In recent years, regulatory processes governing the approval of new health technologies have undergone changes aimed at expediting access. Some of these changes involve the adaptation of established standards of evidence for safety and efficacy, which we refer to as evidence-adapted regulatory pathways (EARPs). While EARPs have provided more timely access to potentially beneficial interventions, critics argue that reducing evidentiary thresholds threatens regulatory integrity, compromises safety, and undermines evidence-based medicine. In this article, we argue that regulatory processes and the therapeutic choices they enable are deeply socially constructed, and that discourse—particularly promissory discourse—plays a constitutive role in shaping regulation and its outcomes. We offer a typology of existing pathways to access health technologies, examine the growth of EARPs internationally and identify some recurring themes in the associated scholarly and public-facing discourses. We show that EARPs are often portrayed in a ‘promissory’ manner that obscures risks and uncertainties. We argue that this promissory discourse can (i) distort patients’ and clinicians’ understandings of evidence and decisions about clinical use and (ii) create undue pressure on funders. We suggest avenues for further research and policy development that could help regulators, in collaboration with clinicians and consumers, to promote socially responsible discourse around EARPs.
DNA computing is an interdisciplinary field working at the intersection of computer science, molecular biology and material sciences to develop novel nanobiotechnologies. In this article, I draw on interview data to critically examine the ethical reflections of sixteen researchers in the field of DNA computing, paying particular attention to their assumptions about the relationship between humans and technology. I argue that most of their ethical reflections imply an instrumentalist understanding of technology that views technologies as neutral means for human-directed ends. Consequently, most research participants see ethical questions as distant to their work and frame their concerns around the misuse of DNA computing applications by bad actors. Expanding on notable exceptions to this instrumentalist tendency in my interview data, I propose an alternative perspective derived from the philosophy of Bernard Stiegler that treats technology as historically and dynamically intertwined with human biology and the social. I suggest that his concepts of general organology and pharmacology provide a non-instrumentalist foundation that could inform more nuanced ethical reflections on DNA computing and other biotechnologies.
‘Metabolism’ is a term commonly defined as the sum total of chemical processes happening within some living entity which sustains that entity. Biogeochemists use this concept somewhat differently. A stark example comes from marine contexts, where biogeochemists sometimes refer to ‘ocean metabolism’. From the standard biomedical perspective, the ocean does not seem to be the kind of thing which can possess metabolism; it does not seem to be a single living entity that is sustained by chemical processes. In the light of this puzzle, this paper does three things: first, we flesh out a distinct biogeochemical sense of metabolism, exploring how this differs from, but retains connections to, biomedical definitions of metabolism. Second, we use this to explain how the ocean can be considered metabolic without needing to be considered an organism. Finally, we explore the consequences and implications of this sense of metabolism–in scientific, epistemic and social dimensions – and of recognising biogeochemical systems, such as oceans or parts of them, as metabolic.
A recently developed genetically engineered (GE) mosquito with synthetic DNA has been categorized by the Secretariat of the Convention on Biological Diversity as a synthetic biology organism. In contrast, a key regulatory agency has construed it as a natural biopesticide. This paper identifies the non-epistemic concern that appears to have motivated that classification decision. It is argued that the mis-classification of a product by a regulatory agency may mean that it undermines its own categorization framework.
In this article, we introduce the notions of algorithmic gaze and nested multifocality as analytical categories for investigating the production of evidence in contemporary biosciences. Drawing on an ethnographic study of a translational medicine project involving the clinic, the wet lab, and bioinformatic work—as well as interviews with bioinformaticians and computational biologists—we show how evidence emerges through the situated negotiation of different gazes, 'professional visions,' and 'styles of reasoning.' We define the algorithmic gaze as an emergent computational mode of seeing and rendering biological phenomena intelligible through pattern recognition, visualization, and algorithmic procedures. Its epistemic legitimacy, we show, is negotiated through its relation to clinical and molecular gazes within 'biomedical platforms.' The concept of nested multifocality accounts for an epistemic condition in which evidence is not only relative to 'epistemic cultures' and specific research situations, but also emerges through a broader multifocal vision that accommodates different gazes and 'professional visions'
Every day research animals of different species are made to live and die in research facilities as part of biomedical research. This article looks at the killing of livestock pigs for organs to be used in transplant science; a science driven by goals to save human lives by improving the use of donated organs. Based on an ethnographic study carried out in Denmark and the US, we explore how people engage in killing pigs and what it takes for humans to kill pigs for research, beyond the technical and procedural work. The article investigates the experiences and reflections related to killing pigs for organ research in three different contexts: the barn, the operating room and the slaughterhouse. The article proposes that killing pigs for organs in scientific contexts is an ethico-emotional practice where both emotions and ethics unfold through negotiations of nearness to the pig, the pig’s organs and the overall purpose of the research. Through three killing stories we show how emotions are evoked, calibrated and redirected to make killing legitimate, doable and bearable for those doing it.
