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Embodying Difference : The Pharmaceutical Mediation of Human and Scientific Values in Diabetes Care


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  • 差異を身につける : 糖尿病薬の使用にみる人間と科学技術の相関性
  • サイ オ ミニツケル トウニョウビョウヤク ノ シヨウ ニ ミル ニンゲン ト カガク ギジュツ ノ ソウカンセイ

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<p>Diabetes is a major health problem in Japan, affecting more than 5 million people directly. Its public health implications grow along with the potential market of newer and simpler medications, making it one of the most dynamic fields of collaboration between the state, scientific research and private pharmaceutical companies. In this article, my concern is to describe how hypoglycemic agents (i.e. diabetes drugs) perform those links, which, in turn, articulate biological and cultural differences by measuring, negotiating and imaging them in medical practice. The increasing presence of pharmaceutical innovations in Japan calls for a shift of focus to the local settings of learning and appropriating such medications in daily life - that is, how people come to understand pills and injections that are designed to treat their disease. After delivering the prescription, the physician has to align the drugs with offers of the salesmen, skills of the pharmacists and patients' complaints etc. Norms of blood sugar, clinical trials and that of social life all become interrelated, through the calculation of which medications constitute sameness to such norms, and those that constitute a difference. By pointing at the metabolism, the drug orients toward an embodied understanding of seemingly unimportant events in daily life: what and when to eat, how much to sleep, where to spend the weekend, etc. It opens new ways for formulating questions and interpretations that differentiate the patient from others, while at the same time displaying the metabolism as part and parcel of the patient's life. But how does one account for such overlapping biological and cultural variations simultaneously? Drawing on the plurality of perspectives surrounding health and disease is an established method of medical anthropologists. Differences play a crucial role in contemporary medicine, and anthropologists are, by profession, attentive to the plurality of illness and its social consequences. However, as recent dialogues between science studies and anthropology have shown, such plurality is present on both sides of the divide, and anthropologists should address them symmetrically if they want to overcome both cultural and technological reductionism. One way to do so follows the practicalities of medicine, where such differences are performed and embodied locally in the relations of scientific knowledge and personal suffering. As shown by anthropologists, putting skills to practice does not necessarily follow their acquisition. Rather, learning is often a part of the very routines it brings about. Similarly, the self-management of chronic conditions is more than simply the internalization of a scientifically given knowledge. The techniques of putting pharmaceuticals to use are embedded in an open-ended mediation of disease: an attunement of bodies and their affects. Through a fieldwork study of the practice of pharmacological therapy at a diabetes clinic in the northern part of Japan, the dominant pluralist model of medical anthropology will be criticized here. I will show, instead, how differences are mobilized in the embodied relationship of science and culture through the technological mediation and daily routine of pills, insulin pens and medication diaries. First, I explore the shifting endocrinological categories that frame the practice of the self-management of diabetes in Japan (ch. 3). Then, I focus in on the specific case study of Suzuran Diabetes Center (pseudonym), to illustrate the interaction between scientific facts and cultural values in the clinical organization of the use of medications (ch. 4). Those interactions take place through the embodied practices of dosing drugs and learning to live with the scientific knowledge they distribute. Such finding is, however, not merely a hypothetical concern of the anthropologist, as I will point out in the fifth section, but a long</p><p>(View PDF for the rest of the abstract.)</p>



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