BioSocieties

Modeling the ‘patient cell:’ performances of proximity and the making of pathological proxies

Timo Roßmann

Scientists evaluate disease models by their capacity to capture salient features of patients’ pathologies. Molecular scientists widely regard patient‑derived human induced pluripotent stem cells (hiPSC) as closer to human disease biology than many other cell models. Yet producing tissue‑specific cells from hiPSC entails deliberate manipulation of their developmental state and properties, raising the question how these cells are engaged as faithful pathological proxies. Drawing on my ethnography of biologists creating cell models to study ciliopathies, I demonstrate that proximity between hiPSC-based ‘patient cells’ and patients’ pathologies is actively produced through practices of modeling the cell. I conceptualize these practices as performances of proximity, describing the conceptual, aspirational, and technical negotiations through which researchers reconfigure cellular properties and the links between donors, cells, and clinical objectives. By examining scientists’ value-making practices in disease modeling as performances of proximity, this study illuminates how hiPSC-based models gain salience in basic research. It also advances theoretical discussions in STS about strategies in disease modeling and the ethical–political stakes of using patient-derived cells.

‘The science that celebrates itself’: the emergence of Biosecurity and Artificial Intelligence as a convergent public policy issue

Os Keyes, Samuel Angelli-Nichols & Nicholas Evans

This paper provides a multiple-methods analysis of an emerging domain of biosafety and bioscience scholarship—the intersection of biosecurity and Artificial Intelligence (AI), or BSxAI. Conducting both funding and genealogical analyses of the literature, we explore how this intersection came to be problematised, and the intellectual and financial sources mobilised in popularising the space. We argue that rather than constituting a conventional scientific domain, BSxAI is an area intentionally cultivated by a narrow range of funding bodies with particular ideological interests tied to the Effective Altruist and longtermist movements. The result, as we discuss, is a concerning degree of intellectual and structural brittleness—one with severe possible consequences for the life sciences, and AI policy, more broadly.

Culture, Medicine, and Psychiatry

Liberation Medicine in Authoritarian Contexts: The Brutality of U.S. Mass Incarceration

Philippe Bourgois

This article engages Führer and Vorhölter’s (2025) reinvigoration of Nancy Scheper–Hughes’s utopian call for liberation medicine in their special issue of Culture, Medicine, and Psychiatry. They offer a practical reconceptualization of liberation medicine as “concrete utopias” in the “medical undercommons”. Inspired by Scheper–Hughes’s humble call for “good-enough” ethnographic engagement in her documentation of a successful solidarity movement of single-mother agricultural laborers in Northeastern Brazil, I highlight ethnographically a (fragile) concrete utopian initiative: a peer-support program for inmates with psychosis spectrum conditions who are swept into the Los Angeles County Jail system’s overcrowded mental health units on a daily basis by routinized law enforcement sweeps of homeless individuals. Developed by former gang members (without mental illness) facing capital punishment charges, this remarkable initiative of solidarity, redemption, and anti-racism through radical caregiving in a claustrophobic carceral environment is carving out a temporarily safe space free from abuse and violence. The larger facility remains gang-controlled and is overwhelmed by what colleagues and I have been calling “predatory accumulation” and “necrogovernance” processes (Hart et al., 2024, 2025). The inmates are powerless, caught within the “carceral mesh” of U.S. political-economic corporate and opportunistic special interests. Furthermore, the discretionary power of “hyperpunitive” U.S. judges allows them to routinely impose Life Without Parole (LWOP) sentences on redeemed inmates incarcerated as adolescents. Inspired by Scheper–Hughes’s practical political optimism coupled with her love for ethnography and political activism, I end with eight practical suggestions for specific state bureaucratic reforms to foment public transparency about the useless cruelty of mass incarceration and the global rise of authoritarianisms in our perilous moment in global history.

Ethos

Growing up otherwise: Situated ethics and pathways to non-violence in Southern Brazil

Dominique P. Béhague, Helen Gonçalves, Ana Paula Jacob, Joseph Murray

This paper proposes a reframing of how young men become embroiled—or not—in the systemic violence that infuses their daily lives. Most frameworks in health and social policy tend to approach violence as rooted in psycho-developmental problems and/or social and structural determinants. These approaches can underemphasize the relational specificities and institutional dynamics through which violence is reproduced and might otherwise be interrupted. Drawing on a 29-year ethnographic study embedded in the 1982 Pelotas Birth Cohort (Southern Brazil), which followed participants from age 15 into their early 40s, this paper puts our interlocutors’ ways of theorizing violence into dialogue with Judith Butler’s work on an ethics of non-violence. Examining how young people alternated between situated and categorical interpretations of violence, we demonstrate the conditions that enabled the former to chart new possibilities for non-violence. We show how young people and their parents unsettled prevailing psychological and social explanations of youth violence by reframing growing up amid violence situationally, as an ethical and political challenge. Two composite case-studies, Vicente and Raul, trace the contingent social and institutional conditions that nurtured a fragile but generative situated ethics and/or gave way to more categorical, discipline-as-care approaches. We close by considering what these insights can offer for more collectivist approaches in public health.

Nafsanalysis: The Problem of Refinement in Sufi Ethics

Muhammad Osama Imran

The nafs is the spirit in its ordeal of embodiment. It is the veil through which separation from God becomes the condition of relation to Him. Drawing on two years of ethnographic fieldwork among practitioners of the Naqshbandia Awaisia Sufi order in Pakistan, this article approaches the nafs as the site of enjoyment that survives refinement by investing itself in piety, renunciation, and in the spectacle of its own defeat. I introduce “nafsanalysis” as an analytic for reading how practitioners interpret their conduct in relation to the enjoyment of the nafs. By approaching “spiritual unveiling” and “psychocorporeal disturbance” as internally implicated modes of experience between which the subject cannot finally adjudicate, this article develops an account of Sufi ethical life in which sin may preserve God-orientation, discipline may nourish the desire it seeks to extinguish, and the veil may protect the intimacy it appears to obstruct.

Therapeutic Sociality: Empathy and care amongst distressed Ethiopian domestic workers

Eva Melstrom

Ethiopian migrant domestic workers frequently experience violence and abuse during employment, which can lead to serious emotional and mental distress. After returning to Ethiopia, some distressed women receive care at residential facilities specifically dedicated to rehabilitating returned domestic workers. In this paper, I examine the narratives from previously distressed domestic workers living in one such facility to understand how they view and respond to the distress of newly arrived returnees. I suggest that through embodied knowing they position the returnees’ distress as familiar, and, importantly, as ambiguous and temporary. It is at this intersection of ambiguous-familiarity where I situate an ethics of care marked by an empathic understanding of having-been-there and what-will-be, a past and future oriented knowledge that precipitates caring responses marked by calm, gentle, and ordinary engagements—a therapeutic sociality. I demonstrate that while empathy may be central to other therapeutic communities across various histories and geographies, it is a foregrounding of embodied knowledge and the imaginative projection of what-will-be amongst previously distressed returned Ethiopian migrant domestic workers that is distinctive to their ethics of care, and may offer both a practical and ethical resource for rehabilitating returned domestic workers.

Health

Mental health is everybody’s business: The doxa and illusio of local public policy implementation

Andrew Passey and Joseph Ibrahim

This paper provides a novel application of Bourdieu’s theory to the implementation of public policy in the mental health field, by deploying two of his lesser-used concepts (doxa and illusio). Framing a local case study as a Bourdieusian game, we demonstrate how these concepts have explanatory power within the field and how national policy discourses at once influenced and constrained by neoliberalism have real and long-lasting effects when it comes to the implementation of public policy. We found three key themes in the case study: doxa as a narrative device (‘mental health is everybody’s business’); the linking of this doxa with the game’s illusio in a shared view that the policy should address the problem of a high rate of ‘inappropriate referrals’ into specialist services; and the consequences of the dynamic between the game’s doxa and illusio for the organisational hierarchy in the mental health services field. We do not evaluate the success of the policy, but instead apply and explore the potential of Bourdieu’s concepts to provide explanatory power to the processes and interactions evident in the implementation programme. This paper highlights the potential of such a theoretically based analytical approach, which could be applied in other contexts and to other health fields and policy domains.

The school lunchbox as a social problem

Juliet Bennett, Alex Broom, and David Raubenheimer

School lunchboxes contain much more than just food. Maternal and paternal moralities, socioeconomic pressures, and the character of contemporary food systems can all be found within them. Lunchboxes, in turn, are microcosms of food system shifts, including the proliferation of highly-profitable, strategically-engineered ultra-processed foods. These commodities, often representing between 40% and 80% of energy intake depending on contexts, are having harmful effects on the health of children and adult populations worldwide. In this paper we examine evolving food system issues as they intersect with school lunchbox dynamics, through in-depth interviews with 34 parents in Australia. The results focus on the affective relations of ‘food parenting’, the fast-paced temporalities surrounding contemporary food cultures, the socialisation of dietary imbalances and governance of food systems and practices. We argue that the school lunchbox is an important example of the individualisation of responsibility for collective, multi-scale, social problems.

People on long-term sickness absence and their experiences and perceptions of professionals from the vocational and the health care sector: In this together?

Christian Jauernik, Poul Frost, Frans Boch Waldorff, Jan Renneberg, and Mette Bech Risør

People on long-term sickness absence in Denmark experience the help and support they receive from professionals as problematic. To understand these issues, this study, through interviews with eight interlocutors, investigated how people on long-term sickness absence perceive and experience professionals from both the vocational and health care sectors involved in their situation. Our study led to two main findings: Firstly, the roles of professionals often transcended their formal boundaries, with caseworkers frequently becoming involved in the sick absentees’ health-related issues, and health care professionals frequently becoming involved in the sick absentees’ vocational issues. Secondly, professionals from both sectors were perceived as enacting one of two positions: A “position of togetherness,” where professionals were perceived as someone helping the sick absentee in managing their situation, and a “position of otherness,” where the professionals were perceived as an additional uncertainty in the sick absentee’s situation. These positions were situational and could change depending on the context and over time. The research highlights the importance of meaningful relationships between professionals and sick absentees, suggesting that fostering a position of togetherness can lead to better outcomes. We believe our findings can help professionals better understand and support people on sickness absence.

Commercial ultrasounds: Blurring and renegotiating boundaries in prenatal care

Marjaana Jones

Prenatal ultrasounds have become a routine component of pregnancy care and a significant social milestone for expectant parents. Although originally developed for medical diagnostics, these technologies also carry important social and emotional connotations. This study examines the growing phenomenon of commercial prenatal ultrasounds in Finland, focusing on how these services blur traditional boundaries in maternity care. The research draws on data from private providers’ websites, interviews with healthcare professionals who perform commercial ultrasounds and with new parents who opted for additional scans during pregnancy. Using reflexive thematic analysis and the concept of boundary work, the study identifies three key areas of contestation: professional remits, the clinical versus non-clinical nature of ultrasound services, and the timing and autonomy of care decisions. The findings suggest that commercial ultrasounds challenge established professional hierarchies, reshape parental agency, and contribute to the commodification of pregnancy. The study highlights the need for further research into the emotional dimensions of prenatal care and the implications of expanding private maternity services in publicly funded healthcare systems.

Self-care and social class: Unpacking inequities in healthcare access during a healthcare reform

Iben Charlotte Aamann, Sanne Lykke Lundstrøm, Anne Frølich, and Barbara Ann Barett

This article explores the implications of social class for healthcare access and self-care practices among patients with complex multimorbidity in Denmark. Despite universal health coverage, socioeconomic disparities persist in healthcare access. We analyze qualitative data stemming from a summative evaluation of a complex intervention to improve integrated care for these patients, which included extended consultations in general practice. Using a sociocultural and psychosocial concept of class, we examine how patients engage with normative ideals of patient behavior and self-care. By highlighting two extreme cases, our findings reveal significant class-based differences in patients’ health practices. While the middle-class patient actively engages in his treatment, the lower-class patient struggles with more pressing life issues, relegating chronic illness management to the background. We argue that future healthcare reforms emphasizing differentiated treatment based on increased self-care may inadvertently exacerbate existing inequity. Such insights are crucial for developing equitable healthcare policies that address the complex interplay between social class and access to healthcare.

What is health? A deconstruction of the World Health Organization 1948 definition

Emmie Wahlström, Jonas Stier, and Benti Geleta Buli

For 75 years, the WHO health definition has been the most influential and widely accepted definition of health globally, having a profound impact on policy making, professional practice, and people’s overall understanding of health. Although there are alternative notions and definitions of health, it is argued that this definition has enjoyed an almost hegemonic position in the health discourse. Still, it has rarely been systematically deconstructed. This text aims to deconstruct the WHO 1948 definition of health in its entirety as well as its parts. This is done to highlight the epistemological variations and potential contradictions embedded within, and the possible consequences of the definition. The findings indicate a multitude of occasionally ambiguous or conflicting readings depending on how the reader and contemporary ideas conceptualize words and phrasing in the definition. For example, interpreting health as binary can be challenged by ideas of the present as constantly changing, suggesting that health in the definition is conceptualized along a continuum. Such alternative – and sometimes contradictory readings – call for clarifications on how the definition is used and interpreted in different contexts. Still, its ambiguity might have helped it remain relevant and applicable across different societies and time periods.

Invisible labour: A qualitative exploration of the professional identity of interpreters working in UK maternity care settings

Tabitha Wishlade, Ginny Mounce, and Helen Allan

The work of professional interpreters is frequently misunderstood and mistrusted, leading to its underuse across healthcare settings. In UK maternity services, this failing contributes to the higher mortality and morbidity of women with limited or no English proficiency. Our study explored interpreters’ professional identities and their contribution to the delivery of care in maternity services. Face-to-face interviews with a purposive sample of professional interpreters working in maternity settings were conducted and data analysed using a version of Foucauldian discourse analysis. Our interpretation of the data is that discourses of ‘women’s work’ were used in constructing the interpreters’ professional identity. Their daily working practice included affective, social and supportive behaviours; however, their subject positions were unrecognised in the voluntary professional codes of conduct for interpreting practice and their labour remained largely invisible and under-valued. Recognising professional interpreters’ identity as invisible labourers suggests that they negotiate biomedical understandings of healthcare interpretation work held by healthcare professionals and women. It allows a more nuanced understanding of interpreters’ practice within maternity settings. Making their work visible offers greater opportunity for regulation, monitoring and evaluation, resulting in greater confidence in its quality and promoting increased uptake.

Threatened by an individual double-edged risk? Representations of suicidal behavior and people who attempt suicide in prevention policies in Denmark. A poststructural policy analysis

Joanna Wisbech, Alexandra Brandt Ryborg Jønsson, and Mari Holen

The aim of this study is to critically analyze how suicidal behavior and individuals who attempt suicide are problematized and represented in Danish suicide prevention policies. Drawing on a poststructural policy analysis approach inspired by Bacchi and Goodwin, we seek to uncover the underlying assumptions, silences, and potential effects embedded in these problem representations, with particular attention to how certain preventive actions are prioritized while broader social, structural, and relational understandings of suicidality are marginalized. Suicide prevention efforts in Denmark have not led to a reduction in suicides and suicide attempts in the last 20 years. Until recently, the underlying assumptions and constructions shaping national suicide prevention policies have received limited scholarly attention. Following this, our analysis focuses on documents published by key stakeholders and decision-makers involved in the national partnership for the prevention of suicide and suicide attempts in Denmark. The findings indicate that individuals who attempt suicide are predominantly framed as both risky and at risk, due to enduring individual vulnerabilities and mental illness. This dual construction positions the person as an active threat to themselves—engaging in suicidal behavior as a result of poor coping abilities—while simultaneously being a passive victim of external threats such as psychiatric conditions or adverse life circumstances. We argue that these dominant, individualized problem representations frame suicidal behavior as a double-edged risk, narrowing prevention efforts to acute, short-term individual support and treatment. This potentially leaves out the contexts people in suicidal distress navigate as sites of intervention.

Health & Place

Special issue editorial: Loneliness and the built environment

Pauline van den Berg, Nina Goldman, Astrid Kemperman, Eric Schoenmakers

Loneliness has emerged as one of the major public health challenges of the 21st century (WHO Commission on Social Connection, 2025). It affects a substantial proportion of the global population (Surkalim et al., 2022) and has profound implications for mental health (e.g. Lim et al., 2016; Mann et al., 2022), physical health (Christiansen et al., 2021; Valtorta et al., 2018), social well-being, and quality of life. This special issue contributes to a significant theoretical shift by demonstrating that loneliness is not only an individual psychological state, but also a spatial-relational phenomenon that is shaped through behavioural and experiential processes embedded within place. From this perspective, places are not just settings for social interaction; they shape how people encounter others, experience social presence, withdraw from others, and develop a bond with their environment. Several studies in the special issue highlight that the built environment influences loneliness not only by facilitating social interaction, but also by enabling forms of co-presence without interaction (Bi et al., 2026; Häussermann et al., 2026) and by legitimizing solitude (Bi et al., 2026; Stone et al., 2025; Hoff and Løvoll, 2026). Other studies show that environments may mitigate loneliness through other mechanisms beyond social interaction. Environments can foster connectedness to nature (Stone et al., 2025; Cai and Wilson, 2025; Castro et al., 2026; Hoff and Løvoll, 2026; Markevych et al., 2025; Schepers et al., 2025; Zhao et al., 2025; McGrath et al., 2025), enhance restoration (Stone et al., 2025; Deng et al., 2026), provide a sense of safety (Deng et al., 2026), or support the development of place attachment (Hoff and Løvoll, 2026; Van Tilburg et al., 2025). Thus, the studies in this special issue challenge the predominantly social-interaction based understanding of loneliness and suggest that meaningful connections to place can modify, complement, or substitute for social relationships (Stone et al., 2025; Van Tilburg et al., 2025).

Unseen struggles, unmet needs: A qualitative study of housing and health disparities among newly arrived migrants and refugees in Greater Western Sydney, Australia

Kritika Rana, Jennifer L. Kent, Shameran Slewa-Younan & Andrew Page

Housing is a fundamental social determinant of health and wellbeing for migrant and refugee populations and serves as a critical pathway through which health disparities emerge and persist over time. However, evidence on how housing disparities shape health outcomes among newly arrived migrants and refugees remains limited, particularly evidence attentive to how these experiences vary by visa and migration pathway. This qualitative study aimed to gain an in-depth understanding of the housing and health disparities faced by newly arrived migrants and refugees in Greater Western Sydney, Australia, and how these disparities converge and diverge across visa pathways. A sample of 30 participants, comprising international students, temporary graduate and skilled visa holders, a recently naturalised citizen, and holders of refugee and humanitarian visas, completed the semi-structured interviews, and an inductive approach to thematic analysis informed by a critical realist perspective and the social determinants of health framework was undertaken to identify contextual patterns and themes. Three overarching themes emerged: (1) Structural determinants shaping access to housing among newly arrived migrants and refugees; (2) Precarious living conditions as intermediary determinants contributing to health disparities; and (3) Intersection of housing instability and financial hardship as interconnected pathways in shaping health inequities. A lack of local rental history, discriminatory rental practices based on visa status and ethnicity, and limited access to formal lease agreements and tenant rights were reported as structural barriers to securing housing across the sample. However, the resources available to offset them diverged by visa pathway, with international students and other temporary visa holders navigating these barriers without access to income support or priority social housing, which collectively heightened housing insecurity. Participants also described how precarious living conditions, such as overcrowding, substandard housing quality, and conflicts in shared accommodation, contributed to health disparities. Moreover, the intersection of housing instability and financial hardship was identified as a key driver of health inequities, with frequent relocations causing housing instability, high rental costs contributing to financial vulnerability, and cumulative stress leading to long-term health consequences. These findings underscore the need for policy interventions, including pathway-specific settlement and institutional support and stronger tenancy protections, to address systemic housing inequities and mitigate the health disparities experienced by newly arrived migrants and refugees.

Therapeutic cultural environments: An indigenous epistemological expansion of the therapeutic landscapes concept

Bruno Marques & Jacqueline McIntosh

Background

Since Gesler’s foundational 1992 paper, the therapeutic landscapes concept has generated a rich and productive research programme examining how place supports healing and well-being. However, the field has developed primarily within Western, post-Enlightenment epistemological traditions, raising serious questions about its capacity to explain, or meaningfully support, the health of the world’s 476 million Indigenous people.

Aim

This paper critically examines the epistemological foundations of the therapeutic landscapes concept, identifies its culturally specific assumptions, and proposes an integrative framework, Therapeutic Cultural Environments (TCE), drawing on Indigenous health philosophies to expand and reorient the field.

Approach

Drawing on a critical conceptual synthesis of the therapeutic landscapes literature alongside Indigenous health epistemologies from Māori (Aotearoa New Zealand), Aboriginal and Torres Strait Islanders (Australia), and First Nations (Canada) traditions, we map the foundational divergences between Western and Indigenous frameworks along three axes: the ontology of place, the definition of health, and the understanding of therapeutic process, and examine how colonisation operationalised the dispossession of therapeutic landscapes, connecting the concept directly to resulting health disparities.

Findings

Indigenous frameworks challenge three foundational assumptions of the therapeutic landscapes concept: that ‘place’ is a spatial container for health processes; that healing is fundamentally an individual and physiological recovery; and that the relationship between person and landscape is contingent rather than constitutive. We propose the TCE framework as an integrative response, expanding the ontology of place from spatial setting to relational co-constitution, the definition of health to include identity, belonging, and intergenerational continuity, and the understanding of therapeutic process from individual to communal and ancestral.

Conclusion

The therapeutic landscapes concept requires not merely diversification but epistemological expansion; the TCE framework offers a theoretically grounded path toward a more inclusive, epistemologically extended landscape-health paradigm.

Tracing dementia: Reminiscence therapy in and from place

Carmen Pocknell, Cassandra Dinius, Ronan Foley, Seán Commins, Joanna McHugh Power & Richard Roche

Across different disciplines, there has been increasing interest in the relationships between early-stage dementia, place and different forms of treatment. Reminiscence therapy has demonstrated benefits in stalling the progression of dementia, especially in its early-stage, and within such therapies, relationships between place memory and the beneficial triggering effect of place-based events and personal narratives have become important aspects. Promoting physical activity outdoors is associated with better management of dementia that additionally recognises a potential role for meaningful local places and spaces. Much of this place-based research, including go-alongs, are informed by mobile methodologies, with new spatial technologies (beyond risk-informed tracking) having much potential when used directly with patients within and outside their home places. However, there remain questions about the feasibility of using such methodologies for the purposes of place-based intervention among individuals with early-stage dementia. We document a recent proof-of-concept study, AIM-WARM, that investigated the potential impact of combining the exercise of walking and reminiscence therapy, in early Alzheimer’s disease groups, to explore how such technologically-enabled place-based tools worked. Instrumental and walkability measures were augmented by digital mapping and a spatial video app, Ubipix, to capture go-alongs across familiar routes traced out within the town of Maynooth (Ireland). Specific findings identified positive results in relation to four distinct aspects of the study: walkability, cognitive instruments, the capturing of place-traces and a positive narrative response to being and moving outdoors. Additional methodological reflection considered the value of go-alongs to capture traces of people’s past within their current everyday neighbourhoods, to help better understand and represent the voice of people living with dementia within community settings.

International Journal of Social Psychiatry

Editorial: From Scaling Interventions to Tuning Systems: Rethinking Global Mental Health Implementation

Marianna Purgato, Orso Muneghina, and Corrado Barbui

In recent years, substantial efforts have been dedicated to developing and testing evidence-based mental health and psychosocial support (MHPSS) interventions aimed at preventing and treating mental health conditions in low- and middle-income countries (LMICs). The World Health Organization (WHO) and other international institutions played a key role in this exercise, developing several evidence-based interventions (World Health Organization, 2024). The relevance and efficacy of these interventions have been established across different countries and in different populations through rigorous randomized controlled trials, and systematic reviews and meta-analyses (Astori et al., 2025; Schäfer et al., 2023).

Nevertheless, key dilemmas and challenges remain in defining strategies that can reconcile the proven efficacy of many evidence-based interventions with their real-world relevance and sustainability (Table 1). These challenges are particularly acute when it comes to implementation, scale-up, and embedding interventions within local health and social systems, where contextual fit, ownership, and structural barriers can often undermine impact (Ceccarelli et al., 2024; Muneghina, 2026). First, there is a potential tension between standardization of interventions and procedures, which is essential for replicability and data collection, and the need for contextual relevance and perceived usefulness in practice. Evidence-based interventions are highly manualized to guarantee fidelity to their original contents and procedures. However, they may not always be acceptable and relevant in their original form across cultural contexts (Fonagy & Luyten, 2019). This issue concerns the terminology, case examples, and linguistic style of the manuals, as well as the training structure and materials, but also the imagery and representations of emotional states embedded in intervention manuals. This tension also reveals deeper epistemic power asymmetries, where the assumptions, language, and knowledge frameworks embedded in interventions are often shaped elsewhere, while local actors are expected to adapt to them.

Public Knowledge, Stigma, and Discrimination Toward Schizophrenia: Results From a National Survey in Türkiye

Haldun Soygür, Köksal Alptekin, Mustafa Yıldız,, Muazzez Merve Avcıoğlu, Çiğdem Penn, and Alp Üçok

Purpose:

In light of the limited and predominantly regional evidence on public stigma toward schizophrenia in Türkiye, this study aimed to address the lack of nationally representative data by investigating public perceptions of schizophrenia, levels of knowledge, and attitudes toward social distance and related factors in a large, nationally representative sample from Türkiye. In doing so, the research questions were explicitly derived from this gap, focusing on how education, socioeconomic status, gender, and familiarity with mental illness are associated with knowledge and social distance.

Methods:

A total of 1,030 adults were surveyed between 4 and 26 September 2019. Data were collected through Computer-Assisted Personal Interviewing (CAPI) conducted by 32 trained interviewers who had received sensitivity training on mental illness before fieldwork. The questionnaire was developed by an expert academic committee with extensive experience in stigma research. Data analysis included frequency distributions, cross-tabulations, and significance testing.

Results:

Overall, 63.7% of participants recognized schizophrenia as a brain disorder, although 27% still attributed it to character weakness, reflecting ongoing stigma. Approximately 40% acknowledged psychosocial factors (e.g. poverty) in the etiology of schizophrenia, 54% recognized its association with cannabis use, and 39.4% considered individuals with schizophrenia to be dangerous. More negative beliefs were observed among lower socioeconomic and educational groups, whereas participants with personal or familial experience of mental illness demonstrated greater knowledge and less stigmatizing attitudes.

Conclusion:

This study provides the first nationally representative evidence on public knowledge, stigma, and discriminatory attitudes toward schizophrenia in Türkiye. While a majority of respondents endorsed biomedical explanations, substantial proportions continued to express stigmatizing beliefs and social distance, particularly among individuals with lower socioeconomic status and educational attainment. These findings highlight persistent structural and informational inequalities shaping public stigma and underscore the need for targeted, culturally sensitive educational and anti-stigma interventions to promote social inclusion and reduce discrimination.

Cross-Cultural Comparison of Perceived Stigma in Major Depressive Disorder: The Role of Spiritual Well-Being, Resilience, and Quality of Life in Austria and Japan

Nataliia Maronchu, Kie Nomoto, Maya Shirakura, Sota Tomiyama, Jean Lillian Paul, Fabienne Post, Ellen B. Rubinstein, Timo Schurr, Yuya Mizuno, Franziska Tutzer, Hiroyuki Uchida, and Alex Hofer

Background:

Perceived stigma in Major Depressive Disorder (MDD) is a well-established barrier to help-seeking, social functioning, and quality of life. However, little is known about how stigma is shaped by cultural context and which psychosocial resources may buffer its effects.

Aims:

This study aimed to examine the relationship between perceived stigma and key protective factors – spirituality, resilience, quality of life, and social functioning – in patients with MDD from Austria and Japan.

Method:

A total of 101 patients diagnosed with MDD (51 from Austria, 50 from Japan) completed validated measures of perceived stigma, spirituality, resilience, quality of life, and social functioning. Correlational analyses, multiple regression, and interaction term models were used to assess the predictive value of psychosocial variables and country moderation effects.

Results:

Spirituality and resilience were negatively associated with perceived stigma across both samples, though only spirituality significantly predicted stigma in regression analyses, increasing to 48% after controlling for age and depression severity. Country-specific models revealed a stronger predictive power in the Japanese sample. While stigma correlated strongly with reduced quality of life in both groups, its association with social functioning varied by stigma dimension and country. The relationship between resilience and financial insecurity was stronger among Japanese study participants than among Austrian participants.

Conclusions:

In summary, spirituality emerged as a central protective factor against stigma in MDD patients, particularly in Japan, underscoring its cultural significance. Additionally, our findings reveal a context-specific relationship between economic stress and psychosocial coping strategies. Despite differences in how stigma is expressed across countries, its adverse impact on quality of life was universal. These results suggest that culturally informed approaches can effectively reduce stigma associated with depression.

Catastrophic Health Expenditure in Mental Health as Coercion in Post–Suicide Attempt Care: A Population-Based Study in Latin America

Felipe Agudelo-Hernández and Laura Fernanda Murillo-Alzate

Background:

Despite an increase in mental health problems, there is low implementation of mental health services, high catastrophic health spending, and a high incidence of coercive mental health practices. This could hinder recovery after a suicide attempt.

Aims:

To analyze catastrophic spending and coercive practices, and their relationship with variables associated with recovery (depression and well-being) and with the functioning of health services (continuity of care), in people who attempted suicide during 2024 and 2025 in Caldas, Colombia.

Method:

A cross-sectional and population-based was conducted with stratified random sampling in Colombia. Validated instruments were applied to determine subjective well-being, depressive symptoms and continuity of care in health services. To determine the perception of coercive practices in the care of suicidal behaviors in health services, an instrument was used that divided coercive practices into formal (physical abuse, isolation, forced hospitalization) and informal (involuntary medication, lack of participation in treatment planning).

Results:

A multiple linear regression was calculated for formal and informal coercion. The model for formal coercion explained 21% of the variance, and the model for informal coercion explained 63.2%, both with high coefficients for catastrophic health expenditures. Compared to those who did not report coercion, those who did reported it presented with more depressive symptoms, worse continuity of care, catastrophic health expenditures, and a lower socioeconomic status.

Conclusions:

There is a relationship between the coercive practices perceived and catastrophic spending on mental health services for psychosocial recovery. Those subjected to any coercive practice may have worse outcomes in terms of catastrophic mental health spending and depressive symptoms. Catastrophic spending is proposed as a form of structural coercion that could hinder psychosocial recovery.

Journal of the Royal Anthropological Institute

Conceptual colour: race, economic knowledge, and the anthropology of financialization

Kimberly Chong

Economic anthropologists now carry out fieldwork in settings for which the ethnographic method was never designed, amongst powerful financial actors who are notoriously difficult to access, and in contexts which transcend geographical boundaries. This has engendered a re-orientation of anthropology, to consider not only the economic lives of people but also the social life of devices and concepts. Drawing on ethnographic readings of corporate documents as well as fieldwork with various fee-earning intermediaries, this article looks at two concepts, ‘emerging markets’ and ‘human capital’, that are directed towards the making of investability in financial imaginaries and thus play a critical role in the production of financialization. Although often portrayed as neutral forms of knowledge, such concepts of economy, it is argued, are implicated in processes of racialization and that financialization is enacted through and produces racial forms. Responding to recent calls to attend to the legacy of empire and colonialism in financial capitalism, and inspired by the Black Radical Tradition, this article shows how colonial ideas of racial ordering are incorporated into these economic concepts. Thus, the invocation of these concepts, which play a vital role in creating legitimacy for intermediaries and their interventions, entrenches racializing dynamics of financialized capitalism.

Liquidity, the makings of India’s emerging economic body

Ikuno Naka

Under Narendra Modi’s premiership, India’s economy is rapidly being ‘dematerialized’ towards a digital economy: ‘faceless, paperless, cashless’ in his words. At first glance, it captures the quintessence of free laissez-faire market reforms, but I argue there is more to Modi’s project of liquidity. This paper re-reads the re-engineering of India’s economy, arguing that this idea of liquidity is what holds together in conflicting tension the polarities for de-regulated free laissez-faire market reforms with a re-sacralized and protectionist nationalism. Grounded in the stories of local builders working the ‘spatial fix’, the multi-sited ethnography recovers how money is more than some medium of exchange or vessel for abstract value. It is itself constitutive of shared dispositions, meanings, understandings, a vernacular, all in service towards a conceived ideal commons. Reframing our understanding of modern money thus, the paper therefore argues that Modi’s monetarist reforms are an assertion for a different kind of collective existence – a re-sacralized socio-spatial project wherein membership demands the reconfiguration of self and of relations, as these builders experience first-hand. The economy is never just about economics; it is inherently political and indelibly personal.

The birth of an earth being: ‘Rights of nature’ in Brazilian Amazonia and elsewhere

Aparecida Vilaça

In June 2023, the Laje River, located in the traditional territory of the Wari’ Indigenous people in Rondônia, Brazil, was declared a legal entity, an earth being, with rights, following the co-ordinated action of an indigenous councillor and non-indigenous activists. This made the Laje the first river in Brazilian Amazonia to attain such a legal status. In this article, I explore the different conceptions of earth being that characterize, on one hand, the indigenous perspective, and, on the other, the perspective of the non-indigenous actors involved in the legislative process. Similar cases in South America and New Zealand are compared, seeking a broader understanding of the equivocations that arise in the encounter between societies that accept instability and the possibility of an alternation between ontologies as positive factors and those societies more oriented towards dogmatism and a unity of perspectives.

The choice to submit: freedom, gender, and the figure of God in Pentecostal Nigeria

Naomi Richman

Why do some women choose to submit to their husbands in marriage? In anthropology, the paradox of ‘chosen submission’ has famously been explored by Saba Mahmood. Her work amongst Egyptian women donning the veil in the Islamic da’wa movement spotlights the notion of ‘piety’ to explore how devotion to God can act as a powerful motivator of human behaviour. This article pushes this line of argument further by seeking to make God a more central figure in anthropological analysis, following recent efforts in the field to create both ‘ethnographies of God’, as well as anthropologies that are ‘theologically engaged’. Drawing on ethnographic research amongst Nigerian Pentecostal women, this article illustrates the ways that marital submission is understood by these Christians as a spiritual state that connects them to God – a theological relation, in other words – as well as a social relation between them and their husbands. By analysing their theologies of freedom and submission, this article shows how theological thinking more generally can shape how power is conceived and wielded by religious subjects.

Singing to the saint: labour of healing at Jaunpur dargahs

Smita Tewari Jassal

On visiting Sufi saint shrines in India, one encounters terminologies reminiscent of legal courts where protocols facilitate active engagement of pilgrims in their own healing. With practices that induce participation in the social world of dargahs, pilgrims not only seek the miracles of saints for material, spiritual, and bodily transformation, but pro-actively ‘work’ to materialize blessings. Based on ethnographic fieldwork at three shrines in Jaunpur, Uttar Pradesh, I argue that the exhausting work of singing to the ‘listening’ saint, is illustrative of ‘devotional labour’. Through a sung bayan, or witness statement, I show how people deploy devotional labour to achieve the desired restoration of health. The muakkil’s ability to confer with possessing spirits, based on his former experience of possession, facilitates interpretation and legal clarification like that provided by solicitors, hence the demand for his expertise by the afflicted. Finally, that possession can be traced to the malicious intent of close relatives raises questions about dargahs as spaces for healing, and the internal and external transformations sought by shrinegoers estranged from familial and social environments. Centred on the category of healers at shrines, termed muakkils, this article seeks to advance ongoing discussions in the anthropology of healing in the subcontinental context.

Amidst (waste) abundance: world-making and struggles in hosting a municipal landfill in the Bolivian lowlands

Vanesa Martín Galán

In recent decades, solid waste has proliferated worldwide, becoming a pressing global issue. This article explores the role of Indigenous people dwelling within and upon emerging waste scenarios, with a specific focus on involved forms of sociality and ontological contestation. Drawing on the case of a municipal landfill sited on a Guarani community in Bolivia, it seeks to understand the social relations with humans and other-than-humans that are generated and through which its world-making takes place. It introduces questions of alterity, dependency, and autonomy into the anthropological field of discard studies, shedding light on how waste may act as a generative force for Indigenous life projects amid dependencies, inequalities, and ontological differences. The article shows how living with the landfill involved the community in a complicated relation with the municipality. Despite the environmental degradation it caused, the landfill became a paradigmatic place of abundance that supported community well-being through the creation of wealth. Moreover, it allowed the community to re-create desired forms of relatedness and exert some degree of control over powerful Others (municipal authorities). Unfolding within the context of consumer disposal, the community’s engagement with the landfill is part of a subordinating integration of Indigenous people into the global economy.

The company you keep: becoming one(self) in an Indonesian convent

Meghan Rose Donnelly

This article investigates companionate processes of self-making in a religious community of Catholic nuns in eastern Indonesia. I argue that the sociality of the convent establishes a unique context for understanding the effects of one’s company on processes of self-becoming. Through two years of participating in convent life, and set against majority-Muslim Indonesia’s religious and ethnic diversity, I offer an experience-near account of the complex ways that nuns negotiate self in the midst of others, each on her own journey of personal transformation. Inspired by concepts of community, intersubjectivity, and empathy, I propose company as a mid-level analytic for anthropological investigations into self and sociality. By attending closely to the dynamics of ever-shifting social groupings, company promises a better understanding of the transformational relationship between self and community.

Boredom, despondency, and the scourge that lays waste at noon: an anthropology of acedia

Richard D.G. Irvine

Attentive to the ways that inertia can take hold of life, Catholic monks recognize despondency as a potential not only within the monastery, but in contemporary society more widely. Such experiences are regularly mapped onto an understanding of what early Christian monks termed ‘acedia’ (a Greek term that can be translated as ‘lack of care’). Taking as my ethnographic starting point the ways in which monks of an English Benedictine monastery understood and narrated the struggle with acedia, I note how this insight has been shared as a matter of public significance: most proximately during the boredom and constraint of the lockdown in response to COVID, but also more generally as something embedded, unrecognized, in modern life. What, then, does it mean to consider acedia as an analytical category? I argue that identifying acedia not only centres despondency as an active presence in life, but refuses to privatize it and strip it of its social dimensions. This fundamental sociality is both in the interaction with the demon of acedia, moving across the boundaries of a porous mind; and also in the means to resist acedia through the stability of shared time and space.

Editor’s preface: AI and linguistic anthropology

Dimitrios Theodossopoulos

Artificial intelligence has rapidly become one of the most significant new areas of anthropological inquiry, and the JRAI is delighted to devote this special section to the topic. The contributions gathered here approach AI from the perspective of linguistic anthropology, a subfield uniquely positioned to illuminate how AI acquires meaning, authority, and social significance. Rather than asking whether AI possesses agency, consciousness, or personhood, the authors examine how people interact with, interpret, and attribute communicative capacities to AI systems. In doing so, they offer an analytically powerful account of AI that avoids anthropomorphizing the technology itself, instead directing attention to the semiotic, linguistic, and social processes through which its apparent intelligence is constituted. The special section also reflects a broader editorial aim of the JRAI: to encourage stronger engagement with linguistic anthropology, a subfield whose analytical resources deserve an even more prominent place in the journal’s future development, particularly as anthropologists seek to understand the profound transformations associated with contemporary AI.

Introduction: Towards a linguistic anthropology of AI

Webb Keane & Constantine V. Nakassis

This essay introduces the themed cluster of articles, ‘Towards a linguistic anthropology of AI’. The advent of artificial intelligence (AI), especially in large language models capable of producing coherent discourse mimicking conversational interaction, is exerting unprecedented pressure on prevailing concepts of language, personhood, and the human. This provides a challenge and opportunity for reflection, particularly for linguistic anthropology, that sub-field centred on language as medium/practice of meaning-making in social life. Moving beyond AI as communicating machine to explore communicative processes that structure AI as ideological imaginary and technological infrastructure, the articles in this cluster draw on linguistic anthropology to examine different facets of AI as people take it up, such as the features that invite users to endow chatbots with personhood (Keane), attempts to use AI to unlock animal communication (Handman), and research seeking linguistic biomarkers predictive of psychopathology (Semel). To contextualize the articles, this introduction offers some basic semiotic distinctions developed within linguistic anthropology needed to parse AI, with a focus on the concept of semiotic ideology. We then situate AI within a set of ideological genealogies – from Enlightenment visions of universal languages to the representationalism of modern linguistics – before turning to themes of transduction and semiosis beyond the human.

‘Everything is a signal’: speaking circuits and noisy signs in the making of language-oriented AI

Beth M. Semel

Contemporary artificial intelligence (AI) technologies are often presumed to be capable of revealing unmediated truths about the world, including the truths language might hold, echoing the long-standing assertion that language’s primary function is to directly translate reality. These interrelated representationalist ideologies unite in vocal biomarker AI, a subarea of machine learning research and development dedicated to optimizing how the voices of people experiencing mental distress are interpreted. Although the premise behind vocal biomarker AI – to listen to the brain through the voice – assigns transcendent semiotic capacities to both AI and language, another story unfolds in practice. Drawing from fieldwork with vocal biomarker AI researchers, I show that researchers take the social, pragmatic, and political dimensions of language to be foundational to its computational modelling. This is because to gather the voice data necessary to their research, researchers must recruit human research subjects and make them speak, contending with the gaps between the subjects’ and their own expectations regarding the meanings and values that language can embody. By underscoring the centrality of disjuncture, maintenance, and partiality – i.e., transduction – in vocal biomarker AI, I counter hegemonic claims about the people behind AI systems and the systems’ abilities to do things with words.

Animal translations: AI and the intelligibility of non-human worlds

Courtney Handman

Amid the general sense of worry that large language models will soon drown out human voices, some researchers are optimistic that machine learning will allow humans to listen to and understand animal voices to an unprecedented extent. As part of a broader project aimed at interspecies communication, a loosely connected set of animal behaviourists, AI engineers, and public-facing animal advocates are working to comprehend ‘animal languages’ and thus to improve the lives of domesticated and wild species. Work in this field not only assumes a novel set of speakers (which can include, for some, plant as well as animal species), but it also contributes to a redefinition of what language is. This article examines how the expansion of language to non-human animals is helping to produce posthuman worlds in which linguistic expertise is partially transferred from humans to machines. These new ways of defining language are especially visible in the forms of translation that people in the world of interspecies communication engage in that link animals, humans, and artificial intelligence. Repeating earlier moments in translation history, a new kind of linguistic expertise makes a new kind of translation possible.

From talking tools to metahumans: social interaction, semiotic skill, and the authority of AI chatbots

Webb Keane

What does it take to turn a tool into a talking tool and that into an ultimate authority? Generative artificial intelligence (GenAI) in its diverse forms, such as large language models (LLMs), is celebrated as a useful tool. But LLM-based conversational agents, or chatbots, the software applications through which ordinary users are likely to engage with LLMs on a regular basis, can seem, for many, to harbour uncanny insights or transcendental knowledge whose sources are inexplicable – resembling what Marshall Sahlins called ‘metahumans’. The temptation to treat chatbots as metahuman is just an extreme case of a more general process. The inferences that chatbot users draw about GenAI’s human or superhuman properties arise in part from the apps’ role as an interlocutor in social interaction. Their authority draws on the pragmatics and semiotics of speech. Much as a prophet embodies and legitimates the authority of divinity, so chatbots can endow the profit-seeking strategies of their corporate owners with a supernatural aura. That such effects can seem intuitively real is, in part, because humans and metahumans address one another on semiotically unequal grounds.

Linguistic anthropology of AI: an afterword

Ilana Gershon

This reflection on the themed cluster of articles on linguistic anthropology and AI addresses what social anthropologists might wish to know about the linguistic anthropological analytical toolkit when turning to large language models (LLMs) as objects of analysis. In particular, this afterword discusses what agency might be understood to be when the scholarly attention is focused largely on how people use communicative repertoires to accomplish complex social tasks with others. Building on how linguistic anthropologists understand human semiosis, the article makes apparent how human communicative agency differs from the communicative agency expressed by LLMs.

Medical Anthropology

Survivors, Artists, and Healers: Collective Healings of Ecological and War-Related Wounds in the Colombian Amazon

César Abadía-Barrero, Vanesa Giraldo-Gartner, Camilo Ruiz-Sánchez & Paola Gamboa-Alzate

Through painting and embroidery, victims/survivors of the armed conflict in southwest Colombia, primarily women, linked their pains, wounds, and sorrows left by the war with their hopes for a beautiful/joyful future in which they can live, once again, surrounded by family, friends, plants, animals, and rivers. Both the artistic process and the final installation,Casa Común(i.e. Communal House), promoted some respite and healing that was felt individually and collectively. Such healing was possible thanks to the emotional labor that these women have done for years to support one another, both inside and outside of formal and institutionalized spaces.

Suturing the Fragments: Topological Agency and the Making of Coherent Worlds in Chinese Family Care

Xiaoyan Dong

Drawing on Li Shen’s Memoir of Illness and Treatment as core ethnographic material, I develop a topological agency framework to examine how Chinese families integrate heterogeneous medical resources amid a fragmented health care landscape. I identify two core topological operations: temporal folding, which activates intergenerational embodied knowledge, and spatial stretching, which crosses hospital-home boundaries to build family-centered care. Grounded in Confucian family ethics of xiao (filial piety) and ci (parental kindness), I recenter the family as a collective agent, challenge the individual-centered paradigm, operationalize topological theory, and offer a localized perspective to inform global scholarship on medical pluralism.

Signifying Others: The Gaze Upon the Mishap and the Specter of Dementia

Shvat Eilat

Older people who suspect impending memory loss face an intensified gaze of others during moments of forgetfulness. Drawing on ethnographic fieldwork with individuals contemplating cognitive decline in Israel, I analyze how “significant others” can become “signifying others.” Through three ethnographic vignettes, I explore regimes of gaze around forgetful moments. Building on Goffman’s dramaturgy and anthropological work on aging and cognitive change, I argue that dementia functions as a specter shaping everyday interactions through “vernacular diagnosis,” where informal assessments position momentary lapses within decline trajectories, prompting responses including protective laughter, strategic concealment, and orchestrating what can be known about oneself.

Between the Gang and Rou: Embodied Experiences and Multiple Practices of Chinese Men with Infertility

Haifeng Long, Fan Zhang & Shu Wei

In this article, we explore the transformation of masculinity among Chinese men throughout their infertility journey, focusing on the interplay of “gang” (hardness) and “rou” (softness) dimensions of masculinity. We documented the embodied experiences and diverse practices of Chinese men with infertility, revealing how cultural factors shape their masculinity. Our research indicates that the “gang” and “rou” aspects of masculinity in men with infertility are not mutually exclusive binaries but are interwoven and dynamically transformed within specific life contexts. This demonstrates the multifaceted possibilities and malleability of masculinity in the face of modern societal change and individual life experiences.