This article explores how local patient support groups can function as sites of everyday activism within a neoliberal healthcare landscape. Based on ethnographic fieldwork with two Breathe Easy groups for individuals with chronic respiratory illness in North East England, the study examines how practices of care, peer support, and informal advocacy subtly challenge the structural marginalisation of chronically ill populations. While members do not explicitly identify as activists, their collective actions—from lobbying for local services to redistributing medical resources—demonstrate grassroots agency grounded in biosocial solidarity and relational care. Drawing on concepts such as biosociality, radical care, and everyday activism, the article shows how these groups redistribute epistemic authority not through protest, but through sustained, care-led micro-politics. Amidst austerity and healthcare reform, their efforts prefigure alternative models of community health governance and challenge dominant narratives of passive patienthood. Navigating insider–outsider roles, these groups create hybrid spaces of patient participation, community action, and informal health provision. The study offers a conceptual framework for understanding support groups as platforms for slow, collective activism operating through relational power. In doing so, it broadens understandings of activism, citizenship, and agency in the context of chronic illness and a restructuring welfare state.
Based on long-term ethnographic research in a neighbourhood in Berlin, Germany, this article develops processes of encountering as an ecological concept for analysing the relations between urban life and mental health. Drawing on go-alongs and qualitative interviews, I show how weak and seemingly absent social relations, oftentimes elusive material elements and the inherent normativity of social situations are ubiquitous components of urban life, and highlight their importance for mental health. Processes of encountering functions as an analytical heuristic that describes how urban environments emerge in the entangling of these three components, and grasps the affective qualities emanating from these entanglements. The concept advances an ontological account of the urban and locates mental health ecologically: Rather than treating urban environments as stable entities ‘out there’ or focusing these elements as isolated variables, the concept empirically unpacks how complex urban environments are constituted, and understands mental health as an effect of these constitution processes.
Recent technological developments in the pharmaceutical sector have fuelled rapid price increases of advanced therapies, but they have also triggered renewed efforts around developing alternative modes of organizing pharmaceutical research and deployment. Examples include patient- and clinician-driven innovation, hospital-based manufacturing, and drug repurposing. While these developments offer a seam of fresh scholarship in the sociology of pharmaceuticals, they are accompanied by an increase in conceptual blurriness. We bring clarity and a consistent conceptual vocabulary to one crucial dynamic: the pharmaceutical commons. We draw together the landscape of current pharmaceutical commoning activities and some of the very fertile current commons scholarship. On this basis, we propose nine characteristics of pharmaceutical commons across three overarching aspects: (1) Property: open, mutualized, based on conditional sharing; (2) Governance: legitimized, based on bounded membership, and with a needs-driven agenda; and (3) Practices: people-led, fair in distributing (financial) risks and benefits, and accountable. In distilling scholarship and current experiments, illustrated by an empirical account of a pharmaceutical commons, we formulate a research agenda to spark a joint-up conversation on this vital topic.
Over the past decade, psychedelics research has returned to the forefront of global psychiatry and neuroscience. At Imperial College London (ICL), researchers find explanations for mental illness and healing in a brain system called the Default Mode Network (DMN) which they identify with the ego or self. Amidst the globalization of psychedelic science and medicine, this model has now become the dominant neurobiological explanation for the efficacy of these drugs. In this paper, I draw on archival and scientific literature, along with data from 24 months of ethnographic research among neuropsychiatrists and substance-users in the psychedelic underground, to examine how neuroscientific claims operate in contemporary debates around a “triple crisis” in psychiatry. Through a sustained analysis of scientific publications by ICL researchers in the 2010s, I show how the conceptual, material, and technical infrastructure of the science depends on mystical notions of “ego-dissolution.” Adopting the heuristic lens of the “default”, I then undertake a semiotic analysis to track the epistemic, material and moral debts propelling the fortunes of the DMN as psychedelic commercialization gains force. The conclusion uses this lens to interpret the role of the DMN model in legitimizing, institutionalizing, and accelerating the Psychedelic Renaissance.
