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Paradoxical bodies: negotiating biomedical fix, responsibility, and care in a weight-loss surgery clinic

AbstractThis ethnographic project explores how inherent discursive and social tensions are expressed and worked out within obesity care at a weight-loss surgical (WLS) clinic. First, complicated doctor and patient encounters occur because WLS follows a medical logic of intervention and is presented as a “biomagical” procedure that miraculously alters the body. Surgeons, however, explain that the surgery’s success depends on patients’ long and hard work. Second, the clinic’s interdisciplinary approach adds more complexity. While expanding the scope of treatment, it blurs the division of labor among professionals and the distinction between body and mind. It also diffuses the responsibility for patients’ lifestyles and recovery among professionals. Third, alongside notions about patients’ autonomy and free choice, their wishes and bodies are constantly channeled, problematized, and negotiated with various family and peer support. While crucial for the surgery’s success, such interconnectedness raises questions about how decision making and social pressures affect the patients’ journey. Thus, WLS is refracted among webs of multiple actors and contradictory perspectives. This complexity invites a reflection on how such tensions and paradoxes destabilize medical power in modifying the body, challenge personal responsibility assumptions, and impact the quality of care.

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The social shaping of biotechnological innovation. The case of Covid-19 protein vaccine in Cuba and the US

AbstractLike other technologies, vaccines are socially shaped by socio-economic, political and organisational factors. Property rights, value capture strategies and public innovation policies guide research teams in the biochemical design of vaccines, with inevitable consequences for their price and accessibility. The Covid-19 pandemic provided an opportunity to analyse this institutional shaping process and its consequences for global public health from a political economy perspective. Indeed, the same type of invention, a recombinant protein vaccine, was simultaneously and originally developed in the US and Cuban biopharmaceutical industries and in the field of philanthropic Open Innovation. The article shows, through empirical research that collected direct testimony from scientists and privileged observers of the vaccine development fields, how certain norms and values characteristic of the US industry (financialization, assetization and de-risk) created a path dependency in the use of proprietary and experimental biotechnologies that made the US vaccine Nuvaxovid more expensive and complex to produce, but no more effective and safe than Abdala, Soberana 02 and Corbevax. In addition, the institutional constraints of the US biopharmaceutical industry on radical innovation, even within a mature biotechnology platform such as protein vaccines, would have resulted in a competitive disadvantage for Nuvaxovid, which was as expensive as an mRNA vaccine but less rapid to market and less reliable in delivery. The case of protein vaccines against Covid-19 thus shows how the institutional architectures of techno-scientific capitalism create not only inequalities but also inefficiencies, and that an innovation path with excellent results is possible even in competition where the market is not the dominant order of worth.

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‘Our biology is listening’: biomarkers as molecular vestiges of early life and the production of positive childhood experiences in behavioral epigenetics

AbstractThe sciences of environmental epigenetics and the Developmental Origins of Health and Disease have become central in efforts to understand how early life experiences impact health across the life course. This paper draws on interviews with epigenetic scientists and laboratory observations in the United States and Canada to show how scientists conceptualize epigenetic biomarkers as molecular vestiges of early life and the consequences this has for postgenomic approaches to health, risk, and intervention. We argue that this process demarcates early life as the optimal time to study and intervene in health and positions biomarkers as conceptual and methodological tools that scientists mobilize to reimagine early life environments. These environments include Positive Childhood Experiences (PCEs), which reflect an emergent and increasingly prominent epistemic object in behavioral epigenetics. Though distinct from widespread research on Early Life Adversity, we show how PCEs continue to essentialize experience in gendered and individualized ways. Further, this paper suggests that focusing on biomarkers as molecular vestiges of early life allows scientists to create stability despite ongoing epistemological and biological unknowns in epigenetics and DOHaD. Our findings contribute new perspectives to social studies of epigenetics, biomarkers, and the production of novel epistemic objects in postgenomic knowledge practices.

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