Naming Miscarried Fetuses: A Politics of Memory and Recognition Among Javanese Muslim Women

Erwin Rasyid Askuri & Dewi Rokhanawati

How do women make miscarriage memorable when pregnancy loss is common yet weakly recognized? Drawing on interpretative phenomenological analysis of 24 interviews with Javanese Muslim women, this article examines how fetal naming and non-naming shape grief, personhood, and moral responsibility. Naming sustained remembrance through prayer, family narratives, and ultrasound images, while some women refused it when biomedical language framed loss as absence or bodily cleansing. These practices were shaped by access to care, household relations, religion, and bureaucratic recognition. The article argues that naming constitutes a politics of memory across biomedicine, kinship, religion, and the state.

Grappling with Overdose Death Through the Art of Divination: A Tribute to Mikey

Jennifer Syvertsen

This essay reads the overdose of “Mikey” through a death tarot card I created to honor his life. In doing so, I explore the possibility of using art to tell a broader story of community care and emotional healing. The death tarot card represents not only material death, but the potential for profound transformation. Mikey was a “street dad” to many living in an encampment whose early death is a tragedy, but whose life story reclaims community where people often see none. Can the intuitive process of creating art from ethnographic data offer medical anthropologists new analytical insights toward healing?

“Our Deaths––Your Shame.” HIV Activism and the Rise of Autocratic Biopolitics in the Russian Federation

Katerina Suverina

This article examines the emergence of radical HIV activism in the Russian Federation through the case of the Front AIDS movement and its confrontation with established health care politics. Drawing on interviews, media sources, and policy analysis, it shows how activists challenged the system based on selective access to treatment and the coercive regulation of people who use drugs. Through direct public action, they reframed HIV and the right to live as a political issue. However, these actions encountered an emerging autocratic biopolitics that absorbed the epidemic into a securitized framework while restricting the political agency of affected populations.

Introduction: Veterinization: Extending Care and Control in More-Than-Human Health

Kieran O’Mahony, Marianna Szczygielska & Ludek Broz

This introduction develops veterinization as a framework for analyzing how veterinary knowledges extend across social and political life. Situating the concept in relation to medicalization and tracing the entangled histories of human and animal health sciences, it examines how veterinary authority and governance, data and standards, infrastructures, actors, and animal ontologies are reconfigured across diverse contexts. Veterinization unfolds as a relational and contingent process spanning domains including infectious disease management, animal welfare and care, and food safety. Veterinary expertise, while oriented to nonhuman life, are inherently biosocial, enacting forms of care and control with consequences well beyond animal health.

Trusting Slaughter: Live Poultry Markets and the Veterinization of Poultry Consumption in Singapore

Lyle Fearnley & Jia Haw Loh

In 1992, Singapore banned live poultry markets (LPMs) How has this veterinary and public health policy transformed how Singaporeans qualify chickens as healthy food? Drawing on archival research and fieldwork with consumers, vendors and veterinary officials, we show that consumers lost knowledge and skills used to evaluate the safety and quality of poultry. In contrast with many anthropological studies of food safety regulation, the prohibition of LPMs did not inspire resistance or alternative food movements but led to the emergence of new forms of consumer trust in expert veterinary authority, poultry vendors, and supermarket brands.

Veterinizing the Settler State: Biopolitics, Care, and Killing in Palestine-Israel

Irus Braverman

Drawing on three multispecies cases in Palestine-Israel – the fallow deer, the griffon vulture, and the free-roaming dog – this article depicts veterinary governance as constitutive of the settler state. Specifically, the article identifies three interrelated but distinct technologies of veterinary power: biopolitics, enacted through population management and selective reproduction; pastoral power, exercised through intimate care and detailed surveillance; and necropolitics, manifested in practices of extermination. The article argues that veterinization advances and naturalizes the state’s settler ecologies. In Palestine-Israel, this dynamic is especially visible in the state’s peripheral regions, in territories it has occupied since 1967, and along the Gaza border.

Veterinization at the Dog-Human-Health Interface Reconfiguring Interspecies Relations in India and the UK

Krithika Srinivasan, Guillem Rubio Ramon & Chris Pearson

Veterinization, catalyzed by worries about rabies in colonial Britain, has reconfigured dog-human relations beyond spaces of ill(health). Tracking human-dog relations across India and the UK, in this article, we argue that veterinization’s reach is enabled by its “species reductionism,” and that the ramifications for human and animal health as well as wellbeing have not been entirely positive. Our analysis points to the need for circumspection about current paradigms of interspecies health and calls for the rethinking of health beyond anthropocentrism.

Wild Vaccinations: Veterinary and Hunter Intersections in Response to Classical Swine Fever in Japan

Maki Kitagawa

In 2018, wild boars (Sus scrofa) infected with classical swine fever in Japan became the focus of veterinary intervention for the first time. Drawing on ethnographic fieldwork on the oral vaccine distribution project and rethinking biosecurity, this article examines the possibility and limits of relating to wild animals in the era of unpredictable infectious disease. The implementation of “wild vaccination” demonstrates that the practical limitations of the vaccine drove veterinization. Yet this was not a unidirectional expansion of veterinary power; rather, it constituted a process of re-learning veterinary expertise, enacted in novel alliances with hunters.

‘Corona is Over’: Temporalities and Material Afterlives of the Covid-19 Pandemic in Kenya

Jacinta Victoria S. Muinde, Paul Wenzel Geissler & Ruth Jane Prince

After what most Kenyans experienced as the “end of Covid” in 2021–22, material remains of anti-epidemic measures, biological traces such as long covid, and memories of deaths persisted. While infection itself left few visible material traces, paraphernalia of its control – masks, tests, handwashing stations, and routines – proved more durable, although often losing or changing their function and meaning. This paper examines Covid-19 residues in western Kenya, their state and use, the meanings people assign, and how they disappear or sediment among leftovers of other epidemics, shaping future pathways unpredictably. We reflect on the afterlives of epidemics in Kenya and elsewhere.

Medical Humanities

Graphic medicine in mental health nursing education: a phenomenological approach to using graphic pathographies as a pedagogical tool

José Mompeán-Mejías, Rocío Juliá-Sanchis

Training healthcare students on topics of psychiatry and mental health is challenging because, besides scientific knowledge, addressing attitudes towards mental health is equally important. In this sense, graphic pathographies, understood as stories of patient experience, can foster meaningful learning opportunities and support a deeper understanding of the patient’s perspective from a more social, emotional and inclusive approach to the healthcare discourse. The purpose of the present research was to explore nursing students’ experiences with a graphic medicine-based intervention in a mental health and psychiatric context. A qualitative study was conducted using a focus group methodology. The Spanish graphic pathography addressing schizophrenia, Las Voces y el Laberinto, was introduced. Four main themes were identified: (1) advantages of graphic pathographies in comparison with other educational materials, emphasising their capacity to enhance information retention, capture the reader’s sustained attention and encourage a uniform interpretation of concepts; (2) potential of graphic pathographies in the assimilation of theory, where students point out that these narratives facilitate the understanding of mental disorders, promote empathy and favour critical reflection on stigma; and (3) usefulness of graphic pathographies in the transfer of knowledge, evidencing its potential for the training of professionals, patient education and social awareness; (4) from reluctance to acceptance: a change in the perception of graphic pathographies in education. The findings advocate that graphic pathographies can enhance learning and reflection on complex mental health content in the context of a well-designed and facilitated teaching session, in which students have prior knowledge on the topic.

Suffering and the collapse of language: between the sayable and the impossible

Lorena Garcia Esparza, Francisco López Muñoz, Ana Olano & Eduardo M García-Rico

This article explores the relationship between human suffering and the limits of language, positing that suffering is not simply an experience of physical pain or emotional distress but a fracture in the capacity to articulate meaning. It clearly distinguishes between pain (a localised sensory experience that is potentially communicable) and suffering (an existential experience that involves a rupture of the symbolic order).

It is argued that suffering appears when personal narrative is interrupted or becomes incoherent, provoking what is termed a ‘collapse of language’—moments when experience exceeds the expressive and symbolic capacity of the subject. This phenomenon is examined from multiple perspectives: the phenomenology of the body, philosophies of the limit (Lévinas, Derrida, Ricoeur) and clinical cases such as trauma, dementia and the diagnosis of serious illnesses.

The text criticises the traditional definition of suffering proposed by Eric Cassell for presupposing a narrative self-consciousness, excluding prelinguistic or non-narrative forms of suffering. The text also tackles the issue of epistemic injustice in clinical contexts, where individuals discredit or lack conceptual resources to articulate their experiences of suffering.

Finally, the article suggests an ethics of care that involves being open to what cannot be fully expressed, understanding that truly responding to suffering means not just trying to understand it completely or get rid of it, but being there in that difficult space where words fall short, while still providing human presence as support.

Return to normal? Remembered futures and the post-pandemic

Sara DiCaglio

The COVID-19 pandemic was and is many pandemics, experienced unevenly by people of different races, classes, bodies, in different locations, nations and circumstances. Moreover, the pandemic evolved across time and through distinct phases. In the USA, for instance, 2 weeks to stop the spread morphed into a summer marked by George Floyd’s death and the ensuing activism; the winter’s joy over vaccination availability became concern over its slow, uneven rollout. Waves of changing pop culture phenomena—Netflix shows like Tiger King or Bridgerton, hashtags like #hotvaxsummer–combined with the lived realities of the day-to-day, marked by illness, death, survival, fear, boredom, violence and grief. It is easy to forget the nuances of that day-to-day reality. Pandemics themselves are out of step with time, as a pandemic’s past and present are a collapsed future time, as symptoms and diagnoses of infection remain out of sync with actual infection. And now, in this quasi-post-pandemic moment, the rhetoric of ‘return to normal’ and discourse about ‘learning loss’ suggest that society should operate uninterrupted—that it is possible to devise a future without the pandemic past. This article introduces the concept of remembered futures, or memories of futures imagined in the past. The pandemic’s lived experience was an experience of many presents and possible futures, and so post-pandemic presents must also make room for those past futures imagined in past presents. To make this argument, I look at three works composed and published during Spring and Summer of 2020: Sabrina Orah Mark’s Paris Review web column, ‘Happily’; Charles Yu’s short story ‘Systems’; and Nguyên Khôi Nguyễn’s graphic novel, ‘Bittersweet: A Pandemic Sketchbook’. I argue that post-pandemic futures do not just require a memory of the past, but a memory of the futures of the past, to find their way towards the new possibilities for the future present.

Shaping Indian biocitizens: Americanisation through medical education in the TB sanatorium paper Sioux San Sun (1938–1941)

Joanna Ziarkowska

The article aims to analyse health-related articles written for Sioux San Sun, an Indian tuberculosis sanatorium paper published between October 1938 and September 1941 in Sioux Sanatorium, Rapid City, South Dakota. To account for the ideological agenda behind the seemingly strictly informative content of the articles devoted to medical education, I apply the concept of biocitizenship. While biocitizenship is usually associated with the era of molecularisation, that is, the 21st century, I argue that it can be traced to the first half of the 20th century, when information campaigns about public health were engaged in the process of shaping medically informed biocitizens. By using particular biomedical language, this process resulted in the reconfiguration of individual personas within diverse spheres of authority, encompassing political, medical, legal and occupational domains. I believe that the main idea behind educational articles in Sioux San Sun is, apart from disseminating medical knowledge, to transform uneducated Indians into biocitizens.

The home within care: exploring home-like design in paediatric/adolescent palliative care environments

Sara Nourmusavi Nasab, Rebecca Mclaughlan & Chris L Smith

This study explores the integration of home-like design elements in paediatric/adolescent palliative care inpatient units, drawing on perspectives from both medical and architectural professionals. Recognising the unique developmental and psychosocial needs of young patients, this research explores how the spatial and emotional qualities associated with ‘home’ are interpreted and operationalised in palliative care environments. A multimethod approach was employed, including a targeted literature review, analysis of seven international paediatric hospice design and semistructured interviews with 22 experts from the medical and architectural fields.

The findings identify two central themes in the design of supportive palliative care settings: (1) Supporting Moments of Normalcy, which highlights the importance of daily routines, social connections and familiar activities in fostering emotional well-being, and (2) Architectural Features of Home, which addresses spatial layout, materiality and aesthetic elements that evoke comfort and familiarity of home.

A key divergence was observed between the disciplines: medical professionals emphasised the emotional and social aspects of care, while architects prioritised spatial configuration and material considerations. Additionally, the study discusses how design approaches may vary between younger children and adolescents in creating home-like environments. The contrast points to the need for more integrated design strategies that balance clinical functionality with emotional and social well-being. Limitations include the lack of direct input from young patients and families, as well as a limited exploration of cultural interpretations of ‘home’. Future research should address these gaps to inform more inclusive and holistic design approaches in paediatric palliative care.

Ethical aspects of medical television: qualitative research methods in the context of China

Xuan Wang & Zheng Zachory Wei

Medical television lies at the intersection between ‘media ethics’ and ‘clinical representation’, shaping the public perception of medical practice. Its epistemic authority is shaped by two main factors: realism (the accuracy of representations compared with real clinical practice) and affective engagement (the emotional impact of dramatised narratives). The research endeavours to unravel the ethical dimensions of Chinese medical television by examining its normative aspects and assessing the balance between pedagogical intentions and commercial imperatives. Using a qualitative-interpretative paradigm that integrates discourse analysis with perceptual evaluation, the researchers conducted an in-depth examination of 280 hours of programming across four television genres (2020–2024). Findings revealed that 32% of respondents expressed full trust in televised medical representations, while 41% indicated moderate trust. Notably, 62% reported encountering factual inaccuracies. Documentary formats received 79% trust ratings, compared with 41% for reality-based programming. Content analysis facilitated the quantification of representational distortions: 52% of programmes employed pathophysiological exaggeration, 74% compressed therapeutic timelines and 59% portrayed unrealistically high success rates (90% effectiveness). This study underscores the significant divergence between medically grounded narratives and dramatised portrayals in popular media, with implications for public health literacy and patient expectations. Future research should delve deeper into comparative regulatory paradigms, exploring how government oversight effectively mitigates misinformation compared with market self-regulation. It is necessary to determine whether epistemic stability is achieved through ethical standardisation or through the pluralistic moderation of the discourse.

Gaze that shamed science: Canine defiance and the ethics of experimental physiology

Ruth Y Y Hung

This paper explores how dogs in Victorian experimental physiology sparked a fundamental ethical and epistemological crisis through their embodied resistance to mechanistic reduction. Using archival evidence from Claude Bernard’s laboratory notebooks, feminist antivivisection literature and the public controversy surrounding the Brown Dog memorial, it argues that canine subjects challenged the conceptual foundations of experimental science through persistent agency and interspecies recognition. The analysis highlights three interconnected acts of resistance: Bernard’s private struggles with ‘uncooperative’ experimental subjects that undermined his mechanistic doctrine; the feminist witnessing practices of Lizzy Lind-af-Hageby and Leisa Katherina Schartau, whose documentation of prolonged experiments exposed the systemic violence masked by claims to scientific objectivity; and the Brown Dog Affair, where a terrier’s transformation from laboratory subject to contested political symbol crystallised intersecting politics of species, gender and class in Edwardian London. Theoretically, the paper develops the concept of felt reality—the embodied, affective dimension of experimental practice that persistently challenged positivist frameworks. Through feminist animal studies, it examines how dogs’ ‘absent referent’ status required elaborate discursive and psychological mechanisms to suppress evidence of their consciousness and agency. This interdisciplinary inquiry contributes to medical humanities by foregrounding animal agency, ethical witnessing and the limitations of biomedical rationality. Ultimately, it argues that Victorian experimental dogs participated as active agents in historical debates over knowledge, ethics and human dominion. Their resistance shaped a counter-history of science—one that evaluates progress not by dominating life, but by the bravery to confront the irreducible otherness of conscious beings and acknowledge, in that vulnerable exchange, the basis for more compassionate scientific practice.

Cases of child sexual abuse (Fi‘l-i Şenî‘) and punishments during the Tanzimat Era in the Ottoman Empire

Mümtaz Dadalı, Arif Hüdai Köke & Nüket Örnek Büken

Objective This study aims to examine cases of fi‘l-i şenî‘ (sexual abuse) against children during the Tanzimat period using archival documents and scholarly literature, with the goal of revealing the punitive measures imposed on perpetrators.

Methods The research employs qualitative methods, specifically document analysis. A keyword search using ‘fiil-i şeni’ in the database of the Ottoman Archives under the Presidency of the Republic of Turkey yielded 29 relevant cases. The documents were examined with particular attention to maintaining semantic integrity on completion of the translation process. These cases were systematically tabulated in the findings section and analysed in the discussion section.

Results The study identified 29 cases of fi‘l-i şenî‘ between 1839 and 1876. Four of these cases occurred before the implementation of the 1858 Penal Code, while 25 were adjudicated based on the 1858 Ottoman Penal Code. In the majority of cases, punishment was imposed in accordance with Articles 197, 198, 199 and 200 of the code.

Conclusion In the period preceding the 1858 Penal Code, pranga punishment—entailing the chaining of offenders’ feet and forcing them to perform hard labour—was prominent. This served both punitive and deterrent functions. With the enforcement of the 1858 Penal Code, the legal framework became more systematic and sexual crimes were more explicitly defined and categorised. In particular, Articles 197, 198, 199 and 200 determined the type and severity of punishment based on the nature of the crime, the victim’s age and the perpetrator’s relationship to the victim.

End chapter: illness memoirs and narrative humility in shaping the language of palliative care

Sankari Palanivel, Sashi Kala Govindarajulu & Rajendran V G

Palliative care communication often balances clarity with compassion, yet its professional and goal-oriented language can inadvertently mute the emotional and existential realities of dying. Illness memoirs, by contrast, linger in the texture of lived experience, offering narrative forms that resist closure and invite deeper engagement with mortality. This study conducts a comparative analysis of professional palliative care discourse and two contemporary illness memoirs, Paul Kalanithi’s When Breath Becomes Air and Jenny Diski’s In Gratitude, applying Rita Charon’s concept of narrative competence and Arthur Frank’s illness narrative typology to examine how each portrays and narrates the experience of dying. Kalanithi’s quest narrative integrates clinical insight with existential reflection, while Diski’s ironic, chaos-inflected style resists conventional narrative resolutions. Juxtaposing these with professional palliative care discourse reveals a narrative gap between institutional goals and the complex interior landscapes of dying patients. We argue that incorporating illness memoirs into palliative care education can cultivate narrative humility, enhance clinicians’ sensitivity to diverse narrative forms and improve the emotional and ethical quality of end-of-life care.

Working in (and between) art and health: challenges and missteps

Priya Vaughan, Chloe Watfern, Barbara Doran, Ann Dadich, Stephanie Habak & Katherine Boydell

Art can have a positive impact on health and well-being and be efficacious in health research and dissemination processes. However, creative, arts-based approaches to research and knowledge translation sometimes have a precarious toehold in the spheres of both health and art. In this paper, we report on failures, misunderstandings, difficulties and ethical tensions associated with work undertaken in, and between, art and health. Using collaborative autoethnography, we draw on professional experiences and relevant literature to present four core challenges that can be encountered, and should be considered, when working in the art and health space: (1) who is art for? (2) gatekeeping, (3) ethical tensions and (4) taste and quality. We share these challenges to make visible the often-tacit expectations, ways of working and hierarchies of knowledge that underpin arts and health work. In our discussion, we offer suggestions for overcoming these challenges, in the hope they will be useful to others working in arts and health. We raise and explore questions—about knowledge, value, art and ethics—that might not have definitive answers, but that are productive to interrogate before undertaking an arts and health endeavour.

Psych ward gothic: melodrama, hospitalisation anxiety and a case for the humanities in psychiatric research

Alastair Morrison

This article offers a critical assessment of representations of psychiatric hospitalisation in modern Western societies, with the goal of informing clinicians’ approach to communication and reassurance around involuntary hospitalisation. With evidence from film and fiction, it shows that these representations overwhelmingly fall into the genre of melodrama and, further, that this genre encodes conflicting but simultaneous historical anxieties about individual self-determination and community belonging, which become engrafted to the psychiatric hospital as a subject. With this critical assessment, the article also offers a model of how humanities scholarship can inform clinical psychiatry at the level of content, as distinct from the emphasis on listening skills and empathy in recent discussions of the humanities in psychiatry.

Reclaiming care: integrating nursing humanities into Philippine nursing education

Noriel Calaguas &  John Paolo Sarce

Traditional undergraduate nursing education often prioritises biomedical and technical skills, neglecting the humanistic dimensions vital for holistic practice. This abstract advocates for integrating nursing humanities, an interdisciplinary field bridging arts, humanities and social sciences with nursing, to humanise care, cultivate empathy and decolonise nursing in the Philippine context. Globally, methods like narrative medicine and arts-based learning foster critical thinking and cultural sensitivity. However, in the Philippines, humanities are marginalised in the Bachelor of Science in Nursing curriculum, a structural imbalance perpetuated by Western biomedical models and colonial legacies that undervalue interpretive knowledge. This marginalisation sidelines Filipino philosophies of care and indigenous epistemologies. This paper proposes a decolonised and culturally grounded integration of nursing humanities, specifically by incorporating local concepts like kapwa, the recognition of shared identity and interdependence, into the curriculum. A case study, demonstrating the use of patient narratives within a pharmacology course, illustrates how narrative and arts-based methods bridge theoretical knowledge with lived experience. This approach strengthens students’ empathy and moral imagination, aligning scientific rigour with compassion and social consciousness. Lastly, embedding humanities prepares Filipino nurses to deliver culturally responsive, person-centred care, positioning nursing humanities as a transformative force towards a more humane and decolonised healthcare system.

The pharmaceutical technician role came about in the early 2000s as part of the public-private partnership called Accredited Dispensing Drug Outlet (ADDO) program. The program aimed to reform local basic over-the-counter drug shops called maduka ya dawa baridi (a socialist state healthcare project established in the 1970s) from their assessed ‘problems’. These problems included ‘questionable medicine quality…untrained staff…[and] illegal dispensation of prescription medicines’ (Rutta et.al 2015, 2). Their reformation was justified by the motive to offer improved access to  ‘affordable, quality medicines and pharmaceutical services in retail drug outlets’ (Rutta et.al 2015, 2). The role of pharmaceutical technician was introduced from the program to produce personnel with the required knowledge and training to manage inventory and to ‘safely’ dispense medicines at reformed drug shops or maduka ya dawa muhimu.

Located precisely within these state-regulated drug shops –  between the biomedicines they sell and their local customers – as a pharmaceutical technician, Mwanga occupies a vital frontline role as a middleman in healthcare delivery, facilitating people’s access to biomedicines. On a daily basis, Mwanga performs the duties of patient clinical counselling and medicine dispensation. They entail understanding customers’ symptoms, advising which biomedicines they should buy, explaining medicine intake and dietary requirements clearly, informing customers about side effects, dispensing and selling biomedicines. Cylia (27, female), a pharmaceutical technician who also graduated from St Francis University College of Health and Allied Sciences, with an Ordinary Diploma in Pharmaceutical Sciences, explained: ‘Duties in the drug shop include dispensing medicine and medicinal supplies, counselling on how to use medicines effectively and to educate society on how to use medication’. Other duties include tracking and recording medicinal sales and stock to forecast future needs (Rutta et.al 2015, 4-5).

It is Mwanga’s and her colleagues’ in-between position and often unacknowledged, invisible labour that is responsible for the functionality of this neoliberal market-led healthcare services provision, through drug shops. The middlemen role of pharmaceutical technicians who operate drug shops, however, expands beyond clinical care and logistics. I argue that, from within a macro pharmaceutical market haunted by the spectral presence of ‘fake’ pharmaceutical medicines – which the public fears, but admit they cannot physically identify – technicians must also perform another vital labour. That of managing customers’ ‘fake’ drugs anxieties, and the fake-talk (Hornberger and Hodges, 2023) or claims about their availability in markets, during clinical counselling and medicine dispensation.

Below, I discuss how pharmaceutical technicians try to manage customers’ ‘fake’ drugs anxieties and fake-talk by filling the role of being the brokers of the state regulatory frameworks, and public health regimes, to the local customers. Firstly, I show, they do so by promoting customers’ trust towards the state’s legal authorisation number, which proves that pharmaceutical products are approved for sale, as an assurance code for medicines’ quality and efficacy. Lastly by rephrasing customers’ claims about impotent, ‘fake’ locally-manufactured biomedicine as a result of poor adherence to therapeutic instructions. This study ultimately illustrates how the technicians occupy a complicated middleman position. Unlike Boissevain’s (1974) purely entrepreneurial brokers or Bailey’s (1969) political brokers who primarily function to maintain institutional power structures, pharmaceutical technicians’ middleman role is multifaceted. It involves trying to protect both the state’s legitimacy and the market’s reputation against the subversion of fake-talk, while concurrently safeguarding the very commercial viability of drug shops that sustain their livelihoods and professional employment.

A haunted market: ‘Fake’ drug anxieties and TAN number as an emblem of trust

On January 25^th, 2023, Mwanga and I had a lengthy conversation about the state of ‘fake’ pharmaceutical medicines in Tanzania. I shared with her data I had collected from online newspapers reporting on the problem of ‘fake’ medicines in the country. In one of the articles, titled ‘Tanzania: When Fake Drugs Can Kill’, the author interviewed a local HIV/AIDS activist to provide an emic viewpoint about the topic at hand. The activist acknowledged that ‘fake’ medicines do exist  in Tanzania’s markets. He raised a panic he shared with the public about how these potentially life-threatening deceptive ‘fakes’, while they are there, they are not easily physically recognisable because they look like ‘original’ products (McLaughlin, 2012). He worryingly said:

‘People have stopped taking their drugs and they don’t know what to do, who to trust or which place to go… It has become a major problem in our community…The problem now is that nobody knows how to tell when the drugs are fake. Even myself, I’m worried.’

Tanzania is especially important to these discussions about ‘fake’ drugs in pharmaceutical markets in Africa because it is at the centre of pharmaceutical regulation on the continent. Over the past two decades, its pharmaceutical industry has seen a shift in increased regulatory measures, especially with the establishment of its federal agency: Tanzania Medicine and Medical Devices Authority (TMDA). It was established in 2003 as Tanzania Food and Drugs Authority (TFDA), as part of a response to strengthen Tanzania’s regulatory capacity in a pharmaceutical market where regulation was previously minor, and the government claimed, made the population vulnerable to ‘poor quality’ medicines (Chorev, 2020). The agency was   later restructured into the TMDA in 2019 (Rutta et.al 2015; Hamill et.al 2021). Although it is still relatively young, the TMDA is already recognised as one of the most effective medicine regulatory authorities in Sub-Saharan Africa, making Tanzania the first African state to be recognised by the World Health Organisation (WHO) as having achieved a well-functioning medicinal products regulatory system (Hamill et.al 2021, 3).

As a pharmaceutical technician working in a drug shop, which is a last port of distribution in a global pharmaceutical supply chain coupled with medicine uncertainties (McLaughlin 2012), Mwanga is at the centre of the politics of biomedicines’ credibility and efficacy. She has to deal (in)directly – during customer clinical counselling and medicine dispensation –  with such anxieties about the ghostly ‘fake’ biomedicines that haunt Tanzania’s pharmaceutical market, even with enforced regulation, and seemingly fragment trust towards it. Therefore, I was keen to know Mwanga’s opinion. When I narrated the story from the article to Mwanga, she responded with an example that seemed to simplify a situation that appeared to be quite complicated. She took a box of fungus treatment from the glass counter between us and showed me a code printed on it, or what she called a ‘TAN number’. She then told me that ‘Medicines that do not have a TAN number are fake and those that do [such as the product she was holding], are not’.

TFDA/TMDA was one of the agencies involved in the early 2000s reformation of drug shops into ADDOs. The agency is also responsible for their regulation, which  includes licensing and inspections (Rutta et.al 2015, 2). TMDA is also responsible for overseeing the mandatory five-year renewal registration of all pharmaceutical medicines (whether locally manufactured or imported) to be sold in the country to Tanzania’s population, for ensuring the ‘quality’, ‘safety’ and ‘efficacy’ of medicines in Tanzania (Chandhuri et al. 2010, 458-9). The TAN number that Mwanga is referring to as an assurance code for medicines’ quality and efficacy is a letter-digit registration code pharmaceutical products receive from the TMDA after it has approved them for sale. It is usually located on the back of the packaging, starting with the letters ‘TAN’ representing Tanzania.

The pharmaceutical technicians’ role in drug shops is not solely confined to  clinical counselling, to facilitate the required dispensation and sales of biomedicine to the local customers. Their duties as middleman requires  them to also manage customers’ anxieties about the presence of deceptive ‘fake’ biomedicines that people believe exist but fear they cannot physically identify, and the fake-talk (Hornberger and Hodges 2023) about their spectral presence in the market. Similarly to how Mwanga has done, during my engagements with different technicians in different drug shops within and around communities in Morogoro, pharmaceutical technicians promoted the TAN number as a valid state-regulatory code that guaranteed ‘safety’ and ‘quality’ in biomedicines. Thus, some advised that,  when uncertain, people should rely on the TAN number to detect the ‘fake’ from the ‘authentic’. On the other hand,  however, people I spoke to seemed not to know what a TAN number is.

Many people living in and around Morogoro Town evaluate the ‘efficacy’ and ‘quality’ of biomedicines differently from the pharmaceutical technicians. That is, by their pharmaceutical brand, retail price and their specified place of manufacture. Not the TAN number. Working at drug shops where many people rely on to access biomedicines, local pharmaceutical technicians such as Mwanga and Cylia sit at this clash point between two distinct regimes of value and efficacy, where biomedical regimes meet local knowledges. I show below how this clash and the anxieties about ‘fake’ drugs play out in drug shops. Later, I discuss how the technicians try to intermediate the knowledge divides between themselves and local customers concerning ‘efficacy’ and ‘quality’ of biomedicines, and promote trust towards the state and the market to try to subdue fake-talk.

Fake-talk and customers’ beliefs about efficacy

At the time of writing, an artemisinin-based antimalarial combination therapy called Artmether and Lumefantrine, locally known as ALu or dawa mseto (meaning mixture), had been Tanzania’s first line of defence against malaria since 2006 (Malisa and Kiriba 2012, 2). As a result, there are many mseto available in drug shops, from different countries, sold at different retail prices between 1,500 and 5,000 Tanzanian Shillings. The ADDO program, which drug shops were reformed under, paved the way for the adoption to make drug shops distributors of subsidised artemisinin-based antimalarial combination therapy. That made the locally manufactured, subsidised, and relatively cheaper ALu, costing as low as 1,500 Tanzanian Shillings,  one of the most popularly bought malaria medications. Ironically, these features that made ALu manufactured in Tanzania more accessible, also made some customers to trust it less and even call it fake.

Salamia, (30, female), who worked at another drug shop in Msamvu, some six kilometres away from the Town’s centre, explained that she has encountered customers who would come to the drug shop and reject mseto from Tanzania, because they believe, it is ‘fake’: ‘…some [customers] would say “I do not want these [ALu manufactured in Tanzania] I want those [imported, more costly antimalarial drugs]. Tanzanians do not know how to manufacture medicine, they are fake”’. Most often, it is expected that in clinical counselling and medicine dispensation situations, the healthcare personnel hold the power to direct the course of treatment (Foucault 2003, 52; Mattes 2011, 164), by simply matching customers to particular commodities. Furthermore, the pharmaceutical medicines may have what it seems like an obvious source, which is the pharmaceutical industry, which falls under and happen through the globalisation of pharmaceuticals. Salamia’s workplace experience depict how pharmaceutical technicians do not operate in a frictionless environment. The fake-talk (Hornberger and Hodges 2023) that Salamia narrated reveals they operate in messy spaces, with contested epistemologies, compounded by customers’ anxieties surrounding impotent, if not dangerous, ‘fake’ drugs in the market.

Anthropologists have already documented that pharmaceutical medicines have social lives (Whyte et al., 2002). The logics that make pharmaceutical medicines to circulate make them to also encounter context-specific evaluations that ascribe them with different social meanings and values (Petryna and Kleinman 2006, 21). In a market haunted by the presence of  spectral ‘fake’ biomedicines, seemingly, the anxieties about ‘fake’ biomedicines produce vigilant customers. Customers do not necessarily have to solely trust pharmaceutical technicians’ knowledge and expertise. They rely on their relativistic beliefs about efficient (Whyte and van Der Geest 1988, 3; Hornberger 2019, 487) and quality medicines as well, to exercise their own judgments and negotiate access to what they believe is good enough for them. That does not only mean pharmaceutical medicines to be sold in Tanzania have to go through a mandatory drug registration process. Upon reaching the market, they also have to undergo customers’ assessments. Therefore, a pharmaceutical medicine might be legally registered and might have a TAN number, but some customers might suspect and claim it to be ‘fake’ if it originates from a distrusted location and/or carries a suspiciously low price.

The anxieties about ‘fake’ pharmaceutical medicines imply that doubts about ‘quality’ in biomedicines are not merely defining features of informal markets (Peterson 2014, Baxerres et.al 2022, 84). Even state-regulated markets experience suspicions and accusations about having ‘fake’ drugs. The customers’ fake-talk that Salamia narrated therefore has the affect of disrupting the ‘order’ (Foucault 2005) that the state’s TMDA attempts to enforce in drug shops, through mandatory drug registrations and drug shop inspections, to keep ‘fake’ biomedicines out of the market. When pharmaceutical medicine’s social identity and reputation matters more than its claimed legal status and biomedical efficacy, and when anxieties about ‘fake’ biomedicines can work against claimed healthcare interventions to subsidise antimalarial medicine sold in drug shops ‘to increase access to malaria treatment’ (Rutta et.al 2015, 6), pharmaceutical technicians must constantly perform the heavy labour of epistemological alignment. Next, I discuss how, under these conditions of deep structural mistrust in the market, where regulation alone does not seemingly eliminate the suspicions of ‘fake’ drugs in drug shops, the technicians shift the claims about ‘fake’ drugs in the market into an issue of customers’ lack of know-how and compliance. That is, they deploy their clinical pharmacy knowledge to teach customers about the bioequivalence of the biomedicines available in their shops, and reframe poor adherence to therapeutic instructions as a probable cause for people’s fake-talk concerning biomedicines’ (im)potency.

Counter-claims to claims about fakeness

Cylia (28, female pharmaceutical technician) worked at one of the drug shops located in the Town’s centre. When I asked her why people would claim that certain antimalarial medications are ‘fake’, she mentioned that with ALu from Tanzania in particular, people would probably assume that it is ‘fake’ because: ‘…ALu has so many tablets, so patients develop poor adherence towards the drug’. Mary (26, female) another pharmaceutical technician who worked at a drug shop about three kilometres from the Town’s centre, echoed Cylia’s opinion. She explained in detail some of the behaviours that patients are supposed to adhere to – including storing and taking medication at an appropriate place and time, respectively. Failure to do so according to her, may counteract the efficacy of treatment and cause claims about fakeness:

‘If a person fails to use [antimalarial] medicine in a correct manner, they will not be able to heal. They may finish the dose [treatment], but because this medicine is consumed according to hourly intervals, if a person is unable to abide by these intervals… they will not get healed from malaria… Another thing is the maintenance of the medicine… you would find that a person would open this package [Mary was holding a box of ALu] and put it on the ground… the ground does not have [good] hygienic conditions, the medicine will lose ubora [quality]… it does happen that a person had consumed the medicine, but because the medicine had already lost ubora, the medicine did not help them.’

What Mary is promoting here is, all antimalarial drugs in the drug shops have the same bioequivalence (Sanabria 2014). That is, there maybe various antimalarial treatments available that differ in their brand names, packaging, origins, retail price, and dosage. Nevertheless, if the customers use them according to the guidelines pharmaceutical technicians provide, they will have the same capacity to treat malaria.

Kufakurinani (2022, 462) has shown how counter-claims to fake-talk about medicine in Harare, Zimbabwe, can come in the form of lack of efficacy being explained not necessarily as proof of ‘fakeness’ but as a matter of the product’s incompatibility with the consumer’s ‘blood system’. Here, the technicians provided another possible reason that can stimulate claims about fakeness: poor conformance with governmentality (Foucault 1991). By attributing fake-talk (Hornberger and Hodges 2023), to non-compliance, Cylia and Mary shifted the anxieties and claims about fakeness away from the state-regulated market and onto the self-regulatory habits of the customers. According to them, the state may work to assure the provision of ‘quality’ biomedicines in the Tanzanian healthcare system through their regulatory measures, but the ‘quality’ and ‘efficacy’ of biomedicines in the market, seemingly, also remain reliant on customer/patient behaviour. 

Occupying this intermediary space between the state’s regulation and local customers, the pharmaceutical technicians’ role in fake-talk management can be interpreted as follows. It extends the reach of the state’s legitimacy in guaranteeing improved access to ‘affordable’, ‘quality’ medicines (Rutta et.al 2015, 2) in a haunted pharmaceutical market into the daily intimate lives of citizens. Simultaneously, it can also be seen as safeguarding the market’s perceived validity and its commodification of health (Whyte 2001, 123) against the destabilising anxieties of ghostly ‘fake’ drugs and the fake-talk accompanying them.

Conclusion

Pharmaceutical technicians operating drug shops in and around Morogoro Town, Tanzania, are the paradigm of middlemen, positioned within the state-regulated drug shops, between the biomedicines they sell and the population that demands them. Usually individuals who hold a minimum academic qualification in Diploma in Pharmaceutical Sciences and registered with the Pharmacy Council of Tanzania, they are frontline caregivers who perform the duties of medicine dispensation, supply chain logistics and basic patient clinical counselling at drug shops. I have argued that however, middlemen’s duties expand beyond clinical care and logistics.

Working in healthcare spaces where people have underlying fragmented trust towards certain biomedicines, haunted by the presence of ‘fake’ drugs, their middleman position demands pharmaceutical technicians to also manage anxieties about ‘fake’ biomedicines in the market.  First, I have shown how they do so by translating formal regulation into frontline trust. They act as intermediaries between the state regulatory frameworks, and  the local customers, endorsing the state’s legal authorisation  code –TAN number – as an objective emblem of authenticity. Second, they absorbed customer anxieties regarding ‘fake’ biomedicines by recasting fake-talk as probable result of customers’ poor adherence to therapeutic instructions.

Pharmaceutical technicians operate in spaces with contested epistemologies where biomedical efficacy is under constant negotiation, relativistic to the technicians’ pharmaceutical science knowledge and customers’ beliefs. Whether they manage ‘fake’ drugs anxieties and fake-talk successfully remains, however, quite ambiguous. Unlike Boissevain’s (1974) purely entrepreneurial brokers or Bailey’s (1969) political brokers who primarily act on behalf of the ruling elites, pharmaceutical technicians, as middlemen, seem to occupy a multifaceted middle ground. Their management of anxieties about ‘fake’ biomedicines seemingly serves to try to endorse  the state regulatory apparatus and protect the commercial market from the fake-talk critique. Moreover, pharmaceutical technicians arguably do not manage ‘fake’ drugs anxieties and fake-talk selflessly in the service of state or market capital. Crucially, in performing this shielding labour, they are simultaneously  safeguarding  the very commercial viability of the workplace that sustains their own wage labour and professional livelihoods.

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Technology and Culture

The Problem with the Sex Toy Narrative: Design and Medical Intent in Early Vibrators

Dianya Mia Hua

This article challenges the dominant interpretation of early twentieth-century vibrators as inherently sexual objects. Rather than reading vibrators retrospectively through the lens of the modern sex toy industry, it examines hand-cranked and early electric devices from the perspective of design, use, and medical context. Drawing on artifacts, manuals, advertisements, and medical literature from Britain and the United States, the article argues that early vibrators were shaped primarily by therapeutic and cosmetic practices linked to massage medicine, gynecological therapy, and orificial philosophy. Attachments later interpreted as “phallic” or sexually suggestive emerged from clinical assumptions about circulation, nerve stimulation, and rectal or vaginal treatment rather than from explicit erotic design. By foregrounding design logic over retrospective meaning, the article reframes the vibrator as a medical and consumer technology whose sexual associations developed historically rather than existing from the outset. In doing so, it argues for a more historically grounded approach to technologies whose meanings shifted over time.

Theory, Culture & Society

Metabolo-politics: Bovine Metabolism and Environmental Biopower

Jonathon Turnbull, George Cusworth, Adam Searle, Else Vogel, François Thoreau, and Catherine Oliver

More-than-human metabolic processes increasingly constitute the locus of contemporary biopower, often responding to industrially-altered biogeochemical cycles. We conceptualise ‘metabolo-politics’ to examine the targeting of bodies and populations via interventions in the biochemical surroundings and ecologies that shape them; and simultaneously, the administration and modulation of materials in the environment via interventions in the bodies and populations that ingest, digest, and excrete them. Focusing on the governance of environmental crises related to carbon and nitrogen pollution, particularly in livestock sectors in the Global North, we offer three analytics for theorising metabolo-politics as a form of governance oscillating between bio-politics and anatomo-politics. They are: the dispositive, which grapples with the relations of matter and discourse that shape emergent problematisations of metabolism; the milieu, which is the more-than-human scene of intervention; and technologies, which are the diverse means through which power is operationalised metabolically and through which bodies, populations, and environments are governed.

Affective Eugenics: Education, Political Polarization, and the Affective Sorting of Futurity

Petra Mikulan and Michalinos Zembylas

This conceptual-speculative article examines political polarization as a deliberate strategy of affective governance in an age defined by mass dispossession and ecological collapse. We argue that polarization should not be treated as a temporary crisis to be resolved but as a governing technology that organizes fragmentation, consolidates elite power, and deflects attention away from demands for structural transformation. To theorize this dynamic, we introduce the concept of affective eugenics, describing how affective governance legitimizes privatized futures for the few while rendering the many surplus through a sentimentalist and biopolitical sorting of affective capacity. Within education, this affective sorting materializes as a triage of feeling: elite institutions cultivate planetary crisis managers, middle-class students are conditioned for resilient compliance, and underfunded schools are left to manage disposability. We conclude by outlining the educational implications of affective eugenics and calling for praxes of affective de-settlement, refusal, and opacity that unsettle these hierarchies.

Transcultural Psychiatry

The Experiences of People with Co-Morbid Serious Mental Illness and Chronic Physical Illness and their Caregivers with Healthcare Access in Jamaica: A Mixed-Methods Study

Patrice Whitehorne-Smith, Kunal Lalwani, Ben Milbourn, Wendel Abel, Robyn Martin, and Sharyn Burns

Globally, people with serious mental illnesses (SMIs) experience significant challenges with healthcare access. This increases their risk of developing chronic physical illnesses (CPIs) and results in negative health outcomes and shorter life expectancy. The Jamaican public mental health service has undertaken several transformations to increase the accessibility of mental health services and improve outcomes for people with mental illnesses. Despite this, there is an absence of research exploring the prevalence of CPIs among people with SMIs and their experiences accessing healthcare in Jamaica. This study seeks to address the dearth of research by exploring the prevalence of CPIs among people with SMIs, as well as their experiences and their caregivers’ experiences of healthcare access. The study utilised a convergent mixed-methods design with a dominant qualitative strand. Surveys were conducted with 306 people with SMIs attending mental health clinics across Jamaica. In-depth interviews were also conducted with 23 people with SMIs and with five of their caregivers. The findings of the study revealed that approximately 29% of people with SMIs also had one or more CPI. Three themes outlined key influences of healthcare access for this patient population: 1) money, family, and social support, 2) emphasis on the medical model, and 3) healthcare culture and expectations. The findings of the study indicate that social and cultural factors underpin the healthcare access experienced by this population and call for multi-sectoral and inter-disciplinary strategies to address the healthcare access needs of people with comorbid SMIs and CPIs.

U.S. Clinicians’ Recognition and Diagnosis of Cultural Concepts of Distress

Yunjung Lisa Chung, Shea Wenzler, Emma Headley, Gabriella Scalzo, Waverley Vesely, and Jared W. Keeley

In an increasingly diverse world, it is important for mental health professionals to be familiar with symptom presentations from a variety of cultures, including cultural concepts of distress. This study aimed to evaluate how U.S. clinicians diagnosed two cultural concepts of distress—hwa-byung and ataque de nervios—and whether the clinicians’ cultural values or competence influenced their diagnosis. A sample of 84 mental health professionals viewed three case vignettes in random order depicting hwa-byung, ataque de nervios, and Generalized Anxiety Disorder. The clinicians provided an unprompted free-response diagnosis and a forced-choice diagnosis from a predetermined list for each vignette. Clinicians provided a wide range of diagnoses for the hwa-byung and ataque de nervios vignettes, with only a minority of participants correctly labeling the cultural concepts of distress. Prompting diagnoses by providing a list of options improved the likelihood of selecting a cultural syndrome. The most common mental health diagnoses selected did not adequately capture the symptom profiles of the cultural concepts of distress. Clinicians appeared to be more familiar with Latinx cultural presentations than East Asian. U.S. clinicians could likely benefit from additional training and exposure to varying cultural presentations of psychopathology. Labeling a cultural syndrome with a psychiatric diagnosis may lead to decreased rapport and insufficient or ineffective treatment options.

Personal Recovery of People with Schizophrenia in Martinique: A Qualitative Study

Coralie Bourzeix, Manon Salvetax, Christelle Samot, Julie Gilles De La Londe, Jean-Sébastien Cadwallader, Marie Koenig, and Marie-Aude Piot

The personal recovery approach in mental health draws on people’s own experiences to build care policies. Models of personal recovery constructed in recent decades have been based on studies in Anglo-European cultural settings. No study has been conducted in Martinique, where Creole culture is prevalent. Our work aimed to explore the recovery experiences of people with schizophrenia in Martinique. We carried out a qualitative study. Fifteen people participated in a face-to-face interview, with collection of sociodemographic data. Three themes emerged from the analysis: self-work; evolving illness role; and rebuilding identity. Our results described a recovery process in which strong importance is given to social norms, involving difficult adjustments among multiple therapeutic approaches and overcoming psychological trauma. Access to employment, housing, and financial autonomy was related to social recognition. These results suggested the value of different approaches to aid recovery, including: support from relatives, peers, and caregivers; valuing their experiential knowledge; support for psychological trauma; fighting against the stigmatization of schizophrenia in Martinique; social support for work and housing empowerment; and recognition of the complementarity of the biomedical, religious, and traditional health care sectors.