Recent developments in pain science, buttressed by findings from neuroimaging, have supported the view that pain is a thoroughly biopsychosocial phenomenon, one that is differentially distributed in inequitable ways. However, the social aspects of pain are still poorly articulated and understood. While pain science has struggled to make sense of what is social, social science has sometimes relied too heavily on the phenomenological experience of pain as isolating. Drawing on key insights from the developing neuroscience of pain - that pain is a response to threat, and that chronic pain can result from central sensitization of the nervous system - I argue that social scientists can productively engage with pain research by developing a critical social science of pain. This social science should engage with pain as a communicative process through which to learn about threat; understand how social inequity may produce and exacerbate pain; and look critically at how the methodologies used to measure and document pain will also shape it. This includes critical engagement with our own social science methods for knowing about pain. Undertaking this work is crucial to producing relevant and contemporary research on pain, particularly in a sociopolitical context where inequality is rising.
Multidisciplinary research addresses complex problems that exceed the scope of single disciplines, but often lacks methodological, theoretical, or goal-based unification. In this paper, I investigate what brings members of data- and technology-intensive multidisciplinary projects together, and what enables them to collaborate effectively and produce valuable scientific outcomes. Drawing on the Haly.Id case study, an agricultural project that aimed at gathering extensive data and developing cutting-edge technologies to manage invasive pests, I propose the concept of ‘data-technology communities’. These are heterogeneous groups of individuals who are not tied by a problem agenda, an adaptive problem space, or a set of practices; rather, they come together by virtue of a common interest in and use of shared data and data collection technologies. Through this common focus, members interact, learn from one another, and collaborate within the delimitations imposed by specific constraints. I further argue that the data-technology community framework provides a useful lens for understanding a growing trend in biological data-intensive research, where the production of large datasets and advanced technologies is often prioritized over critical reflection on their biological purpose and application.
The collaboration between the Cuban Centre of Molecular Immunology (CIM) and the Indian firm Biocon challenges conventional understandings of technology transfer. Initiated in 2003, the joint venture was a unique experiment in South–South biopharmaceutical collaboration. It brought into relation two distinct innovation regimes: Cuba’s public health–oriented model, closely tied to the state and its medical diplomacy, and India’s market-driven biopharmaceutical industry. However, both regimes were animated by postcolonial aspirations for technoscientific emergence in the Global South. The partnership ultimately dissolved, as structural tensions and divergent industrial objectives proved difficult to reconcile. But its apparent failure was also productive. For CIM, it opened access to resources lacking in Cuba and enabled clinical trials on a wider population. For Biocon, it offered research, development, and manufacturing expertise that supported its rise in the global biosimilar market. Drawing on interviews with key actors in Cuba and India, this study situates the partnership within broader debates on innovation regimes, postcolonial science, and the inequalities that shape the global biopharmaceutical economy. The article shows how South–South collaborations, even when framed as alternatives to asymmetric North–South models, remain entangled in (bio)capitalist logics while still opening possibilities for reimagining technological exchange beyond dominant North/South narratives.
The emergence of non-hallucinogenic psychoplastogens signals a profound philosophical and therapeutic chasm in the discourse surrounding psychedelic medicine. Unlike psychedelic-assisted therapy, which emphasizes subjective experience as central to healing, psychoplastogens are framed as purely neuroplasticity-driven treatments, aiming to repair brain circuits without inducing altered states of consciousness. This reconceptualization poses fundamental questions about the role and necessity of consciousness and subjective experience in mental health treatment. Research on non-hallucinogenic psychoplastogens is still in its infancy. However, the field attracts much popular, scientific and financial interest, fueling lively debates. Drawing on the concepts of socio-technical imaginaries, biopolitics, and critiques of psychedelic medicalization and commodification, the paper contrasts PAT’s experience-centered approach with the psychoplastogenic paradigm’s attempt at experiential sterilization, and critically examines the tension between psychedelic therapy’s ethos of confronting emotional difficulty and psychoplastogens’ promise of sanitized, effortless, scalable healing. While scientific and economic forces significantly drive the redefinition of psychedelics, the controversy ultimately embodies competing biopolitical imaginaries of mental health, human suffering, and the very nature of therapeutic transformation, carrying profound implications for psychiatry’s future.
