Global Trials, Local Bodies: Negotiating Difference and Sameness in Indian For-profit Clinical Trials

Global clinical trials depend on a range of standards in order for research results to be comparable. As standardization is more than a mere technical exercise, tensions can arise when things are not uniform. This paper uses empirical data from interviews with principal investigators as well as Clinical Research Organization and pharmaceutical industry representatives working in India’s clinical trial industry to critically examine the ways Indian researchers navigate quests for standardization. It turns the analytical lens to the often obfuscated work of standardization aiming to transcend the biological and cultural specificity of research participants and research sites. Drawing on the concept of local biologies, it illustrates that the universal body presumed by clinical trial methodology is, in fact, a specifically Euro-American one: Indian participants not only need to be made globally comparable but also aligned with the drugs’ future consumers. Focusing on the tensions between biomedicine’s postulation of bodily universality and trial participants’ local biologies, this paper advances recent interventions problematizing the structural violence undergirding global clinical trials. It also contributes to the literature on local biologies in its discussion of how these are negotiated in Indian for-profit clinical trials.

Dr. Ram’s triage

Triage is a process of categorizing potential health and guiding care. It is based on the idea that all bodies are equal while potential vitality is not. I examine the triage processes used by Indian physicians as they collaborated with global health researchers to identify patients for a free, cutting-edge tuberculosis test. As I argue, triage forms and reforms social difference within global health despite its aspirations of standardization and experimentality. Problematizing triage as part of global health’s ordinary affect of affordability reveals local biologies, class biopolitics, and clinical speculation in the field. I conclude by considering new avenues of ethnographic inquiry that are opened by attending to the practiced and depoliticized biopolitics that occurs within clinics as everyday, nonreflexive decisions about how to organize resources and speculate on vitalities.

Exposed Biologies and the Banking of Reproductive Vitality in China

The looming figures of smog-choked cities, cancer villages and contaminated food have become iconic of a modernising China: the tragic, perhaps unavoidable, side effects of a voracious economy. In this article, I examine how the sperm bank—jingzi ku—in China has emerged quite literally as a sanctuary of vitality amidst concerns around food safety, air and water pollution, rising infertility and declining population quality. As a twist on Margaret Lock’s concept of ‘local biologies’, I argue that ‘exposed biologies’ have become a matter of concern in China in ways that have corroborated a place for hi-tech sperm banks within China’s restrictive reproductive complex. Exposed biologies are a side effect of modernisation processes, as industrially manufactured chemicals are increasingly held culpable for a range of pathologies, from cancers to metabolic diseases, disorders of sex development and infertility. Amidst concerns that pollution and modern lifestyles are deteriorating sperm quality in China, the sperm bank stands out as a repository of screened, purified and quality-controlled vitality, and as such sperm banking can be seen as a form of reproductive insurance, not only for individuals but also for the nation.

Exposed Biologies

Smog-choked cities, cancer villages, and contaminated food have become iconic problems of a modernizing China—the tragic, perhaps unavoidable, side effects of a voracious economy. Chapter 3 examines how the sperm bank—jingziku—in China has emerged quite literally as a sanctuary of vitality amid concerns around food safety, air and water pollution, rising infertility, and declining population quality. As a twist on Margaret Lock’s concept of “local biologies,” the chapter argues that exposed biologies have become a matter of concern in China in ways that have corroborated a place for high-tech sperm banks within China’s restrictive reproductive complex. Exposed biologies are a side effect of modernization processes, as industrially manufactured chemicals are increasingly held culpable for a range of pathologies, from cancers andmetabolic diseases to disorders of sex development and infertility.

“I have become a microscope for my own body”: local biologies and the embodiment of biomedical knowledge

This paper explores the way those commonly described as “lay persons”, “the public” or “patients” appropriate biomedical and biological knowledge and make it part of their repertoires of experience, including embodied experience, as well as the specific apparatuses or dispositifs associated with health promotion or education. The paper draws on an extenexperimentalinitiative in health promotion in Brazil. This initiative raises intriguing challenges to current approaches to what counts as knowledge and how it is associated with the empowerment of citizens in relation to health.