Distraction Free Reading

Foucault, Dialectics, and Randomized Clinical Trials: Bridges Between Medicine and Anthropology

A brick wall with a mural depicting a person with a surgical cap and gown holding the stems of a plant, which has narrow leaves and red flowers.

Graffiti on the facade of the building where one of the interviews was conducted. It features a drawing of a healthcare worker wearing a mask and cap, holding a rose. Photo by author.

Well, actually, I think I really wanted to understand how you guys conduct research. So, I read some articles in anthropology and sociology back when I was in medical school, and I remember three things: First, that dialectics always came up. That word was always there… The other was that Foucault was always cited. And the third, well, I couldn’t understand what was written. Those are the three things I remember: Foucault, dialectics, and that I couldn’t understand it, but I knew it was important, and I wanted to learn. So actually, I think to answer your question, I’d love to see the kind of product you generate… to understand how you work in a broader sense. Moving away from this specific research, when I saw [your message], it was this morning when I told you I was looking at your Lattes profile, and I sent a message to Soraya. (Excerpt from an in-person interview with Afonso conducted at a public university on October 3, 2022)

Interconnections, possible dialogues, and translations. These are the three key points highlighted in Afonso’s words during an interview that contributed to my dissertation, defended in June 2024 as part of a graduate program in anthropology at the University of Brasília, Brazil. And these are also key elements for this post, where I will be arguing how we, anthropologists, can build bridges with other fields of science. However, before diving in, I will present the context of the interview with Alfonso, the work that generated the dissertation, and the adjacent reflection that produced this post.

Afonso is a white university professor, trained in medicine, and in his early 40s. This name is fictitious to preserve his identity. I extracted the above passage from the nearly two-hour interview he granted me. We met at the University of Brasília, a familiar place for both Afonso and me, where he welcomed me into his workspace. I had not met him before, and his comments came after I asked how he would like to receive feedback regarding my work. The “Lattes” he mentions is the most widely used academic CV platform among Brazilian scientists, managed by the National Council for Scientific and Technological Development (CNPq). Soraya Fleischer was my doctoral advisor and he knew her. Later on, we discovered other things in common—connections between scientists who live in the same city, even though we conduct research in different fields.

In my dissertation, I reflect on research about and the perspectives of scientists who investigated drug treatments within the “COVID kit.” I conducted the study based on newspaper reports and interviews with twenty-six different scientists carried out between September 2022 and February 2023. The “COVID kit” refers to a series of medications that were publicly promoted and endorsed by Brazilian regulatory bodies for use during the pandemic, even as they were still being tested as treatments for COVID-19.

That’s how I came across Afonso. He studied convalescent plasma. He was critical of the COVID kit, also referred to at the time as an “early treatment.” Perhaps because he was a professor, he had a clear way of explaining the confusion and mishaps that took place during the pandemic in Brazil. According to him, early treatment—the term many politicians used for drugs like hydroxychloroquine to treat COVID-19—is more of a method of intervention than an intervention itself. The term has been used amid global health crises in confusing ways. In biomedical sciences, it refers to the moment when an intervention is proposed. However, for public figures during the COVID-19 pandemic, early treatment was synonymous with boxes of drugs that were to be taken prophylactically, even without scientific evidence (Castro, 2021).

Afonso explained to me that early treatment is often used for illnesses like cancer, where the idea is not to treat an illness before it occurs, but rather to invest in a diagnosis at the beginning of the disease’s course. This allows for proposing a treatment with enough time to observe and monitor the body’s response to the situation, following an intervention. Throughout the interview, Afonso continuously engaged in an empathetic exercise of translating biomedical language into anthropological terms, the latter being more familiar to me.

In this post, I want to highlight some ideas, questions, and reflections on the different ways scientific practices are carried out and the dialogue between them. This interface is particularly interesting because we can observe a series of studies that aim to investigate other fields of knowledge and address some challenges in conducting joint research. Additionally, as someone with an interdisciplinary background—I am trained as a psychologist, work as a substitute professor in an interdisciplinary public health department in the northern part of the country, and over the past year have interacted closely with pharmacists, psychologists, biologists, sociologists, anthropologists, and nurses—I made a deliberate choice to reflect on the frequent translations and dialectics, sometimes successful and sometimes not, that emerge in the construction of scientific work.

