The Biotechnical Embrace
MARY-JO DELVECCHIO GOOD
THE BIOTECHNICAL EMBRACE
ABSTRACT. This essay discusses three interpretive concepts that link bioscience and
biotechnology to society: the medical imaginary, the biotechnical embrace, and the clin-
ical narrative. Drawing on research carried out in the United States and internationally
on the culture and political economy of biomedicine, the essay examines these inter-
pretive concepts through examples from studies of patients, clinicians, scientists, and
venture capitalists engaged in the worlds of oncology and high technology medicine. These
interpretive concepts contribute to an understanding of how the affective dimensions of the
experience of patients, clinicians and scientists invested in high technology medicine are
fundamental to bioscience and biomedicine, and to the political economy and culture of
hope.
KEY WORDS: biotechnology, clinical narrative, culture of medicine, oncology
Cultural and social studies of biomedicine and biotechnology lend them-
selves to examining what anthropologists Fischer XXXXXXXXXXand Marcus
(1998) have referred to as “multiple regimes of truth,” and thus the call
for multi-sited and – implicitly or explicitly – comparative ethnographic
research in the areas of science and technology. Although acknowledging
the importance of “cultural pasts” and “cultural differences,” Fischer
argues that today “it is increasingly artificial to speak of local perspec-
tives in isolation from the global system . . . the world historical political
economy” and “transnational cultural processes” (Fischer 1991: 526). This
formulation echoes recent trends in anthropological studies of biomedicine
and biotechnologies, and the whole domain of scientific research and clin-
ical culture. Such studies highlight the dynamic relationship, tensions and
exchanges between the local worlds in which medicine is taught, prac-
ticed, organized and consumed and the global worlds of the production
of knowledge, technologies, markets, and clinical standards. Although we
may speak about a plurality of biomedicines that are socially and culturally
situated rather than about a single unified body of knowledge and practice,
such local worlds are nevertheless “transnational” in character – neither
cultural isolates nor biomedical versions of indigenous healing traditions.
Rather local meanings and social arrangements are overlaid by global
standards and technologies in nearly all aspects of local biomedicine.
Culture, Medicine and Psychiatry 25: 395–410, 2001.
© 2001 Kluwer Academic Publishers. Printed in the Netherlands.
396 MARY-JO DELVECCHIO GOOD
COMPARATIVE QUERIES
This perspective encourages comparative questions: how do local and
international political economies of medical research and biotechnology
shape medicine’s scientific imaginary, its cultural, moral and ethical
worlds, and the structure of inequalities of use, access and distribution of
medicine’s cultural and material “goods”? How do local and international
ideologies, politics and policies influence professional and institutional
responses to specific needs of particular societies – from the disease
plagues of HIV to scarcity and poverty, trauma and civil strife, to public
health and profit-driven health service markets? What form does the “polit-
ical economy of hope” take? How do the culture of medicine and the
production of bioscience and biotechnology “live” in respective societies?
Joseph Rouse, an American philosopher of science and society, speaks
about American science, about the “openness” of science, arguing for an
analysis that acknowledges that “the traffic across the boundaries erected
between science and society is always two-way.” Rouse discusses the
idea of destabilizing “distinctions between what is inside and outside of
science, or between what is scientific and what is social” (1992: 13). Bruno
Latour, the prominent French scholar of the biosciences, also contends
that “scientific work continually draws upon and is influenced by the
culture ‘outside’ science” (Rouse 1992: 13). Although these comments
are directed to a long-lived internal debate among scholars of science
studies, the concept they propose of two-way traffic across science and
society is perhaps all the more striking in biomedicine. The flow of knowl-
edge, scientific and medical cultural power, market wealth, products, and
ideas is thus not only between local cultures and institutions that create
medical knowledge and organize practice, ethics and the medical market,
but also between the culture and market of international and cosmopolitan
biomedicine and its local variants.
The dynamics of the global-local exchange challenge our notions of
“universalism” in clinical science and “local” knowledge in clinical prac-
tice, stimulating a rethinking of the boundaries not only between science
and society but also between “the local” and “the global.” It is with this
sense of the transnational fluidity of knowledge and practices, appropriated
locally and regionally and integrated into local culture, that I wish to turn
to three interpretive concepts that link bioscience and biotechnology to
society, and that have grown out of comparative cross-cultural analyses
and conversations with colleagues from Europe, Africa and Asia, as well as
from my own research in the United States and Indonesia. These concepts
are “the medical imaginary,” “the biotechnical embrace,” and “the clinical
narrative.”