Experiences of Bicultural Mental Health Clinicians Working Within Australian Mental Health Settings

Erin Joyce, Komal Khan, Dominic Hwang, Anna Browne, Taff Ruvaro, Bindu Joseph, and Michael Olasoji

Access to mental health services for people from culturally and linguistically diverse (CALD) backgrounds remains problematic owing to a variety of factors that contribute to low engagement with mental health services. There is also a need for our mental health systems to be more culturally safe to effectively and equitably support their diverse consumer population. Several initiatives have been explored to increase access to mental health services and improve help-seeking behaviours among CALD populations. One of these measures is the use of bicultural workers (BCWs). This study aims to explore the experiences of bicultural mental health clinicians working in tertiary and community-based mental health services. An exploratory, descriptive qualitative study was undertaken. Data were collected through semi-structured interviews involving n = 18 mental health clinicians in area and community mental health services. Participants were recruited using purposive convenience sampling. Data were analysed using thematic analysis. The findings of this study highlighted three key themes: (a) A shared understanding of the world (subthemes: ‘The lived experience of biculturalism’, ‘Having a different perspective’ and ‘Building rapport and managing boundaries’); (b) Working with other colleagues; and (c) Establishing a BCW model. Participants discussed their ability to use their biculturalism to understand consumers’ perspectives from CALD backgrounds. A shared understanding of the world was also seen as valuable. They reported varied experiences regarding whether their biculturalism was valued within their teams. Many participants felt that establishing a dedicated BCW role model within mental health settings could benefit consumers.

American Anthropologist

The Outsiders: Principled Withdrawal, Whiteness, and Power in the Los Angeles Food Justice Movement

Hanna Garth

This article draws on understandings of whiteness and the misconstrual of South Central Los Angeles to analyze the power dynamics between “outsider” activists and residents of South Central as they worked toward a more equitable food system. As concerns over the “obesity epidemic” and the push for “real food” in the 2000s coincided with a surge in GIS data on “food deserts,” a new cadre of activists, often white and middle-class, began intervening in South Central Los Angeles as part of the food justice movement. Residents had already been organizing around broader social justice issues and food retail equality. Though food justice brought these groups together in multiracial organizing, there were divergent visions about the problem and the goals of food justice work. In some cases of conflict, in a process I call “principled withdrawal,” residents withdrew from project situations that they did not align with ideologically, morally, or practically.

Containing Histories Past and Present: Making Samples in the “Huntington Collection” (1893–1921)

Alanna L. Warner-Smith

The Huntington Anatomical Collection (1893–1921) includes the skeletal remains of immigrants, migrants, and lifelong New York City residents. The collection’s formation was coeval with the formalization of physical anthropology, and the collection was made to serve research aims centered on race and origin. This early focus on race has materially shaped the collection, and, in turn, researchers’ ongoing engagements with it. When delineating research questions and forming samples, researchers (even those critical of race science and the collection’s history) tend to do so along race- and place-based categories prioritized by early curators and physical anthropologists. Treating these categories as the primary axis of difference flattens the complex life histories, movements, and social relations of the people in the collection, thus occluding a view of life courses as lived. Drawing upon archival evidence, I argue that such separation practices have profound implications for how we view belonging, social relations, and kinship in the past. These concerns extend into present questions regarding descendant engagement, as practitioners and institutions define communities of care and navigate future consultation and return.

It Takes Two to Tango: A Pluralist Account for Building Comprehensive Explanations in Human Evolution

Lumila Paula Menéndez, Sophie Veigl

The evolutionary study of human dispersal is a key topic in biological anthropology. However, recent research has revealed inconsistencies between molecular and anatomical data across different timescales and geographic regions. Despite increased interdisciplinary dialogue, these discordances are rarely analyzed in depth or interpreted for their biological significance. We present two case studies: human diversification in Southeast Asia and the Americas, which highlight persistent conflicts between morphological and genetic interpretations. Drawing on recent calls for extending the conceptual tools of evolutionary theory, we argue for a pluralist explanatory framework that can account for developmental plasticity, environmental responsiveness, and multiple trajectories of inheritance. We show how treating different datasets as epistemically equal—rather than subordinating anatomical data to molecular “controls”—allows for more comprehensive and nuanced explanations of evolutionary phenomena. This approach not only offers new insights into past human variation but also addresses long-standing issues of disciplinary fragmentation.

Perfecting Exit: The Politics of Quitting Among Migrant Care Workers in the United States

Cati Coe

Quitting tends to be overlooked in studies of resistance and labor because of its individual and private character, its ineffectiveness in changing conditions of labor, and the difficulty of studying it, in favor of more organized and public protests and strikes. This paper examines why quitting is so popular among African immigrant home care workers in the United States, arguing that exit was attuned to the diffuse power relations of fissured workplaces in which home care workers care for individual clients through the mediation of brokering agencies. Quitting was not entirely individualized and private, as it became a collective strategy nurtured through circulating stories and a widely shared worldview of anti-Black racism and anti-immigrant sentiment. In exploring the complexity, possibilities, and limitations of quitting, I point to the continuum of modes and degrees of resistance, rather than compartmentalizing some as private and some as public. The variability in the degree of privacy and individuation makes these forms of maneuver in relation to diffuse power adaptive to different degrees of scaling up and organizing. As anthropologists attend to the dynamism of resistance in relation to power, they should not overlook the phenomenon of quitting.

Bodies, Stereotypes, and Reproduction: Black Migrants Experiencing Obstetric Violence and Racism in Portugal

Catarina Barata, Chiara Pussetti

This article explores how the mistreatment of women in health care facilities in Portugal takes on particular forms for Black migrant women, shaped by essentialist ideas about race and miscegenation. In line with academic production on processes of racialization and discrimination against minorities and the medicalization of reproductive processes and biocontrol, this paper focuses on how these phenomena are reflected in the gynecological and obstetric care of Black women of Brazilian and African origin in Portugal. The women interviewed within the authors’ research on the ethnopolitics of citizenship and on obstetric violence speak of discrimination based on their ethno-racial, national, and migration status, as well as perceived ideas about their sexuality, behavior, and preferences in maternity and childbirth. Afro-descendant women’s interactions with workers of the health and social care sectors in Portugal are often informed by stereotypes about their bodies and their presumed (in)capacities to be good mothers. By focusing on the experiences of Black migrant women and their perceptions of public health and maternal care, this paper builds on previous work by the authors to address the issue of gynecological and obstetric violence in Portugal.

Campaneando: Surveilling With the Dead in Bogotá’s Drug Markets

Andrés Romero

This article offers a literary ethnography of one of Bogotá’s ollas or drug markets where centuries of violence ripple across the ambiance. It tells the story of the work undertaken by the campaneros, the lookouts who work for criminal governance to protect the olla, and how they cultivate collective attunements for surveilling the place. To perceive, intuit, or forebode threats, the campaneros create a sentineled structure that communicates across corners, while also drawing on drug-induced states of paranoia, clairvoyance, or necromancy. Drawing on extended ethnographic fieldwork (2012–2018) and methods of fabulation, I propose a necromantic ethnography that, by constellating multiple sources, perspectives, forces, and voices, aims to conjure the resonating and palpable force of history and the dead across the olla.

“We Do This Too”: Alternative Futures of Black Motherhood

Patricia Hamilton

In this paper, I draw on black mothers’ engagements with attachment parenting to meditate on this moment of crisis in black reproduction and black mothering. Using Jennifer Nash’s critique of this crisis framing and its consequences for black feminism, I argue that attending to the “ordinary” in black mothers’ experiences may yield alternative visions of black motherhood that depict them as neither dupes nor revolutionaries. The paper is based on a wider sociological project that involves interviews with 19 black mothers living in the UK and Canada. The project’s focus on attachment parenting, a popular but controversial parenting philosophy that rests on both historical and contemporary racialized ideals of good mothering, provides a unique opportunity to generate new perspectives made possible by the diversity of responses the philosophy elicits

Social Theory & Health

Public health, trade unions and empowerment: From learning to draft resolutions to addressing the socioeconomic determinants of health

Jane Thomas, Sean Tunney & Adam Cox

Community empowerment projects aimed at improving health and wellbeing have tended to be ‘place-based’. But they may also be based on ‘communities of interest’. This paper advances an original conception of health-related empowerment by focusing on the work of trade unions, which we treat as being among such communities. Organised labour improves health and reduces inequalities through processes including collective bargaining, even as public health actors have shown resistance to engaging with unions. We focus on an unresearched area of unions’ andragogy that is central to empowerment: that of motion writing and resolution-related mobilisation, arguing this has direct and underexploited implications for public health. Drawing on triangulated data from a UK-wide survey of unions representing more than 2 million members, in-depth interviews and website analysis, we consider how resolution-associated practices can form bridges between people’s individual concerns and collective decision-making. Such ‘micro-meso-macro’ connections can support initiatives that other empowerment projects have failed to establish. This generates a new resolutions-based conceptual model: the multi-level empowerment pathway. Our research contests the prevailing public health paradigm. We build on previous union–health research to help reconsider action on health determinants operating as global challenges, suggesting an internationally applicable infrastructure for participatory action.

Priority-setting in health care: A challenge to solidarity?

Katharina Kieslich

This article explores the relationship between the principle of solidarity and the challenge of setting priorities in health. It addresses an analytical gap that arises from frameworks for fair priority-setting that are inundated with discussions of technical and ethical criteria to help prioritise services, but that do not explicitly consider notions of solidarity. The article employs a categorisation scheme as a heuristic device to descriptively explore the identified research gap. Priority-setting decisions are divided into three categories to reflect the outcomes of prioritisation processes: (1) To fund a treatment, service or infrastructure project; (2) Not to fund or prioritise a treatment, service or infrastructure project; (3) To disinvest or stop funding a treatment, service or infrastructure project. Using Prainsack’s and Buyx’s practice-based definition of solidarity, the article discusses the extent to which different categories of priority-setting outcomes can be labelled acts of solidarity, or not. It concludes that while solidarity is an important principle for designing and financing health care systems, it is not a concept that helps address the complexities of priority-setting because the sacrifices and losses patients are asked to accept are often too high to be justified from a solidaristic point of view.

Sticking, leaking, flowing: patient perspectives and methods for exploring data uses in the public-private datafied health infrastructure

Maja Klausen & Stine Lomborg

As healthcare becomes increasingly datafied, public healthcare systems are becoming more deeply entangled with commercial digital infrastructures. While existing research has examined the political, ethical and infrastructural implications of these developments, less attention has been paid to how patients themselves experience and evaluate health data flows. This article investigates how Danish patients living with chronic illness understand data movement within public-private health infrastructures and explores methodological approaches for eliciting such perspectives. Drawing on five workshops with patients and informed by infrastructural analyses of mobile health apps, we combined written statements, an “attitude compass,” and appscapes (visualisations of app data flows) to facilitate sharing of lived experience, evaluative reasoning and speculation. Analytically, we mobilise the concepts of sticky, leaky and flowing data to characterise patient experiences. Participants frequently described data as “sticky,” becoming stranded across devices, institutions and systems, thereby preventing meaningful circulation to healthcare professionals. Concerns about “leaky” data emerged primarily in relation to speculative reflections on commercial third-party access enabled by digital infrastructures. The findings suggest that contextual legitimacy weighs more heavily than abstract concerns about privacy or public value: When data sharing is perceived as meaningful and potentially life-saving, itis understood as necessary and legitimate.

Reading disgust: a critical gerontological examination of a Hindi-language short story

Tannistha Samanta & Vinay Suhalka

Senescence in fiction has been rarely studied in the cultural gerontological tradition in India. While later life associated with intergenerational authority, or enhanced religiosity or as a cultural process of worldly renunciation, have been themes in the phenomenological corpus of gerontology in India, studying the aging feminine body has remained outside the intellectual sensibilities of this field. In this paper, we analyze the short story, Boodhi Kaki (old aunt) by noted Hindi and Urdu writer, Munshi Premchand (1880–1936) to explore the cultural construction of the abject, an ambiguous liminal stage that is distinct from notions of “Third” or “Fourth” age in life-course studies. As such, by focusing on food and (a devouring) appetite of the older female protagonist, we complicate the entanglements of desire and disgust in aging studies. Ultimately, we explore the transgressive potential of the abject as a self-reclaiming device that upends cultural understandings of age(ing) and gender.

Reconfiguring scientific competition: patent consolidation and the access politics of the HPV vaccine

P. Omkar Nadh

The invention of the human papillomavirus (HPV) vaccine occurred at a moment when academic life science research was becoming increasingly reoriented toward market-driven goals. This transformation, shaped by policy shifts promoting the commercialisation of academic research, altered traditional forms of scientific competition. Economic value came to structure not only research agendas but also the institutional logic of academic practice. Intellectual property rights played a key role in materialising this shift, with powerful market actors influencing the outcomes of scientific contests to secure monopolistic control. The case of the HPV vaccine illustrates how upstream innovation processes, especially decisions about ownership, licensing, and legal structuring, determine downstream outcomes such as pricing and access. This challenges prevailing approaches in public health that treat access inequalities as isolated or downstream issues, instead highlighting how the architecture of biomedical innovation itself shapes the terms of inclusion and exclusion in global health.

Reframing health security: from national protectionism to human solidarity in the COVID-19 era

Arda Gucler

In global studies, the Covid-19 pandemic has been associated with the return of national protectionism at the expense of a human rights-based approach to health. While this may be partially true, this article will shed light on a different aspect of national security. Context plays a key role here. In the context of Western liberal democracies, a securitized approach to health is seen as detrimental to basic constitutional rights such as right to work and mobility. However, from the perspective of low-income countries, national security implies the urgency of a global solidarity in the name of enhanced human rights such as right to food and shelter. This article develops this argument by comparing national security to other competing policy frameworks such as human security, human rights, and global goods in the context of the Covid-19 pandemic.

Chains of exchange: The iterative process of resource-health conversion

Cayley Ryan-Claytor & Jonathan Daw

Existing sociological theories of the positive relationship between resources and health emphasize the fundamental causes and social-structural forces that shape health outcomes, but focus less on intervening mechanisms and the processes by which those resources ‘become’ health. We present the theoretical framework of ‘chains of exchange’: iterative processes of transformation that resources undergo along a causal pathway to ultimately affect embodied health for better or for worse. The choice to pursue a particular chain of exchange is conceptualized as a function of several interactive factors: the inherent characteristics of resources, the individual’s life course history and resource endowment, the gatekeeping practices of institutions, and the social desirability of the exchange. The chains of exchange framework explicitly incorporates countervailing mechanisms and choice architecture into the resource-health relationship by emphasizing individual agency in the process of selectively using resources to affect health. Our aim is to provide a tool, for social determinants of health research and practice, to facilitate the investigation of how interventions at different points of resource exchange and causal proximity to health can have varying levels and kinds of success in shaping health outcomes.

Disease model as attitude: a doxastic framework and the challenges of peer support work in mental health

Guillermo Ruiz-Pérez

The integration of peer support workers (PSWs) in mental healthcare challenges not only the prevailing medical model in practice but also its underlying attitudinal structures. This paper develops a theoretical framework based on Ortega y Gasset’s philosophy of belief to conceptualize disease models as attitudes that shape how stakeholders perceive mental health issues, and secondarily, act with regard to them. Understanding the medical model as an embodied system of beliefs allows for an analysis of resistance to PSWs, as beliefs regarding their usefulness may conflict with stakeholders’ previous attitudes and therefore force attitudinal transformation. We argue that PSW integration can foster a shift from a hierarchical, deficit-based system to a co-productive model that values lived experience and recovery and loosens fixed medical categories. However, this process may not only require structured training, institutional support, and collaborative engagement, but also necessitate professionals to self-reflect on their own attitudes and belief systems. Our proposed theoretical framework posits that attitudinal change, rather than policy reform alone, is key to making peer support a meaningful component of mental healthcare.

Hospital beds as barometers

Clare Herrick

While hospital beds are at the heart of healthcare delivery, they have received little conceptual attention within the social sciences. Instead, the focus has tended to be on explaining their changing numerical characteristics and the consequences of this for patient care, health systems functioning and the practices of the healthcare professions. While the number of beds is certainly of critical importance, this paper pushes beyond this to examine the work that these numbers do and perform. In so doing, it argues that beds are best thought of as a barometer in both a material and figurative sense. As such, beds can gauge system pressure, they act as ‘sentinel’ or warning devices should this change and are responsive to the viscosity (or flow) of health systems. And, in a figurative sense, they are reflective of shifts in prevailing public or political opinion, as well as economic or biomedical trends. Beds are therefore woven into a tight web of system inter relationships and interdependencies which makes the calculation of any ‘optimum’ number of beds, either now or in the future, fraught with challenge.

Decolonising medicine: what role will sociology and sociologists play?

Brigit McWade & Dawn Goodwin

In response to calls for medicine, sociology, the university, and healthcare to be decolonised, this article considers the role of sociologists working in medical education in decolonising medicine. Efforts to decolonise medicine have largely focussed on biomedical knowledge and practice, while work to decolonise sociology has under-explored issues of health or medicine. Sociology in medical education sits between these two lines of work and has yet to be thoroughly scrutinised through a decolonial lens. Consequently, we respond to (Bhambra’s in Critical times 4(1):73-89, 2021 and Meghji’s in Sociology 56(1): 131-147, 2021) invitation for all forms of scholarship, regardless of how critical they perceive themselves to be, to examine their histories and entanglements with colonialism and racism. We grapple with the history and contemporary practice of medical sociology, reviewing its disciplinary identity and relationships with medicine, sociology and medical education. We argue that, as sociologists in UK medical education, we have been socialised into an embattled position as ‘critical friend’ to medicine, and an ‘applied’, ergo lesser, form of sociology, requiring us to continually assert our relevance. In turn, this preoccupation has, until recently, prevented us from confronting our own colonial roots and entrenched white solipsism.

Strategic certainties: epistemic habitus and the performance of knowledge in psychiatric practice

Ángel Martínez-Hernáez

Uncertainty is a structural condition of psychiatry, yet it is routinely concealed by practices that transform ambiguity into apparent clarity. Diagnostic categories remain provisional and culturally variable, but health systems demand resolution. This article develops the concept of strategic certainties to describe how institutions perform knowledge where doubt persists but cannot be admitted. Complementing McGoey’s notion of strategic ignorance, the concept highlights a parallel logic of legitimacy: ignorance manages accountability by suppressing knowledge, while certainty manages authority by asserting it under conditions of indeterminacy. Drawing on two ethnographic studies in Catalonia (community-based care for psychosis and psychiatric responses to workplace harassment) the analysis shows how certainty is enacted through diagnostic anchoring and pharmacological routines in the first case, and through the reframing of structural violence as individual pathology in the second. Across both settings, strategic certainties operated as expressions of an epistemic habitus that channels ambiguity into forms compatible with institutional order and social control. They render action possible and sustain institutional order but often foreclose recognition. The findings show that strategic certainties are patterned institutional mechanisms rather than isolated errors. Understanding certainty as a socio-epistemic practice opens possibilities for care cultures able to sustain uncertainty ethically.

Conspiracy theory as a component of religious biopolitics

Kiarash Aramesh, Federico Germani & Giovanni Spitale

The biopolitics of identity-centered religious movements has been a primary source of conspiracy theories in recent decades. This paper explores the shared characteristics of three examples of identity-centered religious and political movements with biopolitical agendas from three different parts of the world: Christian nationalism in the United States, Hindu nationalism in India, and political Islam in Iran. All these political religious movements rely on and advocate for pro-fertility norms and lifestyles, propagate health disinformation and conspiracy theories, and pursue political power to promote their biopolitical agendas. During the COVID-19 pandemic it became evident that such biopolitical agendas and their conspiracy theories can become popular and cause severe damage. Civil society and bioethical institutions can address this issue as a part of the problems posed by infodemics, resulting from the propagation of disinformation and conspiracy theories at local, national, and global levels.

From the asylum to primary care: problematisation and re-problematisations in the making of formal mental health care in Chile

Jorge Luis Crespo Suarez

In this paper, I examine key milestones in the expansion of mental health care in Chile, showing how it has evolved within the public health system and gained broader visibility and influence in society. To do this, I draw on historical primary and secondary sources, alongside scholarship from historians and other disciplinary specialists, and relevant official policy documents. I analyse how mental health care has changed in meanings, practices and places. From an explicitly coercive response, directed at groups of people seen as disrupting the social and classified using a limited set of medical labels, to a response increasingly framed around the professional responsibility to care for mentally ill persons, drawing on an ever-expanding range of diagnostic categories and experts. From being located in asylums and later in closed psychiatric institutions, to being situated within community-based institutions, and particularly within public primary health care. I argue that these different problematisations of mental health have contributed to the expansion of medical jurisdiction in everyday life. This has mainly occurred through the development and entrenchment of a top-down, expert-led strategy. Although reconfigured across changing normative frameworks, such epistemic, institutional, and clinical solutions have evolved and endured in Chilean policy and are reflected in formal mental health care provision. Consequently, there remains an ongoing risk that epistemological and cultural diversity may be marginalised or selectively reformulated in ways that align with a dominant framework – one that tends to absorb political contestation into an individualised, biomedical approach.

Me, Myself, and IE: describing the actualities of undertaking institutional ethnography

Oliver Birch, Peter Adams, Bruce Cohen & David Newcombe

Through Institutional Ethnography (IE), one can explicate how people’s lives are being socially organised. The ethnographer creates an empirical account of what happens within a complex of institutional order, moving iteratively between data collection methods to see how the ‘institution’ occurs through people’s work, how texts are used to coordinate it, and how these texts reproduce ideology. They follow findings as they arise, with reference to the perspectives of ‘standpoint informants’. However, because this process is iterative, descriptions of IE studies vary greatly. Guidance on how to undertake IE’s methods is often specific to the institution being studied. To aid prospective ethnographers, the article describes a step-by-step process through which IE was interpreted and implemented in practice in a healthcare setting. Though it references research at an Opioid Substitution Treatment (OST) service, the account is not prescriptive; rather, it illustrates how one might undertake IE-informed data collection and analysis while being consistent with what is expected of an IE.

Dispersed HLA variability and the making of solidarity in umbilical cord blood collection in Italy

Lorenzo Beltrame

Umbilical cord blood (UCB) is a source of hematopoietic stem cells used as an alternative to bone marrow transplantation for the treatment of hematological malignancies, blood disorders, and bone marrow failure. UCB is particularly valuable for patients from ethnic minorities who are underrepresented in international bone marrow donor registries. In response, national public UCB banking systems have developed strategies to increase the number of UCB units with human leukocyte antigen (HLA) haplotypes compatible with those of minority populations. This article examines the social implications of the strategies adopted in Italy to capture HLA variability through UCB banking. It argues that the country’s dispersed, territorially distributed network of UCB collection sites operates on a principle of generalized solidarity that enables the capture of HLA variability while mitigating the biases associated with residential segregation and healthcare inequalities. The article ultimately demonstrates that the UCB collection network is not merely a biomedical infrastructure, but a socio-political one.

Social intersectional compassion (SIC) for promoting social justice in health and social care: a critical theoretical review

Ahtisham Younas

Addressing health and social care disparities is an individualistic, organizational, and systemic endeavor. The root cause of disparities is collectively our individualistic unjust behaviours towards others, structural determinants, and systems of power, resulting in oppression of populations. The purpose of this paper is to propose social intersectional compassion framework for promoting social justice in health and social care. Drawing from intersectionality theory and literature about compassion, social intersectional compassion is defined as identifying, understanding, and alleviating individuals’ suffering through intentional and shared examination of their intersecting multiple identities and the impact of social systems and institutional structures on their well-being. The actionable ways to practice social intersectional compassion are: (a) understanding the meaning of suffering from individuals’ perspectives, (b) recognizing the root intersecting identities, structures, and processes contributing to suffering, (c) developing a relational connection with the individuals to attempt to alleviate suffering, and (d) embracing self-vulnerability to be affected by individuals’ suffering. The proposed framework of social intersectional compassion attempts to offer direction on how to alleviate individuals’ suffering and promote social justice and equity during individual interactions and when interacting with underserved communities in everyday life.

Medical gaslighting: conceptual and theoretical foundations

Emma Noble

Medical gaslighting is a term that is frequently found in gray literature but rarely found in formal literature. However, Gaslighting is a term that has been examined in scientific literature, typically in relation to intimate partner relationships. I compare the concepts gaslighting and medical gaslighting in literature to identify critical distinctions and develop the following conceptual definition for medical gaslighting: Medical gaslighting is an interpersonal phenomenon involving a healthcare professional and a patient within which the healthcare professional trivializes, psychologizes, or dismisses the patient’s subjective bodily symptoms and health concerns. This leads to delays in care, medical mistrust, doubt in the reality of one’s bodily experiences, and medical trauma. Habermas’ Theory of Communicative Action and Foucault’s conceptualizations of power are proposed as theoretical underpinnings to the phenomenon of medical gaslighting in order to contextualize the antecedents which make the phenomenon possible and lay the groundwork for future studies that I hope will aim to quantify and mitigate its effects on the health of marginalized populations.

Anthropological Quarterly

“Our Church is Changing Gitanos for the Better”: Masculinity, Stereotypes, and the Christian Moral Order in the City

Antonio Montañés Jiménez

Based on long-term ethnographic research among Roma/Gitano Pentecostal communities in Madrid, Spain, this article examines how Pentecostal Gitano men articulate their moral engagement and struggles within the urban context. It provides an ethnographic account of how rhetoric, archetypes, and references to storytelling—including biblical Christian gendered principles and prevailing heteronormative notions of manliness in barrios—shape the construction of urban Gitano masculinities. The article contributes to the expanding literature on the intersection of masculinity and Christianity, specifically investigating how public expressions of masculine piety and virtue relate to urban experiences, ethics, and reflexivity. Rather than merely documenting behavioral changes, the analysis centers on how Spanish Pentecostal Gitano men narrate profound transformations in their relationships with other Gitano men, their inner emotional lives, and the urban environments they inhabit, following spiritually transformative encounters with the Holy Spirit. A substantial portion of Pentecostal Gitano narratives concerning moral cultivation and masculine moral behavior is articulated through holistic Christian concepts such as los frutos del Espiritu Santo (the fruits of the Holy Spirit). Specific fruits, including amor (love), docilidad (gentleness or docility), and dominio propio (self-control), serve as key idioms that render moral cultivation intelligible, meaningful, and valued within communitarian and institutional Gitano contexts. This article advances scholarship on urban religious masculinities by analyzing how dominant cultural stereotypes inform the construction of Christian public personae in settings characterized by asymmetric cultural power relations, and by linking the emergence of masculine moral and redemptive themes to Christian moral apologetic traditions that emphasize Christianity’s potential to reconstitute social orders and generate societal benefits through the proliferation of Christian churches.

Killing the River to Build the Border: Ecological Violence, the Rio Grande, and the US-Mexico Border

Chilton Tippin

This article advances ecological violence as a theory to describe multiple forms of violence along the Rio Grande in the El Paso, Texas-Cd. Juarez, Chihuahua borderlands. Ecological violence denotes a modality of violence entangling people, more-than-human beings, and the enlivened places they co-produce. This concept complements other theories of violence applied in the US-Mexico border context while insisting that structural harm tethers to land-and-water relations, discursive erasures, and white settler colonialism. I ground these claims in ethnographic research conducted along the Rio Grande in 2024. Fieldwork included multiple longform interviews with a key interlocutor at Ysleta Del Sur Pueblo—a tribe whose ceremonial relationships with the river have been obstructed by the border wall and other infrastructures of exclusion and surveillance—as well as participant engagement with first responders and migrant advocacy groups. In 2024, the El Paso Sector became the deadliest zone for migrants along the entire US-Mexico border, with drowning a leading cause of deaths. These drownings occur as the US has hardened the border, drawing the Rio Grande’s waters into a series of lethal, moat-like canals. This article thus argues that building the border entails a gradual killing of the river, as well as the disruption of Indigenous lifeways and systematized migrant deaths—all of which illustrate ecological violence’s presence in the borderlands.

The Corporeal Humanity of the Kashmiri Militant: Body, Image, Song

Mohamad Junaid

“Kashmiri militant” has been a historically opaque, shape-shifting figure in the Indian nationalist imagination. Represented as a threatening symbolic impurity within the national body politic, the Kashmiri militant is seen variously as dangerously nihilistic, nonpolitical, and incomprehensibly violent; impressionable yet uncompromisingly death-deserving; and embodying an unassimilable Muslim masculinity (in contrast to a desirable Kashmiri femininity). In the visual culture of the Indian occupation in Kashmir, police and military photographers circulate pictures of dead Kashmiri militants, disheveled and bloodied with torn clothes and limbs out of joint, presenting them as wild, hunted felons. For Kashmiris, however, who mourn and memorialize their death, the Kashmiri militant is a polyvalent personhood narrated as bridegroom, child, lover, saint, warrior, and martyr. Based on visual counterculture centered on and inaugurated by Burhan Wani, a young militant whose death led to weeks-long protests in 2016, this article examines the political lives and afterlives of the figure of the “militant” in Kashmir. Situating Wani’s images within the broader history of violence against Kashmiri bodies, the article argues that the “Kashmiri militant,” as a spectral presence in the Indian colonial-nationalist imagination and as an embodiment of moral resistance to Indian control in Kashmiri memory, defies a neat conceptualization of which bodies deserve humanistic consideration. I argue that the militant body as death-deserving is the effect of how the Indian state symbolically and violently polices the borders of nationalism and humanity, as well as of the liberal calculus of innocence and guilt.

BioSocieties

Microbial eccentricity: more-than-human creativity in anthropoeccentric worlds

Valentina Marcheselli

By looking at the study of microbial metabolism in a molecular biology laboratory, this paper aims to explore how the agency attributed to microbes is built into scientific practice and discourse. I mobilize the word eccentric to unpack the creative, ingenious, and unconventional nature that is assumed of microbes. Because of their expected and yet always surprising chemical capabilities, microbes are understood not only as potentially dangerous pathogens, but also as instrumental in fixing the anthropogenic problems to which humans are struggling to find a solution. The paper then moves on to examine the strategic use of microbial potentialities at the interface between the bio- and the geo- and how this recasts human–microbial relations: the anthropos, finding themselves incapable of facing epochal problems, discover their dependency on other entities, but remain a measure of the extent to which a state of affairs is problematic and in need of repair. I call this partial displacement of the anthropos from the microbiologists’ cosmos “anthropoeccentrism” and invite a reflection on the way that the study of microbial metabolism substantiates and redistributes power and agency across scales.

Regulating synthetic biology by naturalizing it: the mis-classification of a GE mosquito

Zahra Meghani

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.

“Thanks Piggie”: the emotional practices of killing livestock pigs in organ research experiments

Sofie á Rogvi & Anja M. B. Jensen

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.

The concept of metabolism in ocean biogeochemistry: departures, consistencies, and implications

Elis Jones & Erin M. Bertrand

‘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.

Validating what counts as knowledge: the algorithmic gaze and nested multifocality in the biosciences

Lorenzo Beltrame, Fabio Gasparini & Erik Hernaamt

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’

Taking medicines out of the market: public hospital-based phage therapy in Belgium and France

Koichi Kameda & Charlotte Brives

As antimicrobial resistance (AMR) intensifies and antibiotic innovation stalls, phage therapy is gaining renewed interest. However, its development is hindered by regulatory, scientific, and economic frameworks that are tailored to the standardised production of chemical drugs. This article examines two non-commercial models of phage therapy in Europe that challenge the mainstream pharmaceutical development paradigm. Based on in-depth interviews (22), as well as analysis of relevant regulatory and scientific materials, we compare the magistral phage model developed at the Queen Astrid Military Hospital in Belgium with the GMP-certified API model of the Hospices Civils de Lyon in France. Both initiatives mobilise public health facilities to produce and deliver phage therapies outside the marketing authorisation pathway. While their regulatory strategies differ, both resist commodification and highlight the role of public institutions in therapeutic innovation. However, they both face similar challenges, such as financial sustainability and regulatory alignment. We propose that hospital-based phage therapy not only serves as an effective last resort treatment option, but also offers a conceptual and institutional blueprint for re-evaluating drugs as a public good. These cases illustrate how public infrastructures can support more equitable, ecologically responsible forms of innovation in a context of global health crisis and therapeutic scarcity.

From genome to voiceome: the quest for voice-based biomarker technologies in health research

Tanja Knaus & Susanne Bauer

With the advent of datafication and AI-mediated analytics, computer scientists and health researchers have begun to target voice data as potential biomarkers. This paper follows the technoscientific and speculative strategies for deploying voice data as biomarkers in health research. Contributing to infrastructure studies, biomedical science studies, and social studies of AI, we describe and analyze emergent knowledge infrastructures involved in translating and enacting the human voice into a set of biomarker variables. This includes start-ups pursuing standardization of voice samples as referential ‘ground truth’ datasets and developing AI techniques as products for clinical trials. Conceptually and strategically, developers of vocal biomarkers have coined the notion of the ‘voiceome’ to draw on omics infrastructures. They use those existing omics platforms as available templates for how to proceed to study voice features as markers of health and disease. Adding machine listening to digital phenotyping and precision medicine, vocal biomarker research may transform psychiatric practices in specific ways under certain erasures and anticipated value, building on infrastructures that are not (entirely) new, but rather complemented and afforded by automation and predictive screening.

Evolution or erosion? Promissory discourses in ‘accelerated’ regulatory approval of health technologies

Sara Attinger, Ian Kerridge, Claire Tanner, Claire Hooker, Megan Munsie, Tamra Lysaght, Christopher Rudge, Alan Petersen & Wendy Lipworth

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.

Culture, Medicine and Psychiatry

Liberation Medicine: Why We Need It Desperately (Even Though or Partially Because We Don’t Know Precisely What It Is)

Seth M. Holmes

The term, liberation medicine, as proposed by Nancy Scheper-Hughes (1992) serves as the productive, critical, and inspiring frame around which this special issue is organized. The collection is on the one hand wonderfully broad – from critique to aspiration and everywhere in between – and on the other hand wonderfully tied-

together. The guest editors of the collection Julia Vorhölter and Amand-Gabriel Führer, must be commended for choosing an ideal floating signifier (e.g., Levi-Strauss, 1950; Laclau, 1996; Hall, 1997) capable of pulling together and allowing space for such diverse scholars, research questions, and geopolitical sites. It is telling that the special issue guest editors come from sociocultural anthropology and social medicine – one grounded primarily in anthropology and the other primarily in medicine, yet both oriented toward the nexus of social processes, social inequities, health, medicine, bodies and the possibilities of the otherwise. And Nancy Scheper-Hughes must be commended for her creative intellect, brilliant turns of phrase, and galvanizing sociopolitical imagination that serve as the jumping-off point for this collection (2026) that may help, in her own words, “provide a space where new ways of addressing and responding to human misery are worked out” (1992).

These reflections on liberation medicine illustrate not only how “floating” is this signifier – understood in relation to quite different referents, but also how provocative, if not, at least for some, inspiring, it is. The 2024 workshop, “Liberation Medicine: Past, Present, Future”, and the articles making up this special collection consider this term for the ways it informs critiques of biomedical epistemology and practice, provides lenses to pay attention to and analyze existing examples of alternative practices in the world, and encourages and instigates action on the levels of practice, program, policy and social movements. Before considering the articles in the collection, I would like to explore briefly some of the key terms.

From Moral Ambiguity to Moral Injury in Nursing Academia: An Autoethnographic Account of Moral Distress and Institutional Life

Patricia Camillo

Moral distress has been documented in clinical nursing, but far less attention has been given to morally troubling experiences within academic healthcare settings. This study examines how conflicts between professional values and organizational culture may give rise to moral ambiguity, evolve into moral distress, and contribute to moral injury over time. Guided by a critical, transformative theoretical framework, this longitudinal autoethnography explores these experiences across a 45-year nursing career in academic settings. Data were generated through sustained self-observation and reflexive writing between 2013 and 2023, using thematic analysis, along with external documents for triangulation. The analysis identified three academic scenarios in which concerns related to student safety, tenure standards, and racism created ethically troubling situations. Across these scenarios, moral ambiguity emerged at the intersection of personal values, professional obligations, and institutional expectations. Moral distress developed when actions taken in response to these situations were unsupported, ineffective, institutionally silenced, or professionally costly. Moral injury became visible retrospectively through the enduring emotional, embodied, professional, and financial consequences of these unresolved moral events. Subthemes included faculty incivility and racism. Recognizing this progression changed how these experiences could be understood. What had long been interpreted as personal failure, poor coping, or professional inadequacy could instead be seen as part of a larger moral struggle shaped by organizational culture. This study suggests that moral ambiguity may be an early and often unnamed part of that struggle and that when it remains unresolved or unsupported, it can move into moral distress and, in some circumstances, moral injury. Bringing these experiences into view may help academic nursing better recognize and respond to the moral consequences of institutional life.

A Fire and Altadena: Biographical Diffraction and Climate Disaster Loss

Elizabeth McKibben

This paper develops a conceptualization of biographical diffraction via a creative autoethnography of climate disaster grief. In January 2025, the Eaton Fire devastated Altadena, California killing 19 people and destroying over 9,000 structures. Among them was my family home. Having lived abroad in Aotearoa New Zealand for 5 years, I return to Altadena after the fire, navigating loss from sites of distance and proximity. Drawing upon Barad’s concept of diffraction and the void, I grapple with the asymmetries of grief, privilege, belonging, and self that emerge with the loss of “home.” To do so, I craft a narrative with audio recordings of my footsteps walking around the debris of the Eaton Fire burn scar. By weaving together sensory vignettes, evocative writing, images, and reflections I consider how climate disaster grief is an embodied and emplaced phenomenon both historically entangled and unequally distributed. I then draw upon cross-cultural learnings to explore how Indigenous knowledge can, and cannot, inform healing of place and self from positions of settler-colonialism. Biographical diffraction is thus presented as a tool for attending to the layered emotional, material, and political dimensions of climate disaster, particularly when “home” becomes an unrecognizable site of trauma, memory, and transformation.

…And Breathe! Wellness, the Nation, and Holistic Reproductive Practitioners in India

Adhvik Shetty

Garbh Sanskar (GS) is an Indian holistic reproductive programme that claims roots in ancient Ayurvedic and yogic traditions while drawing upon contemporary wellness practices and international health policy. GS centres offer breathwork, guided meditation, and counselling to expectant and hopeful couples. This article draws upon interviews with GS practitioners across nine Indian cities to examine how these practitioners use wellness discourses to articulate strategies of individual and national improvement. I argue that GS practitioners seek to interweave soteriological and wellness logics to produce enriched reproductive subjects for a therapeutic vision of nation-building. This project uses wellness to assuage the anxieties of modernity, suggest civilisational exceptionalism, and articulate aspirations for the nation. Together, GS illustrates the emergence of a bio-spiritual therapeutic politics where wellness is part of reproductive governance.

From ‘Sensory’ to ‘Anxiety’: Embodied States, Relational Care, and Ethical Transformation in Parental Care for U.S. Neurodivergent Childhood

Elsa Davidson

This paper draws on an ethnography of care for social–emotional differences in middle-class North American childhood to explore the relation between care practices employed by parents of neurodivergent, or neuroatypical, children, and emergent ethics of care. Focusing on a single case of asymmetrical care, that between a mother and a neurodivergent child, I draw on video-recorded interviews as well other ethnographic material to highlight how practices of care emphasizing forms of bodily and emotional connection, and labors of attunement to embodied states and forms of expression, enable shifts in the caretaker’s perception of, and affective orientation toward, embodied states. In doing so, I show how moments of partially shared feeling across bodies (interembodiment) and intercorporeal connections can engender the parent–caretaker’s perception of enhanced intersubjective understanding, and authentic insight into the child’s embodied experience, particularly with regard to anxious and excited states. As such, I describe the caretaker’s perceptual shift from an individualizing evaluation of her child’s “sensory issues” to a relational understanding of “anxiety” as a collaboratively engendered embodied emotional state that can be altered, felt, shared, and alleviated through non-verbal tactile communication. In turn, I argue that it can be seen as a “gift” of ethical self-transformation that has implications for the care of neurodivergent childhood. In doing so, I suggest that such insight engenders care for a neurodivergent “other” that may come closer to preserving the other’s singularity. Moreover, I argue that such insight rejects a stereotyped understanding of embodied neurodivergent selfhood as bounded, brain-based, and impermeable.

Working in Pairs: The Dialogic Distribution of Clinical Responsibility

Lauren Cubellis

At an innovative site of psychiatric crisis care work, dialogically trained clinicians in Berlin, Germany transformed the skills learned from the Open Dialogue approach into a means for building solidarity in the face of precarious health structures. Learning to sit with unknowing and tolerate uncertainty, at first developed as techniques to support clients in crisis, became a way by which these clinicians navigated a shifting and unsteady health insurance landscape. In the face of budgetary restrictions and increased oversight by health insurance companies, which challenged the terms of their work and ethical commitments, they supported each other by reconfiguring the terms of clinical responsibility: they dispersed the authoritative gaze most often cultivated in institutional psychiatry and risk management approaches, and developed a means for attending to the uncertainty of crisis by sharing the burden of unknowing with each other. They did this through their unwavering commitment to working in pairs.

Witnessing the Theatre of Self-Harm Among South Asian Women: Expression, Performance, and Hot Tea

Anamika Shrimali

This Cultural Case Study examines how self-harm becomes meaningful within particular South Asian moral worlds, drawing on intergenerational family oral histories and autoethnographic reflection spanning Kashmir, Andhra Pradesh, Tehran, and the United States diaspora. Read alongside South Asian ethnographic and clinical scholarship, these narratives show that bodily self-injury can function as a form of situated agency and relational communication when verbal self-assertion is constrained. Building on prior work that interprets suicide and self-harm as gendered forms of communication in South Asia, I focus on the social variability of response: when self-harm compels witnessing and moral recognition, and when it instead meets habituation, ridicule, exhaustion, or strategic inattention. I argue that treating self-harm solely as psychopathology risks misreading its moral and interpersonal stakes and can undermine clinical assessment. A culturally attuned approach requires mapping the moral audiences, relational constraints, and idioms of personhood that structure how suffering becomes legible.

“I Really Feel Heard by AI”: A Cultural Case Study of AI-Mediated Listening Across China and the UK

Xin Zhan

The increasing use of generative AI for emotional support has prompted growing debate about the future of mental health care. This article suggests that such reliance is better understood not simply as a technological shift, but as symptomatic of a wider crisis in the politics of listening. This cultural case study examines the experiences of Lily, a 24-year-old Chinese migrant woman navigating emotional distress across uneven care infrastructures in China and the UK. Drawing on person-centred ethnography, it shows how AI chatbots come to function as provisional sites of care under conditions of precarity, gendered obligation, and moralised endurance. The analysis conceptualises these chatbot interactions as a care-patch: a temporary form of digital holding that emerges where human listening is scarce, delayed, or experienced as burdensome. Rather than treating AI use as a matter of technological adoption, the case situates AI-mediated listening within culturally specific moral relations of obligation and responsibility. In doing so, it reframes therapeutic automation as an index of the erosion of listening as a shared social good and redirects attention to the political and ethical challenge of rebuilding infrastructures of human listening capable of absorbing distress without extracting it, outsourcing it, or returning it as blame.

Palliative Obstinacy: When Care Becomes a Constraint at the End of Life

Gustavo Ortiz-Millán

This paper develops the concept of “palliative obstinacy” to describe situations in which palliative care, rather than alleviating suffering in accordance with the patient’s wishes and values, becomes a new form of clinical paternalism at the end of life. Drawing on a case narrated by Elyse Ona Singer and Norma Alicia Ordóñez-Vázquez of a patient with cancer requesting physician-assisted death, the paper argues that some models of palliative care unjustifiably pathologize the desire to die by treating it exclusively as a symptom of untreated suffering, depression, or inadequate care. Building on the analysis by Singer and Ordóñez-Vázquez, the paper examines the paradox whereby palliative care expands certain end-of-life choices while simultaneously rendering others—especially physician-assisted death—morally or conceptually unthinkable. It argues that denying the rationality of some requests for hastened death risks undermining patient autonomy and imposing a singular moral framework concerning suffering and dying. The paper concludes that palliative care and physician-assisted death should be understood as complementary rather than mutually exclusive options within end-of-life care.

Cultural Anthropology

Datafied Kinship: Individuating Identity in Pakistan

Zehra Hashmi

Pakistan’s National Database and Registration Authority (NADRA) produces the country’s national identity card and runs one of the world’s largest biometric-based identity databases in the world. To be registered in the database, individuals are linked through their kin relations to other uniquely identified individuals—a practice that this article terms “datafied kinship.” Datafied kinship demonstrates how individuals are not atomized bodies, ready to be captured by NADRA’s identity database. Rather, individuals are digitally constructed as a function of their relations with others. This article argues that NADRA’s reliance on kinship reconfigures our understanding of modern identification: individual identity is produced and tracked through relatedness, not biometrics alone. It ethnographically examines how identifiable individuals are produced through identity registration, focusing on the treatment of “system independents”—individuals unconnected to others in the database. In turn, it shows how such a relational logic of identification comes to condition the lives of those it identifies.

Waiting Can Kill You

Lalaie Ameeriar

This article examines the lethal consequences of delayed obstetric care through the lens of maternal temporalities. Drawing from ethnographic fieldwork and autoethnographic narrative, I trace how racialized patients are asked to endure uncertainty, dismissal, and bureaucratic delay even as their medical conditions worsen. Focusing on my experience of an ectopic pregnancy alongside interviews with Black and Brown birthing people, I argue that waiting is not a neutral temporal state, but a racialized and gendered form of harm. Situating these experiences within the anthropology of reproduction, I show how waiting becomes both a medical directive and a disciplinary demand that erodes trust, safety, and survival. The article contributes to debates on obstetric racism, maternal mortality, and refusal by foregrounding waiting as an analytic of harm and a site of ethnographic witnessing. 

When Men Do Care: Masculinity and Labor in Northwest Pakistan

Hadia Akhtar Khan

How do men claim recognition and compensation for their care labor? When a rural economy shifts from agriculture toward international migration, joint households send some sons abroad to work and ask others to stay in the village to take care of the household’s land, women, and kinship obligations. The men who stay argue that this work of “taking care” should be recognized and compensated with half of a migrant brother’s earnings. Drawing on ethnographic research with transnational households in migrant-sending villages in northwestern Pakistan, I examine how men who stay in the village invoke caste, gender, and kinship to claim recognition and compensation for their care labor. While these claims may resemble feminist critiques of the undervaluation of care labor vis-à-vis waged labor in capitalism, the article shows the limits of the politics of recognition of care as labor.