Interconnections Between Different Fields of Knowledge and Scientific Practice in the “Backyard”

Dialogues between different bodies of knowledge are not new to Science and Technology Studies (STS). Authors like Latour and Woolgar (1997 [1988]), Traweek (1993), Martin (1998), Fleischer (2023), Castro (2020), Petryna (2009), and others have investigated areas such as biology, physics, medicine, and the pharmaceutical industry from an anthropological perspective. I see these intersections as a potential counterpoint to the idea of a singular hegemonic science, which would be the only one capable of exploring a field of knowledge—an idea more common in health sciences, for example, where “being from health” and speaking about health becomes an unquestioned prerequisite.

Historically, in Brazil, this entanglement has had several repercussions on the work of scientists in the humanities and social sciences who seek to offer another perspective on health. They often encounter difficulties in getting their research projects approved by ethics committees, which are composed of people trained in the health field. For example, one collection recounts various experiences by researchers who were questioned about the way their scientific work was structured, rather than being ethically evaluated (Fleischer and Schuch, 2010).

While writing my dissertation, I noticed even further the plural potential of the sciences, as Sarmento, Santos, and Abib (2023) and Traweek (1988) have already written. The former highlight the non-consensual nature of scientific practice, while the latter illustrates the “cat’s cradles,” the intertwinings of different bodies of knowledge and disciplines that build another perspective, one that is, in turn, counter-hegemonic. Afonso explores this aspect, especially when he becomes curious about the social sciences’ research methods. He states, “I would really like to see what kind of product you generate… to understand how you work in a broader sense.” This curiosity is demonstrated through actions, as he, while being a researcher, also conducts his investigative work, looks up my Lattes curriculum (mentioned above), and connects with my advisor, Soraya. Thus, to delve deeper into this issue, I want to revisit an earlier moment, just before we started the interview.

I arrived in the parking lot in front of the university building (…) He hung up the phone and said he had seen my Lattes curriculum. He noticed that my advisor’s name was familiar to him. He commented that he knew her because his son attends the same school as Soraya’s daughter. He even mentioned that he had sent her a message earlier, saying he was on his way to be interviewed by me. Afonso quickly told me that he had a strong interest in exploring new areas outside of his comfort zone, such as the humanities, because he realizes the work is different, and that his wife, who is also a researcher but in biology, has much more dialogue with the research he develops. (Excerpt from the author’s field journal, October 3, 2022)

The effects of conducting research in the “backyard” (as Soraya, my advisor, named it) are diverse. This was not the first time a scientist I interviewed had looked up my CV before meeting me in person, curious to know who I was—after all, I was a complete stranger, sometimes recommended by colleagues but sometimes not, who had come across their name through their scientific production. However, the situation above made me realize that the intertwining of the city, the university, and the flows within this space would bring about other unexpected crossings. Perhaps this was because we belonged to different fields and understood that the citadels (Martin, 1998) among scientists make them feel as if there are indeed walls separating different groups of researchers. Such citadels are places, environments where researchers conduct their studies and exchange ideas with their peers. But scientists, it is argued, rarely leave that territory or invite other researchers from different citadels to enter their spaces.

Even though I knew that the university comprises thousands of staff, researchers, professors, and students, this circumstance was different. This experience reminded me that my research could be discussed among scientists. This materialized over time, and the bridges between citadels emerged when I, without knowing beforehand, interviewed two scientists who ended up being an actual couple. They had discussed my research before we met, and on the day we did meet, one of the scientists mentioned that I had contacted her husband as well, and that he had found my research interesting.

Additionally, I reflected on the role of the Lattes curriculum in the networks among scientists. It reveals connections and associations. Before interviewing the couple, I knew they had published together but that was all a document like this could reveal. My curriculum made clear my academic affiliation and the prominent relationship with my advisor, who played an essential role in my training. In scientists’ curricula, there are names, trajectories, and places that mark key moments in their histories, but they also leave gaps and other associations without further details. This was not the first time I encountered doctors who had read anthropologists’ work; perhaps this bridge is more accessible than we anthropologists imagine. And I’m not sure if we have been trained to make the theoretical-methodological effort that Afonso did. In the next and final section of this post, I present a situation that will demonstrate the interest Afonso made clear at the end of the interview. I discuss what this encounter provoked in me, especially as an academic with interdisciplinary training.

Recruiting the Researcher: Between CV Traces and Connections Among Scientists

Afonso also interviewed me after patiently waiting until I had finished my own interview. When we were done, he told me about a research project he had submitted for funding from the United States, which would last five years. At the time he was in the process of putting a team together. The project involved setting up workstations in regions with diverse biological ecosystems, encompassing different types of vegetation: cerrado, Atlantic Forest, Amazon, and caatinga. He said:

But a very important part of this research is the effect that diseases have on the population. Disease causes poverty, disease causes… the same anthropological and sociological issues that also end up impacting diseases, people’s migrations, the low income that causes people to emigrate, and the lack of adequate formal education that would allow people to understand that burning is not the best solution. So, there’s this whole human part—anthropology, sociology—that I think would be super important in this project. (…) One thing I’ve always felt was missing from this team was people to work on the human side of things, so we can work together, you know?”(Excerpt from an in-person interview conducted at the University of Brasília on October 3, 2022).

