; Mol 2002; Rose, 2007, 2013).
Topics might include, but are not limited to:
Relationships between diagnosis and testing technologies: how are new testing technologies and devices transforming the role and meaning of diagnosis in different contexts?
Practices of diagnostic data production: how is diagnostic data produced? By whom? Who has access to diagnostic data and who benefits from it?
Everyday experiences of medical testing: how are diagnostic processes integrated into everyday workflows and health-seeking practices in specific locales? Who (or what) is being tested? What differences of value pertain to medical tests for animals and humans?
Networks of capital involved in the development, design and deployment of testing devices.
The distinctive role of medical testing in the management of non-communicable diseases, mental health, genomic medicine, disease elimination programmes, and public health emergencies.
Submissions can be made to any section of MAT. Authors are encouraged to contact Alice Street (firstname.lastname@example.org) to discuss their article in advance of submission. Deadline for submission is 1st July 2020.
Biehl, J., Coutinho, D., & Outeiro, A. L. (2001). Technology and affect: HIV/AIDS testing in Brazil. Culture, Medicine and Psychiatry, 25(1), 87-129.
Beisel, U., Umlauf, R., Hutchinson, E., & Chandler, C. I. (2016). The complexities of simple technologies: re-imagining the role of rapid diagnostic tests in malaria control efforts. Malaria journal, 15(1), 64.
Beisel, U., Calkins, S., & Rottenburg, R. (2018). Divining, testing, and the problem of accountability. HAU: Journal of Ethnographic Theory, 8(1-2), 109-113.
Birenbaum-Carmeli, D., & Inhorn, M. C. (Eds.). (2009). Assisting reproduction, testing genes: Global encounters with the new biotechnologies (Vol. 18). Berghahn Books
Buchbinder, M., & Timmermans, S. (2011). Medical technologies and the dream of the perfect newborn. Medical Anthropology, 30(1), 56-80.
Büscher, M., Goodwin, D., & Mesman, J. (Eds.). (2009). Ethnographies of diagnostic work: dimensions of transformative practice. Springer.
Hardon, A., Kageha, E., Kinsman, J., Kyaddondo, D., Wanyenze, R., & Obermeyer, C. M. (2011). Dynamics of care, situations of choice: HIV tests in times of ART. Medical anthropology, 30(2), 183-201.
Hutchinson, E., Chandler, C., Clarke, S., Lal, S., Magnussen, P., Kayendeke, M., et al. (2015). ‘It puts life in us and we feel big’: shifts in the local health care system during the introduction of rapid diagnostic tests for malaria into drug shops in Uganda. Critical public health, 25(1), 48-62.
Hutchinson, E., Reyburn, H., Hamlyn, E., Long, K., Meta, J., Mbakilwa, H., & Chandler, C. (2017). Bringing the state into the clinic? Incorporating the rapid diagnostic test for malaria into routine practice in Tanzanian primary healthcare facilities. Global public health, 12(9), 1077-1091.
Jutel, A. (2009). Sociology of diagnosis: a preliminary review. Sociology of health & illness, 31(2), 278-299.
Koch, E. (2011) Local Microbiologies of Tuberculosis: Insights from the Republic of Georgia, Medical Anthropology, 30:1, 81-101
Konrad, M. (2003). Predictive genetic testing and the making of the pre-symptomatic person: Prognostic moralities amongst Huntington's-affected families. Anthropology & Medicine, 10(1), 23-49.
Latimer, J. (2013). The gene, the clinic, and the family: diagnosing dysmorphology, reviving medical dominance. Routledge.
Lee, S. J., & Palmer, J. J. (2018). Integrating innovations: a qualitative analysis of referral non-completion among rapid diagnostic test-positive patients in Uganda’s human African trypanosomiasis elimination programme. Infectious diseases of poverty, 7(1), 1-16.
Mol, A. (2002). The body multiple: Ontology in medical practice. Duke University Press.
Meinert, L., Mogensen, H. O., & Twebaze, J. (2009). Tests for life chances: CD4 miracles and obstacles in Uganda. Anthropology & medicine, 16(2), 195-209.
Nelkin, D. (1996). The social dynamics of genetic testing: the case of fragile‐X. Medical anthropology quarterly, 10(4), 537-550.
Palmer, J. J., Jones, C., Surur, E. I., & Kelly, A. H. (2020). Understanding the Role of the Diagnostic ‘Reflex’in the Elimination of Human African Trypanosomiasis. Tropical Medicine and Infectious Disease, 5(2), 52.
Rapp, R. (2004). Testing women, testing the fetus: The social impact of amniocentesis in America. Routledge.
Rose, N. (2013). What is diagnosis for. Lecture given at the Institute of Psychiatry (London) on, 4.
Rose, N. (2007). Genomic susceptibility as an emergent form of life. Genetic testing, identity, and the remit of medicine. En Regula Valérie Burri & Joseph Dumit,(Eds.), Biomedicine as Culture: Instrumental Practices, Technoscientific Knowledge, and New Modes of Life, 141-150.
Smith-Morris, C. M. (2005). Diagnostic controversy: gestational diabetes and the meaning of risk for Pima Indian women. Medical anthropology, 24(2), 145-177.
Street, A. (2018). Deep diagnostics. Limn 9 Little Development Devices/Humanitarian Goods.
Street, A. (2011). Artefacts of not-knowing: The medical record, the diagnosis and the production of uncertainty in Papua New Guinean biomedicine. Social Studies of Science, 41(6), 815-834.
Taylor, J. S. (2008). The public life of the fetal sonogram: Technology, consumption, and the politics of reproduction. Rutgers University Press.