We Keep Us Safe: De-escalation, Working Time, and Abolitionist Praxis at The Sanctuary

Jake Nussbaum

This essay explores “de-escalation,” the embodied practice of intervening in interpersonal conflict and crisis without resorting to police or carceral tactics. Drawing on eighteen months of ethnographic research at The Sanctuary, a non-profit organization in Philadelphia that provides free social services, clothing, and food to vulnerable populations, I show how de-escalation practitioners use their bodies to manipulate both time and space into non-carceral outcomes. I focus on four overlapping techniques: suspension, the open hold, bridging, and collectivity. Unlike much of the clinical and psychological research on de-escalation, I situate these techniques within Black feminist, performance studies, and anthropological analytics that insist on the embodied nature of political struggle and the malleability of time and temporality. I argue that de-escalation at The Sanctuary creates a space-time in which abolitionist horizons of a future without police or prisons are negotiated through intimate, quotidian social interactions.

Solar Pioneers: The Frontier Entrepreneurialism of a Sluggish Energy Transition

Myles Lennon

Scholars, activists, and politicians attempt to provoke urgent climate action by christening 2050 as the decisive date by which the United States must transition from fossil fuels. But I contend that calendrical teleologies do not actually motivate the everyday people, activists, and workers leading the U.S. energy transition. This article explores another temporal schema seemingly unrelated to climate: the American pioneer settling the frontier, realizing his destiny through individual initiative. I contend that this origin story works in tandem with contemporary entrepreneurialism to affectively animate a market-based approach to energy transitions that is anything but rapid. Thus, consideration of frontier temporalities can contextualize the sluggish pace of decarbonization. While many studies identify various catalysts of renewable energy adoption, my analysis of “the renewable energy frontier” suggests that these inquiries overlook the insidious individualism of energy transitions in a capitalist context, in which “the market” is misunderstood as an accelerator of change.

Encounters at the Edge of Night: An Ethnography of the Weird

Andrew Alan Johnson

When doing ethnography, ethnographers often hear stories that cannot be. Explanations that shelve away such “weird” stories into cultural boxes or reframe them as metaphors for something familiar close the door not only on the theoretical possibilities of openness, but also do not do justice to their interlocutors’ own inquiries about the world. Here, I draw upon stories of ghosts and unsettling dreams taken from my fieldwork in Thailand, both from my interlocutors’ and my own experience, as a way to contradict evidentiary regimes. Taking up the idea of “the weird” from literary studies and the Buddhist philosophy of Nagarjuna, I understand such stories not as representations of the mundane workings of economy or psychology, nor as culturally-bound narratives, but instead as a co-creation of a world always unfinished and unfixed. Seeing Nagarjuna’s notion of contradiction as a method, I argue that a productive, dialogic engagement with the weird can destabilize not only the ethnographic encounter, but also the way that the world works.

For example, take this article about how middlemen in the Indian healthcare system are considered dangerous (Singh 2025), in which the author writes, ‘For them (middlemen), medicines, diagnostics, treatment and supplies are not matters of human need but tools for generating profit, with patients reduced to instruments in a larger commercial grid…’ The larger problem with such claims is that there is an inherent discomfort in bringing money and health together because economic value and ethical value are incommensurable (Lambek 2008). In practice, however, any service or commodity pertaining to health, such as sales of pharmaceuticals or seeing a private doctor, is treated commercially, just as any other commodity. Yet in the dominant discourse about healthcare commodities and services, these commodities are held to be the preserve of specialists – doctors and pharmacists – whose moral credentials are presumed to guarantee their proper handling (Peterson 2014). This disjunction between how healthcare should not be commercial and what actually happens in practice hides a range of commercial actors and their everyday activities in hospitals, ports, consultancy offices, clinics, pharmaceuticals’ wholesale and retail marketplaces. Anthropological enquiry into these interstitial spaces, networks and middlemen allows us to understand how the delivery of health care actually happens on the ground with middlemen assuming many roles in the market (Perkins 2024, Barnreuther 2020, Bjorkman 2021). In this paper, I look at the role of middlemen in the pharmaceuticals’ industry of north India. Amidst global fears of fake pharmaceuticals from India, I examine how middlemen create trust with consumers and simultaneously stoke suspicions towards one another. I look at two kinds of middlemen – those operating online and offline – as both have considerable presence in the markets. This paper shows how middlemen simultaneously engage in trust-making as well as trust-breaking practices, whichever suits them in order to sustain themselves in the markets.

Background

The conceptual backdrop and empirical material of this paper comes from my research on Indian pharmaceuticals’ markets from May 2020 to December 2023. I was a research fellow on the project: ‘What’s at stake in the fake: Indian pharmaceuticals, African markets and global health’, that  challenges commonplace assumptions about fake drugs as a major threat to public health, and draws on ethnography to ask what claims about fake pharmaceuticals actually do. In this project, by attending closely to questions of practice, I looked at how drugs’ authenticity or fakeness is created in global market nodes and marketplaces. In other words, I locate pharmaceuticals’ circulation as authentic or fake as social, rather than pharmacological, facts.  For example, the term –‘substandard’, mainly understood in terms of pharmacological quality in scholarly discussions or public health institutions such as the WHO, had a completely different meaning in the markets. It was often received as ‘sublegal’ by my interlocutors and they argued that it is the quality of the dossier accompanying the approvals for the pharmaceuticals/manufacturing plant by the national drug regulatory authorities that decided whether it was ‘substandard’ or not (Thakur 2023). This observation from the field is pertinent, given the fact that Indian pharmaceuticals’ quality is often questioned globally by public health scholars, policy makers and leading public health agencies, a claim that recent work questions (Hodges and Garnett 2020, Hodges 2019, Hodges and Hornberger 2023). Fakes and middlemen featured together especially because wholesalers, drug regulators, retailers highlighted that it is through brokerage and middlemen that fakes proliferate in the markets.

During my ethnographic research, I encountered many middlemen. They were spread out globally (in Africa, USA, China) as channel partners handling multiple pharmaceutical companies; they were carrying and forwarding (C&F) agents handling a state’s logistics of pharmaceuticals for some or many companies; they were wholesalers in markets of Lucknow or they were ‘hawkers’ who bought medicines for smaller villages in or around Lucknow districts for a surcharge of two percent of sales; or they were online app owners who delivered medicines from local storage spaces to individual houses’ doorsteps, especially during Covid-19. In this piece I focus on the pharmaceutical industry of north India and present the accounts of online and offline middlemen and customers, primarily in Lucknow, the capital city of Uttar Pradesh. The city serves as a hub for healthcare services and commodities for other neighboring states. It also hosts a large logistics hub named ‘Transport Nagar’ (Transport city) for the distribution of pharmaceuticals and vaccines to and from Lucknow across the country. 

India’s healthcare industry is one of the largest sectors in the country and was projected to reach USD 638 billion in 2025, while the e-health market was estimated to reach USD 10.6 billion in the same year.[1] Privatization and commercialization of health markets are considered the main reasons for the proliferation of middlemen in India (Pitchforth, Bisht and Murray 2012, Hunter 2018). In India’s healthcare industry, there are multiple scales of middlemen that make possible the delivery of everyday health. However, middlemen are not just brokers who make rules and regulations legible as negotiators and translators so that ‘universal outcomes’ are produced at local levels (Mosse and Lewis 2006, Bierschenk et al 2002, Knodel 2021, Hunter 2018). Their work goes beyond bridging institutional gaps, making legible regulatory differences or even monetizing information gaps in the markets.

Shops cannot fly – accountable middlemen

Suketu has had a warehouse for pharmaceuticals’ wholesale for twenty-five years in Lucknow’s medicine market in Aminabad. Like several other wholesalers in this market, Suketu was an apprentice at one of the shops in this market earning very little. But with experience he opened his own shop. This market emerged in the late 1990s when the neighboring city, Kanpur, was no longer the sole logistical hub for pharmaceuticals and medical devices. The warehouses are small and compact, with an office for the president of Chemists’ Association of Lucknow, and most of the people in the market know each other. Retailers and customers often buy in bulk. Suketu is aware of the global fears concerning fakes and middlemen. He shared with me how multinational pharmaceutical companies are trying to introduce blockchain technology and minimize the number of people handling pharmaceuticals so that they are not tampered with, and that packaging will have QR codes to reassure customers. Suketu counters global fears surrounding Indian pharmaceuticals with his local market expertise and his understanding of what customers want from middlemen. He says,

‘People are not concerned whether there are middlemen[2] involved in delivery of pharmaceuticals. They are concerned if middlemen know which medicines are required and they are assured of the quality because we have shops here and we will not run away in a night. We are here to stay.’

As I nudged him more to explain this, he said,

‘We are not just wholesalers or retailers, we are also in a way doctors because we know so much- not just about the trade and ailments, but our clients- should we give a ‘hard dava’ (more potent medicine) to someone because this person also has to take care of an ailing mother-in-law or should we give vitamins because this person does not care enough about his food – we decide all of that. More so in the retail outlets if not here. But some people think that middlemen make money and that’s all they do.’

Suketu’s understanding of clients and what they might require draws on the age-old role of middlemen who bridge gaps through situated knowledge. We can see this in Sidney Mintz’s account of the ‘higgler’ (1956), who takes into account how someone who produces avocados would not be able to sell them directly and understands their perishability. This knowledge comes from working in the markets, and yet it is usually brushed off as insufficiently important to be renumerated. This knowledge also needs to be acted upon swiftly and with discretion in ever-changing contexts (Geertz 1979). Suketu, for instance, knows which client is busy enough to forget what medicines they might require. He also knows which retailer in which part of Lucknow will buy what kind of medicines in bulk, such as protein powders, for example, in areas with lots of gyms.

When Suketu shared with me that he has a shop, he was trying to establish that one of the roles of middlemen entails being available for accountability, that when people are dissatisfied with the product (due to side effects, efficacy concerns, or expiration issues), they have a physical space to return to and complain. He adds that, ‘it is not just about how fast I am able to get this medicine, or how I can trace the journey of the medicine to my shop…’. Quet (2017) argues that within the framework of logistics, changes are not about the physical properties of pharmaceuticals. Perceptions about their value shift each time they move from one point to another. Therefore, what Suketu performs, are everyday acts of creating trust in the pharmaceuticals that he sells. His work entails cultivating trust amongst customers by showing that he can be held accountable when something does not work out. This is an accountability made tangible by his consistent physical presence in the markets.

When Suketu shares that creating trust amongst customers is not about tracing the journey of the medicine, but rather his physical presence, he is also taking a jibe at those who create trust using online platforms. He fuels accusations against his competitors by saying,

‘…even if people buy medicines online, they come to us saying, that time you gave me this medicine, I took it but is not working, you gave us fake medicines!’

Suketu adds, ‘…then when I look closely, I realize it is from an online website and not from us. These online people will spoil our dhandha (business)also.’

For Suketu, middlemen like himself are not the problem. Rather, the problem are online middlemen whom people cannot see, who have no physical shop and are thereby not accountable to anyone. These are the middlemen who are spoiling the business and maligning the reputation of middlemen overall. His emphasis is on people rather than the commodity: clients should be able to know more about where and from whom they are buying their medicines, rather than simply which medicines they are buying.

Money-saving online medicines

India’s e-health market was projected to reach USD 10.6 billion in 2025. And it is further on the rise, particularly after Covid-19, during which e-commerce platforms were available to assist quarantined people. My fieldwork showed that many people now access medicines through e-platforms in India. Multiple platforms sell prescription drugs wherein the customers have to first consult a doctor provided to them by these apps via tele-medicine (free of cost) and then obtain a prescription from them. Alternatively, customers can also upload a valid prescription online onto the app, which is then validated by the online doctor or pharmacist.

Manju works as a household helper in central Lucknow and often prefers online pharmacies for buying products such as infant milk powder for her six-month-old. However, she rushes to a local clinic in case there is any emergency. She shares with me,

‘If I buy milk powder from online pharmacies, they are much cheaper and easier. Sometimes I also speak with someone on the phone who handles these pharmacies and they help me decide which milk powder will be better for the baby if she’s colicky and vomits.’

But she also fears that she might get something harmful for her child from these websites. I ask her if she has had any bad experiences. She denies it but adds,

‘I have not faced any issues with multivitamins, milk powders etc so far. However, when I go to the doctor at the local clinic, she asks me, did you give her this medicine? If yes, where did you buy them from? And always scares me that medicines sold by online vendors are not that great and even by local chemists. I must always consult her in case I want to give something to the baby.’

What Manju shares is certainly a concern about buying from middlemen, whether online or offline. But she has built trust over time through experience. She tells me in a rather low voice,

‘…it is not that I don’t understand what everyone wants to convey. When doctors prescribe medicines, they give me red, yellow, blue pills without sharing what are their names and brands. It is just so that I don’t find out and buy them cheaper online.’

Prabodh, a sales manager of a major online pharmacy, shared that online pharmaceutical websites function as intermediary platforms, charging their own fees and cutting the costs of retailing. Without my bringing up the common concerns about fakes on online pharmaceutical websites, he brought up the aspect of authenticity through commodity tracking. He argues that while people are not visible and shops are not physically traceable, people can trace products on online websites. In his view, this is more important than being able to trace people. He said,

‘Here people get more authentic, more branded stuff than any other local shop. If you come to me bringing any batch of medicine, I can immediately find the details about the distribution chain and find out where exactly the glitch or the mix up happens. We have a full tax support team which includes a doctor, a pharmacist and several other members who are at the beck and call of consumers 24/7 so you can be assured that your health matters to us. And guess what, it is so much cheaper than your local pharmacy guy. That’s why people are switching to online pharmacies. Because they want to know where fake medicines come from (if at all) because only we can track it, we have the purchase bill and the sales bill. Local pharmacies cannot provide that because there are so many people involved in the chain. And most of the people do not even know everyone so there are higher chances of fakes in circulation.’

For Prabodh and several others who run small (in sales volume) apps and platforms in the city for delivery of online sales, their biggest asset is product traceability. And they too survive in the market by arguing that their counterparts – middlemen locally based in Aminabad – are the ones who sell fakes; who do all the milavat (adulteration). In practice, people’s consumption is based on what is convenient for them, just as Manju’s case shows. For example, Shivansh’s father suffers from diabetes and must take medicines daily, so Shivansh buys them regularly in bulk online. This saves him a lot of money. He says that sometimes ‘they have such heavy discounts that I buy a lot of medicines for my father.’ But whenever anyone in his family has a cold or fever, they rush to the nearby pharmacist or clinic and request antibiotics since they have to work seven days a week and missing a day means losing day’s pay. I spoke with several consumers about their pharmaceutical buying practices and found that people rarely ordered medicines that were required ‘immediately’. Given that online delivery takes at least twenty-four hours even in urban areas and since online platforms do not have face to face consultations or prescriptions, most of the customers do not opt for that.

Conclusion

What I have shown through middlemen like Suketu and Prabodh is their constant declaration of superiority and trustworthiness – of not selling fakes – while they cast doubt on others, whether online or offline, as awash with fakes. These declarations are partly driven by the need to establish their own importance in the markets, especially since fakes, greed, and middlemen are constantly associated with each other globally, and partly by the desire to malign their competitor while capturing most of the market.

For middlemen, being able to deliver medicines to people in the remotest locations and in times of dire need also means that they can associate themselves with the virtues of global health (Hodges, Hornberger and Thakur 2026, this issue). Suketu’s friend Naresh, who is also a wholesaler in the Lucknow’s pharmaceutical markets, announced one day, ‘This medicine market will crumble if we middlemen do not work’. Yet, behind Naresh’s  confidence, many of my interlocutors detect greed. They sense that people like Naresh are ethically in the wrong since they thrive on the ill-health of people, and on their vulnerabilities especially when they are ready to pay whatever price is required for their health. And yet, none of these same interlocutors believes that people like Naresh should be, or even could be, removed from the markets.

Middlemen present this paradox: they are indispensable outsiders (Bjorkman 2021)  who are at the same time actually forming the insides of the markets. Sometimes they build people’s trust in them in an atmosphere that constantly associates them with fakes and danger, while sometimes they stoke fears about other middlemen. By looking at how middlemen make possible the delivery of pharmaceuticals’ in and around Lucknow, I have shown that moving beyond the moralistic stance whether middlemen are good or bad, whether they should be removed or that they are profiting on ill-health of people, yields us a much richer and nuanced understanding of their everyday work in the markets.

[1] www.ibef.org

[2] In many of these markets, middlemen were not happy when anybody (including me) used the Hindi term for middleman such as bichauliya or dalaal. Those terms are considered pejorative and undignified according to them. However, many of them did not have issues with using the term in English- middleman.

References

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Björkman, Lisa, ed. 2021. Bombay brokers. Duke University Press.

Dayen, David. 2020. “Behind the Coronavirus Threat, A Middleman Destroying Prescription Drug Markets”. The American Prospect. https://prospect.org/2020/02/25/behind-the-coronavirus-threat-a-middleman-destroying-prescription-drug-markets/

Desai, Chetna. 2016. “Online Pharmacies: A Boon or Bane?” Indian Journal of Pharmacology 48 (6): 615–16. https://doi.org/10.4103/0253-7613.194865

Edema, Grace. 2025. “Enforce distribution guideline to tackle fake medicines, pharmaceutical group urges government”. PUNCH. https://punchng.com/enforce-distribution-guideline-to-tackle-fake-medicines-pharmaceutical-group-urges-govt/

Geertz, Clifford. (1979) 2023. Sūq: Geertz on the Market. Chicago: Hau Books.

Hodges, Sarah. 2019. “The case of the ‘Spurious Drugs Kingpin’: Shifting pills in Chennai, India.” Critical Public Health 29 (4): 473–83. https://doi.org/10.1080/09581596.2019.1593948

Hodges Sarah and Emma Garnett. 2020. “The Ghost in the Data: Evidence Gaps and the Problem of Fake Drugs in Global Health Research.” Global Public Health. 1103–18.

Hodges, Sarah, and Julia Hornberger. 2023. “The long shadow of fake drugs and the social lives of fake-ness.” Medicine Anthropology Theory 10 (3). https://doi.org/10.17157/mat.10.3.9065

Hodges, Sarah, Julia Hornberger and Nishpriha Thakur. 2026. “Middlemen, fakes and global health: Opening provocations”. Forthcoming this issue.

Hunter, B. M. (2018). Brokerage in commercialised healthcare systems: A conceptual framework and empirical evidence from Uttar Pradesh. Social Science and Medicine, 202. https://doi.org/10.1016/j.socscimed.2018.03.004.

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Knodel, Kathrin. 2021. “NGO Brokers between Local Needs and Global Norms: Trajectories of Development Actors in Burkina Faso.” Cultural Dynamics 33 (4): 298–315. https://doi.org/10.1177/09213740211029683.

Mintz, Sidney. 1956. “The role of the middleman in the internal distribution system of a Caribbean peasant economy.” Human Organization 15 (2): 18–23. https://doi.org/10.17730/humo.15.2.x5k4022515r6068u

Mosse D, Lewis D. 2006. Theoretical approaches to brokerage and translation in development. In: Lewis D, Mosse D (eds) Development Brokers and Translators. The Ethnography of Aid and Agencies. Bloomfield, CT: Kumarian Press, pp.1–26.

Patel, Parthika. 2026. “Delhi Tramadol Premix Interception Leads Police to Illegal Drug Unit in Bihar”. Medical Dialogues. https://medicaldialogues.in/news/industry/pharma/delhi-tramadol-premix-interception-leads-police-to-illegal-drug-unit-in-bihar-166240

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Quet, Mathieu. 2017. ‘Values in Motion: Anti-Counterfeiting Measures and the Securitization of Pharmaceutical Flows’. Journal of Cultural Economy 10(2):150–62. https://doi.org/10.1080/17530350.2016.1258001

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This ordinary exchange shows how scarcity in Iran’s pharmaceutical market quickly becomes a question of trust in where the medicine came from, whether it is genuine, and who to believe. To make sense of this, I draw on Hornberger and Hodges’ concept of ‘fake-talk’, which examines how claims about fake drugs circulate and what those claims do in social life.^[2] Similar to rumours, fake-talk exerts its power without requiring scientific evidence or a verifiable source, deriving its potency from three social functions it serves. First, it makes scarcity intelligible as a problem of authenticity, turning shortages into questions about whether medicines are foreign, expired, smuggled, repackaged, or real. Second, it redistributes trust, since patients often rely less on official regulatory assurances than on brokers, pharmacists, relatives abroad, and other informal certifiers. Third, it gives both state officials and market actors a language through which they can (de)legitimise pharmaceutical circulation as the state labels unauthorised medicines, some of which are claimed to be counterfeit, expired, or unsafe, while consumers and dalals use claims of fakeness to challenge the reliability and efficacy of domestic production and to authorise alternative routes of access to compensate for the state’s failure in pharmaceutical provision.

Fake-talk helps show how claims about fakeness connect everyday acts of care to informal trade and disputes over Iran’s ‘pharmaceutical nationalism’. In this article, I use ‘pharmaceutical nationalism’ to name state projects that seek health sovereignty through domestic production, generic substitution, import management, and reduced dependence on foreign pharmaceutical firms.^[3] Rather than treating pharmaceutical nationalism as a settled state project, I use fake-talk to examine how its claims to autonomy are unsettled in practice. In Iran, policies of self-sufficiency seek to assert state control over pharmaceutical production and distribution, yet the everyday credibility of these policies is negotiated through informal intermediaries who source, authenticate, and circulate medicines beyond the formal regulatory system. These policies aim to ensure the population’s access to affordable, quality medicines—a goal stated despite the international sanctions imposed by the U.S. and its allies. Yet this pursuit of autonomy also exposes the importance of intermediaries, who help patients find medicines, assess their authenticity, and move between formal and informal routes of access.

These intermediaries are more than profit-seekers within an illicit economy. They help turn suspect or unauthorised medicines into provisionally acceptable options. In doing so, they emerge as key figures, facilitating access to medicine and acting as unofficial arbiters in distinguishing the fake from the authentic. Therefore, they assume roles traditionally reserved for state regulatory frameworks within the formal healthcare system, regulating the availability, affordability, and safety of medicines.

Access to Pharmaceuticals in Iran: Between Self-Sufficiency and Sanctions

Since the 1979 Revolution, Iran’s pharmaceutical sector has moved from reliance on multinational companies towards state-supported domestic production of generic medicines.^[4] Sanctions have intensified this drive for self-reliance and made pharmaceutical production central to Iran’s claims of health sovereignty. Despite sanctions officially exempting medicines, the broader financial and trade restrictions have profoundly affected Iran’s capacity to interact with the global pharmaceutical market, necessitating substantial government intervention.^[5] Efforts have included facilitating customs processes for importing raw materials, subsidising domestic pharmaceutical companies’ production costs, and making direct financial contributions to health insurance organisations’ premiums.^[6]

State officials laud these efforts as triumphs in asserting national autonomy and sovereignty, claiming that “97 per cent of medicines needed in Iran are domestically produced”^[7] and that “the drug production capacity in Iran is 4.5 times the domestic demand,”^[8] and that “Iranian companies can produce 80 to 90 percent of pharmaceutical raw materials.”^[9] Yet, the lived experiences of patients contending with conditions such as diabetes,^[10] haemophilia, and cancer^[11] tell a different story, revealing a pronounced disconnect between official claims and the actual accessibility of essential medications. In state-run pharmacies across Iran, individuals, prescriptions in hand, gather closely as they await their turn to approach the pharmacists positioned behind the counter, who are gatekeepers to a scarce and highly sought-after commodity: medication.^[12] 

During an interview, Leila, a middle-aged resident of Tehran, expressed her profound scepticism regarding government claims of pharmaceutical self-sufficiency, saying, “They [government officials] are ‘lying like dogs’! If they were really making the drugs I need, I wouldn’t be struggling to find them.” Her choice of words vividly illustrates her doubts, and the strong feelings official statements evoke.

Later, in a discussion with a young man employed at an importing company in Tehran, I inquired about his perceptions of the quality of Iranian medicines compared to imported alternatives. His response was illuminating: “What Iranian medicine? Aren’t they all repackaged Indian and Chinese medicines?” This comment perpetuates a widespread rumour, speculating that Iranian drugs are inferior, rebranded, or second-rate versions of Indian and Chinese products. Moreover, Iranian manufacturers, depending on the type of medication, may reverse-engineer patented drugs, import Active Pharmaceutical Ingredients (APIs), and produce certain drugs under licensing agreements.^[13] This dependence on international research and development, as well as imported ingredients and equipment, reinforces the perception of domestic pharmaceuticals as substandard, counterfeit, or mere imitations. Thus, fake-talk encapsulates scepticism towards the authenticity and efficacy of domestically produced medicines, serving as a medium for individuals to challenge the legitimacy of government rhetoric surrounding health sovereignty.

Conversely, the Iranian government cautions consumers against unauthorised imports obtained through alternative routes, branding them counterfeit or expired, and at best ineffective, at worst harmful, further complicating the discourse on contested authenticity.^[14] This concern extends beyond illicit imports with dubious biographies to include scepticism towards verifiable domestic products that enter informal pharmaceutical markets.

In these informal pharmaceutical markets, known as ‘Bazaar-e Daru’,^[15] fake-talk becomes empirically visible in the everyday acts through which medicines are assessed by asking whether a drug is foreign, checking expiry dates, reading packaging, comparing brands, invoking relatives abroad, or seeking reassurance from a dalal. Bazaar-e Daru is therefore not simply a shadow market for scarce medicines. It is a site where authenticity is socially produced, where state regulation is both enacted and bypassed, and where brokers acquire authority by translating uncertainty into provisional trust. This is why fake-talk matters analytically, as it allows us to see how claims about fakeness organise relationships among patients, pharmacists, brokers, diaspora couriers, and state regulators before any laboratory confirmation of falsification takes place.

On the Middlemen

Within Iran’s Bazaar-e Daru, three figures emerge as middlemen: pharmacists, diaspora Iranians, and dalals (brokers). Pharmacists navigate the thin line between formal healthcare services and unauthorised medicine distribution; diaspora Iranians participate in transborder care, transporting medicines in acts that merge healthcare gift-giving with suitcase-smuggling; and dalals, the vendors and brokers working in the informal pharmaceutical markets, sustain the supply chains of contraband medicines. Their work moves between formal and informal, legal and unauthorised channels. Despite their ambiguous positioning, these middlemen form a triad essential to pharmaceutical access and authentication.

The Pharmacists

Pharmacists in Iran extend beyond their traditional healthcare roles, becoming key players sustaining the Bazaar-e Daru. They face ethical dilemmas exacerbated by pharmaceutical policies, consumer preferences, and the privatised markets in which they operate. In some cases, through hoarding government-allocated stocks, rationing and upselling medications, or selling expired medications, pharmacists respond to supply shortages and regulatory failures while also exploiting consumers’ vulnerabilities.^[16] In doing so, they trade on their expert status.

In an interview I conducted with a woman in her early twenties, she shared a scenario that highlights pharmacists’ involvement in the discourse of ‘fake-talk’. She had been searching for imported Gardasil, an HPV vaccine, and upon not finding it, was told by a friend to visit a private pharmacy on the eastern side of Tehran. When she inquired about the vaccine’s availability, the pharmacist suggested its Iranian equivalent. However, she was sceptical of this substitution, fuelled by the perceived inferiority and anecdotal evidence suggesting that the Iranian version had more adverse effects and lower efficacy. Persisting with her request for the imported variant, the pharmacist eventually revealed that it was available outside the ‘official market’, albeit at a significantly higher cost. This situation exemplifies how shortages, intensified by the government’s efforts to ban the imported variant in support of domestically produced HPV vaccines,^[17] accelerate the circulation of contraband medicines in and out of pharmacies.

These pharmacists rely on dalals to obtain the contraband imported medicines, while also leaking domestic and foreign-made government-controlled pharmaceuticals into the informal market. Therefore, pharmacists’ participation further blurs the boundaries between regulated and unregulated medicine supplies. A 2012 study^[18] on Iranian pharmacists reported that more than half of the respondents had a positive outlook towards supplying unofficial and unregistered medicine through alternative sources in case of medication shortage.

In response, the Iranian government has introduced measures such as promoting emergency numbers for public inquiries and complaints against malpractices such as price hikes, drug smuggling in pharmacies, and counterfeit sales.^[19] Furthermore, health officials regularly announce surprise inspections in privately owned pharmacies. For instance, a government news agency reported that in less than a year, in the city of Shiraz, over 5,000 inspections were conducted across 602 private pharmacies, detecting the “presence of drugs outside the country’s official list.”^[20] These measures indicate the evolution of fake-talk from a concept associated with unregulated markets to a significant concern within the formal pharmaceutical system.

The Diaspora Iranians

Iranians living abroad have become inadvertent suppliers and couriers of medicines to their kin back home. Their involvement is not only logistical; it grows out of familial responsibility, a form of transborder care built on trust.

For instance, I recently received a parcel from a friend in Bristol, UK, destined for her family in Iran. In it were everyday items like hair and nail supplements, vitamins, and even medical shoes. Also, last year, while visiting Iran, I delivered a bottle of “Natural Joint Pain Supplements with Turmeric, Boswellia, and Snail” to my grandmother after my grandfather had insisted on their benefits. My grandmother now claims these pills have “miraculously cured her,” but she refuses to take Iranian or other imported versions of the supplement since her supply ran out.

While these items might seem ordinary, they do more than meet physical needs: they carry familial obligation, affection, and reciprocity. The supplements, though potentially on par with Iranian equivalents in quality, are cherished for their perceived superiority—a perception not solely attributable to their foreign branding but also to a phenomenon I describe as ‘affective authentication’. By this, I refer to the emotional and moral value embedded in these manifestations of transnational care, where giving exceeds simple transaction and where commodities acquire added layers of perceived efficacy and safety through the relational ties that accompany their transfer, rather than through regulatory approval or clinical verification.

However, diaspora Iranians face ethical quandaries as they navigate their dual role as caregivers and agents within an informal pharmaceutical network, highlighting broader challenges in global health. They must tread a fine line between delivering vital care and potentially disrupting local healthcare infrastructures or breaching regulations. In doing so, the Iranian diaspora’s contribution to the pharmaceutical supply becomes more than just a matter of logistics; it shows how care, trust, and cultural identity shape global pharmaceutical markets and the dynamics of fake-talk. The process of affective authentication subverts traditional debates around authenticity, typically dichotomised into genuine versus counterfeit categories, by introducing a third dimension of authenticity that is emotionally and culturally constituted. This form of authentication, therefore, surpasses the conventional metrics of pharmaceutical quality and standards by elevating the perceived value and trustworthiness of otherwise suspect drugs.

The Dalals

Dalals, or brokers, play a crucial role in Iran’s Bazaar-e Daru, offering essential access to the international medicine market and filling gaps left by official distribution channels. They navigate both formal and informal pharmaceutical networks, frequently interacting with healthcare professionals and travellers. Beyond merely managing the flow of medicines, dalals engage in a broader spectrum of activities that redefine traditional brokerage roles.

Healthcare professionals, who control the official medicine distribution network, sometimes channel domestically produced or officially imported medicines to dalals. This practice shifts the legal risks associated with illegal sales to dalals, rather than the healthcare professionals themselves. In turn, dalals occasionally supply medications to private pharmacies and doctors, collaborating with third-party suppliers and smugglers to import medicines. Their reliance on suitcase-smuggling by Iranian tourists and diaspora travellers, who execute orders for a fee, underscores their connected role.

Operating within this partially informal and unregulated market, dalals inadvertently challenge the government’s pharmaceutical policies. They face constant monitoring and intermittent, yet severe, policing as part of broader anti-smuggling initiatives. These initiatives aim to prevent or eradicate the perceived contribution of dalals to the illegal distribution of dangerous ‘fake’ pharmaceuticals in Iran.^[21] As such, the cautionary aspect of dealing with dalals lies in navigating the blurred lines of legality and authenticity. Patients seeking access to medicines must discern the right sources amid a complex web of information and uncertainty. This confusion is often compounded by competing claims and assurances from various middlemen within the Bazaar-e Daru.

A particularly intriguing aspect of dalals’ role is their emulation of medical expertise. As demonstrated by Davood and Maryam’s interaction discussed in the introduction, Davood not only identifies the medication Maryam seeks for her mother’s heart condition but also confidently assures its authenticity and quality by specifying the brand and expiration date. Dalals like Davood frequently offer advice on the use cases, side effects, and efficacy of medicines, displaying a comprehensive knowledge of the illicit market’s offerings. This performance of expertise goes beyond mere salesmanship; it positions them as unofficial arbiters of authenticity, efficacy, and quality in the Bazaar-e Daru.

Based on these dynamics, dalals represent an alternative, or at times complementary, segment to the official healthcare structure. Their ability to anticipate market demands, to procure and circulate otherwise scarce drugs, and most importantly to authenticate them to consumers not only reflects their critical role in maintaining informal markets but also their influence over the discourse of ‘fake talk’. The scope of dalals’ influence, however, stretches far beyond their contributions to pharmaceutical markets. Their operations extend into the distribution of medical equipment, health supplements, cosmetics, and even specialisedfood products. Moreover, dalals with higher financial and social credit may assume advisory roles, offering insights into navigating Iran’s import-export regulatory environment and acting as pseudo-solicitors or business logistics experts.

These roles and functions embed dalals into the broader informal economy of goods and services in Iran and position them as unofficial mediators, arbiters, and regulators of the healthcare system. As mediators, they bridge the gap between formal and informal pharmaceutical and medical networks. At the same time, as arbiters, they assess the quality and authenticity of healthcare commodities, including pharmaceuticals, mostly through dialogue rather than empirical evidence. Their regulatory role involves managing the risks and legal aspects of pharmaceutical distribution, thereby influencing market volatility and playing a key role in Iran’s healthcare system.

Conclusion

In concluding the investigation into Iran’s pharmaceutical markets, I have explored the network of middlemen: pharmacists, diaspora Iranians, and dalals. These intermediaries, far from being mere participants in an illicit economy, assume critical roles in shaping access to, and perceptions of, drug authenticity and safety amidst international sanctions and state policies driven by pharmaceutical nationalism.

Iran’s attempt to assert sovereignty over pharmaceuticals is marked by a clear contradiction. Volatility in the drug market, ongoing scarcities, dependence on international sources for raw materials, and widespread scepticism towards domestic pharmaceuticals among the Iranian populace all highlight the challenges to the government’s aspirations for sovereignty and its promises of self-sufficiency. The ethnographic evidence shows a gap between state claims and patients’ everyday experiences of searching for medicine.

Moreover, middlemen in this context facilitate access to medicines while enacting a vernacular politics of pharmaceutical care that both borrows from and unsettles state pharmaceutical nationalism. In dissecting the roles and narratives of middlemen, this article highlights how these individuals collectively construct a parallel healthcare infrastructure—one that is critiqued for perpetuating the circulation of drugs claimed to be fakes or counterfeits, and is labelled as illegal, yet simultaneously occupies a conspicuous and seemingly indispensable role in sustaining the current pharmaceutical ecosystem in Iran.

I therefore do not argue that dalals, pharmacists, and diaspora Iranians simply broker state pharmaceutical nationalism. They mediate and unsettle it. State pharmaceutical nationalism defines sovereignty through domestic production, formal regulation, and reduced dependence on foreign suppliers. Informal intermediaries redraw these boundaries in practice by making foreign, smuggled, or diaspora-sourced medicines appear necessary, trustworthy, and socially legitimate when they secure treatment for Iranian patients. The nationalism enacted here is less a doctrine of state self-sufficiency than a vernacular politics of pharmaceutical care, in which the nation is invoked through the obligation to keep Iranians alive, even when doing so requires routes the state marks as unauthorised or suspect. The Iranian case shows that pharmaceutical nationalism is not realised only through factories, subsidies, import controls, or regulatory agencies. It is also negotiated through informal markets, brokers, pharmacists, patients, and diaspora circuits that compensate for the failures of official provision. These actors do not stand outside the national pharmaceutical project. They redraw its boundaries by deciding which medicines can be trusted, which routes are legitimate, and whose authority counts in moments of scarcity. Fake-talk is the language through which these judgements are made. It allows state officials to mark informal circulation as dangerous, while enabling consumers and dalals to question the authenticity of domestic production and to legitimise alternative routes of access. Pharmaceutical nationalism in Iran, therefore, appears as a contested field in which sovereignty, care, suspicion, and circulation are continually brokered.

References

^[1] A ‘dalal’ in the context of the Iranian pharmaceutical trade refers to a middleman who facilitates the distribution and authentication of medicines, predominantly within informal markets.

^[2] Hornberger, J., & Hodges, S. (2023). Fake-talk as concept and method. Medicine Anthropology Theory, 10(3), 1–22. https://doi.org/10.17157/mat.10.3.7291      

^[3] Hayden, C. (2007). A Generic Solution? Pharmaceuticals and the Politics of the Similar in Mexico. Current Anthropology, 48(4), 475–495. https://doi.org/10.1086/518301

Mentanko, J. (2023). The limits of pharmaceutical internationalism: Mexico, the Third World, and the resource of medicinal plants in the 1970s. Humanity: An International Journal of Human Rights, Humanitarianism, and Development, 14(1), 85–101. https://doi.org/10.1353/hum.2023.a902632.

^[4] Cheraghali, A. M. (2017). Trends in Iran Pharmaceutical Market. Iranian Journal of Pharmaceutical Research : IJPR, 16(1), 1–7. https://www.ncbi.nlm.nih.gov/pubmed/28496457

^[5] Aloosh, M., & Aloosh, A. (2015). Lift sanctions now to save public health. Nature, 520(7549), 623. https://doi.org/10.1038/520623c

Setayesh, S., & Mackey, T. K. (2016). Addressing the impact of economic sanctions on Iranian drug shortages in the joint comprehensive plan of action: promoting access to medicines and health diplomacy. Globalization and Health, 12(1), 31. https://doi.org/10.1186/s12992-016-0168-6

Yazdi-Feyzabadi, V., Amini-Rarani, M., & Delavari, S. (2020). The Health Consequences of Economic Sanctions: Call for Health Diplomacy and International Collaboration. Archives of Iranian Medicine, 23(4Suppl1), S51–S53. https://doi.org/10.34172/aim.2020.s11

^[6] Yousefi, N., Moradi, N., Dinarvand, R., Ghiasi, G., Inanloo, H., & Peiravian, F. (2019). Policies to improve access to pharmaceutical products in shortage: the experience of Iran food and drug administration. Daru: Journal of Faculty of Pharmacy, Tehran University of Medical Sciences, 27(1), 169–177. https://doi.org/10.1007/s40199-019-00259-2

Kheirandish, M., Rashidian, A., Kebriaeezade, A., Cheraghali, A. M., & Soleymani, F. (2015). A review of pharmaceutical policies in response to economic crises and sanctions. Journal of Research in Pharmacy Practice, 4(3), 115-122. https://doi.org/10.4103/2279-042X.162361

Olyaaeemanesh, A., Jaafaripooyan, E., Abdollahiasl, A., Davari, M., Mousavi, S. M., & Delpasand, M. (2021). Pharmaceutical subsidy policy in Iran: a qualitative stakeholder analysis. Health Research Policy and Systems, 19(1), 150. https://doi.org/10.1186/s12961-021-00762-6

Hosseini, S. A. (2013). Impact of sanctions on procurement of medicine and medical devices in Iran; a technical response. Archives of Iranian Medicine, 16(12), 736–738. https://www.ncbi.nlm.nih.gov/pubmed/24329148

Mohammadi, D. (2013). US-led economic sanctions strangle Iran’s drug supply. The Lancet, 381(9863), 279. https://doi.org/10.1016/s0140-6736(13)60116-6

Davari, M., Walley, T., & Haycox, A. (2011). Pharmaceutical policy and market in Iran: past experiences and future challenges. Journal of Pharmaceutical Health Services Research: An Official Journal of the Royal Pharmaceutical Society of Great Britain, 2(1), 47–52. https://doi.org/10.1111/j.1759-8893.2011.00042.x

^[7] YJC News Agency. (2018, November 20). 97% of the country’s needed drugs are domestically produced: We have no imports in the field of radioactive drugs [News article]. Retrieved from https://www.yjc.ir/00SGFz

^[8] Mehr News Agency. (2019, October 17). The capacity of drug production in Iran is 4.5 times the domestic demand. Retrieved from https://mehrnews.com/xQp8h

^[9] Tehran Times. (2019, July 22). Iran able to produce 90% of needed pharma raw materials: VP. Retrieved from https://www.tehrantimes.com/news/438445/Iran-able-to-produce-90-of-needed-pharma-raw-materials-VP

^[10] Kheirandish, M., Varahrami, V., Kebriaeezade, A., & Cheraghali, A. M. (2018). Impact of economic sanctions on access to noncommunicable diseases medicines in the Islamic Republic of Iran. Eastern Mediterranean Health Journal = La Revue de Sante de La Mediterranee Orientale = Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit, 24(1), 42–51. https://www.ncbi.nlm.nih.gov/pubmed/29658620

^[11] Karimi, M., & Haghpanah, S. (2015). The effects of economic sanctions on disease specific clinical outcomes of patients with thalassemia and hemophilia in Iran. Health Policy, 119(2), 239–243. https://doi.org/10.1016/j.healthpol.2014.12.011

Shahabi, S., Fazlalizadeh, H., Stedman, J., Chuang, L., Shariftabrizi, A., & Ram, R. (2015). The impact of international economic sanctions on Iranian cancer healthcare. Health Policy, 119(10), 1309–1318. https://doi.org/10.1016/j.healthpol.2015.08.012

^[12] Radio Farda. (2020, October 20). Iran’s Insulin Shortage Prompts Scrutiny. Retrieved from https://en.radiofarda.com/a/iran-s-insulin-shortage-prompts-scrutiny/30903314.html

^[13] Ebadi Fardazar, F., Sarabi Asiabar, A., Safari, H., Asgari, M., Saber, A., & Ebadi Fard Azar, A. A. (2019). Policy Analysis Of Iranian Pharmaceutical Sector; A Qualitative Study. Risk Management and Healthcare Policy, 12, 199–208. https://doi.org/10.2147/RMHP.S209318

^[14] Sirrs, C. (2023). Fluid Fakes, Contested Counterfeits: The World Health Organization’s Engagement with Fake Drugs, 1948–2017. Medicine Anthropology Theory, 10(3), 1-29. https://doi.org/10.17157/mat.10.3.7234

^[15] “Bazaar-e Daru,” as a term, does not have any reference to its shadowy nature. It means “Pharma Market” and can be used to refer to the Pharma Market in general. Nevertheless, it is commonly and colloquially used to refer to the availability of pharmaceuticals beyond the official and regulated service providers within the healthcare system. Therefore, it creates an undertone of informality/illegality in its use. Here, I use these terms in an ambivalent moral-legal sense, whereby the Bazaar operates in an oxymoronic state of illegality and informality.

^[16] Sabbagh-Bani-Azad, M., & Varastehmoradi, B. (2017). Regular inspection and committing major malpractices: Case of Pakdasht pharmacies. Journal of Pharmacoeconomics and Pharmaceutical Management, 3(1/2), 5–11. https://jppm.tums.ac.ir/index.php/jppm/article/view/34

^[17] Khabar Online. (2023, May 13). Cancer drugs are not easily found / Gardasil vaccine is obtained from the black market. Retrieved from https://www.khabaronline.ir/xk2pz

^[18] Shahverdi, S., Hajimiri, M., Pourmalek, F., Torkamandi, H., Gholami, K., Hanafi, S., Ashrafi Shahmirzadi, N., & Javadi, M. (2012). Iranian pharmacists’ knowledge, attitude and practice regarding counterfeit drugs. Iranian Journal of Pharmaceutical Research : IJPR, 11(3), 963–968. https://www.ncbi.nlm.nih.gov/pubmed/24250525

^[19] Student News Agency. (2022, April 30). How to follow up on the profiteering and violations of pharmacies? Retrieved from http://snn.ir/fa/news/1007947

^[20] IRIB NEWS AGENCY. (2018, December 8). Contact this system for drug complaints! Retrieved from https://www.iribnews.ir/009daX

^[21] Fakhrzad, N., Yazdi-Feyzabadi, V., & Fakhrzad, M. (2024). Drivers of vulnerability to medicine smuggling and combat strategies: a qualitative study based on online news media analysis in Iran. BMC Health Services Research, 24(1), 383. https://doi.org/10.1186/s12913-024-10805-7

Sociology of Health and Illness

More Than a Role Dispute: Physician Associates and the Changing Grounds of Medical Authority

Louise Ashley

This article examines how the legitimacy of physician associates (PAs) is constructed and contested in English medicine. Drawing on Critical Discursive Psychology, it analyses formal submissions to a government commissioned independent review of medical associate professions from the British Medical Association, General Medical Council and United Medical Associate Professionals to ask: What does conflict over PAs reveal about fractures in medical status and power? The findings show that these actors do not simply disagree about a new occupational role but mobilise shared concerns, especially around safety, standards and responsibility, through competing legitimacy logics. For the BMA, legitimacy is framed predominantly through boundary protection and the exclusivity of medical expertise; for the GMC, through regulatory governance and system assurance; and for UMAP, through workforce contribution and professional integration. Conceptually, this article extends jurisdictional accounts by showing that contemporary role disputes concern not only who controls clinical tasks but also which criteria and institutions are authorised to validate healthcare work. The PA controversy therefore reveals a pluralisation and institutional fragmentation of the grounds of medical authority, rather than its straightforward decline or reproduction.

Vigilant Algorithms and the Contagion of Risk in Automated Opioid Risk Assessment

Amelie Lange & Benjamin Lipp

Amid the ongoing opioid crisis, U.S. health systems have extended prescription monitoring interfaces with proprietary reports that provide clinicians with algorithmic risk scores to guide opioid decisions. However, little is known about how such tools shape clinical encounters, professional authority and accountability in everyday care. This article examines the case of NarxCare, a widely adopted risk-scoring system, through a multi-sited ethnographic study combining clinician interviews, interface walkthroughs, documentary analysis and clinic observation. We find that NarxCare operates through multiple opacities, presenting scores as authoritative yet unexaminable. It produces an amalgamated risk by collapsing diverse concerns—overdose, liability and societal harm—into a single number. Through its logic of contagion, physicians themselves become risk subjects, their reputations and careers tethered to the scores of patients they treat. These dynamics illustrate how this algorithmic automation recasts prescribers as governable agents of the opioid crisis; however, by unsettling established epistemic cultures of safety, it fails to completely enrol them as actuarial enforcers. In practice, clinicians respond by refusing, anticipating, or domesticating the scores, but cannot evade them fully. NarxCare thus reconfigures rather than resolves opioid risk, a dynamic with significant implications as algorithmic infrastructures expand across healthcare and scoring enters new domains.