THE BIOTECHNICAL EMBRACE 397
THE MEDICAL IMAGINARY
An ethnographic slice through “multiple regimes of truth,” narratives
of patient experience and of clinical science, and documents on medi-
cine’s political economy, suggests ways in which the affective and
imaginative dimensions of biomedicine and biotechnology envelop physi-
cians, patients, and the public in a “biotechnical embrace.” The medical
imaginary, that which energizes medicine and makes it a fun and intriguing
enterprise, circulates through professional and popular culture. Clinicians
and their patients are subject to “constantly emerging regimes of truth in
medical science” (Marcus 1995: 3; Cooke 2001), and those who suffer
serious illness become particularly susceptible to hope engendered by
the cultural power of the medical imagination. The connection between
medical science and patient populations and the cultural and financial flow
thus becomes deeply woven; the intensity of such connections may be
measured in part through the flourishing of disease-specific philanthropies,
through NGOs and political health action groups, and through the financial
health of NIH ($20.3 billion allotted in the 2001 budget), even under a
political regime that promotes tax cuts and small government.
Americans invest in the medical imaginary – the many-possibility
enterprise – culturally and emotionally, as well as financially. Enthusiasm
for medicine’s possibilities arises not necessarily from material products
with therapeutic efficacy but through the production of ideas, with potential
although not yet proven therapeutic efficacy. An officer of one of the most
successful biotechnology firms in America indicated that biotechnology
enterprises are in the business of producing ideas about potential thera-
peutics, from designer anticancer therapies to the manipulation of damaged
genes.
So, think about a biotechnology company as a pharmaceutical company XXXXXXXXXXIf you start
with an idea and you are by definition working on something in the pharmaceutical industry
that is likely to fail, XXXXXXXXXX% of the time XXXXXXXXXXThat was one of the myths of biotech XXXXXXXXXXSo
you are proposing to start a company in which there is a 90% chance of failure, the cost
of product development is $500–900 million, and from idea to the time when you have
a revenue stream from product development is 12 to 15 years. So your question is really,
against that fundamental absurdity, how do you build a business, right? . . .
If you start at that purely abstract level, what do you have to sell? You don’t have your
product yet, so what do you have to sell to feed the beast that you are about to build? Well,
there are only two things that you have to sell: the one is you can sell things that are or look
or smell like equity XXXXXXXXXXWhat’s the problem with that? At the end of the day, the pie is so
split up, nobody makes any money on their equity, the dilution is intolerable. So what else
do I have to sell? Well, instead of selling pieces of the company, an interest in the home,
I can sell pieces of pieces, which I call rights, for example in certain of my discoveries
or products, and this is where the pharmaceutical companies come in, and they say we
will pay for you to do some research on our behalf, we will take the product that results
398 MARY-JO DELVECCHIO GOOD
from it, we the pharmaceutical company will commercialize it and pay you a royalty. So I
withstand the dilution, I start generating revenues from collaboration, . . . and then I hand
off the more expensive parts of forward integration of manufacturing and sales, I don’t
have to take on those burdens.
The question then becomes, so call those your children. Keep the family alive by selling
your children. The question is, is the nature of your platform prolific enough that in having
sold off some of your children, you haven’t sold off all of your future. Because if all you
are at the end of the day is getting some royalties, from the 10% of your efforts that didn’t
fail, you are never going to be a big company. (Holtzman 2001)
Such firms seek to make public the scientific imaginary; until very recently,
they have been the darlings of venture capital. (See the business sections
of The New York Times and the Wall Street Journal during January 2001–
April 2001 for analyses of recent market weakness.)
At more mundane levels, Americans live in a world in which the
medical imaginary has star billing in medical journalism, television
advertisements, and globally popular television productions such as ER.
(ER is among the most popular television programs in Indonesia and
China.) The imminent discovery of cancer cure, effective genetic therapy,
the manufacturing of new and better mechanical hearts, the engineering
of tissue and the genetic alteration of pig cells to offset organ shortages,
the latest results of clinical trials on AIDS therapies and the effective-
ness, cost, and contested patents – all become part of the daily and
global circulation of popular, business and medical knowledge. Our vast
interests, financial and certainly emotional, in “the political economy of
hope” are very evident in daily market reports and public discourses. The
circulations of knowledge and of the ethereal products of the medical
imaginary are of course unevenly distributed. The robustness of local
scientific and medical communities, of NGOs and political health activ-
ists, influence how this global knowledge is shared, accessed, and used.
(See for recent studies: on Brazil, Bastos 1999; on American research
oncology, Cooke 2001; on French science, Rabinow 1999; and on medical
missions for high technology treatment of multi-drug-resistant tubercu-
losis [MDRTB] and HIV for the poor, Farmer XXXXXXXXXXAlternative stories,
misuses and failures of medicine’s cultural power and possibilities, are
also part of the traffic in the medical imaginary: failures (as in prema-
turely attempted genetic therapy leading to patient death); fraud (in clinical
trials in oncology); discouragement (when promising therapeutics appear
ineffective); greed (physicians trafficking in organs, brokering transfers
from the poor to the rich). (New York Times, Boston Globe, Organs
Watch [http://sunsite.berkeley.edu/biotech/organswatch/] 1999–2000) Yet
these tales are set