Summary
Written by Stephen Molldrem
The body of work about tuberculosis (TB) in the interdisciplinary field of Science and Technology Studies (STS) is relatively small compared to rich traditions of TB research in anthropology, sociology, history, and applied social sciences (Bowker and Star 1999, p. 165-194) . STS is an interdisciplinary field concerned with understanding the social, technical, cultural, political, and economic bases of scientific knowledge; the drivers of change in the trajectory of scientific fields; and the causes and effects of shifts in science policy (Felt et al. 2017) . STS started in the 1970s, emerging from constructivist and anti-positivist tendencies in fields such as sociology, anthropology, history, Information Studies, and Policy Studies. Nora Engel and Bharat Jayram Venkat are two preeminent examples of scholars working on TB within STS, with Engel focusing on TB diagnostic innovations and Venkat on antibiotics and the concept of “cure” in the history of TB elimination initiatives in India (Venkat 2021; Engel 2020) . Both scholars use qualitative, archival, and document analysis methods to describe how changes in the diagnostic and curative technologies used to manage TB have shaped global responses to the disease. Venkat has articulated how the possibility of TB’s elimination through the application of antibiotics also paradoxically produced the conditions for forms of sometimes-incurable drug-resistant TB (DR- TB) to emerge. Engel focuses on challenges faced by developers and implementers of novel TB diagnostics, advocating for more STS perspectives in this work.
Across STS-oriented studies of TB, the difference that the STS perspective provides is attention to how novel technologies and regimes of disease elimination change not only the management of TB and knowledge about TB, but also the TB organism. In STS, Mycobacterium tuberculosis appears as an active agent in what Hannah Landecker calls “the biology of history,” or “a recursive structure in which knowledge is produced in and through matter that itself has been altered by previous modes of thought” (Landecker 2016, p. 37) . Rather than strictly an object of intervention to be diagnosed, cured, or studied in relation to patient and stakeholder experiences, STS scholarship insists on TB being a socio-historical actor that resists its own management and exceeds paradigms enacted by people, institutions, and technologies to understand and control it. In the next phases of STS research about TB, a main challenge for scholars will be translating these powerful constructivist insights – which are often seen as esoteric or set apart from applied aims – into the policy regimes and programmatic approaches that are used to govern and manage TB epidemics (see, Molldrem et al. 2023) .
References
Bowker, Geoffrey C., and Susan Leigh Star. 1999. Sorting Things Out: Classification and Its Consequences. MIT Press.
Engel, Nora. 2020. “Innovating Tuberculosis Diagnostics for the Point of Care.” In Understanding Tuberculosis and Its Control: Anthropological and Ethnographic Approaches, edited by Helen Macdonald and Ian Harper. Routledge.
Felt, Ulrike, Rayvon Fouché, Clark A. Miller, and Laurel Smith-Doerr, eds. 2017. The Handbook of Science and Technology Studies. 4th ed. MIT press.
Landecker, Hannah. 2016. “Antibiotic Resistance and the Biology of History.” Body & Society 22 (4): 19–52. https://doi.org/10.1177/1357034X14561341.
Molldrem, Stephen, Sedilame Bagani, Vishnu Subrahmanyam, et al. 2023. “Botswana Tuberculosis (TB) Stakeholders Broadly Support Scaling up next-Generation Whole Genome Sequencing: Ethical and Practical Considerations for Botswana and Global Health.” PLOS Global Public Health 3 (11): e0002479. https://doi.org/10.1371/journal.pgph.0002479.
Venkat, Bharat Jayram. 2021. At the Limits of Cure. Critical Global Health: Evidence, Efficacy, Ethnography. Duke University Press.
Stephen Molldrem is a qualitative social researcher, health policy analyst, and ethnographer situated in Science and Technology Studies (STS), public health ethics, and critical data studies. He is based at the University of Texas Medical Branch in the Department and Institute for Bioethics and Health Humanities, School of Public and Population Health.