Making Decisions or Enacting Shoulder Care? Challenging Assumptions About Matters of Concern in the Orthopaedic Shoulder Clinic

Anna Louise Skovgaard, Brian Elmengaard, David Høyrup Christiansen & Mette Terp Høybye

Because of increasing pressure on healthcare resources in many countries, public health policies are increasingly occupied with how to optimise decision-making processes to ensure medical interventions are appropriate, necessary and aligned with the preferences and values of patients. One prominent example is the concept/model of shared decision-making (SDM) which target clinician-patient interactions in the clinic. Such public health goals raise renewed questions about what matters to people when seeking healthcare, which models such as SDM may not be able to fully account for. In this article, we draw on ethnographic fieldwork in two Danish shoulder clinics. We identify specific uncertainties as they manifest in guidelines and the clinic, and draw on pragmatist-inspired theory, to argue that decision-making emerges as interactional work in what has been conceptualised as the subjunctive mood, to make treatment proposals acceptable. In this process doubt and hope are inherent elements to be acknowledged and managed, rather than avoided. Thus, we argue that such pragmatist ideals are fundamental to shoulder care. Our findings call for an approach to clinical decision-making in research and policy that considers the everyday concerns of patients and clinicians as they seek to navigate highly uncertain terrains.

The Complex Dynamics of Healthism in Birth Cohort Studies: Comparative Perspectives From the United Kingdom, the Netherlands, Brazil and Portugal

Sahra Gibbon, Carola Tize, Taylor Riley & Tatiane Muniz

Longitudinal birth cohort studies are an under-examined context for considering the dynamics of healthism. This article presents a comparative perspective from the ‘Biosocial Lives of Birth Cohorts’ study, which takes birth cohorts as an ethnographic object of knowledge-making, social practice and participation in the Netherlands, Brazil, Portugal and the United Kingdom. Drawing from ethnographic research with participants and professionals involved in cohort data collection, we examine how, in the routine monitoring and measuring of bodies and lives in cohort studies, ‘healthism’, as an individualised form of moral self-responsibility for health, is entangled with medicalisation. Healthism is also at stake in the way that individual cohort test results are communicated and received. Yet the relational dynamics of cohort studies, which encompass but also exceed the scope of healthism, are also shaped by the precarity of public health infrastructures and closely entangled with the motivational desire of cohort participants, as birth cohorts can act as a stopgap for public health failures. In this way, we demonstrate how birth cohorts are an important context for considering the politics of health and how medicalisation is entangled with healthism in cohort data collection, even as this unfolds in tension with efforts to collectively intervene in public health.

Social Studies of Science

Chemical Governmentality: Manufacturing Politics in Oil Refineries

Sarandha Jain

Petroleum products silently govern human relations not only through ideology or policy but through their chemical composition and material form. What is the technical-chemical work that translates geological formations of oil into sociopolitical formations of human relations? How is governmentality encoded into petroleum products during their manufacturing? This article develops the concept of chemical governmentality to analyze how engineering processes in oil refineries govern sociopolitical life. Drawing on ethnographic research in Indian refineries and households, I examine how fuels such as kerosene, Liquefied Petroleum Gas (LPG), or Piped Natural Gas (PNG) are chemically and infrastructurally configured to produce distinct forms of domesticity, sociality, and state-citizen relations. Refining processes, product specifications, and testing protocols embed political logics into petroleum products, disciplining consumers through material means. Chemicals cohabit human worlds not just through toxicity, but also through governmentality. My analysis foregrounds chemical engineering as an arena where material machinations participate in the production of everyday government.

Toward Differentiated Biological Citizenship: Genetic Controversies and the Creation of Taiwan’s Collective Informed Consent Law for Indigenous Peoples

Yu-Yueh Tsai

Since the 1990s, Taiwan has promoted genomics as part of its shift to a knowledge economy. However, controversies concerning Indigenous genetics and genomics extend into political, sociocultural, and historical dynamics. This has prompted a movement among Taiwan’s Indigenous activists, culminating in legal reforms that made Taiwan the first country to enact legislation mandating collective informed consent for Indigenous peoples in 2016. This article proposes the concept of ‘differentiated biological citizenship’ to explain how Taiwan’s Indigenous peoples have developed bioethics governance. First, the article analyzes the origin, dynamics, and main events of this controversy, arguing that it should be understood in the context of globalization and Taiwan’s evolving identity politics. Second, the article traces how different actors (scientists, Indigenous elites, and government officials) negotiate a series of actionable strategies and develop collective informed consent based on the law. Finally, examining such issues as the relationship between trust and distrust and the power inequality between Indigenous and Han peoples, this article also investigates the difficulty in practicing collective consent as a governance model for Indigenous communities.

Beyond Balance: An Ethnography of Validity and Engagement in Citizen Science Practice

Eran N. Schwarzfuchs

Citizen science (CS) is often characterized as involving inherent trade-offs between scientific validity and public engagement. While existing literature has documented these competing imperatives, less is known about the concrete organizational mechanisms that enable their coexistence. Based on ethnographic fieldwork at the Israel Center for Citizen Science (ICCS), this article examines how hybrid knowledge production is sustained not by resolving this tension, but by structuring it. ICCS functions as a unique scientific site where the primary ‘instruments’ are communities of human participants. Through analysis of validation processes (mechanical objectivity, standardized protocols) and engagement practices (role-switching, boundary work), I demonstrate that the validity-engagement tension acts as a mechanism rather than a hurdle. The analysis reveals a structure of ‘fractal biopower’—nested power/knowledge relations where the division between subject and object repeats at every scale: Nature is subject to participants’ observation, participants to institutional management, and institutions to scientific evaluation. This recursive structure allows contradictory logics to operate simultaneously, suggesting that contemporary science increasingly functions through the management, rather than the purification, of hybrid tensions.

The Changing Concept of Actionability in Precision Medicine

Dominik Hofmann

This article tracks the origins, developments, and current usages of the concept of actionability in precision medicine. Originally a label for highlighting ‘incidental’ findings from genetic research, over time this concept became ascribed to catalogued genetic ‘variants’ that are both potentially pathogenic and ‘druggable’. Drawing on a qualitative document analysis, the article identifies several clusters of relevant actors promoting actionability, and several developments to which the concept was subject over time. The concept answers to various problems that emerged gradually, at different points in time, and partially as consequences of previous solutions: the translation between genomic testing in research and clinical settings, the problem of overdiagnosis resulting from a technologically induced information overflow, the complexity of test results combining various dimensions of meaning of non-linearly linked variables, and the problem of having to ‘personalize’ a therapy selection while integrating a new logic into a pre-existing health system.

Social Science & Medicine

Socioeconomic adversity and child health following the COVID-19 pandemic: A convergent integrated mixed-methods review of household and neighbourhood inequalities

Christine Wilson, Sarah Hanson  Lauren Flannery, Katie Warncken & Nicholas Steel

Children experience inequalities in health at household and neighbourhood level, even in wealthy countries. Measures to contain the COVID-19 pandemic such as school closures, followed by the cost-of-living crisis, did not affect all children equally. This review aimed to understand the impact of socioeconomic adversity on child health and development following the COVID-19 pandemic.

Systematic literature searches used the SPIDER tool to identify studies, and a convergent integrated approach to combine and synthesise quantitative and qualitative data. A mixed methods appraisal tool was used to appraise for risk of bias.

Three integrated findings were identified from 125 studies: 1. Socioeconomic adversity and unequal exposure to risk; 2. Community support and professional input as protective influences. 3. Structural and system-level requirements to address socioeconomic adversity.

COVID-19 restriction measures were associated with worsening family finances and health of disadvantaged children who experienced cramped living conditions and insecure food and housing. COVID-19 amplified existing health inequalities. These inequalities could potentially be reduced through public health interventions such as improved availability of community services, greater consideration of sociodemographic factors in healthcare settings, and by professionals using their collective voice to influence policy development, for example through improved data sharing to help public-sector services make the best use of available data to support vulnerable families.

Understanding school-related gender-based violence from the perspectives of children with disabilities and community stakeholders in Sierra Leone

Steven Kaindaneh, Rosanna Kamara, Abu Bakarr Bangura, Sapana Basnet, Alexandre Chailloux, Julia De Kadt, Elena Schmidt

School-related gender-based violence (SRGBV) affects millions of children globally and is prevalent in Sierra Leone. SRGBV involves abuse at and around school and can affect children’s health, school attendance and academic performance. Due to disability stigma, children with disabilities are often more affected by violence at school and in the community but evidence on this relationship remains weak. Using community-based participatory methods, including focus group discussions, geospatial mapping and photography, this study explored the perspectives, experiences and needs of children with disabilities regarding SRGBV. Findings revealed that children with disabilities in this context experience high levels of physical, psychological and sexual violence and their experiences are shaped by the characteristics of their natural and built environment, political and economic factors and social and cultural norms. The study highlights specific hotspots for violence within and around their schools and provides insights into the relationships between SRGBV, disability stigma, gender inequality and poverty. Suggestions made by children for improving safety and ending SRGBV include training teachers and parents on disability, making environmental and sanitation improvements, enhancing road safety and traffic regulations and strengthening SRGBV reporting and accountability mechanisms. The study has helped to amplify the voices of children with disabilities and highlighted the importance of disability-inclusive participatory methodologies in conducting SRGBV research and ensuring richness and quality of data.

Paternalism, parsed. Presenting empirical insights into the actions of physicians under the Austrian law on assisted dying

Julia Fischer, Klara Doppler, Tamina-Laetitia Vielgrader, Gerhard Aigner & Karl Stöger

Rationale

In all jurisdictions with laws standardising the process of assisted dying, physicians play a key role. That they do is a concern in the academic literature, with critics accusing physicians of medical paternalism, particularly in relation to their role in assessing requests for assisted dying.

Objective

By exploring how physicians handle medical assessments under the 2022 Austrian Dying Decree Act, we aim to add empirical insights to the overly theoretical debate on medical paternalism in the context of assisted dying.

Method

After employing a maximum-variation sampling strategy, we conducted episodic interviews with 16 assessors recruited among 51 preselected physicians. Thematic analysis was used to interpret the interview data.

Results

When conducting assessments, it was crucial to physicians that they could relate to the request and empathise to the extent of imagining making the same choice if they found themselves in the requester’s circumstances. They did not support requests that they could not relate to, even when the requester met the legal access criteria for assisted suicide. They did so for self-protective reasons.

Conclusion

Criticising the practice of assessing requests for assisted dying through the lens of paternalism leads to oversimplifying the real-world complexities of the matter. Denying or shaming physicians for considering self-interested motives in their assessment practice will not make them disappear.

Gamete selection in gay male surrogacy: Procreative labor beyond gestation

Margot Lherbet

The findings show that gamete selection involves intensive reflexive work through which intended fathers negotiate equality within the couple, manage genetic asymmetries, anticipate social stigma, and articulate moral responsibilities toward egg donors. These choices are shaped by biomedical constraints, legal frameworks, and market logics, but also by emotional and ethical considerations, including efforts to recognize and symbolically compensate women’s procreative labor in contexts where donor bodies are structurally anonymized and commodified. At the same time, strategies aimed at protecting children from discrimination often reproduce racialized and gendered hierarchies embedded in reproductive markets.

By focusing on a triply specific configuration—same-sex male couples, non-compensable genetic choices, and the absence of pregnancy—this article highlights how procreative labor operates as a site where structural inequalities are both made visible and re-enacted through individual decision-making. Without presupposing procreative labor as an analytical framework, the study demonstrates its empirical relevance while extending it to include reflexive, emotional, and political dimensions that remain underexplored in existing scholarship.

Climate change experiences among women with psychiatric illness – a qualitative exploration of lived experiences and service needs

Siqi Xue, Leanne M. Lacap, Lisa D. Hawke, Charlotte Munro, M. Ishrat Husain, Samantha Wells, Madeha Umer, Suvercha Pasricha & Sean A. Kidd

People with pre-existing psychiatric illnesses are recognized as a high-risk group in climate-health research, yet few qualitative studies explore their experiences. This study explored the gendered experiences of women with psychiatric illnesses in relation to climate stressors and identified the tailored supports they perceive as necessary to maintain their mental health and wellbeing.

Between January and December 2025, 23 participants took part in four focus groups at an academic psychiatric hospital in Toronto, Canada. The study used a service-user-informed qualitative design in collaboration with people with lived experience, who contributed to developing the interview guide and interpreting the findings. Codebook analysis with an intersectional lens was applied to examine pathways linking climate stressors to mental health impacts and service needs in this under-studied population.

Three main domains emerged: (1) mechanisms by which climate stressors exacerbate psychiatric symptoms, (2) how these impacts intersect with gendered roles and responsibilities, and (3) patient-identified priorities for climate-informed mental health interventions. Participants reported disrupted care, forced isolation, difficulties with medication adherence, strained communication with clinicians, and bidirectional interactions between physical and mental health. Women described reproductive guilt, caregiving burdens, reactivation of sexual trauma, and feelings of disempowerment.

Participants identified actionable priorities, including accessible climate preparedness resources, clinician training, peer support spaces, and hospital-based programs fostering social connection and adaptive coping strategies. These findings reveal social and institutional pathways linking climate stressors to mental health risks, and provide guidance for gender-responsive, service-user-informed interventions to enhance resilience in the context of climate change.

“We all agree” – or do we? Strategic participation in health echo chambers among mothers on Facebook

Darryn DiFrancesco

Access to health information and the “information environment” are now understood as social determinants of health. Correspondingly, researchers are increasingly concerned about the potential impacts of internet “echo chambers” – ideologically insular online spaces – on health beliefs and behavior. Understood as “health managers” for their families, mothers are a population of particular interest, yet little research has explored their experiences in online echo chambers. This manuscript draws on findings from an 18-month internet ethnographic study of ideologically-insular Facebook parenting groups – one “science-based”, the other focused on “natural parenting”. Through inductive analysis, I assert that the apparent ideological homogeneity of echo chambers is not a structural feature, but a side effect of mothers’ strategic participation. Five categories capture mothers’ strategic participation: (1) appreciating the echo chamber; (2) concealing differences to avoid rebuke; (3) plural membership; (4) hacking the algorithm; and (5) evolving participation. These findings reframe engagement with echo chambers as an active, intentional process, casting mothers as strategic architects of their health information environments. In this framework, mothers treat echo chambers as only one option among many in the broader information landscape. This study has implications for how researchers, clinicians, and health educators understand the relationship between parenting ideology, maternal health learning, and the evolving online information environment.

Pesticide suicide as a relational structural event: linked lives, gendered kinship and reputational governance in rural China

Yong Yu, Wenzhao Huang, Keke Qin & Zheng Ren

Background

Pesticide self-poisoning was a major cause of suicide in rural China. Although mortality has declined, little is known about how earlier suicide waves continue to shape bereaved families, kinship relations and village life decades later.

Aims

To examine how a past wave of pesticide suicides shaped linked lives, gendered kinship obligations and intergenerational inequality in rural China, and to theorise these deaths as relational structural events.

Methods

Between October 2024 and March 2025, we conducted a qualitative life-history case study in a Hunan village where multiple pesticide suicides occurred in the 1980s–1990s. After identifying all 12 known bereaved households in the relevant settlement, we interviewed 28 relatives and 7 key informants. Data were analysed using framework-informed thematic analysis, with life course theory as the primary framework.

Results

Pesticide suicide redirected linked rural lives through four mechanisms: role substitution and trajectory resequencing in schooling, labour and care; gendered moral accounting that allocated earning, caregiving, silence and blame across kin positions; reputational transmission through village memory, marriage screening and informal governance; and unequal repair through ritual containment, kin-based rescue, informal monitoring and reverse investment in children’s education.

Conclusion

We develop a relational structural-event model showing how sudden, stigmatised death can become intergenerational inequality through linked lives, gendered kinship, reputational governance and uneven social repair. Public health postvention matters, but the primary contribution is to theorise how suicide loss is socially transmitted across kin and community life.

The feminist care work in abortion funds

Ophra Leyser-Whalen, Briana Trejo, Kari White

We contribute to the research on care work and emotion work through a focus on abortion fund workers in an abortion restrictive landscape. We utilize interview data collected from 23 abortion fund staff and volunteers serving Texans after the onset of the COVID-19 pandemic and a subsequent Texas Executive Order that suspended abortion care for 30 days. We find that abortion restrictions led to increased workloads for abortion fund workers and more desperate situations for callers, which then necessitated fund workers to provide intensive emotional support to callers. This led some volunteers to experience burnt out, and staff described strategies to mitigate burnout, including delving into a community of care model for the workplace. These findings add to the literature on abortion funds, and on human services workers and emotion and care work, which is particularly timely in the current post-Dobbs landscape where abortion fund staff and volunteers are facing similar and new challenges.

The management of daily topics in conversations with individuals with Alzheimer’s disease in Chinese residential care

Hao Zhao, Tailun Zhang, Lili Liu, Shuai Zhang & Wen Ma

Background

Individuals with Alzheimer’s Disease (AD) often experience difficulties managing topics in daily interactions, which can hinder their participation in interactions and affect their social engagement. There is a gap in exploring the interactional dynamics and the maintenance of personhood when interacting with individuals with AD in asymmetric institutional settings.

Objectives

This study aims to examine the interactional competence of individuals with AD and how their vulnerabilities are managed in daily-topic interactions within institutional healthcare settings.

Methods

This study adopts Conversation Analysis (CA) to examine video-recorded conversations between a trained researcher and individuals with mild cognitive impairment due to AD residing in two residential care facilities in China.

Findings

Individuals with mild AD demonstrate agency within asymmetric interactions by reshaping conversational frames, preserving face, and situating themselves within relational contexts to maintain their personhood. This agency emerges only when interlocutors actively engage, providing validation and recognition while accommodating temporary incoherence. These findings underscore the collaborative nature of sustaining identity in dementia care and highlight the particular significance of such interactional practices within the Chinese cultural context.

Implications

Conversation partners can support agency in individuals with AD by ratifying frame reconfigurations, sustaining topics, acknowledging repetitions, and responding flexibly to disengagement. Care facilities are also expected to create more opportunities for residents to engage in casual conversation.

Emotional labour in therapeutic work – the case of physiotherapists and psychotherapists in Poland

Bartosz Mika & Justyna Zielińska

This article presents a comparative analysis of emotional labour among physiotherapists and psychotherapists in Poland, based on 26 in-depth interviews conducted separately with practitioners working primarily in private practice. Despite differences in therapeutic modality – physiotherapists intervening through the body, psychotherapists through the psyche – the analysis reveals structural convergences in their emotional experiences. Drawing on Hochschild’s concept of emotional labour and Bolton’s typology of emotion management, the article examines how practitioners employ both surface and deep acting. The article’s key contributions are threefold. First, it offers an innovative comparative approach, providing empirical evidence of professional similarities across therapeutic modalities (and some differences). Second, it reconceptualises therapy sociologically as a normative and relational setting. Third, it clarifies the boundaries between emotional labour and self-care.

A paradigm shift in fertility care? Discourses on AI for IVF in the Netherlands and the UK

Esca van Blarikom & Manuela Perrotta

Artificial intelligence (AI) is increasingly promoted as a transformative innovation in in vitro fertilization (IVF), particularly for embryo selection. This article examines how discourses surrounding AI in IVF reflect broader shifts in medical paradigms and market logics. Drawing on a comparative critical discourse analysis of clinic websites, media texts and professional publications in the Netherlands and the United Kingdom, we explore how stakeholders frame the promise and potential of AI-enabled embryo selection. Our findings reveal three interconnected dynamics. First, UK discourses predominantly construct a paradigm shift from evidence-based medicine (EBM) toward data-driven care, positioning AI as a solution to the perceived limitations of randomised controlled trials. Dutch sources, by contrast, largely sustain EBM principles, framing caution as a safeguard against false hype and escalating costs. Second, UK clinics and technology developers predominantly employ promissory narratives that create self-fulfilling prophecies about an AI-driven future, while Dutch actors largely resist the inevitability of technological fixes. Third, the meaning of patient choice diverges: in the UK, choice is increasingly conflated with consumerism, enabling clinics to market unproven add-ons at additional cost; in the Netherlands, patient choice remains more insulated from market forces, though globalised imaginaries exert growing pressure. These findings illuminate how commercial interests and sociotechnical imaginaries shape reproductive care beyond clinical evidence, raising ethical concerns about equity, regulation and the commodification of hope. The IVF sector offers a critical lens on the wider implications of AI-driven medicine for healthcare governance in an era of marketisation.

Beyond legality: Bureaucratic violence and obstacles to abortion care

Ashley McKay & Melanie Heath

Pregnant people across the globe continue to face significant barriers in their ability to access abortion care. Some of these barriers are due to bureaucratic systems that can delay or even deny abortion care access, highlighting how complex procedures, fragmented systems, and opaque rules bring challenges to getting services, especially for those with fewer resources or less institutional familiarity. Illuminating these operational processes and outcomes, this study advances the concept of “bureaucratic violence” to capture how administrative barriers can produce harm. Drawing on 36 in-depth interviews with Canadian reproductive health professionals and advocates, we identify three forms of bureaucratic violence. First, general bureaucratic impediments mean that individuals face poor access to information and technological challenges to accessing care. Second, bureaucratic processes generate funding barriers that restrict some populations from obtaining services. Finally, bureaucratic procedures for billing create additional obstacles to receiving care. Overall, this article uncovers how bureaucracy can serve as a formidable barrier that results in violence against some pregnant people’s bodily autonomy and their ability to access abortion.

Street-level bureaucracy and relational autonomy in HIV status-neutral care implementation: A study of jail staff and incarcerated individuals

Linnea A. Evans, Kaitlyn Jaffe, Amy M. LeClair, Abigail W. Batchelder, Brindet Socrates, Chiteara M. Thomas, Alysse G. Wurcel, Elizabeth A. Evans

In the U.S., nearly 8 million people are incarcerated in jail each year, a majority of whom are structurally vulnerable and at elevated risk for poor health, including HIV. Jails have been identified as strategic settings for health interventions, offering opportunities to deliver “status neutral” HIV services (testing, prevention, and linkage to care) to people who may otherwise have intermittent access to care. To understand barriers and facilitators to integrating HIV care into routine jail health services, we conducted semi-structured, in-person interviews with 15 incarcerated individuals and 13 jail staff at two county jails. While interview guides focused on HIV care, participants largely reflected on the provision of healthcare in jail more generally. Both groups converged on their understanding of institutional constraints (e.g., resource and capacity limitations; an absence of protocols), with staff additionally highlighting organizational silos and threats to their clinical autonomy as obstacles to adopting status-neutral HIV care. However, staff and incarcerated individuals diverged on care experiences. Staff described respect for patient autonomy, whereas incarcerated individuals described feeling unheard, invalidated, or subject to care delays. Participants’ reactions to these limitations varied and are interpreted using concepts of street-level bureaucracy and relational autonomy, which highlight how frontline decision-making and interpersonal dynamics interact in carceral settings to restrict clinical staff autonomy, and in turn, medical autonomy of incarcerated individuals. Our findings show that the provision of routine healthcare and integration of status-neutral HIV care requires addressing institutional constraints and relational dynamics that shape perceived autonomy and trust in carceral settings.

Uncertainty and luck discourses in intersex/VSC reproduction and family-building journeys

Limor Meoded Danon, Marcy Brink & Daniela Crocetti

Are we “lucky” to live in an era of rapidly expanding medical technology? Drawing on qualitative interviews with people with Variations of Sex Characteristics (VSC), their partners, and medical professionals across multiple national contexts, this article examines how “luck discourse” is mobilized in narratives of family building. Participants frequently invoke luck, often in contradictory ways, to describe their experiences of pursuing parenthood in technoscapes that include uterus transplantation (UTx), surgical sperm retrieval (TESE/MicroTESE) and other assisted reproductive technologies. Rather than treating such inconsistencies as error, we ask what luck discourse does and reveals. We analyse invocations of luck as sociolinguistic acts that mediate tensions between agency and constraint, autonomy and medical authority, hope and despair across medicalized life courses. These invocations often index broader concerns surrounding inequality and medical authority, while providing a flexible language for uncertainty. Building on this analysis, we propose a sociological typology of luck that conceptualises it as a dynamic, non-binary, and indexical resource. We identify three primary domains of luck discourse: temporal, statistical, and structural; alongside a cross-cutting agentive dimension through which individuals negotiate responsibility and control. Attending to luck discourse offers a valuable methodological and analytical entry point for understanding how people navigate uncertainty and how broader social dynamics, inequalities and conflicts are reflected and negotiated through luck discourse.

Nested sovereignty: Necropolitics and the gendered burden of unpaid care and domestic work in sub-Saharan Africa

Cynthia Itbo Musah & Susan J. Elliott

Women in sub-Saharan Africa (SSA) carry a disproportionate burden of unpaid care and domestic work (UCDW), with significant consequences for their health and wellbeing. This burden persists despite widespread recognition of the inequity. Yet less is understood about how it is reproduced through household authority structures and intergenerational norm enforcement within the very populations it harms. Drawing on Mbembe’s necropolitics, we theorise UCDW in SSA as a necropolitical arrangement through which sovereign power consigns women to conditions of slow death by normalising the ordinary, cumulative toll of reproductive labour under conditions of state abandonment. We then develop the concept of nested sovereignty to account for how this arrangement persists. Nested sovereignty describes a multi-scalar structure of power in which the state, through its withdrawal from infrastructural provision and abdication of its protective obligation, creates the conditions for patriarchal household authority and intergenerational norm enforcement to govern women’s bodies. Placed in conversation with Nancy Krieger’s ecosocial theory, nested sovereignty points toward a necrosocial orientation to health, showing how necropolitical arrangements operating through social reproduction become biologically inscribed as illness, diminished wellbeing, and unequal life chances. From this perspective, the home appears not as a private space outside politics but as a site where state abandonment produces embodied conditions of life-in-death and where sovereign power operates through the everyday relations of social reproduction.

Society and Mental Health

State-Level Paid Sick Leave Policies and Population Mental Health during the COVID-19 Pandemic in the United States

Rachel Donnelly and Courtney E. Boen

Financial hardship was pervasive during the COVID-19 pandemic, with adverse consequences for mental health. However, access to state-level paid sick leave during the pandemic had the potential to reduce the mental health burden of financial hardship—a possibility that has not been tested in prior research. Using nationally representative survey data on more than 1.7 million individuals from the Household Pulse Survey (August 2020 to November 2022) merged with state-level data on paid sick leave policies, we estimated a battery of two-way fixed-effects linear probability models to examine whether paid leave policies buffered the association between financial hardship and depression and anxiety risks. Results show that experiencing financial hardship increased depression and anxiety risks but that the mental health consequences of financial hardship were dampened for respondents living in a state with an active paid sick leave policy. Moreover, because racially minoritized adults, women, transgender adults, and less-educated adults were more likely to experience financial hardship over the period, our study highlights the potential for paid leave policies to reduce population inequities in mental health. We point to paid sick leave policies as an important macro-level determinant of mental health with especially salient mental health consequences for marginalized groups.

Curare | Zeitschrift für Medizinethnologie |ournal of Medical Anthropology

(A)symmetrische Beziehungen Professionelle Einblicke in den psychiatrischen Krankenhausalltag

(A)symmetrical relationships: Professional insights into everyday life in a psychiatric hospital

Andrea Kuckert

Fallbeispiele  haben  uns  als  Mitarbeitende  im  Krankenhaus motiviert, uns mit der Thematik der (A)symmetrie näher  auseinanderzusetzen.  Im  Rahmen  der 36. Jahrestagung der Arbeitsgemeinscha” Ethno-logie  und  Medizin  (AGEM)  in  Kooperation  mit dem Alexius/Josef Krankenhaus in Neuss und der Verbundforschungsplattform  Worlds  of  Contra-diction (WOC) der Universität Bremen wollten wir diese  Thematik  aus  verschiedenen  Perspektiven beleuchten. Mit dem Titel „(A)symmetrische Bezie-hungen: Facetten der Kooperation im psychiatri-schen  Krankenhausalltag“,  organisiert  von Ehler Voss und Andrea Kuckert,  konnten  wir zahlreiche Sprecher*innen gewinnen, die sich mit uns auf einen spannenden Weg gemacht haben. Ausgangspunkt  war  die  Frage,  wie  die  Mitarbei-tenden  in  einem  psychiatrischen  Akutkranken-haus in unterschiedlichen Bereichen und Zusam-menstellungen miteinander kooperieren. Dazu  muss  man  sich  zunächst  Folgendes  vor Augen  führen:  Der  Alltag  in  einer  Psychiatrie wird   von   unterschiedlichen   Akteur*innen   be-stimmt.  Neben  den  Patient*innen  gibt  es  unter anderem  den  ärztlichen  und  den  p!egerischen Dienst, Psycholog*innen, Mitarbeitende der thera-peutischen  Dienste  wie  Sport-,  Ergo-  und  Musik-therapie, klinische Sozialarbeiter*innen und Ge-nesungsbegleiter*innen    wie    Seelsorger*innen oder Ehrenamtler*innen sowie Mitarbeiter*innen in Verwaltung, Raump!ege und Küche, die mit-einander  auf  unterschiedlichen  Ebenen  koope-rieren.  Eingebettet  sind  diese  Beziehungen  in ökonomische, infrastrukturelle und gesellscha”-liche Rahmenbedingungen. Zudem beein!ussen die  sozialen  und  kulturellen  Hintergründe  von Patient*innen und Mitarbeitenden die jeweiligen Beziehungen genauso wie die Wahl der Behand-lungsform,  insbesondere  die  der  Medikation. Dabei  zeichnen  sich  die  Beziehungen  der  betei-ligten   Akteur*innen   durch   unterschiedliche Asymmetrien in den Bereichen des Wissens, des Handelns, der Macht und des Nutzens aus.

Case studies motivated us as hospital staff to delve deeper into the topic of (a)symmetry. At the 36th annual conference of the Working Group for Ethnology and Medicine (AGEM), in cooperation with the Alexius/Josef Hospital in Neuss and the collaborative research platform Worlds of Contradiction (WOC) at the University of Bremen, we wanted to explore this topic from various perspectives. With the title “(A)symmetrical Relationships: Facets of Cooperation in Everyday Psychiatric Hospital Life,” organized by Ehler Voss and Andrea Kuckert, we were able to attract numerous speakers who embarked on this fascinating journey with us. The starting point was the question of how staff members in an acute psychiatric hospital cooperate with one another in different areas and constellations. To understand this, it’s essential to first consider the following: Daily life in a psychiatric hospital is shaped by a variety of actors. In addition to the patients, there are, among others, medical and nursing staff, psychologists, employees of therapeutic services such as sports, occupational, and music therapy, clinical social workers and recovery support staff such as chaplains or volunteers, as well as employees in administration, housekeeping, and the kitchen, who cooperate with each other on various levels. These relationships are embedded in economic, infrastructural, and social frameworks. Furthermore, the social and cultural backgrounds of patients and staff influence the respective relationships, as does the choice of treatment, especially medication. The relationships between the actors involved are characterized by various asymmetries in the areas of knowledge, action, power, and benefit.

Experienced Involvement: Ein Projekt, um das Wissen von Menschen mit psychischen Krankheitserfahrungen für andere positiv zu nutzen

Experienced Involvement: A project to use the knowledge of people with lived experience of mental illness for the benefit of others.

Andrea Kuckert, Andreas Rexin Alexius & Heidrun Lundie

Mit Peergroups wie dem Trialogforum wurden in der Psychiatrie bereits erste Schritte unternom-men, in der Behandlung die Sicht von Betro!e-nen  deutlich  in  den  Fokus  zu  nehmen  und  als Ressource  zu  nutzen  (Bock und Sielaff 2010). Da-mit verbunden ist der Versuch einer gesellschaftlichen  Entstigmatisierung  der  psychiatrischen Behandlung   in   einem   Akutkrankenhaus.   Mit dem  EU-Programm  Leonardo  da  Vinci (EX-IN Deutschland E.V. 2025) wurde das Ziel verfolgt, genau dieser Gruppe der Psychiatrieerfahrenen eine Qualifikation zu ermöglichen, mit der sie als Mitarbeitende  in  psychiatrischen  Diensten  tätig werden können. Aus diesem Projekt hat sich das Curriculum EX-IN entwickelt, das die Grundlage einer   eigenständigen   Ausbildung   zur   „Gene-sungsbegleitung“ bildet.EX-IN  ist  die  Abkürzung  des  englischen  Aus-drucks „experienced involvement“ und bedeutet, dass Menschen, die eine psychische Erkrankung oder  Krise  erfahren  haben,  an  der  Behandlung von akut Erkrankten teilhaben. Durch ihr indivi-duelles Erfahrungswissen sind sie die Expert*in-nen für ihren Krankheits- und Genesungsverlauf und können durch dieses Wissen die Patient*in-nen unterstützen. Gleichzeitig bringen sie durch ihr  Expertenwissen  auch  eine  neue Qualität  in die multiprofessionellen Teams ein.

With peer groups like the Trialogue Forum, initial steps have already been taken in psychiatry to clearly focus on the perspective of those affected in treatment and to utilize it as a resource (Bock and Sielaff 2010). This is linked to an attempt to destigmatize psychiatric treatment in acute care hospitals. The EU program Leonardo da Vinci (EX-IN Germany e.V. 2025) pursued the goal of providing precisely this group of people with lived experience of mental illness with qualifications that would enable them to work as staff in psychiatric services. The EX-IN curriculum developed from this project and forms the basis of independent training for “recovery support.” EX-IN is an abbreviation of the English term “experienced involvement” and means that people who have experienced a mental illness or crisis participate in the treatment of acutely ill patients. Through their individual experiential knowledge, they are the experts on their own illness and recovery process and can use this knowledge to support patients. At the same time, their expertise brings a new quality to the multidisciplinary teams.

Medien und Medizin als Ressourcen füreinander. Polio-Schluckimpfung im BRD-Fernsehen der 1960er- und 70er-Jahre

Media and Medicine as Resources for Each Other. Polio Oral Vaccination on West German Television in the 1960s and 1970s

Tobias Becker

Nachdem ab 1962 in der Bundesrepublik Deutschland flächendeckend die Oralimpfung gegen Poliomyelitis („Kinderlähmung“) eingeführt wurde, gab es intensive und langjährige Werbekampagnen, bei denen besonders dem Fernsehen als neuem gesellschaftlichen Leitmedium eine immer größere Bedeutung zukam. Der Artikel analysiert diese Rolle des Fernsehens für die Propagierung der Polio-Schluckimpfung sowohl hinsichtlich der Vielzahl an re-daktionellen Sendungsbeiträgen als auch mit Blick auf einflussreiche staatliche Werbespots. Das Argument lau-tet, dass die Propagierung der Polio-Schluckimpfung in den 1960er- und 70er-Jahren eingebettet war in ein teils institutionalisiertes, vor allem aber informelles Zusam-menwirken von medizinischen und medialen Akteuren, die in strategischen Allianzen voneinander zu profitieren suchten. Der Artikel beschreibt, wie Medien als Ressourcen der Medizin, umgekehrt aber auch Medizin als Res-source der Medien dienten. Zudem zeigt er auf, wie sich die Werbestrategien im Laufe der 1960er- und 70er-Jahre veränderten. Dieser medienhistorische Blick fördert zu-tage, dass die Behauptung, der Rückgang der Erkran-kungsfälle in den frühen 1960er-Jahren sei maßgeblich dem berühmt gewordenen Werbeslogan „Schluckimp-fung ist süß – Kinderlähmung ist grausam“ zu verdanken gewesen, ein medialretrospektiver Mythos ist, der auf ei-ner meist unzutreffenden zeitlichen Zuschreibung beruht. Der Artikel stellt die historische Einordnung des Slogans richtig und erläutert den in den 1970er-Jahren vollzogenen Wandel der Werbelogiken für das Impfen – weg von Abschreckungs- und Schockbildern hin zu Darstellungen eines unbekümmerten Immunitätsversprechens –, wie sie bis heute eingesetzt werden.

After oral vaccination against poliomyelitis (‘polio’) was introduced nationwide in the Federal Republic of Germany in 1962, there were intensive and long-term advertising campaigns in which television, as a new leading medium in society, became increasingly important. The article analyses this role of television in promoting oral polio vaccination, both in terms of the large number of editorial broadcasts and in terms of influential advertising spots by the state. The argument is that the promotion of oral polio vaccines in the 1960s and 1970s was embedded in a partly institutionalised, but primarily informal, collaboration be-tween medical and media actors who sought to benefit from each other through strategic alliances. The article describes how the media served as a resource for medicine and, conversely, how medicine served as a resource for the media. It also shows how advertising strategies changed over the course of the 1960s and 70s. This perspective from media history reveals that the claim according to which the decline in polio cases in the early 1960s was largely due to the famous advertising slogan ‘Oral vaccine is sweet – Polio is cruel’ (Schluckimpfung ist süß – Kinderlähmung ist grausam) is a retrospective media myth based on a mostly inaccurate chronological attribution. The article thus sets the historical context of the slo-gan straight as well as it explains how advertising logics for vaccination changed in the 1970s – moving away from deterrent and shocking images towards depictions of a carefree promise of immunity as they continue to be used today.

Cryonics 2.0. Implicit Transhumanism, Anti-Aging, and the “Rise of Rationalism”

William Dawley

Wie wurde die Kryonik durch futuristische Entwicklungen in KI und Anti-Aging-Medizin beeinflusst? Kryonik bezeichnet die Praxis, menschliche Körper mit Frostschutzlösungen (Kryoprotektiva) zu durchdringen und – der Hoffnung auf eine zukünftige Wiederbelebung – bei extrem niedrigen Temperaturen zu lagern. Kryoniker*innen (diejenigen, die Kryonik praktizieren oder sich dafür anmelden) erhoffen sich eine Wiederbelebung durch verschiedene biologische und digitale Methoden. Diese reichen von der Wiedererwärmung, Heilung und Verjüngung des Körpers über digitale und biologische Verbesserungen bis hin zur digitalen Rekonstruktion der Person oder des Bewusstseins. Bis vor Kurzem war Kryonik ein Randphänomen und erst in jüngster Zeit Gegenstand ethnografischer Manuskripte. Doch Fortschritte in der KI, die Altersforschung und andere kulturelle Entwicklungen haben sie in den Mainstream gebracht. Mit der zunehmenden Verbreitung des Themas Kryonik und der steigenden Zahl von Kryoniker*innen haben sich auch deren Lernprozesse, ihre Selbstwahrnehmung und ihre Art der Präsentation verändert. Trotz der Rolle von KI bei der Etablierung transhumanistischer Ideen wie der Idee der Auslagerung des Bewusstsein außerhalb des biologischen Körpers „jenseits der Kohlenstoffbarriere“ zeigen ethnografische Daten und Umfragen, dass sich Kryonik auf zwei alternativen Wegen verbreitet: durch das wachsende Interesse an Anti-Aging-Forschung und -Behandlung sowie durch den Aufstieg des Rationalismus und damit verbundene Bewegungen wie den Effektiven Altruismus und den Langzeitansatz. Mitglieder des Forschungsteams „Human Futures”.

How has cryonics been affected by futuristic developments in AI and anti-aging medicine? Cryonics is the practice of perfusing human bodies with antifreeze solutions (cryoprotectants) and storing them at ultralow temperatures in the hopes of future revival. Cryonicists (those who practice or sign up for cryonics) hope for revival by a vari-ety of biological and digital methods, ranging from re-warming, healing, and rejuvenating the body, to adding digital and biological enhancements, to recreating the person or consciousness in digital form. Cryonics was until very recently a very fringe phenomenon only lately the topic of ethnographic manuscripts. But it has been mainstreamed not only by advances in AI, but by the study of aging, as well as other cultural developments. Along with this mainstreaming and the growth in the number of cryonicists, there have been changes in how cryonicists learn about cryonics, how they self-identify, and how they present cryonics to others. Despite AI’s role in mainstreaming transhumanist ideas, such as consciousness outside the biological body, ‘beyond the carbon barrier’ my ethnographic and survey data show that cryonics is popularizing along two alternative routes: through a surging interest in anti-aging research and treatment, and through ‘the Rise of Rationalism’ and Rationalist-adjacent movements like Effective Altruism and Longtermism. “Cryonics 2.0” is the name that members of the “Human Futures” research team have given to this new context for cryonics, wherein many cryonicists shed the explicit language of immortalism and transhumanism in favour of longevity and Rationalist discourses.

Health & Place

Neighbourhood socioeconomic inequalities in mental health: Systematic review on moderation by environmental attributes

Rebecca A. Reid, Beiou Zhang, Suzanne Mavoa, Julia Gilmartin-Thomas, Sarah Foster, Jerome N. Rachele

Neighbourhood socioeconomic disadvantage has been consistently associated with an increased risk of poor mental health. Beyond socioeconomic conditions, neighbourhood environmental attributes have the potential to shape mental health, either supporting or harming wellbeing. While numerous reviews have examined the relationship between various neighbourhood characteristics and mental health, evidence on whether objectively measured environmental attributes moderate this relationship in the context of neighbourhood socioeconomic disadvantage is yet to be synthesised. This systematic review synthesised evidence from studies examining environmental attributes as moderators of the relationship between neighbourhood socioeconomic disadvantage and mental health. From seven databases and a grey literature search 19 studies were identified for inclusion. Moderation findings were mixed. Greenness and blue space were generally protective in disadvantaged neighbourhoods, while air pollution exacerbated poor mental health. Evidence for parks and walkability was inconsistent and may reflect unmeasured factors such as safety and quality. Noise and elder support centres were examined in one study each, highlighting the limited evidence on these attributes. In addition, more longitudinal research examining a broader range of environmental attributes is needed to inform urban planning policies aimed at reducing mental health inequalities.

Navigating the neighbourhood: A qualitative study of parents’ perceptions of the food environment in Rotterdam

Holly A. Harris, Veerle van Garling, Inge Merkelbach, Paul Kocken, Pauline W. Jansen

Families living in socioeconomically disadvantaged neighbourhoods are disproportionately exposed to unhealthy food outlets. Yet less is known about how families perceive and navigate these local food environments in everyday life. Parents play a key intermediary role in translating neighbourhood food environments into family food purchasing decisions. As such, this qualitative study explored how parents of children aged 8 to 10 years perceive and experience their neighbourhood food environment in Rotterdam (the Netherlands). Fifteen semi-structured interviews were conducted with parents from socioeconomically diverse neighbourhoods. Data were analysed inductively using a constructivist grounded theory approach. Two overarching themes conceptualised parents’ engagement with the food environment as a relational and adaptive process, whereby “perceiving the neighbourhood food environment” was continually recalibrated through parents’ “use of the food environment in everyday life”. Perceptions were shaped by what felt available, acceptable, and accessible, extending to digital food retail and influenced by community norms and safety. These perceptions were recalibrated as families actively engaged with their food environment through planning grocery shopping, navigating in-store trade-offs between price, quality and health or environmental values, and outsourcing meals for time management or enjoyment. Experiences of using the food environment, in turn, reshaped perceptions, forming a dynamic perceive-use-recalibrate feedback loop. Public health interventions should address both neighbourhood and consumer food environments, combining urban planning with strategies attuned to how families perceive and navigate food choices in everyday life.

Understanding the burden of poor health outcomes among climate-related migrant populations in Sub-Saharan Africa: a scoping review

Max Bobholz, Carly Schanock, Tinuola Oladebo, Crispus Mwemaho, Julius Ssentongo, Agnes Nyabigambo, Julia Dickson-Gomez, Bryan Johnston, Roy Mayega, Wei Xu, John Bosco Isunju, Kirsten Beyer

Background

The climate crisis plays a central role in the displacement of millions each year in Sub-Saharan Africa (SSA). Few studies have explored the burden of poor health outcomes among climate-related migrants (CRMs) in SSA. This scoping review aimed to summarize this limited body of literature and identify gaps for future research.

Methods

A protocol was developed and registered with OSF before performing the literature search. Four databases were systematically searched, identifying 392 unique records. After screening the titles and abstracts of these articles for relevance, 18 articles were sought for full-text review to assess alignment with the pre-defined inclusion criteria. Ten articles were reviewed in depth and summarized to identify key themes.

Results

Included articles originated from Western, Eastern, and Southern Africa and focused primarily on flooding, droughts, and environmental degradation. The five key health outcomes identified were (i) poor mental health and solastalgia, (ii) poor physical health, (iii) loss of financial livelihood, (iv) reduced access to healthcare, and (v) poor social health. Sense of place was also observed to be disrupted, as CRMs reported feelings of solastalgia.

Conclusions

CRMs experience significant and wide-ranging health and place-based struggles. These outcomes are deeply connected and contribute to many quality-of-life challenges. This study highlights a critical research gap in understanding how displacement and climate change contribute to poor health outcomes and disruptions to sense of place, especially in SSA.

Anthropologie et Sociétés

Inventorier, collecter et échantillonner les mémoires: Le musée et les héritages singuliers

Inventorying, Collecting, and Sampling Memories The Museum and Singular Legacies

Thierry Bonnot 

En anthropologie, les interactions entre les ethnologues et leurs interlocuteurs sur le terrain constituent des matériaux scientifiques pour l’enquête, générant différents types de documents : enregistrements, notes, images, films, fichiers numériques. Ces documents n’ont pas de valeur informative en dehors de la relation ethnographique par laquelle ils ont été produits. Ils ne peuvent être considérés comme des données ou des sources brutes. Lorsque l’enquête concerne des objets de patrimoine, entrés ou non au musée, ce questionnement se double d’une dimension problématique que l’on peut résumer ainsi : les objets matériels étant intégrés à un ensemble de relations, sont-ils en eux-mêmes des documents ou la cristallisation de ces relations ? Que documentent les objets ? L’histoire de leur production, celle d’une entreprise, d’une région, d’une famille d’industriels ? Ou celle d’un collectionneur, d’une enquête, d’une relation avec un anthropologue ? Cet article tentera de répondre à ces questions à partir d’enquêtes de terrain au long cours, où l’ethnographie a été amenée à croiser l’histoire, la muséologie et l’archéologie, notamment à l’occasion d’une donation et d’un travail d’échantillonnage de collections dans les réserves d’un musée, en France.

In anthropology, interactions between ethnologists and their interlocutors constitute scientific material for research, generating different types of documents: recordings, notes, images, films, and digital files. These documents have no informative value outside the ethnographic relationship through which they were produced. They cannot be considered raw data or sources. When the survey concerns heritage objects, whether or not they are in a museum, this question is compounded by a problematic dimension that can be summarized as follows: since material objects are part of a set of relationships, are they themselves documents or the crystallization of these relationships? What do the objects document? The history of their production, of a company, a region, and a family of industrialists? Or that of a collector, an investigation, a relationship with an anthropologist? This paper will attempt to answer these questions based on long-term field research, where ethnography has been brought to intersect with history, museology, and archaeology, particularly in the context of a donation and sampling of collections in the reserves of a museum in France.