Proponents of evidence-based conservation (EBC) maintain that environmental intervention ought to be based on biodiversity data and data synthesis, instead of relying on unproven theory, individual expertise, and customary practices. This paper analyzes the epistemology of EBC, in which data are bestowed, explicitly or implicitly, with a privileged status and intrinsic evidential significance. I problematize this view by reviewing the complex knowledge infrastructure and dynamics involved in turning data into evidence within biodiversity conservation. Building on the philosophical literature on the nature, journey, and social embeddedness of data, I highlight the critical role of scientific protocols in producing reliable, actionable knowledge for conservation. I argue that protocols are established precisely because data do not have the highest epistemic privilege or intrinsic evidential significance. To illustrate my point, I examine two case studies: the Conservation Evidence project and the Red List of Threatened Species. I discuss some of the conceptual and practical consequences of improving the epistemology of EBC. Furthermore, I show how protocol implementation can generate multiple data communities that are constrained by, yet open to, negotiations regarding evidential standards.
This article explores the practical and material configurations of the ‘person(al)’ in experimental cancer immune therapy, where immune cells from the patient’s cancer tissue are used to eliminate incurable cancers. Drawing on ethnography from Denmark, we examine personal cancer immune therapy as a carefully steered practice—a choreography—through which tissues and cells originating from the same person are reconfigured in unpredictable ways. Cancer tissue, conventionally perceived as a dangerous ‘other’, holds the potential to act as a lifesaving ‘self’ in the form of a personal cure. Conversely, T-cells, conventionally perceived as protectors of the embodied ‘self’, can act as life-threatening ‘others’, endangering the person from whom they originated. We develop the notion of ‘choreographies of nearness’ to analyse how immunological and ontological relations are enacted in the clinical and experimental practices of personal cancer immune therapies. Tracing the execution of clinical protocols in ethnographic detail, we show that this emerging medical practice involves choreographies through which tissues and cells are enacted as neither strictly self nor other, but as ‘near’ the embodied person from whom they derive. Unpacking the potential of the ‘near self’, we expose the laborious and high-stakes ways of doing the ‘person(al)’ in this therapy.
Health measurement shapes peoples’ political relationships with the state, with services, with one another, and with oneself. But what are the political dynamics at play when people can’t/won’t/don’t have health measurements taken? And what is the political predicament of those whose needs, values, and experiences don’t fit within the measures available? This paper presents a case study of one youth mental health service’s efforts to improve their collection of outcome measures, and reinvigorates the concept of ‘sick role’ to describe young people as defying the ‘data roles’ expected of them. The concept of data roles draws attention to the political dynamics of measurement on two interlinked scales: the interpersonal, embodied measurement encounter; and the systemic care-measurement assemblage. In the case reported here, measures are hard to collect given the ‘routinized intimacy’ required, and the restrictive, normative, individualised understandings of need inscribed within available measures. Yet defying measurement equates to a marginalised, precarious political position for young people and for the services that support them. In sum, the data roles expected of young people ask too much of them, and do too little for them.
This article examines the development and integration of predictive artificial intelligence (AI) in clinical cardiology in Denmark. Employing a conceptual lens of nearness, I analyze how researchers and cardiologists unsettle and redraw boundaries between human and artificial intelligence. Based on ethnographic fieldwork on the CARDIAIHD algorithm, which predicts survival prognoses for patients hospitalized with ischemic heart disease, I demonstrate how AI is alternately enacted as a near-human ‘wingman’ or ‘butler’ and as an inferior, subhuman tool. While researchers rhetorically position the algorithm as a potential and valuable substitute to human reasoning, in clinical practice, its sometimes clinically unintelligible predictions lead cardiologists to disengage from it and exclude it from their decision-making. I argue that, for algorithms to acquire near-human qualities in practice, they depend on human hosts who experience affective-moral obligations and who are called to substitute for and care for the inadequacies of ‘artificial’ intelligence. The paper advances nearness as an analytical framework for examining transformations in how the category of the human is understood, experienced, and enacted in biomedical research and clinical care, particularly in contexts promoted to entangle human and ‘artificial’ intelligence.