It’s intriguing how Afonso places anthropology as the “human part” of this project, which once again contrasts with the idea of health sciences as the hegemonic knowledge. At the time, Afonso asked me if I knew anyone who would be interested in the project, but no name immediately came to my mind. Therefore, now, albeit belatedly, I raise some questions in this piece: What if, in the midst of our fieldwork, we receive invitations and proposals to think together about a question posed by another researcher? What do we do? What kinds of questions are we asked when we are interviewing these scientists? What do they reveal about the moment these people are going through? And our answers—what do they say about us? How willing are we to work interdisciplinarily with other forms of knowledge, such as biomedicine? How much do we write for other fields in search of dialogue or try to be clearer for areas outside our own? What are the limits of the relationships we propose, and what does the other side do with them? Although I see much about the dialogues between different bodies of knowledge, I don’t see as much about how to propose these dialogues.

Certainly, it’s uncommon in my field of research to receive invitations like this. I’ve had only two other somewhat similar situations, but they were not about research projects. Most of the scientists I interviewed were quite welcoming and kind, a characteristic that Castro (2020) also experienced while investigating a clinical research center. Later, I thought that the people conducting this kind of research often need to forge ties, leave things open-ended, so that their studies—involving thousands of patients—can happen. It’s always necessary to build bridges between citadels.

Furthermore, I found myself reflecting on how the topics we research and the questions we ask are, over time, absorbed and transformed by us, who are in constant interaction with other bodies of scientific knowledge. We acquire the vocabulary of those we study, and sometimes those people also want to learn about ours. And as an anthropologist, I trust in our reflective capacity (Ferreira, Brandão, 2021).

Personally, I hope that other scientists understand anthropology, but at the same time, it’s essential that anthropology also enters other spaces and accepts invitations outside of its own citadel. I’m no longer sure if this is excessive optimism, but I believe that other scientists may think like Afonso, recognizing the importance of anthropology and understanding that it can contribute with its perspective in spaces that are less familiar to it. This way we can build ever-larger “cat’s cradles” (Traweek, 1993), intertwinings of distinct areas which foster more points of encounter. And this is also important for anthropology, which at times may be critical towards biomedical knowledge while using its own specialized language. Our dialectic is not always so dialogic: when Afonso says he doesn’t understand what we say and write, he exposes the linguistic barriers that anthropology also imposes in this process.


References

Castro, Rosana. Economias Políticas da doença e da saúde: uma etnografia da experimentação farmacêutica. 1 Ed. São Paulo: Hucitec, 2020.

Castro, Rosana. Mesmo sem comprovação científica…:Políticas de liberação da cloroquina. DILEMAS: Revista de Estudos de Conflito e Controle Social, Rio de Janeiro, p. 1-12, 2021.

Fleischer, Soraya and Patricia Schuch. Ética e regulamentação na pesquisa antropológica. Brasília: Letras Livres: Editora Universidade de Brasília. 2010.

Fleischer, Soraya. “Alfineteira humana”? As crianças na ciência do vírus Zika produzida em Recife/PE. Sociedade e Cultura, Goiânia, v. 26, 2023. DOI: 10.5216/sec.v26.75242. 

Latour, Bruno and Steve Woolgar. A vida de laboratório: a produção dos fatos científicos. Rio de Janeiro: Relume Dumará. 1997 [1988].

Martin, Emily. Anthropology and the cultural study of science. Science, Technology & Human Values, 23(1), p. 24–44, 1998.

Petryna, Adriana. When Experiments Travel: clinical trials and the global search for human subjects. Princeton: Princeton University Press, 2009. 258 p.

Sacramento, Igor, Allan Santos, and Roberto Abib. A doença como política da verdade: Bolsonaro, COVID-19, e o testemunho. In: Ciência em conflitos: negacionismo, desinformação e crise democrática.

Oliveria, Thaiane Moreira de, Reynaldo Aragon Gonçalves, and Roberto Kant de Lima. Belo Horizonte: EDOC Brasil. 2023.

Traweek, Sharon. Beamtimes and Lifetimes. The World of High Energy Physicists Cambridge, Mass.: Harvard University Press. 1988.

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