Des outils de papier aux gestes savants (de la documentation)

From Paper Tools to Scholarly Gestures (of Documentation)

Jean-François Bert,  Emmanuelle Chapron, Jérôme Lamy et Simon Dumas Primbault 

Cet article explore le rôle de trois « outils de papier » — liste, registre et dossier — dans la production et l’organisation des savoirs. En s’appuyant sur une approche croisant histoire et anthropologie, les auteurs montrent comment ces dispositifs matériels structurent la pensée, standardisent les pratiques et facilitent la communication savante. Chaque outil permet ainsi d’interroger la persistance de gestes documentaires, y compris à l’ère numérique, où coexistent anciennes et nouvelles pratiques d’inscription. L’étude de ces trois outils révèle une « logistique de la pensée » où le papier conditionne les modes de raisonnement, de collaboration et d’archivage.

This article explores the role of three “paper tools”—list, register, and file—in the production and organization of knowledge. Drawing on an approach that combines history and anthropology, the authors show how these material devices structure thought, standardize practices, and facilitate scholarly communication. Each tool thus allows us to examine the persistence of documentary practices, even in the digital age, where old and new methods of recording coexist. The study of these three tools reveals a “logistics of thought” in which paper shapes modes of reasoning, collaboration, and archiving.

Apprendre avec les objets: Documentation et valorisation de la collection ethnographique de l’Université de Montréal (Note de recherche)

Learning through Objects: Documentation and Enhancement of the Ethnographic Collection of the Université de Montréal (Research Note)

Violaine Debailleul, Ingrid Hall et Eugène Fournier

Le Département d’anthropologie de l’Université de Montréal dispose, depuis sa fondation, d’une collection ethnographique comptant près de 4 000 objets. Si l’intégration de la collection aux activités d’enseignement et de recherche a varié au fil du temps, on constate, depuis une quinzaine d’années, un regain d’intérêt à son égard. Les objets sont mobilisés dans un nombre croissant de cours, selon différentes formules qui intègrent de façon plus ou moins poussée la culture matérielle. Parallèlement, des expositions sont organisées. Dans ce cadre universitaire, la documentation occupe une place particulière, car elle est au coeur des activités pédagogiques tout en favorisant la valorisation de la collection. Ce texte a pour objectif de présenter la collection et ses usages afin de montrer la richesse qu’elle représente pour le Département d’anthropologie et au-delà. Sont abordés l’histoire et la nature de cette collection, les défis liés à sa documentation, les différentes façons de la valoriser et, enfin, les enjeux éthiques contemporains auxquels il faut désormais faire face.

The Department of Anthropology at the Université de Montréal has maintained, since its founding, a collection of ethnographic objects comprising nearly 4,000 items. While the integration of the collection into teaching and research activities has varied over time, a renewed interest has emerged over the past fifteen years. Objects are increasingly being mobilized in courses, through various approaches that incorporate material culture to varying degrees. At the same time, exhibitions are organized. In this academic context, documentation plays a particular role, as it lies at the heart of pedagogical activities while also contributing to the valorization of the collection. This text aims to present the collection and its uses in order to highlight the richness it represents for the Department of Anthropology and beyond. It examines the history and nature of the collection, the challenges related to its documentation, the different ways of enhancing it, and, finally, the contemporary ethical issues that must now be faced.

Pratiques collaboratives de documentation au Musée de l’Holocauste de Montréal: Les fonds des frères Gerhart et Herbert Maass (Note de recherche)

Collaborative Documentation Practice at the Montreal Holocaust Museum: The Gerhart and Herbert Maass Family Archives (Research Note)

Marie-Blanche Fourcade

Cette note de recherche explore des pratiques collaboratives de documentation au Musée de l’Holocauste de Montréal à travers l’étude de cas des fonds d’archives des frères Maass. À partir d’une approche ethnographique ancrée dans la pratique professionnelle, le texte met en lumière la manière dont la documentation collaborative peut créer un espace de dialogue, de partage et de co-auteurité. L’expérience menée avec Barbara Maass, fille de Gerhart et nièce de Herbert Maass, illustre bien la puissance de cette collaboration, qui a permis de rendre les fonds plus visibles et d’en approfondir la connaissance, de tisser de nouveaux liens, mais aussi de renforcer la portée mémorielle et historique des archives. Cette note de recherche analyse certains impacts de ce projet pilote sur la collection, sur les participants et sur la transmission de la mémoire. Elle montre comment cette pratique de documentation peut renforcer la responsabilité collective et inscrire la préservation de la mémoire dans un partenariat durable entre le musée et la communauté.

This research note explores collaborative documentation practices at the Montreal Holocaust Museum through a case study of the archival collections of the Maass brothers. Drawing on an ethnographic approach grounded in professional practice, it highlights how collaborative documentation can create a space for dialogue, sharing, and co-authorship. The experience conducted with Barbara Maass, daughter of Gerhart and niece of Herbert Maass, powerfully illustrates the impact of this collaboration, which made it possible to increase the visibility of the fonds and deepen knowledge of them, to foster new connections, and to strengthen the memorial and historical significance of the archives. This research note analyzes some of the impacts of this pilot project on the collection, the participants, and the transmission of memory. It shows how this documentation practice can strengthen collective responsibility and embed the preservation of memory within a sustainable partnership between the museum and the community.

Description et indexation critiques des documents dans la collection numérique Nipakanatik (Note de recherche)

Critical Description and Indexation of Documents in the Nipakanatik Digital Collection (Research Note)

Juste Roy, Jean-Sébastien Sauvé, Julie Lise Simard et Nancy Wiscutie-Crépeau 

Au sein de la Nation Anicinabe, la raréfaction des porteuses et porteurs de connaissances conduit à percevoir les archives comme des outils de revitalisation culturelle. Historiquement, les objets culturels anicinabe ont été décrits par des allochtones selon des perspectives canado-européennes, contribuant à l’affaiblissement de la langue, des savoirs et des mémoires des ancêtres. Cette note de recherche présente les normes adoptées par Minwashin pour la description des documents dans la collection numérique Nipakanatik. L’organisme s’est doté d’un comité de gouvernance, le Cercle Mitonentcikan, et a codéveloppé avec des partenaires issus des communautés un schéma de métadonnées et une liste de descripteurs-sujets contrôlés. Ces dispositifs permettent de décrire les documents de la collection de manière à refléter les perspectives anicinabe et à stimuler la revitalisation de la langue anicinabe.

Within the Anicinabe Nation, the decreasing number of knowledge holders has led to viewing archives as tools for cultural revitalization. Historically, Anicinabe cultural objects were described by non-Indigenous people from Euro-Canadian perspectives, contributing to the weakening of ancestral language, knowledge, and memory. This research note presents the standards adopted by Minwashin for describing documents in the Nipakanatik digital collection. The organization has established a governance committee, the Mitonentcikan Circle, and has co-developed, with community partners, a metadata schema and a list of controlled subject descriptors. These measures enable documents in the collection to be described in ways that reflect Anicinabe perspectives and support the revitalization of the Anicinabe language.

IArtefact: Un projet de mobilisation de l’intelligence artificielle pour la documentation d’objets ethnographiques (Note de recherche)

IArtefact: An Artificial Intelligence Mobilization Project for the Documentation of Ethnographic Objects (Research Note)

Sandrine Lambert et Martin Hébert

Cette note de recherche présente le projet IArtefact, mené au Département d’anthropologie de l’Université Laval entre 2023 et 2024. Face à la relative sous-utilisation de la collection ethnographique du département — riche, variée et composée de 465 objets —, le projet a exploré de nouvelles voies pédagogiques pour réactiver ces matériaux. Il a mobilisé des systèmes d’intelligence artificielle (SIA) afin d’automatiser et d’enrichir la documentation de la biographie sociale d’objets choisis, dans le cadre d’un protocole de recherche constamment encadré par une intervention humaine. Les résultats sont présentés comme une preuve de concept, mettant en lumière à la fois les potentialités et les limites de l’intelligence artificielle générative pour les textes et les images en anthropologie. Au-delà des informations spécifiques obtenues sur les objets eux-mêmes, l’apport principal du projet a été de susciter un intérêt renouvelé, tant scientifique que pédagogique, pour la collection. Plus largement, cette note de recherche propose une réflexion sur la manière dont les technologies numériques peuvent favoriser un dialogue entre les artefacts de culture matérielle et la pratique anthropologique contemporaine, repositionnant les collections ethnographiques comme des ressources actives pour l’enseignement, la recherche et la réflexion critique.

This research note presents the IArtefact project, conducted in the Department of Anthropology at Université Laval between 2023 and 2024. Confronted with the relative underutilization of the department’s ethnographic collection—rich, diverse, and consisting of 465 objects—the project sought new pedagogical ways to re-engage these materials. It employed artificial intelligence systems (AIS) to automate and enrich the documentation of the social biographies of selected objects, within a research protocol consistently guided by human oversight. The results are presented as proof of concept, highlighting both the possibilities and limitations of generative AI for text and images in anthropological research. Beyond the specific information gathered on the objects themselves, the project’s main contribution was to stimulate renewed scholarly and pedagogical interest in the collection. More broadly, this research note reflects how digital technologies can foster dialogue between material culture artifacts and contemporary anthropological practices, resituating ethnographic collections as active resources for teaching, research, and critical reflection.

L’anthropologue, les singes et la camera: Des images animalitaires à une anthropologie visuelle multiespèces

The Anthropologist, Monkeys and the Camera: From Animalarian Images to a Visual and Multispecies Anthropology

Gaspard Renault 

Si les ethnographies multiespèces impliquant des primates non humains se sont multipliées à travers les sciences sociales au cours des dernières décennies, l’anthropologie visuelle s’est quant à elle relativement peu intéressée aux enjeux épistémologiques d’un tel tournant. Face à ce constat, cet article pose le cadre théorique et méthodologique d’une anthropologie visuelle multiespèces. À partir d’un inventaire historique des figurations de singes et des discussions qui animent l’anthropologie et la primatologie concernant l’usage de la caméra et des images, il resitue d’abord ce projet à la frontière entre sciences sociales et naturelles. Puis, en revenant sur les résultats d’une enquête menée dans des centres de réhabilitation pour singes en Bolivie, l’article met en avant l’intérêt d’une approche multimodale pour penser le rôle des images animalitaires. Enfin, la dernière partie explore les intentions esthétiques et narratives d’un projet de film documentaire réalisé dans le prolongement de l’étude présentée. De manière transversale, l’article défend ainsi l’intérêt d’une approche multimodale et cinématographique pour rendre compte des logiques affectives qui sous-tendent les rapports entre humains et animaux pris dans des dynamiques de conservation de la nature.

While multispecies ethnographies involving non-human primates have gained ground across the social sciences in recent decades, visual anthropology has shown relatively little interest in the epistemological issues raised by such a shift. In light of this observation, this paper sets out the theoretical and methodological framework for a multispecies visual anthropology. Drawing on a historical overview of representations of monkeys and of debates in anthropology and primatology concerning the use of cameras and images, it first situates this project at the frontier between the social and the natural sciences. It then revisits the results of a study carried out in primate rehabilitation centres in Bolivia, highlighting the value of a multimodal approach for thinking about the role of animalarian images. Finally, it explores the aesthetic and narrative intentions of a documentary film project developed as an extension of the study. Overall, the paper argues for the value of a multimodal and cinematographic approach to accounting for the affective logics that underlie relationships between humans and animals within the dynamics of nature conservation.

Private recruitment firms are part of Germany’s expanding field of international nurse recruitment, where development agencies, hospitals, embassies, Goethe Institutes, language schools and even individual nurses are all mobilized for the project of luring foreign-trained nurses into Germany. Over the last decade and a half, a wide array of government-initiated recruitment activities have sought to meet growing demand for nurses in an ageing society, amid exacerbating retention issues in a sector that offers less and less decent working conditions (Pillars of Health 2022). New migration legislation has made it easier for foreign-trained professionals to enter Germany and have their nursing degrees recognized (even if the process remains lengthy and laborious for both workers and employers), and a series of bilateral treaties with origin countries support the migration of nurses.[2] Following a strong focus on recruitment from Western Balkan countries, in particular Bosnia and Herzegovina and Serbia, in the late 2010s, Germany’s international nurses now increasingly originate from non-European countries, notably the Philippines, India, Tunisia, Brazil, and Mexico (Hanrieder and Janauschek 2025). Next to state-managed recruitment programmes, an estimated three quarters of international nurses come through private recruitment agencies (Pillars of Health 2022) like the one cited above. Recruitment firms are only subject to voluntary certification instead of being bindingly regulated, and they compete for nurses, clients, and legitimacy.

While the editors of this series came across middlemen when studying claims about fake pharmaceuticals (Hodges et al. 2026), we encountered them as major protagonists when studying contentious and diffused debates about the ethics of recruiting international health workers to high-income countries (Hanrieder and Janauschek 2025). In Germany, the reluctance of state actors to regulate nurse recruitment, but also the reluctance to offer countries of origin tangible compensation or co-investment in return for their skilled labour export, shifts the focus to the “(un)ethical conduct” of the middlemen, especially the recruitment agencies. Yet, by letting agencies compete in a largely unregulated market, the meaning of ethical recruitment remains deliberately vague and becomes part of a narrative justification of one’s “ethical” business practices that is viewed as offering a competitive edge over “fake” or rogue agencies.

This essay argues that Germany’s effort to create a reliable pipeline of qualified and committed immigrant nurses while also addressing ethical concerns about nurses’ rights and the brain drain which is exerting contradictory pressures on middlemen, who are asked to deliver efficiently but ethically. Similar to other groups of middlemen investigated in this special issue, recruitment agencies’ relational labour is expected to bridge contradictions and mediate between conflicting pressures (Hodges et al. 2026). Navigating this ambiguity, recruitment agencies strive to legitimize their services to regulators, employers (mostly hospitals), and nurses. A key legitimizing strategy is to demonstrate how an agency differs from variously defined “bad apples” in the business. Agencies seek to set the bar by denouncing the “fakeness” of competitors as not being real businesses, invoking  private sector values such as business integrity, reliable service delivery, and professionalism. Yet they also claim moral superiority over competitors due to their genuine, instead of “fake”, care for migrant workers. Price becomes an important marker of one’s proclaimed sincerity and trustworthiness as a middleman, with established recruiters often charging double or triple per nurse compared to the ~5,000€ offered by “fake” agencies who are described as acting like “human traffickers”. Importantly, reliance on private self-regulation has shifted the moral debate about a contested practice – poaching nurses from lower-income countries – to a debate about rights and obligations between recruiters and nurses. Consequently, firms have begun questioning the right of nurses to change recruiter or employer. The harmful effects of nurse-poaching from countries of origin and their health systems, by contrast, are barely addressed.

Internationally, the active poaching of health workers from low-middle income countries has long been criticized in global health. The practice not only epitomizes North-South asymmetries, but also a general lack of equity-oriented regulation in global health. Also labelled “meta-governance”, global health policy falls back on soft standards and best practices instead of well-resourced and binding public policy (Jones and Hameiri 2022). This is also true of health worker migration governance, with the 2010 WHO Global Code of Practice as the central instrument listing important principles such as migrant rights and support for sending countries, but lacking any teeth (Yeates and Pillinger 2019). Such vagueness combined with a strong reliance on private sector dynamics leaves ample space for middlemen to define “business standards” in Germany. Given the German health sector’s growing demand for trained professionals and recognition of the public sector’s incapacity to train or recruit the numbers needed, the loosely governed and largely self-regulated nature of the intermediary space between employers and nurses is set up by design.

Global health scholars have pointed out the role of recruitment agencies as brokers and mediators (Merz et al. 2024) next to nursing colleges (Masselink and Lee 2010) and professional associations (Walton-Roberts 2021). As Merz and colleagues argue in the case of India, recruiters’ profit orientation contributes to exacerbating inequality among nurses, where recruiters skim off the most experienced nurses for employment abroad, and entrench poor access to nurse services in the regions left behind (Merz et al. 2024). Our observations echo such critiques but also take up insights about other types of middlemen in global health – traders and brokers who through their practices shape the normative contours of a field. For example, middlemen in the gamete market have been shown to negotiate complex and hybrid values and thereby also moral boundaries (Bärnreuther 2020). These (dis)qualifications are expressive of various evaluative standards invoked by players in the field – and thus echo observations about eclectic, contextual and expressive “fake-talk” about pharmaceuticals (Hornberger and Hodges 2023). A difference is that talk of “fake drugs” has strong connotations of crisis and urgency – insinuating a need for the hard hand of the state (Hornberger and Hodges 2023). Talk of unauthentic, unreliable, unprofessional, uncaring (and thus in some sense fake) recruiters, by contrast, is not securitized and rather serves to create a sense of moral certainty (and business stability) for a contested practice that affects and mobilizes actors and rationales from various sectors – health providers, human resource experts, diplomats, bureaucrats, development specialists (see Bärnreuther 2020).

Our contribution is based on a study of nurse recruitment initiatives in Germany conducted in 2022 and 2023. We have reviewed the laws, bilateral agreements, and available documented information about the plethora of public and private organizations that co-produce international nurse recruitment. We also interviewed 31 key informants – recruitment agencies, employers, nurse representatives from trade unions, activists, experts, and public officials in the various governmental and quasi-governmental agencies mobilized for recruitment. We mostly spoke with persons based in Germany, but also with experts, union representatives and public officials in international institutions and origin countries. Since many of the actors and institutions we trace are quite recent and only started engaging in international nurse recruitment during or after the pandemic, we can only provide a snapshot of a dynamic field.  

Make or buy – a middleman for every occasion

“Make or buy” – this is the typical business question that, according to the founder of another brand-new recruitment agency, health providers asked themselves regarding foreign nurse recruitment. He observes that quite a few hospitals now are “making” instead of buying the recruitment. They send delegations to other countries to advertise nursing jobs and find candidates, and handle the migration and recognition process themselves.

Yet they often reach out for middlemen. Finding willing candidates, teaching them the German language, and supporting their paperwork and the long immigration and skill adaptation process, even private integration, and family reunification – all these tasks can be and often are outsourced to middlemen. The required documentation – of nursing degrees’ equivalence and compatibility, visa, passports – is voluminous, and full accreditation can only occur in-country through special exams or complementary coursework. Candidates may drop out along the way, never reach the necessary level of German, or be shocked at the working conditions they find themselves in when in Germany, especially because most foreign nursing degrees are more medical and less geared towards basic physical care than the German nursing professions. Middlemen promise to manage this process and deliver employable workers who stay.

One option for employers seeking help with recruitment is to reach for public middlemen such as the GIZ. This is the German state-owned international development agency and more specifically, the GIZ’s commercial International Services department. GIZ operates the so-called Triple Win programme with selected countries. The name with the many winners postulates that German health industries win as they get workers, migrants win as they get jobs, and home countries win as they reduce unemployment and receive remittances. As a middleman, GIZ promises that clients can “benefit from our extensive experience and global presence”[3]. It manages the language training, paperwork, and travel of candidates. These services are paid for by the client, not the candidates, who upon passing the language exam are placed in German nurse aide jobs until their credentials are fully recognized. More recently, another public agency, the German Agency for International Healthcare Professionals (DeFA), has also begun offering recruitment services. Initially set up to help private employers and recruiters navigate the accreditation bureaucracy – thus at times functioning as a middleman for middlemen – DeFA has since morphed into a recruitment agency itself. Their activities are flanked by the support and brokerage of other public institutions – such as the Goethe Institute, which is responsible for German cultural diplomacy and offers German language classes tailored to the nursing profession – or embassies and chambers of commerce establishing business contacts.

Beyond state programmes, a large and diverse ecology of private recruiters offers their services. Given that Germany has not ratified the ILO Convention 181, which demands public licensing of recruitment agencies, practically anyone can become a middleman. Middlemen now come in many shapes and sizes – part-time individuals organising a few calls and some paperwork from their living-room desk to multinational corporations moving human capital in the thousands annually. A regulator described her observations of emergent private recruiters as follows:

There are those who are coming out of the language school model and realised job placement in language classes actually works quite well and they grew out of that. Then there are those who are coming out of the insurance risk management thing and want to calculate just any project with risk stuff. Then there are those coming out of the IT world who think we are doing it as a super amazing start-up because we digitalise everything and we don’t even need that many people and we can scale it up immensely. And then there are the carers who enter into it with their whole personality and should never calculate their hourly wage, they try with so much personal effort to be the best in the market. Then there are the ones who survive mainly on their marketing but don’t really have any structure behind there.

We encountered similar types. A start-up, having dealt in quite unrelated consumer goods before turning to nurse recruitment, bet on a model that can be scaled and rationalized. For example, before recruiting a candidate into their training programme, this start-up’s candidates must pass a tailored assessment of their language learning abilities. Yet we also encountered language school-based agents specializing in cultural integration, faith-based institutions with humanistic credos, and agents who professed that they would go the extra mile to make recruits feel at home in Germany – for example, find a mattress for the visiting family member, or be available on the phone when the hard time of the year, Christmas, hits the newly arrived.

Given this diversity, many properties seem to qualify individuals and businesses to become middlemen. Among these, international networks stand out. The CEO of a German recruiter active across East Asia, North Africa, and Latin America puts it quite bluntly: “It’s purely opportunistic, we have personal connections in each of our countries. And I have the theory that nearly every agency has only made a selection because they somewhere have an opportunistic reason to go to this country”. Given the importance of personal connections, it also does not surprise that we found ex-politicians or their relatives to be CEOs of recruitment agencies.

In other words, the agencies themselves also rely on middlemen to establish contacts and access recruits. And middlemen do not always need to be formal institutions. For example, many of our participants knew of hospitals or care homes turning employees into middlemen. Employers simply approach their foreign-trained staff and offer them cash rewards if they convince qualified colleagues or friends back home to migrate to Germany and start working with them.

Professionals versus bad apples, and a legitimate shared enterprise

This blend of improvisation and formalization leads to intensive debates about good versus bad business practice. Some of this was driven by clients’ (hospitals) concern about the reliability and identity of recruitment firms. We were told of prominent stories circulating among hospitals about fraudulent agencies – agencies one could name “fake” due to their phantom nature – they did not deliver the promised contingents of nurses, or even went bust or disappeared altogether. Likewise, occasional but highly alarming media reports about agencies’ abusive practices vis-à-vis nurses further increased legitimation pressure. It was indeed commonplace among our interviewees, both from public and private recruiters, to talk about the bad apples out there – middlemen who engaged in fraudulent or chaotic or unprofessional practice, or who were simply “traffickers”.

Private recruiters also use softer disqualification of competitors. They highlight that their own services can exceed the package offered by Triple Win, for example regarding post-arrival integration services such as matching with hospitals and support with a broad set of everyday challenges for new arrivals. This serves to justify higher prices and seeks to define what is needed for real and durable integration. One interviewee from an agency used the term “strategic recruitment” to explain that their services cost time and money. Employers looking for international staff, he said, often did not understand the requirements of strategic recruitment. He suggested that “most of them privately use Tinder and think we are a Tinder for nurses”. And while some middlemen might then just promise unrealistic things, the interviewee’s company would not engage in such reckless matching but be closer to the actual time and cost of recruitment.

To distinguish themselves from competitors, some recruiting agencies now resort to voluntary certification with a fair recruitment certificate. They form a community of currently over 70 certified agencies that, for example, guarantee to recruits that they need not bear the costs of migrating, and to employers that jobs will be filled.[4] As one agency explained to us, their offer within this context was to give a “one year warranty” – if within the first year a recruited worker leaves, the employer gets a replacement.

Having a certificate is good in terms of signalling trustworthiness. In fact, as one CEO told us, their company website displays logos of business associations, public organizations, and even from unrelated programmes from the start-up world, if they look good or have the German flag.

Additionally, having a certificate is good in terms of meeting and debating business standards. As noted above, members of that certificate association told us that they were warning each other of thieves – companies which snatched recruits from their programmes. Some agency heads described it as immoral and poor conduct that other recruiters offered head hunting fees to candidates who switched to their agency or employer. Other agency heads did not attribute blame to the workers themselves – who could blame someone who got 3000 Euros in cash to buy their first set of furniture? Yet vis-à-vis competitor firms, agencies mobilize moralized arguments. A private recruiter specialized in integration services says she did it “in order to protect the nurses”, another recruiter specified that Filipino nurses switching companies would risk the stain of a bad reputation as being unreliable. Some agency interviewees were grumbling that nurses were “overly protected” by the norms of the certificate, and might take advantage of the agencies’ services such as language courses without ultimately becoming a nurse in Germany.

In this contest to secure both workers and clients, participants seek to distinguish themselves as honourable businesses in order to gain access to, and hold on to, scarce workers. They try to co-shape the rules of the game at a business frontier where profit margins, scalability, and calculability are still being negotiated. Criticizing competitors’ bad practice here can address clients’ need for reassurance – given past debacles with phantom and in that sense fake recruiters and given the absence of public regulation. Yet furthermore, the registers of professionalism, business integrity, and worries about quality allow recruiters to criticize competitors as what one may call “substandard” (Sirrs 2023) – not entirely fraudulent, but still a sort of fake compared to functioning, and as we heard above, “strategic” recruitment.

What usually lies beyond such criticism of bad practice – but sometimes shines through when recruiters and officials mention that origin countries would like to get something in return for the lost workers – is the question of what this business does to origin countries’ health systems. Only one interviewee, who works for a big German employer, opined that the talk about decent business and fairness only served to rationalize the “modern colonialism” that Germany’s poaching of foreign nurses amounted to. For most middlemen, participating in this market, it is about populating a new niche with lots of need for problem solving, and making it both calculable and honourable through rationalization and legitimation.

Globally speaking, the market for middlemen in international nurse migration will foreseeably keep evolving, and remain ridden with tensions. States keep changing their immigration and emigration regulations, often struggling to reconcile a need for international labour with increasingly harsh and hostile immigration policies, employers keep looking for reliable but affordable workers, and the migrants look for recruiters they trust. Where they bet on the wrong middlemen as recently happened in UK-based proliferation on “dodgy” agencies recruiting care workers under post-Brexit visa schemes, migrants end up in exploitative contracts or with recruiters who can no longer sponsor their visas (Das et al. 2024; Das 2025). Yet notably, governments such as the German or British one also refrain from more binding regulation of recruitment agencies and more systematic inspections. Keeping the middlemen slightly in the shadows keeps the recruitment going without forcing governments to resolve its practical and ethical contradictions.

[1] All interview quotes translated from German.

[2] The Federal Agency of Labour has signed treaties with Bosnia and Herzegovina, the Philippines, Serbia, and Tunisia in 2013 (Serbia has meanwhile suspended its agreement); and in 2021/2 with Brazil, Colombia, Indonesia, Jordan, Kerala (India), and Mexico. For further detail see Hanrieder and Janauschek 2025.

[3] See link: https://www.giz.de/en/workingwithgiz/76712.html

[4] See link: https://www.faire-anwerbung-pflege-deutschland.de/guetegemeinschaft, last checked 21 March 2026.

References

Bärnreuther, Sandra. 2020. Traders of gametes, brokers of values: mediating commercial gamete donations in Delhi. Economy and Society 49:3, 455-473.

Das, Shanti; Kalanaki, Marjan and Zeke Hunter-Green. 2024. ‘Pretty dodgy’: alarm over suspect care agencies granted Home Office licence to act as visa sponsors. The Guardian 3 March, https://www.theguardian.com/society/2024/mar/03/alarm-over-suspect-care-agencies-granted-home-office-licence-to-act-as-visa-sponsors.

Das, Shanti 2025. Flawed UK visa scheme led to ‘horrific’ care worker abuse, says watchdog. The Guardian, 16 March, https://www.theguardian.com/world/2025/mar/16/flawed-uk-visa-scheme-led-to-horrific-care-worker-abuse-says-watchdog.

Hanrieder, Tine and Leon Janauschek. 2025. The ‘ethical recruitment’ of international nurses:
Germany’s liberal health worker extractivism. Review of International Political Economy 32:4, 1164–1188.

Hornberger, Julia and Sarah Hodges. 2023. Fake-talk as concept and method. Medical Anthropology Theory 10:3, 1–22.

Jones, Lee and Shahar Hameiri. 2022. Explaining the failure of global health governance during COVID-19. International Affairs 98:6, 2057–2076.

Masselink, Leah E. and Shoou-Yih Daniel Lee. 2010. Nurses, Inc.: expansion and commercialization of nursing education in the Philippines. Social Science and Medicine 71:1, 166-172.

Merz, Sibille; Hunter, Benjamin J.; Murray, Susan F. and Ramila Bisht. 2024. Market making and the production of nurses for export: a case study of India–UK health worker migration. BMJ Glob Health 9:e014096.

Othman, Mousa. 2023. Gesundheitsfachkräfte aus dem Ausland – Arbeitsumstände. Presentatiomn to Unterausschuss Globale Gesundheit im Deutschen Bundestag Berlin, 22.05.2023. https://www.bundestag.de/resource/blob/949642/ee4639627d6f4ce67b3926f46c3363cd/20_14-1_0040_Mousa-Othman_PPP_Gesundheitsfachkraefte-aus-dem-Ausland-data.pdf.

Pillars of Health. 2022. Country report on health worker migration and mobility in Germany. b3b4063d-pillars-of-health_country-report-on-health-worker-migration-and-mobility_germany.pdf (cstor.eu).

Sirrs, Christopher. 2023. Fluid fakes, contested counterfeits: The World Health Organization’s engagement with fake drugs, 1948–2017. Medicine Anthropology Theory, 10:3, 1-29

Walton-Roberts, Margaret. 2021. Intermediaries and transnational regimes of skill: nursing skills and competencies in the context of international migration. Journal of Ethnic and Migration Studies 47:10, 2323–2340.

Yeates, Nicola and Jane Pillinger. 2019. International health worker migration and recruitment: global governance, politics and policy. London: Routledge.

Based at the University of Zurich as an anthropology lecturer in the early 2000s, I conducted ethnographic research at the WHO and carried out extensive interviews with WHO, pharmaceutical industry, and Interpol stakeholders involved in IMPACT. This allowed me to document how IMPACT operated before its activities were erased from institutional memory. Combined with a deep dive into the WHO online and the Interpol media archives, this material has enabled me to reconstruct the curious, short-lived, yet significant episode in the history of a taskforce.

It all started in 1985 at the seminal WHO conference entitled The Rational Use of Drugs, held in Nairobi. There, the issue of fake medication was mentioned for the first time as a possible concern for the WHO, though more as an afterthought than a top agenda item (WHO 1987). A few years later, the matter was raised again during the 1988 World Health Assembly. Delegates from Hungary worried ‘that in some countries a number of drugs, mainly those arriving by unofficial channels, are counterfeit and substandard,’ and asked ‘How could such drugs ever be used rationally?’ (WHO 1988a, 84-85). Other delegates were easily swayed by the threat to health which such fake drugs presented. They agreed that fake drugs needed to be treated with the same resolve as illicit drugs, namely as a criminal matter if not a security concern. This is how the matter of fake drugs was catapulted from an afterthought into an explicit concern itemized in the WHA41.16 resolution (WHO 1988b). Having taken this palpable shape, it consequently compelled the WHO Secretariat into action.

Yet the Secretariat was aware that neither its staff nor national health inspectors could deal with this alone. The WHO Secretariat’s coordinator of IMPACT, put it in 2011: ‘If you want to investigate where the counterfeits come from and how they come, you need to be doing enforcement work. It is not pharmaceutical inspectors who can do that, [they] don’t have the power.’ This is the moment when the WHO started talking to Interpol, the International Police Organisation (WHO 1992, 4). What started out as an awkward encounter – as there was no precedence for such a collaboration – soon became an enthusiastic union. The WHO conceded that it needed proper executive powers to carry through search, seizures and arrests, and the ability to draw on crime intelligence to confront the global criminal networks that were assumed to be behind fake drugs. They also roped in the pharmaceutical industry, the holder of secrets, urging them to be more munificent in sharing data on their products being faked, even if this might compromise their brand names at times (WHO 1992).

It must be mentioned here that all this happened even though the extent of the threat was utterly unknown and purely anecdotal. A WHO expert recalled that ‘somebody invented the 10% [statistic] just to get interest. He gave it away to journalists. It was one of our colleagues.’ The expert was convinced that it was this invented statistic, that 10% of all medications being consumed are fake, that triggered the next step: the ‘Joint WHO/IFPMA Workshop on Counterfeit Drugs’ where all parties would be forged into a team ready to tackle the circulation of fake drugs. Dr Hu Ching-Li, one of the Assistant Director-Generals of the WHO, closed that conference with a motivational shout-out: ‘If we all work together – industry, WHO, drug regulators, police and customs – we must, and will, succeed.’ Cheered on by national regulatory agencies (WHO1996) this collaboration was firmed up and formalised in 2006 in the so-called Rome Declaration, which served as the founding document for IMPACT.[1]

So convivial was the relationship of the taskforce partners that the WHO made space for it in its Geneva headquarters, even furnishing an office to one of Interpol’s people.[2] Together, members of the WHO Secretariat and the delegate from Interpol planned and executed a whole range of policing operations, including Operation Storm in Southeast Asia; Operation Pangea, focused mainly on Northern countries and internet trade; and, finally, Operation Mamba I, II, and III, a set of operations carried out in East African countries. Each of these operations were proudly brought to the public’s attention through headlines such as “Operation Mamba (Impact) – targeting counterfeit medicines in Tanzania”;[3] “Police across Southeast Asia target counterfeit medicines in multi-agency operation,”[4] or “Illegal online medicine targeted in first internet day of action.”[5] Each of these press releases, showcasing their successes, featured the numbers of arrests and/or quantities of suspicious medications seized. For example, one press release trumpeted: “In Tanzania 191 locations, including pharmacies, warehouses and illicit markets, were inspected resulting in the seizure of 100 types of products. […] Police closed four pharmacies, and 18 drug shops found to be in breach of the law. A total of 44 police cases were opened.”[6]

With the acceleration of IMPACT’s activities, the WHO Secretariat found itself able to respond efficiently to member states’ rapidly growing concerns about fake medications. It also capitalised on the appeal of the taskforce as a form of governance built not on stable institutions but on networks and the ability to connect people and things (Boltanski and Chiapello 2005). Interpol, meanwhile, found that assuming the mantle of protecting public health significantly amplified its moral authority and relevance. The pharmaceutical industry, for its part, could position itself as genuinely invested in the safe consumption of its products. “It is a win-win situation!” exclaimed an Interpol officer based at the WHO (interview with Interpol officer, 2010).

However, as already mentioned, if one were to look now, in 2026, at this episode of collaboration, one would find nothing. The internet archival sources, which 15 years ago abounded with mentions of raids and special operations carried out under the IMPACT’s name, are simply missing. What happened?

By applying the analytic lens of middlemen onto this short-lived three-way marriage of the WHO, the police and the pharmaceutical industry, we can see that IMPACT’s strength was also its weakness. As I will show, one moment it was seen as uniquely bringing together all that was needed to fight fakes – a fight in which the health agenda was paramount, but law-enforcement muscle and industry expertise and secrets were also needed. In the next moment, IMPACT was seen as a henchman to Big Pharma and its commercial interests. 

To understand this, let me lay out before you some of the classic – in the sense of old-style but also enduring – ideas about how to think with the middlemen (as we do in the introduction to this special series). Sidney Mintz (1956), in The Role of the Middleman in the Caribbean Peasant Economy, argues against the widespread disparaging image of middlemen as parasitic. This image assumes that middlemen put themselves opportunistically between producers and customers in order to take a cut of the profits earned by hard-working farmers, with the effect of making goods more expensive for customers. To counter this notion of the middleman, Mintz shows how middlemen provide an essential service. Looking at daily produce market interactions, he shows that middlemen possess specific acumen that helps in bringing products to market and making sure they get sold. This acumen is carefully tailored to the product, be it easily perishable goods, like avocados, which need to be packaged and transported in a certain way and sold within a short period of time, or longer-lasting goods like sugar cane, which can be brought to market when other traders have to leave already to make it home in time. Mintz (1956: 23) makes clear that middlemen are “not economically redundant but actually essential to the distributive process.” Without their special acumen and motivation to read the market and manoeuvre accordingly, the local economy would cease functioning. Farmers would not be able to tend their fields if they had to take their goods to the market themselves, which means that consumers would not be provided with the diversity of goods they require and desire. Like a market middleman, IMPACT connected different actors in a way that served each one’s needs. It brought to the WHO’s health agenda the skill and acumen – executive force, and criminal and industry intelligence – it lacked within its ranks of public health bureaucrats and specialists. And it brought to both Interpol and Big Pharma the veneer of moral action.

Georg Simmel (1908), in a closely related way to Mintz, shows how “the stranger,” epitomised in the role of the traveling trader, equally fills a gap by its very nature of coming from outside. The stranger’s ‘position in this group is determined, essentially, by the fact that he has not belonged to it from the beginning, that he imports qualities into it, which do not and cannot stem from the group itself” (Simmel 1908: 1). Therefore, rather than being seen as a threat, a stranger brings foreign skills and qualities that are seen as an asset. Furthermore, the stranger comes free of any baggage: he has no alliances and biases towards any faction; he is the friend of anyone and no one. This makes him particularly trustworthy, and people tend to seek his advice and judgment (Simmel 1908: 2). This is how IMPACT was treated by the WHO: it brought something new and unique to the table, yet by being its own taskforce, it remained distinct from the WHO. Interpol was especially seen as a ‘stranger’ to the field of public health. They were greeted enthusiastically, with nobody expecting them to have any major stakes themselves in fighting fake drugs beyond what they were meant to do anyway, namely fighting crime. The pharmaceutical industry had been conscripted into the taskforce under the same bearing, to provide intelligence and to fight crime.

However, if we follow the figure of the middleman to its conceptual limits, we find that both the middleman and the stranger share what might be called a thin identity. Their defining trait is their ability to occupy interstitial spaces without fully belonging. This lack of rootedness makes them useful, yet they are also thought of as superfluous and subjected to suspicion. As Mintz (1956) notes, middlemen are often viewed negatively as driven by profit into arrangements where they have no grounds to belong. Similarly, Simmel (1908: 2) observes that the stranger’s freedom to maintain a ‘bird’s-eye view of relationships’ ‘contains many dangerous possibilities,’ for in times of upheaval, outsiders are easily cast as instigators. Not belonging with ‘us’ can quickly be read as belonging with the wrong ‘others.’ Like the optical illusion where a young woman becomes an old woman with a blink of an eye, the very position that enables the middleman or stranger to mediate so effectively becomes the ground for people turning against them, pointing fingers and driving them out.

Being turned from dependable friend into suspicious crook is what happened to IMPACT. In 2008, during the 61st World Health Assembly, IMPACT experienced a dramatic fall from grace. Once seen as a trusted ally, its virtue was suddenly cast into doubt. The WHO and its strategic partnership with law enforcement and the pharmaceutical industry to fight the fight against fake drugs began to appear as corrupt. Critics argued that Big Pharma was not there to advance an agenda of securing access to health but had its own self-interested agenda in the fight against counterfeit drugs: discrediting generics and protecting their competitive advantage by enforcing intellectual property rights. In short, IMPACT was accused of trying to block efforts to improve access to affordable medicines for the poor.

Looking back, observers describe IMPACT’s downfall as a pivotal moment when previously separate issues collided explosively. In one room, the Nigerian delegation and its European and African allies were still advocating for IMPACT’s mission, pushing for an expanded mandate and increased funding (WHO 2008a). Next door, delegates decried the harmful effects of a narrowly defined intellectual property agenda on access to health (WHO 2008b). These concerns were carried across rooms by representatives from Thailand, India and Argentina, with a Brazilian delegate stating plainly: “WHO has a crucial role in promoting health issues, and that should not be mixed with law enforcement measures, which might be interpreted as a means to drive out producers of legitimate generics” (WHO 2008a).

Awareness of the dangers of an Intellectual Property (IP) driven agenda had grown exponentially in the post-Trade-Related Aspects of Intellectual Property (TRIPS) era, amid fierce debates over the interpretation of its flexibilities, including the parallel imports of antiretrovirals (ARV) during public health crises (Cloatre 2013). From this perspective, IMPACT suddenly appeared as a Trojan Horse, allowing Big Pharma to infiltrate WHO’s inner circle and influence policy implementation to their advantage.

With this sudden and momentous twist in the collaboration between the WHO Secretariat, Interpol and the pharmaceutical industry, none of the parties were given a chance to defend themselves. No matter how much those invested in creating IMPACT tried to distinguish between interests, urgencies and motivations, their efforts failed. From the start, IMPACT had been an interstitial, subsidiary outsider – like most middlemen, it was never seen as having its own rationale or identity. The narrative allowed only two interpretations: either IMPACT served WHO’s lofty agenda or it served Big Pharma’s.

Led by the Brazilian and Indian health missions in Geneva, vocal critics successfully argued that WHO’s very raison d’être was at stake. They insisted that IMPACT – and with it, WHO’s collaboration with police and drugmakers – must be abandoned immediately. Rejecting any compromise, they even managed to fracture the coalition of African countries who feared losing out if police and pharma withdrew their attention from combating fake medicines.[7]

In the end, history was rewritten. In 2012, a new resolution was passed that made no mention of the previous activities or resolutions on which IMPACT had been founded. As if starting from day one, this resolution established an entirely new process: the Member State Mechanism (MSM). Its activities – ‘information exchange,’ ‘technical support,’ and ‘norm setting’ (WHO 2012) – were the soft tools a health institution could offer to combat fake medicines; no longer was there any mention of the law enforcement power of the police or the insider knowledge of the pharmaceutical industry.

With this shift, the drug-security rationale – which conceived of fake medication as the product of organised crime and criminal intent – was replaced by a drug-safety rationale. This approach assumed that fake drugs could be outcompeted by affordable generics and that their existence was driven by ignorance rather than malice. Consequently, soft regulatory measures were seen as sufficient to transform bad practices into best practices (Hornberger 2018). It was as if the whole concern that produced IMPACT had been nothing more than crying wolf. And perhaps it was, given that the scale of the fake medicine problem had always rested on shaky evidence and invented numbers, especially the infamous ‘magic 10%.’[8]

Ultimately, what we see here is that IMPACT’s position as an interstitial middleman was precisely what made it so attractive. It filled a gap that no one else could, tackling a problem – real or imagined – with a unique acumen at a time when fake medicines were framed as a major criminal threat. Yet, sitting at the intersection of competing agendas and working styles also made IMPACT vulnerable to accusations of partisan bias. In the blink of an eye, its mission of protecting access to health could be reinterpreted as serving other interests. Its lack of a clear identity meant it could not distinguish itself from the agendas surrounding it. And being a middleman also meant having no independent significance beyond its ‘betwixt and between’ position. Once support faded and the WHO was asked, in no uncertain terms, to disavow its former attraction, IMPACT’s historical record – by then an embarrassment for WHO – could simply be erased (WHO 2012).

What remains, then, is a remarkable absence. The ease with which WHO’s collaboration with the taskforce was erased from the record belies the impact of IMPACT, the effects of the middleman that unfurled, despite its nondescript identity. Before its fall from grace, IMPACT, as WHO’s fixer, had given form and substance to the figure of fake drugs through forceful interventions, publicity campaigns, guidelines, partnerships and a stream of memos and charters (IMPACT 2011). It framed fake medicines as a criminal matter and, more importantly, as an urgent threat to health.

This figure, once brought to life, does not simply fade away – quite the opposite. Unlike the middleman, whose identity is fragile and easily erased, the figure of fake drugs thrives on its overdetermined identity. It persists without evidence, traveling from context to context, carrying its sense of urgency into new arenas, and compelling further action (Hornberger and Hodges 2023).

And indeed, that is exactly what happened: the figure of fake drugs has been traveling widely and effectively ever since. Once cut loose from its womb at the WHO – where it had been imbued with the authentic force to evoke a health threat – it was free to roam and be adopted. One of its keen adopters was the police. Interpol, having been part of IMPACT, had learned how attractive it was to fight fakes in the name of protecting public health. For policing, which is often in crisis, such moral high ground is rare. Unsurprisingly, they had little desire to relinquish this newfound mission. Instead, they established their own Illicit Goods and Public Health program.[9]

Freed from WHO’s watchful eye, Interpol could partner with whomever it chose in its self-defined fight against fake drugs. And they chose not only the pharmaceutical industry but the entire brand-based industry, who were also eager to enlist police support. The industry’s goal was not merely to have intellectual property rights enshrined in international and national legislation, but to ensure states actively enforced these rights through local police and prosecutors (Hornberger 2024). Here, the specter of fake drugs – evoking visceral fears of patients being killed by the very medicines meant to cure them – conveniently provided urgency and legitimacy for cracking down on all forms of counterfeiting (Hornberger and Hodges 2024). This leaves us with an important insight about the role of middlemen in global health: while middlemen often remain invisible, or their traces are easily effaced, what they leave behind and what they set into motion can be momentous. Looking back, we are left wondering not only where these shifts originated but how their logic continues to shape alliances, agendas and enforcement practices long after the middleman has disappeared.

[1] See link (no longer accessible) at “Declaration of Rome” www.interpol.int/public/ICPO/speeches/SGWipo20070.

[2]  See link (no longer accessible) at http://www.interpol.int/Public/ICPO/GeneralAssembly/AGN7.

[3]  See link (no longer accessible) at “Operation Mamba (Impact) – targeting counterfeit medicines in Tanzania,” Interpol, www.interpol.int/public/news/2008/mamba20081029.asp

[4] See link at (no longer accessible) “Police across Southeast Asia target counterfeit medicines in multi-agency operation,” Interpol, www.interpol.int/public/icpo/pressreleases/pr2008/pr200865.asp

[5] See link at (no longer accessible) “Illegal online medicine targeted in first internet day of action,” Interpol, http://portal.interpol.int:1967/public/icpo/pressreleases/pr2008/pr200863.asp

[6] [6]  See link (no longer accessible) at “Operation Mamba (Impact) – targeting counterfeit medicines in Tanzania,” Interpol, www.interpol.int/public/news/2008/mamba20081029.asp

[7] Interview with Interpol official, June 2012.

[8] Interview with WHO expert, January 2011.

[9] See link at “Illicit Good and Global Health,” Interpol, www.interpol.int/content/download/5263/file/Illicit%2520goods%2520and%2520global%2520health.pdf.

References

Boltanski, Luc, and Ève Chiapello. 2005. The New Spirit of Capitalism. Translated by Gregory Elliott. London: Verso.

Cloatre, Emilie. 2013. Pills for the Poorest. An exploration of TRIPS and access to medicines in sub-Saharan Africa. London: Palgrave Macmillian.

Hornberger, Julia and Sarah Hodges. 2024. ‘Policing Fakes.’ The Cambridge Journal of Anthropology 42 (2): 1-14. https://doi.org/10.3167/cja.2024.420202.

Hornberger. Julia. 2024. ‘The gospel of fakes: policing, intellectual property conferences and the problem of persuasion.’ The Cambridge Journal of Anthropology 42 (2): 15-30. https://doi:10.3167/cja.2024.420203.

Hornberger, Julia and Sarah Hodges. 2023. ‘Fake Talk as Concept and Method.’ Medicine Anthropology Theory. 10 (3):1-22. https://www.medanthrotheory.org/mat/article/view/7291.

Hornberger, Julia. 2018. ‘From Drug Safety to Drug Security: A Contemporary Shift in the Policing of Health.’ Medical Anthropology Quarterly 32 (3): 365–83. https://doi.org/10.1111/maq.12432.

Impact. 2011. ‘IMPACT. Facts, Activities, Documents Developed by the Assembly and the Working Groups 2006-2010’. Rome: Italian Medicine Agency.

Mintz, Sidney. 1956. ‘The Role of the Middleman in the Internal Distribution System of Caribbean Peasant Economy’. Human Organization 15(2): 18-23. https://doi.org/10.17730/humo.15.2.x5k4022515r6068u.

World Health Organisation. 1987‎. The Rational Use of Drugs: Report of the Conference of Experts, Nairobi, 25–29 November 1985. Geneva: WHO.

World Health Organisation. 1988a. Summary Records of the Committees. WHA41/1988/REC/3. Geneva: WHO.

World Health Organisation. 1988b. World Health Assembly Resolution WHA41.16, “Rational Use of Drugs. Geneva: WHO.

World Health Organisation Division of Drug Management and Policies. 1992. Counterfeit Drugs. Report of a WHO/IFPMA Workshop, 1-3 April 1992. WHO/DMP/CFD/92. Geneva: WHO.

World Health Organisation.1996. Proceedings of the Eighth International Conference on Drug Regulatory Authorities (ICDRA), Bahrain, 10-12 November. WHO/DMP/ICDRA/1997.1. Geneva: WHO. https://iris.who.int/handle/10665/69794.

World Health Organisation. 2008a. Summary Records of Committees. A61/2008/REC3, WHA 61, Geneva 19-24 May. Geneva: WHO.

World Health Organisation. 2008b. Report of the Intergovernmental Working Group on Public Health and Intellectual Property (PHIIP), A61/9. Geneva: WHO.

World Health Organisation. 2012. Sixty-Fifth World Health Assembly Geneva, 21–26 May 2012, Resolutions and Decisions, Annexes, WHA65/20212/REC/1. Geneva: WHO.

Simmel, George. 1908. ‘Der Fremde’. In Soziologie: Untersuchungen über die Formen der Vergesellschaftung. Leipzig: Duncker & Humblot.

I’m walking through Mwenge, one of Dar es Salaam’s central business districts. I’ve been spending time here with Hassan, a petty cosmetics trader, who carries his goods in a suitcase as he makes his daily tour of the market. We’ve been walking a while and Hassan suggests that we stop by at his favourite salon, Lina’s Beauty Salon. He says:

“Lina is my friend, so she always tells me what new products her customers like. Sometimes she lets me rest in her salon. So, I sit and listen; I then go and buy the products and then sell them here.”

When we arrive at Lina’s, we meet Mikidadi, another petty cosmetics trader, taking a break from his long tour of the market. We start talking about Mwenge, and their experience with customers and products. I ask them whether product quality or the possibility of fake cosmetic products is ever a concern for their customers?  Mikidadi explains:

“If I can use this lipstick for example, and my lips aren’t burning, then the women trust me.  So, I take the lipstick out from the package, and I apply it on my lips, and I say, ‘See, nothing is happening!’ I make my customers feel comfortable, and if they’re comfortable, they’ll come buy from me again, knowing that my products are OG [original].”

For “suitcase traders” like Hassan and Mikidadi, turning public spaces into market opportunities, whether through chance encounters with a passer-by or in beauty salons, is part of their daily routine. The suitcase trader, who is the middleman in this article, forms a subcategory of what is known as wamachinga. Wamachinga are mobile street hawkers or petty traders, often migrants who have come from villages into Tanzania’s capital city of Dar es Salaam (Rizzo, 2011).

What is interesting about the suitcase trader is that, unlike other wamachinga who sell shoes, cloth, mobile chargers, or even food from stalls, suitcase traders circulate through streets and salons, carrying their products in hand luggage. This mode of selling allows them to occupy the market differently from more regulated traders, moving across and along its boundaries rather than remaining fixed within them. This article examines the relationship between fakes and middlemen to understand how claims about fake products are identified, but more importantly, how they are mitigated.

In Mwenge market, considerable uncertainty surrounds the circulation of fake products. While some may indeed pose risks according to global health standards (Cockburn et al. 2005, 302), they remain widely purchased. This reflects not only consumer demand but also the appeal of these goods as a means of accessing global commodities. Here, “fakes” encompass both counterfeit branded products, such as imitation MAC lipstick, and unregulated or illegal products.

The key to understanding suitcase traders operating in this environment of uncertainty lies not in asking whether the products they sell are fake or harmful, but in examining how they negotiate and manage suspicion around fakes. Such focus shifts away from fixing the question of whether a product is fake or not, as seen in many global discourses (Mwai 2020; World Health Organization 2024; Sirrs 2023; Buowari 2012), and toward the everyday practices through which suspicion and the perceived threat of counterfeit cosmetics are handled. In this way we are able to think critically of the role of middleman within global health discourses.

I argue that the figure of the “suitcase trader” of the Mwenge cosmetics market reveals forms of concern about fake products that are distinct from those articulated by public health officials. My analysis of these traders shows how these middlemen work to negotiate, mitigate and respond to consumers’ concerns about fakes. As set out in the introduction to this series, middleman with little formal training can still speak confidently on matters of health. They place themselves at important points where people, goods and ideas move (see Hodges, Hornberger and Thakur 2026, introduction to this series).

In the case of suitcase traders, it is their mobility which they use to powerfully disperse the suspicion that their products might be fake. They stage on-the-spot embodied performances of flirting, joking and singing that draw female customers into a playful, exaggerated sense of being desired. At the same time, the suitcase itself, as a symbol of distant travel, evokes access to desirable goods from abroad, reinforcing the seductive appeal while subtly deflecting attention from broader associations between cross-border circulation and the influx of fakes (Skeggs 2013).

Global public health concerns about fake cosmetics

Within global health research, much of the literature attempts to fix the ontology of the “fake”. Central questions include: Where do fakes come from? How do we determine what is fake or not? Interpol defines pharmaceutical crime as a major global public health concern, and the trade of counterfeit and illicit medical products as a “global criminal phenomenon” affecting all countries around the world.[1] Similarly, the World Health Organization (WHO) uses the slogan “counterfeit drugs kill” in their anti-counterfeiting campaigns (Seiter 2009).

Counterfeit medicines and products are a global public health concern. Public health narratives often emphasize the risks consumers face from unknowingly using fake drugs or products. Cosmetics are frequently highlighted in these discussions as examples of the health dangers posed by counterfeits. In Tanzania, fake cosmetics, especially skin-lightening products, feature prominently in debates about health risks (Karungamye 2023; Lewis et al. 2011; Mori, Meena and Kaale 2018; WHO 2024).

Skin lightening products, despite being banned in the country, can be found in many drugstores and cosmetics stores (Mori, Meena and Kaale, 2018). As a result, regulatory agencies such as Tanzania Bureau of Standards (TBS) and Tanzania Medicines and Medical Devices Authority (TMDA) have focused on cracking down on these products.[2] Perhaps it is their illegality that makes them “fake,” or perhaps it is simply easier to police fake cosmetics than medication. Skin lightening products, because of their outwardly visible effect on the body, become the prime example of the dangers of fake products on the human body (Dadzie and Petit 2009; Parvez et al. 2006). Moreover, because cosmetics are applied directly to the body, they are often considered close to medical products, at least in popular understanding, even if experts classify them differently. For consumers, cosmetics are strongly tied to the body, to health and achieving a “healthy appearance”.

Despite these grey areas between products and their effects, the counterfeit literature largely prioritizes risk and harm (WHO 2024) and assumes that it is necessary to clearly distinguish fake products from genuine ones. I argue instead that these blurred boundaries enable multiple meanings and understandings of fakes to emerge. The suitcase trader complicates conventional definitions of what counts as “fake,” prompting questions about what fake products mean to consumers, what they do for and to consumers, and how ideas of authenticity and fakeness are produced and negotiated in everyday life.

This is very much helped by the fluid identity and mobility of middlemen themselves.  They are not defined by a fixed identity but by relationships. They move in between spaces and roles. From these relationships, certain characteristics and possibilities emerge. Furthermore, what makes them middlemen in global health is that they work with issues that matter to global health (see Hodges, Hornberger & Thakur 2026, introduction to this series).

In this section, I have analysed the broader contexts of “fakes” in global public health literature. In the following section, I will examine the markets in Tanzania and the regulation of “fake” cosmetics within these markets.

Understanding Mwenge Market and the regulation of cosmetic products in Tanzania

Mwenge Market exemplifies Tanzania’s traditional local markets, where traders operate both wholesale and retail businesses. The market hosts a diverse range of goods and services, including food, electronics, clothing, cosmetics, beauty parlours, spas and barbershops. Because many businesses operate informally or in hard-to-find locations, traders often depend on strong customer relationships to attract sales. This is especially true for suitcase traders, who actively cultivate these connections.

The market also demonstrates the close interaction between formal and informal trade, as registered stalls and petty traders share the same space. As shown in Figure 1, Hassan walks through the market with his suitcase alongside formal clothing stores and potential customers. When asked about challenges, Hassan emphasized a shared understanding among traders: “You’d think that there’d be so much competition between the registered traders versus us but honestly, we’re all just trying to make a living.”

This interconnectedness may also stem from shared experiences with police and regulatory bodies such as TMDA and TBS, which monitor the market for counterfeit cosmetic products. Like in many cities, petty traders are often associated with illegality and informality and are frequently portrayed as unwanted actors in the urban economy (Bhowmik 2010).

For example, Juma, a suitcase trader in the market, explained that from time to time the traders are harassed by police officers who ask them for money. He says, “Of course, they [police officers] try to take money from us. We know each other, though. It’s always the same ones stopping you. One time this officer asked me if I paid taxes for the products I’m selling. Why do I have to pay taxes? The person I bought the products from already did that, so it’s not my problem. I told her that and she let me go, only after I gave her money for a soda.”

The TMDA, formally the Tanzania Food and Drugs Authority (TFDA), was established in 2003 under the Ministry of Health to regulate the safety, quality and efficacy of food, medicines, cosmetics and medical devices.[3] During independence, various agencies were set up to regulate medicines in the country under the 1978 Pharmaceuticals and Poisons Act No. 9 (United Republic of Tanzania, 1978). However, the Pharmacy Board was not mandated to regulate cosmetics and medical devices. These products were neither registered by the Board nor regulated by any entity. However, with economic, social and technological changes, and the government’s implementation of free market policies, regulating cosmetics and medical devices became important and, as a result, there was a need to bring product control functions under one institution to meet the new challenges of the free market. TFDA became TMDA in 2019 and, after a shift of responsibilities, TBS became responsible for regulating food and cosmetics.[4]

Although responsibilities have shifted from TMDA to TBS, both agencies continue to police the market for what they classify as “unfit” products, including expired, damaged, adulterated, improperly stored or labelled, and counterfeit goods (TMDA 2015, 4). In 2021, TMDA confiscated fake beauty products worth about sh27 million (about $10,000) from La Happy Cosmetics in Mwanza, seizing 77 types of cosmetics and urging traders and consumers to avoid such goods (The Citizen 2021). Similarly, in 2023, TBS seized fake beauty products and medicines worth sh21 million from markets in Dodoma, Singida and Tabora.[5]  

Overall, Mwenge market shows how formal and informal trade exist side by side in Tanzania. Suitcase traders navigate these spaces through personal relationships while managing suspicion that is placed on their informality by police and regulatory agencies like TMDA and TBS. By focusing on their customers and emphasizing the quality of their goods, suitcase traders actively shape and respond to perceptions of authenticity and fakeness, often making concerns about fake cosmetics a non-issue in practice.

Performing Desire

Using Hornberger and Hodges’s (2023) concept of “fake talk,” I analyse how suitcase traders use performance of trust and authenticity to ease concerns about fake cosmetics and public health risks.  The concept of fake talk highlights that claims of fakeness can be understood for what they do in various social spaces. The power of fake talk is not in its evidence but in how it can bring resolution to the lack of evidence (Hornberger and Hodges 2023). In this case, it can resolve customers’ concerns about the threat of fake cosmetics.

Hassan, my host in Mwenge Market, guided me through the market during his daily rounds, demonstrating deep familiarity developed over years of work. During fieldwork with him and other traders, I also observed how they engaged with customers and strategically navigated concerns about fake products. Hassan emphasized that success in Mwenge depends on understanding customers, building trust, and knowing which products are in demand. As he explained, although traders often sell similar goods, “what differentiates you from other traders is your relationship with the customer. You must know how to impress women.”

When Hassan told me this, it confirmed for me what I had already observed: suitcase traders would often flirt with their customers by complimenting them or singing to them. For example, Hassan would call his customers “mpenzi” (my love)  or “shemeji” (sister-in-law).[6] Similarly, Juma would call his customers “mchumba” (fiancée) or compliment them on their smile and call them beautiful. In another instance, I passed a suitcase trader in a salon, singing as he was showcasing his products: “Nampenda, msichana mmoja, mweupe kidogo, mweusi kidogo” (I love her, love her, this woman. She’s a little light skinned, a little dark skinned).

At first, I didn’t think much of it because this often happens to women. It was only when Hassan pointed out that he purposely flirts with women because he believes that it is the only way he gets his customers to buy his products, that I realized this was a way for traders to form relationships with their customer base and gain their trust, a sort of performance to attract more customers. Hassan said:

“All women like to be complimented and made to feel beautiful. The only reason why she’s buying something from me is because she doesn’t feel beautiful. So, I make her feel beautiful, it always works.”

Mikidadi, another trader, when explaining to me why there are more male suitcase traders than women, said: “Women don’t want to be complimented by other women. I know the products and she can trust me when I tell her that she’ll look beautiful. Another woman could be jealous of her and lie to her. It’s easy with me.”

These traders’ performances were highly gendered. They believed that when they positioned themselves as men who knew what their female customers wanted, in this case being desired and complimented, they would gain their customers’ trust. For them, treating each customer like their girlfriend or wife, courting them, meant that they would be able to make a sale. By flirting with the customers, the traders believed that they could determine the kind of products that are popular with the customers and at the same time create relationships that enable them to continue selling their products, as in the case of Mikidadi putting on lipstick to prove authenticity.

Observing the women in the interactions, I noticed that some of them reacted rather irritated. But most of them played along: not because they actually fell for the trader, but perhaps because there was something rather theatrical and exaggerated about the trader’s advances. It turned the encounter from a form of harassment into a form of play, which woman did not mind and which often made them laugh and give the trader a chance.

Quality and authenticity were also performed through the act of selling the products in carry-on suitcases. This suitcase was an important prompt in this performance of desire and desirability. It evoked the fantasy of international travel and trade. The suitcases that these traders carry are compact carry-on bags, carefully filled with a wide array of goods. Their small size allows everything to be displayed at once, making the cosmetic products immediately visible to potential customers.

According to the traders, the products were deemed sellable if they were internationally branded or expensive, and selling products in carry-on bags provided that illusion. Mikidadi explained the difference:

“Women want products that come from abroad. I think it makes them feel like they’re getting something of high value. When we sell products that are written in Swahili, no one buys them. Sometimes, I sell a product knowing that it is made here [in Tanzania], but as long as it’s written in English or French, women buy.”

The traders also explained that this is the reason why they sell the products in carry-on suitcases. Juma explained:

“Before, we used to sell our products by hand, but quickly we realized that selling like that, women don’t buy. They want to see something of quality. Quality things come in the right packaging. When we sell our products in the suitcase, it’s like we went to China and Kenya to get the products ourselves.”

For suitcase traders, the suitcase helped create the impression that their goods came from abroad. Because locally manufactured products were often associated with low quality or fake goods, traders used this image of international trade to reassure customers. The suitcase itself served as a visible marker of authenticity, even though customers did not necessarily believe the products were truly imported. What made these traders persuasive was not the truth of their claims but how they performed them. Through flirting, compliments and suggestions of foreign origin, they worked to mitigate concerns about fake cosmetics and build trust in their products

Conclusion

By exploring the relationship between suitcase traders and their customers, my analysis uncovered how these traders work to negotiate, mitigate and respond to consumers’ concerns about fakes. Suitcase traders succeed by developing a deep, experience-based understanding of Mwenge market, the products and their customers. They recognize that customers are drawn to imported goods for their perceived quality and status, but also worry about risks like fake products. They also understand the complexities of determining what is fake and what is not. 

Using this insight, traders position their goods as both desirable and trustworthy. They draw on diverse forms of knowledge, including contemporary beauty ideals, historical and social constructions of beauty, economic dimensions of consumption, and global health discourses concerning product safety and counterfeit goods. In doing so, they appeal to women’s aspirations about beauty while reassuring them about safety.

By highlighting the role of suitcase traders as trusted middleman, this study challenges dominant global health narratives that frame informal traders and markets as inherently risky, instead revealing how trust, authenticity and knowledge around health are actively produced within them. It further shows that global health is not only governed by institutions and policies, but is also shaped through everyday practices of exchange, negotiation, persuasion, adaptation and performance, as well as the relationships that sustain them.

[1] https://www.interpol.int/en/Crimes/Illicit-goods/Pharmaceutical-crime-operations

[2] https://www.thecitizen.co.tz/tanzania/oped/let-us-crack-down-on-these-fake-cosmetics-2530316

[3] https://www.tmda.go.tz/pages/tfda-profile

[4] https://www.tmda.go.tz/uploads/publications/en1546244565-10%20Years%20Book%20english-2.pdf

[5] https://fullshangweblog.co.tz/2023/12/09/tbs-yateketeza-chakula-na-vipodozi-feki-zenye-thamani-ya-zaidi-milioni-21-8/

[6] “Shemeji” can refer to a brother-in-law, sister-in-law, or any close friend of a spouse.

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Cultural Anthropology

Out of Time? Chronocracy and Ageism in Brexit–COVID-19 England

Cathrine Degnen

Generation or relative age is a common way humans define social difference. In Europe and North America, old age is frequently perceived as a period of decline and loss, a condition “successful aging” paradigms exhort individuals to avoid for as long as possible. Explicit and implicit ageist beliefs, discourses, and practices marginalize later life, portraying it as undesirable and inferior. This essay explores how imagined generational relationships with time—younger people as future facing, older people as out of time—enrol linear, future-oriented temporal perspectives in reproducing ageism. The aftermath of the Brexit referendum, followed closely by the COVID-19 pandemic, serve as my ethnographic examples. These two extraordinary events permit me to highlight how chronocracy (Kirtsoglou and Simpson 2020)—that is, the denial of coevalness or coexistence in time through everyday temporal regimes—reinforces unequal power dynamics, and to explore how generational groups are differently valued in contemporary England.

Act Blur, Live Longer: Muslim Artists Blurring the Categories of Singapore’s Smart City

James McGrail

In 2024, Singapore was again named “Smartest City in Asia,” a position achieved through the strategic deployment of surveillance infrastructures and technocratic governance. This article explores the practices of three Muslim artists whose work challenges the limiting categorizations produced by the intertwined logics of Smart Nation governance and state racialization. Based on fieldwork conducted since 2022, I argue that by offering their work plausible deniability through the strategy of “blurring,” these artists operate in the highly surveilled context of Singapore by being unclear publicly. This not just marks a strategy of evasion. By engaging with the anthropologies of Islam and surveillance, I argue that these artworks disrupt established categories, revealing the inherent complexities of identity obscured by technological efficiency and racial categories. Through these works, which go beyond the visible, these artists create space to imagine something otherwise by complicating the neat categorization of the Singapore state. 

Poisonous Images: Taranto’s Environmental Crisis between the Visible and the Invisible

Jasmine Clotilde Pisapia

This article explores poisonous images—images that both register and trouble the visibility of toxicity in Taranto, Italy, one of Europe’s most polluted cities due to the continent’s largest steel factory. Centered on photographs taken in the city’s contaminated cemetery, the essay asks how slow violence can be apprehended ethnographically when pollution remains unevenly perceptible and causally elusive. I argue that the photographic image, beyond its forensic or legal promise, functions as an ethnographic hinge between matter and meaning, visibility and refusal, foregrounding aesthetics as a political as much as a sensory problem. Through three photographic acts produced by cemetery workers, a local performance artist, and myself (as anthropologist), the article proposes “flickering” as an anthropological method—attuned to the intermittence between visible/invisible, absence/presence, and the oscillation of death in everyday life. These poisonous images do not stabilize evidence: they pulse in and out of consciousness, capturing uncertainty and unequally distributed exposures and sensibilities. The cemetery emerges as both site and figure for grasping the metamorphosis of death amid the environmental crisis, where mourning and inheritance remain perpetually unsettled.

The Traffic in Repairmen and a Case of Gender Impropriety in Post-War Sarajevo

Halide Velioğlu

In postwar Sarajevo, repair is mainly a masculine activity, and people lean on communal networks to get things fixed under dire economic circumstances. Yet increased numbers of women without men in their households as an effect of the war necessitate the mediation of other women in facilitating access to men’s labor. Women of social capital who have access to men gain prestige by proffering male repair services. Examining the case of a gender-nonconforming woman provides rich insight into the pivotal role that “gender propriety” plays in establishing systems of daily care, normalcy, and social order in Bosnia. The mundane gendered work of repairing broken things ultimately depends on cultivating, sustaining, and sometimes recalibrating relationships among women.

“To hell with symbols!”: Men, Pigeons, and the Violence of Interpretation

Robbie Peters

This article examines men who race pigeons in the back alleys of an Indonesian neighborhood amid government crackdowns on gambling. It introduces the equivocal pigeon: a bird these men present as a-symbolic, or incapable of saying things for or about them. The equivocal pigeon is an intellectually provocative animal that upsets commonsense ideas about birds and men and meaning and turns the city inside out by bringing its back alleys into view but not into understanding. The article shows how racing pigeons achieve this feat by drawing men into busy alleys while shrouding them in a thicket of opaque interactions. It views the city from its alleys, where the pigeon confounds postcolonial ways of knowing and governing people. Building on Javanese ways of not knowing, it shows how the pigeon is a meaning-defying animal that protects men from what they call the violence of interpretation (kekerasan interpretasi).

Wounds in Utopia: The Politics of Gay Football in 4T Mexico

Max D. López Toledano

LGBT+ football teams have proliferated in Mexico in recent years, allowing communities who previously struggled with feeling at the margins of the nation to make new claims to respectability and national belonging. At the same time, these have developed surprising alliances with political parties, blurring in some cases the relationships of partisan representation that Mexican electoral politics are built on. These patterns, I contend, have been largely enabled by the sociopolitical transformations of Mexico’s 4T movement, which has instilled a climate of change surrounding cultural hierarchies of gender and sexuality. In this context, emergent fractures within queer groups have shed light on the contradictions of “Mexican humanism,” Mexico’s newly coined political philosophy. Exhibiting the characteristics of a human security regime, Mexico’s 4T acts as backdrop to a broader array of political paradoxes that accompany the country’s gay football scene—a space of “wounds in utopia,” where wounds, healing, and violence may all coexist. 

Alienating “Dead Capital,” Eating Moral Principle: Patriarchal Obligation, Land Sale, and Desires of Abandon on Kenya’s Urban Frontier

Peter Lockwood

North of Nairobi, the city’s sprawl enters a landscape of impoverished smallholders, causing land prices to skyrocket. Kenya’s economic commentators urge these part-time proletarians to sell their land—deemed unproductive “dead capital”—as an antidote for rural poverty. Senior men from the region insist this ancestral land cannot be sold, because retaining it while working for wages constitutes the cornerstone of masculine personhood. However, in a world of peri-urban destitution, where wages cannot provision desires for middle-class lifestyles, masculine principles of land retention are being abandoned for experiences of abandon. Male landowners alienate family land to fund lifestyles of conspicuous consumption, especially in alcohol. The consumption of dead capital to furnish desires of abandon suggests that Nairobi’s urban expansion is made possible by such binge economies of land on its peri-urban peripheries. The conclusion proposes consumption as a theory of changing moral orientations to the short term when people encounter economic dead ends. 

Hierarchical Precarity: Dance Hosting, Labor Struggles, and Masculine Insecurities in China

Juan Chen

Young Chinese male migrant workers partner with middle-aged women in dance halls, and sell intimacy and romantic relationships in everyday locations as “dance hosts.” Dance hosts experience considerable job precarity and masculine insecurities. While frequently expressing a desire to leave, most hosts remain in the profession and perpetuate their precarious existence. This article explores the relationship between precarity as a labor condition and precarity as an ontological experience among dance hosts. I argue that while precarious labor may stabilize daily living, it also causes new insecurities that destabilize people’s lives. This article theorizes the concept of hierarchical precarity to explain labor motivation and suggests that the decision to engage in precarious labor hinges on its capacity to address one’s most pressing insecurities, outweighing the additional precarity it creates. I conclude by highlighting how gender relates to different forms of labor struggle and workers’ agency in navigating the hierarchically ranked precarity and masculinities. 

Bitter Sweetness: Compelling Greenhouse Farming and the Inter-Mobility among Middle-Aged Farmers in North China

Yue Liao

This article examines how middle-aged Chinese farmers navigate their position between a highly mobile new urban elite and the traditionally immobile elderly peasantry through a set of practices I term inter-mobility. Based on ethnographic research in Huanglu village, I explore how their adoption of new greenhouse technologies is shaped by both the shifting political-economic landscape of post-socialist China and their desire to align kin-based solidarities with emerging values of progress. I argue that these farmers use greenhouse farming to cultivate a strategic, in-between position, distinguishing themselves from the perceived stasis of the older generation while upholding familial commitments, unlike the perceived rootlessness of younger urban entrepreneurs. This inter-mobility is animated by an ethos of yongxin, which frames their entrepreneurial risk-taking as a form of intergenerational care. The study highlights how China’s broader societal transformations generate not just new agricultural technologies but also new subjectivities within its stratified mobility regimes.

Recalling the Suicide: Affective Storytelling and the Ethics of “Good” Womanhood

Anjali Krishan

Drawing on ethnographic research conducted in Delhi, this article examines middle-class married women’s stories about the suicides of their female neighbors. Paying attention to “what moves” women emotionally and “what matters” to them in recounting their stories of life and willful death, these stories are ethical commentaries on what constitutes “good” womanhood, specifically “Hindu” womanhood. Anthropological scholarship in South Asia has established that supposedly good womanhood hinges on how successful middle-class women are in pursuing a modern, globalized “good life” while being rooted in traditional, predominantly Hindu, cultural norms and values. This analysis of suicide storytelling demonstrates that women are not passive subjects of this binary; instead, they actively adjudicate the ethical validity of mainstream constructs of good Hindu womanhood, in the process questioning middle-class understandings of what constitutes a life worth living and whose suffering matters. Such ethical questioning allows the narrators to make political claims for recognition and rights while performing a subtle critique of the prevailing gender politics within Modi’s India.

Rust and Reparations: Memory, Labor, and the Politics of Repair in Senegal’s Railway Workshop

Charline Kopf

This essay examines the multivalences of repair in Senegalese railway workshops, where workers maintain and modify aging wagons from suburban and former transnational rail services, originally imported from France, and later from India and Pakistan. I trace three interrelated dimensions of repair. First, I show how repair operates as both replacement and improvisation, challenging the assumption that maintenance necessarily counteracts decay; instead, it can accelerate deterioration. Second, I analyze repair as reappropriation, focusing on workers’ “tropicalization” of foreign technologies to fit local conditions. Finally, I explore how the inevitability of failure, stemming from the machines’ inherent faults, demands creative mending and continuous perseverance. These practices generate not only new objects assembled from scrap but also narratives of West African railway workers whose engineering contributions have long been marginalized in colonial and postcolonial histories. Material patching thus becomes an act of reparation, asserting technical authorship and forging alternative histories of infrastructure, labor, and expertise. 

East Asian Science, Technology and Society: An International Journal

Welcome toトピアTopia!

Erika Szymanski, Koichi Mikami & Jane Calvert

We have written the introduction to this special issue on responsible research and innovation (RRI) in the UK and Japan as a visitor’s guide to an imaginary island holiday park to emphasize how we have centered the situatedness of practices that contribute to responsibility in science and technology. Our overarching argument is that RRI cannot be discussed as a program without foregrounding its location, and that RRI therefore needs “alternative practices”—heuristics that inspire adaptation in context—above “best practices” that might be exported from historic centers of investment to historically marginalized peripheries. We have also gravitated to experiment and play as strategies to find more space for intellectually rich, personally satisfying, and collectively enjoyable work amid pressures for STS researchers to take on rote service work under RRI mandates. We welcome you to the place—トピアtopia—that our collaboration has built and invite you to travel with us through the alternative practices we have sketched out here.

Histories of Scientific Responsibility in Japan and the United Kingdom

Yuko Fujigaki, Ryuma Shineha, Robert D. J. Smith & Steve Sturdy

We historicize talk of social responsibility in relation to science and technology. By charting the multiple and contested notions of responsibility that scientists have espoused from the early twentieth century to the present, we show how scientists have used the word strategically, at different times and in different contexts, to project their preferred views of how science should relate to wider society. Comparing Japan and the UK enables us to highlight both the context-specific meanings that scientists have associated with responsibility, and the way that such meanings have come into conversation with one another. By so doing, it also helps us think about the purpose and implications of current and emerging configurations of “responsible” research and innovation—including how those configurations may shield scientists from certain kinds of responsibility while embracing others.

The Rise of Public Engagement in Japan and the UK: Reconsidering Conventional Narratives through a Cross-country Dialogue

Koichi Mikami, Erika Szymanski, Jusaku Minari, Robert Smith & Niki Vermeulen

This paper juxtaposes major historical developments in public engagement in Japan and the UK to unsettle the idea that the UK experience of how “publics” have been accounted for in science policy might be taken as a common or representative story. In comparison to the UK and European moves “from deficit to dialogue,” recent events in Japan are much less well-known internationally, and do not follow the same pattern. Rather than being either “ahead” or “behind,” Japan’s experience has connected similar concepts or approaches in different ways. We highlight these contrasts to challenge and open up dominant Western narratives, to create space for considering how movements for public engagement with science—or what has been called “the participatory turn”—may unfold in different ways across different contexts. Simultaneously, we point to idiosyncrasies in the UK experience that may not always be observed as such. In so doing, we demonstrate that connections—or, as it may be, the absence of connections—between public engagement, science policy, and social responsibility cannot be taken for granted and must be addressed in specific contexts.

Two Tales of Long-term Collaboration: Social Scientific Involvement in Artificial Intelligence in Japan and Synthetic Biology in the UK

Arisa Ema & Jane Calvert

Researchers in science and technology studies (STS) are increasingly being called upon to contribute to research programs in the natural sciences and engineering, often under the heading of ethical, legal and social issues (ELSI), or more recently, responsible research and innovation (RRI). There has been little work to date that compares these experiences across countries and contexts. In this paper, we present two accounts of STS involvement—in artificial intelligence in Japan and synthetic biology in the UK. Although we work in two different technoscientific fields in two different countries, similarities emerge. Our accounts both show the importance of long-term, low-stakes collaborations, built up organically over time—collaborations that trouble the distinction between being either an “insider” or an “outsider” to a technoscientific field. We argue that RRI is more likely to be expansive and imaginative if it is done in the context of such collaborations, and that it is important for research funders to cultivate the conditions that make them possible. We end by calling for more tales from STS researchers of their experiences of RRI and ELSI across countries and contexts, to provide tools and resources for future collaborative work.

The Soba Restaurant and the Oyster Bar: Peripheral Spaces for Responsible Research and Innovation

Robert Smith, Ken Kawamura, Erika Szymanski, Ryuma Shineha & Jane Calvert

As STS researchers working closely with scientists and engineers, we have been invited into, created, reluctantly entered, and stumbled upon many kinds of spaces, some of which might be considered spaces for responsible research and innovation. Here we discuss a selection of these spaces, drawing on our work in synthetic biology in the UK and molecular robotics in Japan. They include a multidisciplinary workshop, a public engagement event, an art performance, and several panels at scientific conferences on the ethical, legal, and social issues raised by our fields of study. Many of the spaces were owned and controlled by scientists and engineers, and our participation in them was constrained by pre-existing frames. But even in those spaces we designed ourselves it was difficult to challenge institutionalized practices and dominant understandings of the relationship between the natural and social sciences. We often found that those places that were most conducive to provocative, productive and critical cross-disciplinary dialogue were at the peripheries of formal events. We explore the importance of peripheral spaces for RRI, drawing on the examples of interactions that took place at a soba restaurant and an oyster bar.

Informal, Institutional and Interdependent Openings for Responsible Research and Innovation

Sujatha Raman & Dan Santos

Cross-cultural comparisons generate valuable insights about how the social sciences can shape technoscientific domains and trajectories. In this Special Issue Commentary, we reflect on the rich insights contained in the articles exploring social scientific experiences with responsible research and innovation (RRI) in Japan and the UK, and organize our reflections around three types of opening for thinking about and approaching RRI going forward. First, we affirm the importance of exploring informal spaces for cultivating RRI, especially for consolidating connections and opening up opportunities. Secondly, and relatedly, we argue that possibilities for informality are intertwined with the institutional (e.g. projects, practices, norms), and much can be learned from comparing different experiences at this nexus. Finally, we draw attention to the productive potential of investigating interdependencies for enabling novel ways of approaching RRI, with respect to both forging collaborations between social and biophysical researchers, and in framing and undertaking public engagement initiatives.

Ethos

Charisma revisited: Or why narcissism matters

Jeff Bennett

In 1990 Charles Lindholm published his landmark study of Charisma, shedding new light on a complex and controversial topic. Today, more than 30 years later, understanding charisma has become newly important as authoritarian leaders and populist politics have begun to reshape the global political landscape. This paper returns to Lindholm’s original study to address the two phenomena Lindholm felt were most important – namely, the personality configurations of charismatic leaders and their followers and group psychodynamics. Unlike Lindholm, however, I approach these phenomena from the vantage point of intersubjective self psychology, a post-Freudian theoretical framework that is particularly well-suited for analyzing the popular appeal of figures like Jim Jones and the group dynamics that bonded the members of the People’s Temple to the movement. To make this point, Lindholm’s original case studies are referenced throughout the paper and a distinction between destructive and reparative leadership is made to highlight the difference between ‘leading’ and ‘trailing’ edge orientations as they pertain to charismatic leaders and their movements.

Can a lizard ride on a housefly?: Navigating uncertainty and moral life in an Accra Zongo, Ghana

Emily A. Williamson

How can uncertainty become a resource for ethical life rather than a threat to it? Focusing on a Zongo community in Accra, Ghana—also known as a “traveler’s camp” or “stranger’s quarters”—this article examines how people use a creative form of communication called the practice of folding to sustain relationships shaped by conditions of uncertainty. I define this practice as a form of indirect communication that brings together opposing ideas, materialities, and geographies that are not typically associated with one another. Contributing to literature at the intersection of uncertainty, language, and morality, I argue that the practice of folding cultivates and sustains intersubjective uncertainty, inviting participants to keep doubt, questioning, and possibilities in active tension. It enables a particular form of ethical attunement I term an ethics of traveling-with—an obligation to continually shift perspectives in order to understand other points of view, thereby delaying or even refusing resolution. These findings offer new insights into moral life in contexts of fragility, improvisation, and interdependence, challenging the common assumption that moral striving necessarily seeks resolution, judgment, or evaluation.

Divine intimacy, frustration and the madness of the city: Changing transhuman kinship in China

Keping Wu & Robert P. Weller

This essay shows the affective resonances of the collision of gods, humans, and rapidly shifting landscapes in a newly urbanized part of Suzhou, China. The first section discusses how ties to spirits are not just metaphors or projections of human kinship, but literal parts of a kinship system that invoke responsibilities of care, based on links of both affect and blood. The second turns to how such intimacy is not always pleasant, and how the closest relationships to gods often begin with sickness and suffering, and in some cases with death leading to deification. Examples of these intimacies include Amei’s painful calling to be a spirit medium (and thus a god’s daughter) and her niece Xiangling’s death and deification as the concubine of the god who took her. The last section turns to the rapid urbanization of the area over the past two decades, which has destroyed all the local temples along with the villages they served. This dis-placement has created a new affect of frustration in the daughters of the gods, due to the interruptions of their responsibilities of care. In the case of Xiangling’s mother, the frustration spiraled into madness after the urbanization process destroyed the statue of her deified daughter. Integrating Navaro-Yashin’s analysis of spaces of ruin with insights from scholars working on the emotional tensions built into intimacy, we reveal how the dis-placements of rapid urbanization have transformed those intimacies to create an affective and embodied ruination.

A sea of anchors: towards (more) global psychological anthropologies—Introduction to a virtual special issue

Thomas Stodulka, Anni Kajanus, Suzana Jovicic

This commentary reflects on the contemporary trajectories and futures of psychological anthropology through the metaphor of a “sea of anchors.” Rather than reproducing binaries of center and margin, we conceptualize “anchors” as temporary and dynamic points of orientation through which theories, methods, collaborations, and infrastructures condense and circulate unevenly across regions and disciplines. Building on contributions to the 2026 Ethos virtual issue, we argue for more decentralized, accessible, and collaborative forms of psychological anthropology that move beyond disciplinary silos while remaining attentive to enduring asymmetries in global knowledge production. We examine how psychological anthropologists navigate critical and often marginal positions between anthropology, psychology, and related fields, and how this intermediary position enables productive forms of interdisciplinary mediation, critique, and collaboration. At the same time, we emphasize that decolonizing psychological anthropology requires more than theoretical critique alone: it demands transformations in citation practices, research infrastructures, collaboration, and institutional accessibility. Contemporary psychological anthropology, we suggest, is uniquely positioned to engage constructively with both the humanities and sciences while critically interrogating universalizing psychologies, extractive epistemologies, and emerging global inequalities. By advocating for a plurality of interconnected “anchors,” we envision psychological anthropology as a politically engaged, empirically grounded, and globally collaborative field capable of fostering alternative forms of scholarly exchange and future-oriented anthropological practice.

International Journal of Social Psychiatry

Why Should We Revive Narrative Psychiatry in the Shadowy Times of Artificial Intelligence? And How?

Dinesh Bhugra, Fabiana Ricci and Antonio Ventriglio

Narrative psychiatry is dead… is it really? Can it be revived in the present era, in which growing enthusiasm for the advent of Artificial Intelligence (AI) in healthcare is shifting the focus towards symptom checklists and algorithmic approaches? On the one hand, AI is expected to facilitate clinical work and enhance efficiency for many clinicians and healthcare professionals; on the other, its rapid integration may generate substantial challenges for certain medical specialities.

Medicine is grounded in the principle of primum non nocere (Anon, 2008). As Trudeau in the 19th century famously observed, the role of the physician is ‘to cure sometimes, to relieve often, and to comfort always’ (as cited in Siegel, 2018). However, with medical and surgical advances emerging at an unprecedented rate, clinical attention has increasingly shifted towards interventions and investigations, a trend further reinforced by the growing adoption of AI, which tends to privilege symptom-focused and algorithm-driven approaches. Have we lost the art of medicine? Have the traditional aims of medicine gradually given way to an imperative to cure always? Similarly, has the principle of relieving often been replaced by an expectation to relieve always? Some of these shifts reflect genuine advances in our understanding of the brain and body, while others arise from the changing social expectations and transformations in societal structures. The social contract between medicine, particularly psychiatry, patients, their carers and society at large remains a fundamental yet frequently neglected dimension of clinical practice (Lidz et al., 1988). Healthcare professionals and policymakers must ensure that this contract is grounded in shared understanding and explicitly negotiated expectations.

Involving International Experts in DSM-6: A Geopsychiatric Approach

Neil Krishan Aggarwal, Antonio Ventriglio, Dinesh Bhugra, and Albert Persaud

In January 2026, the American Psychiatric Association (APA) announced its intention to involve international experts for the sixth edition of the Diagnostic and Statistical Manual of Mental Disorders, tentatively titled DSM-6. Oquendo et al. (2026), writing on behalf of the Future DSM Steering Committee, emphasized that because expert consensus on the interpretation of available data remains the guiding model of the DSM, careful consideration must be given to who is designated as an expert shaping its future direction. They argued that this is essential to ensure the integration of more globally inclusive epistemologies and scientific approaches. In the same article, Oquendo et al. (2026) further maintained that adopting a cultural lens enables the decentering of Western epistemologies and fosters the incorporation of more inclusive, globally informed perspectives, thereby strengthening the cross-cultural validity of DSM diagnostic criteria. Consistent with this objective, Wainberg et al. (2026) reported that the Future DSM Socioeconomic, Cultural, and Environmental Determinants of Mental Health Subcommittee has invited global experts to present on current knowledge and to delineate future directions. Concurrently, Oquendo et al. (2026) cautioned that any modifications to diagnostic criteria or codes must be implemented in a manner that preserves global clinical utility and avoids unintended adverse consequences for patient care. These writings raise questions about the engagement of international experts with DSM-6 committees, how globally inclusive this process will be, and the extent to which their recommendations will be implemented. In this paper, we advocate that the interdisciplinary orientation of Geopsychiatry offers practical guidance to integrate global epistemologies and scientific approaches in DSM-6.

Caregivers’ Perspectives Regarding the Use of Psychotropic Medication in Children and Young Adults: A Systematic Review

Phoebe M. Downey, Jack C. Collins, Sarira El-Den, and Claire L. O’Reilly

Background:

The use of psychotropic medications in children and adolescents is increasing worldwide. However, caregivers’ perspectives regarding the use of these medications in young people remain underexplored.

Aims:

To explore caregivers’ perspectives towards the use of psychotropic medications in the treatment of mental disorders in young people.

Method:

A systematic search was conducted across five databases (MEDLINE (ALL), Embase, PsycINFO, CINAHL, and Scopus) using a search strategy encompassing the concepts ‘psychotropic medications’, ‘mental health’, ‘attitudes’, ‘young people’, and ‘caregivers’ to identify relevant records published up to 25 March 2024. Records were screened by title and abstract against predefined criteria, followed by full-text review. Data were synthesised and presented in tables. Quality assessment was conducted using the Mixed Methods Appraisal Tool.

Results:

After screening 1,296 records, 17 studies were eligible for inclusion. Findings were categorised into caregiver attitudes (n = 12), experiences (n = 2), and preferences (n = 9) regarding the use of psychotropic medications in young people. Most caregivers reported negative attitudes, with scepticism, fears of adverse effects and addiction, and doubts regarding efficacy commonly mentioned, including in those whose children had experience with psychotropic medication. Some caregivers were open to the use of psychotropic medications in their children if it was deemed necessary, however, psychotherapy was overwhelmingly the preferred treatment modality. The methodological quality of included studies was mixed; while many met criteria for appropriate sampling and analysis, few used validated measures, and high risk of bias due to non-response and reporting limitations was common.

Conclusion:

This review emphasises the importance of acknowledging and addressing caregiver concerns and actively involving them in the decision-making process. The substantial heterogeneity in study designs, measures, and participant characteristics reinforces the need for future research to employ validated instruments alongside both qualitative and interventional approaches to capture caregiver perspectives and the contextual factors that shape them.

Making a Home for Individuals With Serious Mental Illness: A Systematic Review

Emi Patmisari, Yunong Huang, Ros Wong, Mark Orr, Sumathi Govindasamy, Emily Hielscher, and Helen McLaren

Background:

Housing is widely recognised as a key social determinant of mental health and recovery, yet the concept of home remains under-theorised and inconsistently applied in practice and policy.

Aims:

The aim of this systematic review is to examine home for people with serious mental illness (SMI), focussing on various stakeholder perspectives reported in literature.

Methods:

Records from CINAHL, Emcare, ProQuest, PsycINFO, PubMed, Scopus, and Web of Science (n = 5,309) were double screened, resulting in 26 peer-reviewed studies for inclusion. Thematic analysis identified fifteen themes synthesised according to perspectives of four different populations: individuals with SMI; their family members; landlords; staff; and sector experts.

Results:

Contrary to a house, home was described as shaped by emotional safety, personal control, daily routines, and the quality of social relationships. Findings underscored the need for relational, flexible, and context-sensitive housing approaches that support autonomy, continuity, and belonging.

Conclusions:

This review contributes to a more nuanced understanding of home as a multi-dimensional and negotiated concept, from the perspective of multiple stakeholders, with implications for mental health policy, service design, and future research.

Evaluation of Parents’ Self-Compassion Levels and Parenting Styles

Sema Sal and Mükerrem Kabataş Yıldız

Background:

Parenting plays a critical role not only in supporting children’s healthy growth and development but also in contributing to a meaningful and fulfilling life.

Aims:

This study evaluates how parents’ self-compassion levels, which significantly influence their well-being, affect their parenting styles.

Methods:

The research was conducted using a cross-sectional and descriptive design. Data were collected through an online form between April and October 2024, using a general information form, the Self-Compassion Scale, and the Multidimensional Parenting Styles Scale. Data analyses were performed using SPSS 25.0. Descriptive statistics, including mean, standard deviation, minimum/maximum values, frequency, and percentage, were used to summarize the findings.

Results:

The effect of parents’ self-compassion levels on parenting styles was analyzed using one-way analysis of variance (ANOVA). The results indicate that most parents exhibit high levels of self-compassion and positive parenting behaviors. Additionally, as self-compassion levels decrease, negative parenting behaviors tend to increase.

Conclusion:

These findings suggest that self-compassion is a key factor in the parenting process, and supporting parents’ self-compassion levels may contribute to developing more positive parenting behaviors. Therefore, it is recommended that psychosocial support and awareness programs be developed to enhance parents’ self-compassion levels.

Professional Perspectives on Mental Distress: Exploring Attributional Differences and Their Association With Stigmatizing Attitudes Among Psychiatrists, Psychologists, and Social Workers

Martin Wolgast, Katarina Fredriksson Tham, Maja Straht, and Henrik Levinsson

Background:

Mental health professionals often differ in their explanatory models of mental distress, which may influence their attitudes toward individuals experiencing such conditions. Stigmatizing attitudes among providers can adversely affect therapeutic relationships, service quality, and recovery outcomes.

Aims:

This study investigates the attributional frameworks—biological, cognitive-behavioral, psychodynamic, and social-realist—endorsed by psychiatrists, psychologists, and social workers in Swedish adult psychiatry. It further examines how these explanatory preferences are associated with stigmatizing attitudes toward individuals with mental distress.

Method:

A cross-sectional survey was conducted with 715 licensed psychiatrists, psychologists, and social workers. Attributional orientations were measured using a revised version of the Maudsley Attitude Questionnaire (MAQ-R), and stigma was assessed with the revised Opening Minds Stigma Scale for Health Care Providers (OMS-HC-R). Group differences were analyzed using General Linear Models, and associations between attributional frameworks and stigma were explored through linear regression. Given the cross-sectional design, causal inferences cannot be drawn from the observed associations.

Results:

Psychiatrists reported significantly stronger endorsement of biological attributions compared to psychologists and social workers, while psychologists favored cognitive-behavioral and psychodynamic explanations. Social workers exhibited the strongest preference for social-realist attributions. Endorsement of biological and cognitive-behavioral models was positively associated with higher stigma scores, although these associations may reflect broader occupational or systemic influences. In contrast, social-realist attributions were associated with lower stigma. Psychodynamic attributions showed no significant association.

Conclusions:

Differences in attributional frameworks among mental health professionals are associated with variation in reported stigmatizing attitudes. These findings underscore the importance of addressing explanatory diversity in interdisciplinary training and suggest that nuanced understandings of etiology may inform stigma-reduction efforts. Future research should explore the role of contextual and institutional factors, as well as potential confounders, in shaping these relationships.

Empowering Gen Z’s Mental Health in a Hyperconnected World

Dani Fadillah and Bai Long

Background:

Generation Z faces unprecedented mental health challenges in a hyperconnected digital environment. While technology offers benefits such as access to resources and support networks, it also poses risks including anxiety, depression, and social comparison. Comprehensive studies integrating diverse methods to examine these challenges remain limited.

Aims:

This study investigates the intersection of digital engagement and psychological well-being among Generation Z, with a focus on identifying risks and exploring proactive strategies for resilience.

Methods:

A mixed-methods approach was adopted, combining (1) bibliometric analysis of 1,103 Scopus-indexed publications (2020–2024) using VOSviewer, (2) qualitative content analysis of 500 social media posts across TikTok, Twitter/X, and Instagram, and (3) semi-structured interviews with eight experts in psychiatry, psychology, and digital education. Data were triangulated to enhance validity.

Results:

The bibliometric analysis revealed three dominant research clusters centered on psychopathology, resilience and public health, and developmental/family-oriented perspectives. Social media discourse emphasized risk narratives, self-presentation pressures, peer support, and digital detox practices. Expert interviews highlighted rising clinical risks, identity strain, untapped peer support, and gaps in policy and education. Triangulated findings show convergence on risks, but also divergence where lived experiences and expert perspectives foreground coping strategies and resilience overlooked in the academic literature.

Conclusions:

Hyperconnectivity functions as both a stressor and a source of resilience for Gen Z. A multidimensional approach involving individuals, educators, policymakers, and digital platforms is necessary to promote digital well-being and strengthen youth mental resilience in the hyperconnected world.

ChatGPT-4 in Psychiatric Discharge Summaries: Toward a More Comprehensible and Emotionally Sensitive Clinical Communication

Julio Torales, Marcelo O’Higgins, Beatriz Di Martino, Diana Kunihiro, Liz Carbajal, Fabiana Pereira, Enrique Franco, Anthon Daniel Torres-Romero, Antonio Ventriglio, João Mauricio Castaldelli-Maia, Tomás Caycho-Rodríguez, and Iván Barrios

Background:

Psychiatric discharge summaries are vital for ensuring continuity of care, yet they are often written in technical language that can be difficult for patients to understand and may cause emotional distress or reinforce stigma. With increasing patient access to medical records, there is a pressing need to develop communication tools that are both comprehensible and emotionally safe.

Aim:

This study aimed to evaluate the diagnostic fidelity, linguistic clarity, emotional sensitivity, treatment comprehension, and readability of psychiatric discharge summaries rewritten by ChatGPT-4 based on real clinical cases.

Methods:

This was the first study in South America to examine the use of a generative language model for rewriting psychiatric discharge summaries. A mixed-methods, observational cross-sectional design was applied. Twenty-five anonymized clinical cases were rewritten using ChatGPT-4. Three psychiatrists independently assessed each AI-generated summary across four dimensions: diagnostic fidelity, clarity of language, perceived emotional risk, and understanding of treatment. Readability was evaluated using the Fernández-Huerta Index and the INFLESZ Scale. A thematic analysis of evaluators’ written comments was also conducted.

Results:

Summaries generated by ChatGPT-4 were rated positively, particularly for clarity and treatment explanation. Significant improvements in readability were observed across all diagnostic groups (p < .001), with mean values surpassing recommended thresholds for general comprehension. However, five summaries remained below those thresholds, and some diagnostic inaccuracies were noted (e.g. omissions in bipolar disorder). Evaluators also highlighted emotionally charged or stigmatizing language in a few cases.

Conclusions:

ChatGPT-4 can enhance the accessibility and emotional appropriateness of psychiatric discharge communication, supporting more patient-centered care. Nevertheless, professional oversight remains critical to ensure clinical accuracy and contextual sensitivity. Future research should include patient feedback, assess long-term outcomes, and explore hybrid human-AI collaboration models.

Journal of Critical Public Health 

Bait and switches in academic publishing

Kirsten Bell

In this editorial, I would like to reflect on the phenomenon I am calling here ‘bait and switches’ in academic publishing. Rather than representing an anomaly, I want to suggest that it’s simply business as usual for corporate publishers. While few are in the position to be able to substitute a lower-tiered open access journal for a higher ranked subscription one, they have realised – or, at the very least, assumed – that branding is all that matters to academics.

Becoming embedded: A process evaluation of weight management services developed with, not for, communities

Hannah Newman, Louca-Mai Brady, Elspeth Mathie, Kathryn Almack & Wendy Wills

There is growing interest in whole systems-based approaches to obesity, yet little understanding about how these can be achieved or about the tensions inherent in navigating the social, emotional, and behavioural issues within behaviour change interventions. We were commissioned to evaluate a programme of place-based, whole-systems approaches to tackling obesity and health inequalities for adults, children and families in areas with higher-than-average obesity rates and socioeconomic deprivation. Underpinned by an embedded ethnography approach, this process evaluation explored how best to engage diverse communities in service delivery and development using evidence-informed approaches, and whether services can be co-produced with communities and people with lived experience. Our approach combined: focus groups and interviews with staff, service users, commissioners and other external partners (n=64); participant observation; membership of a Strategic Oversight Group; and qualitative research training for staff.  This unique project demonstrates factors important for shaping a whole systems approach, including the value and challenges of community engagement, and the limitations caused by how services are commissioned. Consideration is needed regarding how systems and structures can facilitate or create barriers to ‘embedded’ research and the implementation of whole systems approaches, involvement and co-production, and take account of wider determinants of health and inequalities.

Continuity of biopolitics in late Soviet and post-Soviet Russia: What policy documents can tell us

Olga Temina , Olga Zvonareva & Klasien Horstman

From a critical public health perspective, public health serves as an instrument of biopolitics in modern societies. Through public health measures, citizens’ bodies are regularised to exhibit desirable characteristics. However, what is considered desirable differs between epochs and political configurations. In this article we aimed to discern what kinds of subjects were envisioned as ideal and what configurations of public health were consequently produced in the late Soviet Union and post-Soviet Russia. Through the analysis of legislative documents that have regulated Russian public health since their first codification in 1971 until now, we traced transformations of the state’s biopolitical agenda. We demonstrate how the Soviet paternalistic state aimed to provide health(care) for all while coercing those who did not share its ideals of health. We show how the liberalisation and marketisation of the 1990s attempted to transform citizens into responsible patient-consumers, and how, nowadays, public health regulation balances neoliberal ideas of health and Soviet notions of control. ‘Reading off’ legislative documents highlights how public health is transformed in line with biopolitical agendas, which exist in continuity and are deeply rooted both in the agendas of the past and imaginaries of the future.

Synthetic certainization in medical controversy: Evidence synthesis, NICE recommendations and the drug-device complex in stroke prevention

Gowree Balendran & John Abraham

The National Institute for Health and Care Excellence (NICE) recommends rivaroxaban for stroke prevention in patients with non-valvular atrial fibrillation in England. While not a directive to practitioners, that advice is widely regarded as authoritative and intended to guide practice. Yet a medical device, INRatio2-PT for monitoring coagulation/blood-clotting and producing crucial data on rivaroxaban in its key clinical trial, was defective. Following discovery of the defective device, a medical controversy about the therapeutic value of rivaroxaban ensued. Drawing on social science theories of medical controversies, such as ‘chronic contestation’, ‘closure’, ‘corporate bias’, and ‘countervailing powers’, this article describes the unfolding of the INRatio2-PT/rivaroxaban controversy and seeks to explain it. We explore the role of key protagonists based on documentary and interview data. Our findings about the media partly support ‘countervailing powers’ theory, while those regarding industry and regulators support ‘corporate bias’ theory. We found little evidence of chronic contestation of medical knowledge-claims. Rather, we contend that a sociological process of closure through synthetic certainization of knowledge-claims that rivaroxaban is efficacious and cost-effective evolved via the combined political power and interests of the medical-industrial complex, capitalist industry, and the regulatory state. Synthetic certainization, together with a regulatory ideological commitment to innovation, curtailed contestation and discouraged the medical profession from facing troubling uncertainties.

Excess mortality in England and Scotland in 2022: The long shadow of austerity and the return to an unacceptable pre-pandemic baseline

Daniel R. R. Bradford, Denise Brown, Gerry McCartney, Margaret Douglas, Ruth Dundas & David Walsh

Concerns exist that mortality remains elevated after COVID-19 peaks. This study examined whether mortality in England and Scotland in 2022 exceeded predictions from austerity-era (2012–2019) and pre-austerity (2001–2010) trends. Time trend analysis was conducted using data from 2001–2022. The outcomes were observed and expected age- and sex-standardised mortality rates (ASMRs). Expected 2022 ASMRs were calculated from austerity-era and pre-austerity trends. Excess deaths were estimated by comparing observed and expected ASMRs. Observed ASMRs were higher than austerity-era predictions and substantially higher than pre-austerity predictions. In England, excesses for females were 4.4% (4.0–4.8) and 38.2% (95% CI: 37.7–38.7), and 7.2% (6.8–7.6) and 57.0% (56.4–57.6) for males. In Scotland, excesses for females were 3.4% (2.2–4.5) and 26.6% (25.2–28.0), and 2.6% (1.5–3.8) and 45.2% (43.6–46.9) for males. COVID-19 accounted for 5.3–6.5% of deaths in 2022 and explained much of the excess compared to austerity-era trends. ASMRs were 1.68–1.94 times higher in the most versus least deprived areas. Deaths attributable to COVID-19 explain much of the excess compared to austerity-era trends. However, 879,430 excess deaths relative to pre-austerity trends, even excluding COVID-19 deaths, highlights the devastating impacts of austerity on public health. 

Is there a place for hope in the imagined future of public health? A commentary building on Freire’s sociology of hope.

Paul Ward & Belinda Lunnay

By examining hope through a sociological lens, this commentary frames hope as a critical sociopolitical tool for public health to address structural inequalities and foster healthier communities. We draw on Paolo Freire’s pedagogies of oppression and hope, since they provide a ‘praxis of hope’. We explore the concept of hope – explaining what it is, to then consider what it enables – conveying the ways hope is imperative to human flourishing and imperative in the imagined future of public health. We present a case for public health engagement in developing ‘hope-based’ practices and policies which means working with communities to identify the factors acting as oppressive forces and then, through critical consciousness development, working towards overcoming these in a move towards hope (and health).

Challenges of researching racism in healthcare

Hannah Bradby, Suruchi Thapar-Björkert, Beth Maina Ahlberg & Sarah Hamed

The unprecedented transnational protests following the killing of George Floyd highlighted the need to re-examine institutions that uphold various social injustices experienced by racialised minorities. Black Lives Matter protests thus created a serious reckoning with racism and facilitated global conversations. Against the backdrop of these protests, we evaluate our study of healthcare workers, exploring racialisation in Swedish healthcare including the design and implementation of an anti-racist initiative in healthcare education. We reflect on how the silencing of discussion around racism in Sweden led to difficulties in recruiting participants and the effect of the shift in public discourse following the Black Lives Matter uprising of 2020. The project was ultimately successful in recruitment and outreach to professional and regional authorities. However, this success is contrasted by the lack of structural change in embedding anti-racism as a core value in healthcare practice. We conclude by noting that conversations about anti-racism differ from implementing anti-racist practice in commissioning, evaluation, and service delivery.

Science as Culture

Biologics of resistance: Open Insulin and the limits of bioengineering-as-activism

Andy Murray

The Open Insulin Project is a community lab-based effort to make affordable insulin using bioengineering. The growth of financialised biotechnology and biomedicine yielded both a crisis of access to motivate and surplus resources to enable Open Insulin. Project volunteers attempted turn spillover expertise and materials against the status quo to produce a ‘biologic of resistance.’ However, adopting the production of a biologic pharmaceutical as the project’s core ultimately constrained their resistance effort. The focus on the available resources and expertise limited project members’ ability to manage important dimensions of producing usable insulin, including the imposing prospects of purification, scaling, and regulatory approval and the legal nuances of intellectual property. Paradoxically, Open Insulin members found themselves reproducing key features of the financialised biomedical model they aimed to resist, including the embrace of hype and speculation, the depoliticisation of intellectual property, and pressure for accelerated regulatory approval. This case demonstrates how the commonsense logics of contemporary biocapitalism can carry over into resistance movements and limit their capacity. The emergence of community biology and biotechnology initiatives like Open Insulin calls attention to biomedical inequities and provides a vision of biomedicine operating on more altruistic motives. However, it also raises questions about the limits of technological interventions to address inequities in financialised biocapitalism. The embrace of a narrow strategy that privileges technological intervention ultimately resulted in a similarly narrow, incremental form of resistance that shied away from broader systemic critiques.

Good chemistry and its interruptions: about caring scientists and uncooperative molecules

Jonna Brenninkmeijer & Jeannette Pols

Science policy has increasingly organised science as if it were a training ground for excellent individual scientists who can be found through fierce competition for research money and publications. This focus on science as a competition for research excellence is embedded in a specific interpretation of what ‘good’ scientific practices are. Ethnographic analyses of scientific practices using the notion of care can elucidate what good science implies in practice and how it is perhaps hindered. In a Dutch chemistry lab, researchers cared for good science by working towards socio-material collaboration. They were responsible for each other, their materials, and their chemistry work. They shared knowledge and skills to affect the material world. And they were dependent on the actions of their colleagues, technologies and chemicals. Their work was exciting because of this socio-material collaboration, but also frustrating when resistance of materials or competition hindered their caring practices. That is, good science as a collaborative and knowledge sharing practice was hindered by current values about good science which emphasise research excellence and positive results, especially when chemicals did not collaborate. This asks for an understanding of care and good science that is not merely focussed on successful research practices, but also on the hard (sometimes slow, boring or frustrating) work that does not always feel ‘good’ or end ‘well’, but is still part of the research process.

Modes of visual framing in neuropsychological deception detection research

Larissa Kaiser

In the German context, where legal skepticism toward polygraph-testing intersects with emerging concerns about AI-based deception detection, neuroscientists position their work through methodological restraint and epistemic distancing. Their critical stance toward both visual determinism and applied polygraph-tests serves not only to manage uncertainty, but to claim scientific authority in a contested field. By tracing how visual framing enables both conceptual clarity and epistemic credibility, the analysis contributes to STS debates on the role of visuality in scientific knowledge production. It calls for closer attention to how images, practices, and imaginaries mutually shape what counts as evidence and epistemic possibility in neuroscience.

Challenging epistemic injustices in the 2020 Environmental Performance Index: an engagement

José Antonio Ballesteros-Figueroa

This article presents an engagement study rooted in ethnographic fieldwork at the Yale Center for Environmental Law and Policy (YCELP) during the development of the 2020 Environmental Performance Index (EPI), a widely cited global metric for assessing environmental policy performance. As both researcher and participant, I reflect on the tensions and power dynamics that emerged when questioning the epistemic assumptions embedded in the quantification of environmental governance. Drawing from Science and Technology Studies (STS) and theories of epistemic injustice, I analyze how quantitative devices (QDs) like the EPI reinforce global hierarchies by excluding or subsuming territories with limited data infrastructure or contested sovereignty. The study explores how decisions about what counts as a “country,” what data are “valid,” and who gets to decide these criteria are shaped by sociotechnical, political, and institutional constraints. I document my efforts to co-create more inclusive knowledge practices through the development of threshold questions for evaluating sovereignty, which sought to challenge the index’s default reliance on ISO codes and centralized governance assumptions. Despite the partial success in including some underrepresented territories, many others remained excluded, revealing how data availability and political recognition jointly structure epistemic visibility. This paper argues that efforts to reform global environmental metrics must move beyond technical fixes to confront the historical and structural injustices that shape knowledge production. By illuminating the micro-politics of quantification, the study contributes to broader debates on environmental justice, data ethics, and the responsibilities of researchers in co-producing more equitable representations of the world.

Science, Technology, & Human Values

Striving for Presence on a Hospital Ward: Phenomenology and Re-Embodiment for a Nurse-Operated Telepresence Robot

Luna Dolezal, Karl Atkin, Nik Brown, Sanna Metsäketo, Sarah Nettleton, and Daniel Robins

This article examines the phenomenology of nursing care delivered through Välkky, a full-body teleoperated humanoid robot trialed in a Finnish hospital ward in 2023. Bringing science and technology studies into dialogue with phenomenology, we analyze qualitative data from observations, focus groups, and interviews with nurse-operators, managers, roboticists, and one patient involved in the pilot. We argue that Välkky’s deployment constituted a “robot drama” in which the frictions between robotic imaginaries and situated clinical practice produced “infrastructural inversions,” making visible normally tacit dimensions of nursing care. To conceptualize these dimensions, we develop the notion of “experiential care infrastructures”: the embodied, affective, and relational conditions that underpin care but can be overlooked in task-based approaches to robot design. Our analysis shows that Välkky afforded limited experiences of telepresence, and that nurses found the technology to interrupt rather than enable caring relations. We conclude that the design and deployment of telepresence robots in healthcare settings must attend to experiential infrastructures that make ethical and relational care possible.

Navigating Indeterminacy in Wildfire Risk Map Production in the United States

Miranda Simes

Wildfire risk maps have emerged as a prevalent yet contested scientific object in the United States and internationally. These maps, often a patchwork of bright reds and oranges, depict relative risk scores for different locations. Dozens of these maps from private companies and public agencies have proliferated in recent years, yet members of the public and scientists alike have posed questions about map accuracy: can the maps reliably depict the risk of such infrequent, high-consequence events? In this article, I examine these maps as a contribution to the Science and Technology Studies scholarship on the production of risk assessments. Though they appear orderly and neat, wildfire risk maps are the result of complicated, layered scientific decisions. Drawing on interviews with wildfire risk map producers, I analyze how these maps are socially constructed and materialize future risk. Almost universally, these map producers share a lack of confidence in their approaches to modeling wildfire risk because they view wildfire as unpredictable and risk modeling as faulty. How then do these actors determine what constitutes success or a lack thereof? I find that many, in their attempts to navigate indeterminacy, turn instead to personal knowledge of wildfire risk in the places they live.

Ask the Dust: The Rise of Popular Expology in Pesticide Activism in France

Jean-Noël Jouzel, Giovanni Prete, Bastien Soutjis, and David Demortain

This article focuses on social movements’ engagement in the field of environmental health through a particular form of knowledge production: “popular expology.” This concept reflects the growing development of initiatives aimed at producing data on human exposure to pollutants, rather than establishing the causes of health effects, as “popular epidemiology” does. To develop our concept, we draw on the case of the French anti-pesticide movement. For more than a decade, organizations from this movement have increasingly invested in the performance of studies designed to demonstrate the presence of pesticide residues. We show that popular expology is encouraged by the difficulties social movements face in producing epidemiological data, by the development of a market for affordable pesticide detection tools, and by the increasing accessibility of toxicological and epidemiological knowledge produced by research and expert institutions. We also analyze two roles that popular expology plays for social movements: on the one hand, embodying invisible pollutions and raising the attention of the media to this issue; on the other hand, demonstrating weaknesses in regulatory risk assessment. This article, therefore, suggests the need for a broadening of our understanding of the use and production of science as a political mode of action for environmental social movements.

Making Soils into Carbon Sinks: A Sociology of Soil Carbon Quantification Through a French Model

Céline Granjou, Hélène Guillemot, Laure Manach, Robin Leclerc, Antoine Doré, Léo Magnin, and Stéphanie Barral

Since COP21 in 2015, carbon neutrality targets have emphasized the enhancement of various carbon sinks, including soils, to help sequester carbon away from the atmosphere. What does it take to make soils into carbon sinks? This article focuses on a French digital model of soil carbon cycling named AMG, which quantifies soil carbon stocks and their evolution under various agricultural practices. We examine how AMG circulates and transforms within a loosely connected network of actors and organizations involved in agricultural development, climate research, land-use planning public administrations, and carbon commodification. We show how the model evolves into three distinct yet interconnected regimes of carbon quantification—in climate academic research, local public action, and carbon markets—that contribute to building and expanding a sociotechnical infrastructure for quantifying soil carbon sequestration potential. Our findings contribute to the literature on environmental quantification and knowledge infrastructures by calling for a shift from viewing knowledge infrastructures as stable and fixed, toward an approach that emphasizes open-ended, flexible, and ongoing processes of infrastructuring. We also contribute to the literature on soil–human relations by emphasizing how this model fosters a new focus on the active role of soils in the global carbon cycle and climate change mitigation.

Social Science & Medicine

Social capital and vaccine decision-making: A scoping review

Erynn Monette & Gabrielle Duval

The term social capital has been widely used in social science to explain how relationships, norms, and shared resources shape opportunities within communities. This concept has gained recent prominence in public health research as scholars seek to understand the social dynamics underlying vaccine decision-making and hesitancy. Guided by major theoretical perspectives of Bourdieu, Coleman, and Putnam, this paper examines how social capital has been applied to the study of vaccine uptake and synthesizes research findings about its influence on vaccination behaviours. Sources (n = 581) were gathered from the databases Medline, Embase, CINAHL, and Web of Science and uploaded to Covidence. Following removal of duplicates (n = 124), the titles and abstracts of 457 sources were screened for inclusion of the search concepts “vaccination” and “social capital”. Full texts of 67 sources were screened for relevant use of search concepts (i.e., study focus on vaccination behaviours and use of “social capital” as an underpinning theory), resulting in 34 articles for final inclusion. Studies were coded for their theoretical grounding, methodology, and the specific forms of capital examined. Findings indicate that social capital shapes vaccine decision-making in complex and context-dependent ways. While higher levels of trust, cohesion, or civic participation are often associated with vaccine uptake, strong bonding ties and community-embedded norms sometimes facilitate the spread of misinformation and reinforce hesitancy. Overall, the review demonstrates that social capital can function as both a facilitator and barrier to vaccination, underscoring the importance of local context and the need for nuanced, theory-informed approaches to understanding vaccine behaviours.

“It’s really easy to fall under the radar and get lost” – being unseen in postpartum care pathways after hypertensive pregnancy

Lisa Hinton, Katherine Tucker, Carol Dumelow, Sabrina Keating, Lucy C. Chappell & Richard J. McManus

Hypertensive disorders of pregnancy, experienced by around 10% of women, are among the most severe health problems affecting people during and following pregnancy. Symptoms can persist in the weeks and months following birth, with potential to impact longer-term health. Postnatal care has long been recognised as a critical period for mother and baby, and emerging evidence suggests it is a window of opportunity for cardiac remodelling after a hypertensive pregnancy. But provision is often not fit for purpose and haphazard. To understand what care women receive, how it gets done, and additional barriers for minority or socially deprived groups, we undertook interviews and focus groups with 44 women with a recent hypertensive pregnancy and interviews with 36 health professionals providing postnatal care in National Health Service (NHS) maternity care, primary care and community services in England. Analysis revealed that, despite the first six weeks being an important period for managing blood pressure, women often fall through the cracks between secondary and primary care. Invisible to these siloed clinical specialities, women are faced with new self-management and surveillance responsibilities alongside the work of new motherhood. Analysis, informed by Meleis’s transitions theory and Gidden’s concept of ‘distanciation’, develops Scott’s ‘sociology of nothing’ to explore responsibilities and consequences of being ‘unseen’ between services.

Initiating talk about suicide and self-harm in psychotherapy with adolescents with depression in China: A conversation analysis approach

Shuai Zhang, Xueli Yao, Qingwei Song, Jing Zhou & Meili Cheng

Talking about suicide and self-harm with depressed adolescents is a delicate aspect of psychotherapeutic interaction. While conversation analytic studies on suicide risk assessment have concentrated on adult populations in western settings, little is known about how suicide and self-harm are initiated in Mandarin-language psychotherapy for depressed adolescents. Drawing on conversation analysis and employing 24 audio recordings as the data, this study examined how talk about suicide and self-harm was initiated and responded to in psychotherapeutic interactions with depressed adolescents in China. We identified two primary initiation patterns: therapist-initiated inquiries and client-initiated disclosures. Specifically, therapists initiated inquiries by grounding inquiries in clients’ prior accounts, softening inquiries, and progressing incrementally from general mood inquiries to specific questions about suicide and self-harm. Clients initiated disclosures by embedding disclosures in their narratives, managing delicacy through mitigations, and exercising agency in shaping the therapeutic agenda. Both patterns were accomplished through calibrated interactional practices that balanced therapeutic obligations with the sensitivity of the topic, presenting the initiation as collaborative achievements shaped by mutual orientation to delicacy. This study contributed to the understanding of the complexities in the psychotherapeutic interactions with adolescents with depression and provides implications for offering evidence-based insights into recognizing and responding to the openings of suicidal talk.

The ethics and moral psychology of HPV vaccination: Evidence from a cross-cultural study

M. Alejandra Petino Zappala, Andrea Quint, T.N. Phuc Nguyen, Julia V. Schulz, Johannes T. Doerflinger & Nora C. Heinzelmann

Vaccine hesitancy is a major threat to public health worldwide. Debates about vaccines are often moralized; however, how ethics and ethical judgments relate to vaccination intention remains underexplored. Here, we identify ethically relevant concerns from the academic literature that we operationalize for a pre-registered survey to study how ethical judgments relate to parents’ intentions to vaccinate their children against HPV. We also investigate potential sociocultural influences on ethical judgments: we compare parents from the US, the UK, and Germany. We find that parents’ ethical judgments in all countries are strongly associated with vaccination intention. We also find cross-cultural differences in how their trust in science, physicians, and institutions relates to perceived sociomoral pressure. Still, in the three countries trust moderates the negative correlation between perceived health risks and vaccination intention. These results suggest that campaigns highlighting ethical aspects of vaccination and targeting relevant moral concerns could be effective against hesitancy.

What’s a policy without trust? How the legacy of policing shapes experiences of drug decriminalization in British Columbia

Alissa Greer, Becca Wood, Naomi Zakimi, Benjamin D. Scher

Historically, coercive and distrustful relations between police and people who use drugs have contributed to profound and enduring health harms. British Columbia’s drug decriminalization policy, introduced in 2023, aimed to shift these dynamics and promote health and wellbeing by reducing criminalization and improving interactions with police. Drawing on qualitative interviews with 38 people who use drugs with diverse and intersecting structural vulnerabilities, including Indigeneity, racialization, and economic and housing precarity, we examine perceptions and experiences of policing and policy during the first year of decriminalization. Participants described a persistent legacy of police violence, including physical, psychological, and symbolic harms, that shaped enduring mistrust toward both policing and the policy itself. This mistrust constrained the perceived legitimacy of decriminalization, with participants questioning whether the policy meaningfully altered entrenched institutional practices, culture, or power relations. Past and present policing also remained a structuring force of social marginalization, shaping the everyday realities of people who use drugs. Rather than a departure from previous enforcement regimes, the legacies of policing overshadowed the potential benefits of decriminalization. These findings demonstrate how historical harms and institutional legacies mediate health-oriented policy reforms through fear, mistrust, and constrained legitimacy. Drug decriminalization is not implemented in a vacuum; its capacity to improve health and wellbeing depends on the sociohistorical contexts and legacies that structure how people engage with police, institutions, and health policy.

“New barefoot Doctors”: How social workers navigate HIV care and structural marginality in Yi ethnic minority communities

Apei Song

Social workers play a critical yet underexamined role in HIV prevention and treatment in China’s remote ethnic minority regions. Drawing on ethnographic fieldwork conducted between 2024 and 2025 in two Yi-autonomous mountain townships, this study examines how social workers navigate structural inequality and constraints within HIV care. This study identifies three interrelated agentic practices. First, women’s healing workshops provide spaces that empower widowed women living with HIV through relational and cultural forms of support. Second, social workers advance drug assignment by advocating for simplified antiretroviral regimens, negotiating flexible dispensing arrangements, and translating biomedical knowledge into locally meaningful terms. Third, social workers engage in emotional stabilization and decriminalizing care, softening surveillance-oriented governance through ethical discretion and relational mediation. Framing as “new barefoot doctors,” social workers enact relational, structural, and institutional forms of agency that repair inequities and humanize HIV governance. The findings highlight the importance of culturally embedded, equity-oriented social work in advancing humane and effective HIV care in marginalized settings.

Bargaining and calibration: How SGM people navigate intersectional oppression in healthcare

Ning Hsieh & Stef M. Shuster

Sexual and gender minority (SGM) people experience far-reaching health inequities, yet their responses to such oppression remain underexplored. Related, recent scholarship has called for more intersectional analyses of SGM health. Drawing on interviews with a diverse sample of 40 SGM individuals, this study investigates participants’ experienced and anticipated barriers to care, the strategies employed to navigate these challenges, and how an intersectional lens offers a different vantage point to analyze their experiences. We identify bargaining – giving up or downplaying aspects of identities and relevant health information – and calibration – adjusting actions in anticipation of oppression – as two strategies participants used to navigate healthcare under intersecting inequalities related to sexuality, gender, and race/ethnicity. These ongoing strategies helped participants manage healthcare barriers and anticipated discrimination but came with significant costs to their health. We contribute to medical sociology by introducing the concepts of bargaining and calibration as agentic responses to healthcare inequities.

Privatizing and prescribing identity: How Canadian biotechnology firms capture queer, trans, and neurodivergent movements for profit

Megan Q. Linton & Kai Jacobsen

The pivot to telehealth through the COVID-19 pandemic spawned numerous private investor-owned virtual care firms, capitalizing on loopholes and outdated policies in Canada’s healthcare regulatory framework. Amidst neoliberal biocapitalism, these health technology firms are increasingly functioning as primary care providers to fill the growing gaps in care under austerity. Contemporary health companies co-opt identity politics and social movement rhetoric in their marketing, transforming marginalized communities into profitable niche markets. One such company is PurposeMed, a venture-capital backed start-up that operates private virtual clinics for HIV PrEP medication (Freddie), gender-affirming care (Foria), ADHD assessment and prescribing (Frida), and a pharmacy (Affirming Care). We analyze PurposeMed as a case study to illustrate broader trends in the creeping privatization of health. We reveal the results of a power structure and social network analysis of PurposeMed to understand the corporate powers transforming Canadian health care. Next, we present a critical discourse analysis of PurposeMed’s marketing and branding strategies, highlighting their exploitation of the existing digital networks and health information-seeking patterns of queer, trans, and neurodivergent communities to accumulate capital. Combined, our results demonstrate that healthcare privatization and commercialization in Canada is not an accident; rather, PurposeMed is the inevitable result of deliberate policy choices and austerity politics. We conclude by calling for urgent scholarly attention to the communities targeted by creeping privatization of Canadian health care and the firms profiting from them.

Including “sexual” in sexual and reproductive health labor: Gendered experiences of sexually transmitted infection (STI) prevention, testing, and treatment among young people in Texas

Brooke Whitfield

Sexually transmitted infections (STIs) in the U.S. have been persistently high for over a decade, and they disproportionately burden young people. Yet limited qualitative research has explored how young people understand, navigate, and experience STIs amid this ongoing epidemic. Drawing on in-depth interviews with 33 young people (ages 15–25) across Texas, this study examines the gendered dynamics of STI prevention, testing, and treatment through a reproductive labor framework. Findings reveal adolescent girls and young women assume the majority of sexual health labor: managing prevention, initiating testing, and coping with the emotional and relational consequences of infection. This unequal distribution of labor appears linked to the greater salience of STIs for adolescent girls and young women, as the sexual double standard renders testing positive more consequential for them than for adolescent boys and young men. At the same time, young men’s limited engagement in STI prevention reflects broader structural neglect: sex education and reproductive health policy in the U.S. have long centered on pregnancy prevention and excluded young men. As a result, young people of all genders are poorly equipped to engage in proactive, communicative approaches to STI prevention. By extending the concept of reproductive labor beyond fertility and contraception to encompass STI-related care, this study highlights how gendered and heteronormative systems of education and policy produce unequal sexual health responsibilities. Comprehensive, inclusive sex education that reframes STI prevention as shared sexual health work can help redistribute this labor and reduce STI burden among young people.

Locked out of the ward: Workflow-based care refusal for people living with HIV in China’s general hospitals

Yong Yu, Wenzhao Huang & Shishi Tang

Background

With the scale-up of antiretroviral therapy (ART), people living with HIV (PLWH) increasingly require non-HIV inpatient and procedural care in general hospitals, yet access remains precarious.

Aims

To examine how refusals of non-HIV care for PLWH unfold within routine general-hospital workflows.

Methods

We conducted an interpretive qualitative study in three provincial capitals in China (Changsha, Guangzhou, and Nanning) between May 2024 and October 2025. We interviewed 58 PLWH about one index non-HIV care-seeking episode each (80 interviews, including 22 follow-ups) and 16 key informants spanning perioperative, ward/bed, infection-control, and HIV follow-up roles. Episodes were reconstructed as node-by-node event chains and analysed using framework analysis and mechanism-oriented thematic analysis.

Results

Participants seldom described refusal as a single explicit denial. Instead, they described a recurrent care-refusal cascade across routine nodes including admission, consultation, perioperative assessment, ward acceptance, and transfer. Five linked mechanism modules connected HIV visibility to responsibility shifting, procedural deferral or delay, pathway resetting, navigation burden, and anticipatory avoidance. Costs are reported only as banded spillover indicators. The cascade appeared less likely to escalate when decision ownership was explicit, HIV was managed under standard precautions, and navigation support was available.

Conclusion

Unequal access can be interpreted as processual discrimination embedded in routine workflow governance rather than as isolated acts of refusal. By specifying a process model of “denial without denial”, the study identifies organisational breakpoints for accountable, traceable, and repairable hospital pathway governance.

Fatherhood and men’s participation across diverse antenatal care systems in rural Eastern Zimbabwe: A qualitative study

Anthony Shuko Musiwa, Morten Skovdal & Lawrence Mbuagbaw

Men’s participation in antenatal care (ANC) is widely seen as essential for improving access, uptake, and pregnancy outcomes in sub-Saharan Africa (SSA), the region with the world’s highest maternal and child mortality rates. However, current studies often approach participation narrowly through involvement in biomedical ANC, overlooking local fatherhood experiences and men’s relational and culturally grounded roles beyond clinical settings. Drawing on Afro-communitarianism and social capital frameworks, we conducted a qualitative study in Mafararikwa, rural Eastern Zimbabwe to explore the forms and meanings of men’s participation in ANC and the relational and communal factors influencing such participation. Collaborating with 101 participants including health professionals, caregivers, and community key informants, we generated data using in-depth interviews, consultative sessions, focus group discussions, and storyboarding. We thematically analyzed the data in QDA Miner Lite using a thematic networks approach, identifying two main themes and nine sub-themes highlighting men’s dynamic roles during pregnancy and ANC—leadership, decision-making, provision, protection, domestic support, emotional support, love, and care—embedded in relational and communal structures. The themes also revealed that men coordinated with spouses, relatives, community members, and diverse ANC providers to support ANC across indigenous and biomedical settings, demonstrating collective responsibility. Men’s ANC participation in Mafararikwa highlights local fatherhood experiences, Afro-communitarian values of identity and solidarity, and social capital mechanisms of resource mobilization, reciprocity, and trust. Interventions should recognize men’s diverse roles, leverage relational networks, and integrate culturally rooted approaches to ANC. Further research should apply Afrocentric frameworks, foregrounding local fatherhood experiences, Afro-communitarian values, and social support networks.

When solidarity turns bad: Misappropriated and exclusive solidarity as problematic forms of solidarity in healthcare

Elias Weiss & Barbara Prainsack

For a long time, scholarship on solidarity has primarily focused on its prosocial dimensions. Solidarity is typically seen as a socially, ethically, or politically desirable good—something that strengthens or expresses social cohesion. More recently, however, scholars have begun to examine the troubling aspects of solidarity. In this paper, we argue that problematic, or even harmful, forms of solidarity fall into two main categories. First, exclusive solidarity, where solidarity among a group deprives those excluded from access to essential goods or rights. Second, misappropriated solidarity, where the main benefits accrue to those performing solidarity—sometimes even at the expense of those ostensibly meant to benefit. Using two specific examples, we show how excluding migrants from public healthcare harms both the excluded and the included, weakening the broader solidaristic system. We also argue that using collective insurance contributions to fund unproven treatments, such as homoeopathy, can undermine trust and fairness. Finally, we revisit debates on linking healthcare entitlements to lifestyle choices to illustrate how exclusion and misappropriation can combine. We conclude that adopting an understanding of moral agents as shaped by their relationships to others can help prevent solidarity from becoming harmful.

“Care is nowhere but everywhere”: Improvising care in medical precarity in urban Somali refugee community in Kenya

Hyojin Im

Urban Somali refugees in Nairobi, Kenya, navigate healthcare within a landscape defined by chronic insecurity, fragmented governance, and racialized exclusion. This ethnographic study examines how Somali refugees in Eastleigh experience and respond to medical precarity, understood as a structurally produced condition where formal health institutions are present yet inaccessible. Drawing on key informant interviews and focus group discussions with 98 refugees, health workers, and community leaders, alongside field observations conducted between 2018 and 2019, the analysis shows how care is deferred, avoided, and reassembled under conditions of economic constraint, legal risk, and institutional mistrust. Rather than withdrawing from care altogether, participants navigated illness through relational infrastructures that include pharmacies, household networks, and trusted intermediaries providing credit, advice, and continuity. These practices make care possible while also exposing refugees to exploitation and uneven quality in poorly regulated pharmaceutical markets. Participants also articulated a moral horizon of health shaped by aspirations for dignified treatment and transnational imaginaries of functioning health systems. The findings show that improvised care is not an informal deviation but a rational and ethical response to structural neglect. Medical precarity, in this context, does not merely constrain care; it reorganizes care through relational infrastructures and a pastoralist logic of medical seeking, characterized by continual recalibration of trust, cost, safety, and recognition across fragmented health systems. Yet these practices cannot fully resolve the health capability gap between knowing what care requires and having the conditions to make such care possible.

The hope gap: a qualitative analysis of tiered hypertension care in China

Bo Li

Despite China’s tiered healthcare system positioning primary care as the cornerstone of hypertension management, patients’ bypassing of community clinics for hospital care reveals a hope gap as an unequal institutional capacity to cultivate the resources essential for sustained condition management that quality- and trust-based explanations leave unexamined. Drawing on abductive thematic analysis of 24 semi-structured interviews with hypertensive patients in Shenzhen, and guided by Gili & Mangone’s sociology of hope, this study explores how hope is socially mediated through patient-provider interactions across care levels and how these experiences of hope influence treatment-seeking decisions. Findings reveal that community clinics typically generated fragile, contingent forms of hope due to perceived limitations in expertise and resources, leading some patients to delay or avoid care. Hospitals, by contrast, offered structured and anticipatory hope, albeit undermined by overcrowding and long waits, reinforcing patients’ preference for hospital care. Patients navigated these hope differentials, investing time, money, and effort to secure hope as a resource for managing hypertension. By conceptualising hope as relational, socially embedded, and structurally produced, the study advances a sociological understanding of systemic inequities in healthcare access and utilisation. Addressing the hope gap, rather than solely redistributing clinical resources, may be key to strengthening primary care and alleviating hospital strain in China and comparable tiered systems.

Between trust and traceability: How immigrant-serving organizations become sites of both care and surveillance

Nilüfer Akalın

This article examines how immigrant-serving community-based organizations become implicated in state monitoring systems as they partner with public health programs. Drawing on ethnographic research and interviews with medical professionals, frontline workers, and administrators in a city in Upstate New York, I analyze how data requirements tied to state health programs incorporate immigrant-serving organizations into systems of oversight. Using the concept of system embeddedness, I show that (1) the financial precarity of immigrant-serving organizations, combined with their trusted relationships with immigrant communities, makes them indispensable actors in state-led health programs and gives rise to datafication practices; (2) data functions as a form of currency, as organizations receive funding in exchange for collecting multilayered information about immigrants; and (3) these data are entered into interoperable infrastructures that circulate information across agencies, increasing immigrants’ legibility and monitoring. The article demonstrates how CBOs become key sites where care and oversight are co-produced, and it foregrounds the ethical stakes of expanding data infrastructures in immigrant healthcare contexts amid intensified immigration enforcement. The findings highlight the need to rethink how data are collected, shared, and used in ways that protect community trust while limiting the incorporation of care sites into expansive surveillance regimes.

Human milk for cancer care: Science-in-extension and gendered digital labor

Revital Harari, Ayelet Oreg & Anat Herbst-Debby

This qualitative case study examines how human milk is framed, negotiated, and justified as a therapeutic resource for adults with cancer within a large digital peer-to-peer human milk-sharing community. Drawing on discourse analysis of posts and comment threads from an online group dedicated to milk donation for oncology patients, the study analyzes how participants construct therapeutic meaning in a context marked by biomedical uncertainty and limited institutional guidance. The findings show that members selectively draw on a pragmatic mode of reasoning we term ‘Science-in-Extension’, in which biomedical language and principles are selectively appropriated and applied beyond their established evidentiary contexts. Rather than fully rejecting biomedical authority, participants appear to rework it in pragmatic ways within a digitally mediated space of uncertainty.

Professional and regulatory logics of care: Unraveling the institutional contexts of personal care workers’ well-being failure

Shixin Huang & Tat Chor Au-Yeung

Attracting and maintaining a sustainable care workforce is a persistent global challenge for the long-term care (LTC) sector. Personal care workers account for the largest proportion of the LTC workforce and provide the most frequent daily assistance to older adults with complex care needs. Yet, their caring labour has been poorly recognized and valued by the society. Keating et al. (2021) suggested that because of chronic system failures in the LTC sector, personal care workers experience substantial “well-being failure” characterized by adverse well-being outcomes in multiple dimensions, including material, relational, and subjective well-being. The concept of “well-being failure” highlights how the care crisis imposes collective well-being challenges on the personal care workforce, calling for a systemic understanding of workers’ hardships at a structural level. Drawing from the theory of institutional logics from the organization studies literature, in this study we examine the institutional logics that shape the well-being failure of personal care workers in residential care homes. Using the residual-productivist welfare regime of Hong Kong as a critical case example, together with in-depth interviews with 52 personal care workers and stakeholders in the LTC sector, we argue that the professional logics of professional hierarchy and the regulatory logics of compliance and risk containment have systematically translated into dysfunctional care culture and organizational arrangements that demoralize personal care workers at the frontline of care. Practical implications for team communication and collaboration between regulator and private service-providers are discussed.

Alcohol in the workplace: an ethnographic study of professional bartender culture and risk management

Alix Boirot & Marta Lotto

Background

Alcohol consumption among bartenders is higher than in most other professions. However, the cultural and occupational meanings of drinking in this setting are underexplored.

Methods

Drawing on symbolic interactionism, this ethnographic study explores how bartenders interpret and regulate their alcohol use in their professional environment. Fieldwork was conducted in Marseille, France, in 2023 and included 22 in-depth semi-structured interviews and 320 h of participant observation with 38 bartenders working in 33 independent bars. Data were analysed inductively.

Results

Findings reveal a “professional culture of drinking” where alcohol serves multiple functions: commercial, relational, ritual, and self-regulatory. Bartender drinking was tolerated by all concerned parties (managers, clients, etc.) and was often considered part of their identity, provided that service quality remained unaffected. Consumption frequently occurred in a “grey zone” where personal and professional boundaries were blurred. While most bartenders interviewed recognized the associated risks, they mainly emphasized mental not physical harms. They feared dependence but rarely sought formal healthcare services; instead, informal peer-based regulation and support predominated, together with self-regulation strategies like limiting hours of drinking and using non-alcoholic shots.

Conclusions

Alcohol use among bartenders cannot be understood solely as a health-risk behaviour; it must be situated within professional norms and social logics. Public health interventions should move beyond prescriptive regulation to co-constructed approaches to prevention that respect occupational culture, valorise existing peer-based moderation practices, and strengthen dialogue between health professionals, employers, and workers.

Rethinking the social structuring of health: Toward an epidemiological sociology

David Consolazio

This paper engages with ongoing debates on the limitations of social epidemiology in explaining the social structuring of health. While the field has been highly successful in documenting the patterned distribution of health outcomes across social groups, it remains largely anchored in an epidemiological paradigm that prioritises identifying statistical associations over explaining underlying social processes. Building on this limitation, the paper argues for a reorientation towards what can be defined as an epidemiological sociology, in which sociological theory plays a central role in shaping research questions, analytical strategies, and the interpretation of empirical findings. In doing so, it argues for re-centring sociological thinking in the study of health, emphasising the role of agency, social mechanisms, and meaning-making processes. By advancing a more integrated perspective on the relationship between social conditions and health – illustrated through a critical engagement with research strands such as intersectionality, social network analysis, agent-based modelling, experimental psychosocial interventions, behavioural economics, qualitative methods, biological pathways, and neighbourhood effects – the paper contributes to ongoing efforts to bridge sociology and epidemiology. It ultimately suggests that a stronger incorporation of sociological insights can support the development of more effective and equitable public health interventions by targeting the mechanisms through which health inequalities emerge.