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Wisdom and the path-dependent politics of biomedical research

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Dragos Simandan
Dragos Simandan
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Abstract

A discussion of the wise stance in biomedical research as an epistemological attitude that systematically combines multiple perspectives, coupled with a reflection on the path-dependent politics of biomedical knowledge production.
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J. Biosoc. Sci., (2017) 49, 563–565, © Cambridge University Press, 2016
doi:10.1017/S0021932016000638 First published online 21 Nov 2016
Debate
WISDOM AND THE PATH-DEPENDENT
POLITICS OF BIOMEDICAL RESEARCH
DRAGOS SIMANDAN
1
Geography Department, Faculty of Social Sciences, Brock University, Ontario, Canada
In their reply to my commentary (Mason et al., 2017; Simandan, 2017) Mason et al.
provide a thoughtful and engaging discussion of my original points, and go beyond it, to
offer a glimpse of the politics of current biomedical research. They highlight further
evidence that neoliberal policies, such as structural adjustments (see also Simandan,
2010a, 2011a; Peck, 2013), are a causal factor in the increased prevalence of tuberculosis.
They point out how fear, shame and the anticipation of contempt have led tuberculosis
patients to worry about disclosing their diagnosis to friends and family, and therefore, to
compound their medical problems in the long term and to generate avoidable risks for
their families and for public health. In sum, it becomes abundantly clear that
tuberculosis cannot be understood simply as a biomedical problem, and instead requires
a breath of social, historical, cultural and political dimensions of analysis (Mason et al.,
2016). I have argued at length elsewhere that specialized research programmes are not
sufficient for grasping the complex problems that confront our social world, and that we
need to practise ‘the wise stance’towards them (Simandan, 2002, 2010b, 2011b, 2011c,
2013, 2016). One of the attributes of wisdom is the ability to address a problem through
multiple inter-related frames of reference (Sternberg & Jordan, 2005; Walsh, 2015). It
therefore strikes me that the integrative framework Mason et al. have articulated is a
welcome step towards practising the wise stance in biomedical research. I will follow
with interest the development of their research programme and will only add here two
suggestions for further enquiry prompted by their reply.
The first suggestion pertains to broadening the target of their theoretical framework.
Tuberculosis is an infectious disease, and it is almost tautological to note that infectious
diseases are inherently social phenomena. This fact opens up the prospect of generalizing
Mason et al.’s framework to all infectious diseases. This would be no easy task, as it
requires a careful negotiation between generalizing and remaining attentive to the
unique signature of each infectious disease. But it would help inject a much needed social
dimension to biomedical research, a field still mired in a problematic scientific imaginary
that naively reifies the separation between the objective realm of science and the
subjective realm of values, politics and morals (Rosenberg, 2015).
1
Email: simandan@brocku.ca
563
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And this point brings me to the second suggestion for future enquiry: we need a more
incisive analysis of the path-dependent processes (Simandan, 2012; Rixen & Viola, 2015)
through which tuberculosis has been constructed and framed as a biomedical problem.
The discursive construction of tuberculosis as a disease enables the apparently natural
step of conceiving it as a problem to be addressed by medical researchers, as an issue of
biomedical research (Abbott, 1988; Foucault, 2012; Rosenberg, 2014, 2016). This
narrow framing is a power move that over decades has systematically legitimized the
pattern of access to research funding mentioned by Mason et al.: whereas ‘hard science’
medical projects can secure such funding, investigators from fields interested in the social
dimensions of this disease (health geography, health economics, medical sociology and
medical anthropology) have often been left out. In other words, we need to become more
cunning about the politics of biomedical research and the power wielded through the
framing and reframing of tuberculosis and other diseases.
Acknowledgments
This research has been funded through Insight Grant No. 435-2013-0161, provided by
the Social Sciences and Humanities Research Council of Canada.
References
Abbott, A. (1988) The Birth of the Clinic: An Archaeology of Medical Perception. Routledge,
London (originally published in French in 1963).
Mason, P. H., Roy, A. & Singh, P. (2017) Reciprocity-building and the importance of
interdisciplinary collaboration in tuberculosis research. Journal of Biosocial Science
doi: 10.1017/S0021932016000626.
Mason, P. H., Roy, A., Spillane, J. & Singh, P. (2016) Social, historical and cultural dimensions of
tuberculosis. Journal of Biosocial Science 48(2), 206–232.
Peck, J. (2013) Explaining (with) neoliberalism. Territory, Politics, Governance 1(2), 132–157.
Rixen, T. & Viola, L. A. (2015) Putting path dependence in its place: toward a taxonomy of
institutional change. Journal of Theoretical Politics 27(2), 301–323.
Rosenberg, A. (2015) Philosophy of Social Science, 5th edition. Westview Press.
Rosenberg, M. W. (2014) Health geography I: Social justice, idealist theory, health and health care.
Progress in Human Geography 38(3), 466–475.
Rosenberg, M. W. (2016) Health geography II ‘Dividing’health geography. Progress in Human
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Simandan, D. (2002) On what it takes to be a good geographer. Area 34(3), 284–293.
Simandan, D. (2010a) On how much one can take: relocating exploitation and exclusion within the
broader framework of allostatic load theory. Health & Place 16(6), 1291–1293.
Simandan, D. (2010b) Beware of contingency. Environment and Planning D: Society and Space
28(3), 388–396.
Simandan, D. (2011a) Kinds of environments –a framework for reflecting on the possible contours
of a better world. The Canadian Geographer 55(3), 383–386.
Simandan, D. (2011b) The wise stance in human geography. Transactions of the Institute of British
Geographers 36(2), 188–192.
Simandan, D. (2011c) Is engaged pluralism the best way ahead for economic geography?
Commentary on Barnes and Sheppard (2009). Progress in Human Geography 35(4), 568–572.
564 D. Simandan
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Simandan, D. (2012) Options for moving beyond the canonical model of regional path depen-
dence. International Journal of Urban and Regional Research 36(1), 172–178.
Simandan, D. (2013) Learning wisdom through geographical dislocations. Professional Geographer
65(3), 390–395.
Simandan, D. (2016) Proximity, subjectivity, and space: rethinking distance in human geography.
Geoforum 75, 249–252.
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dynamics of tuberculosis. Journal of Biosocial Science doi: 10.1017/S0021932016000614.
Sternberg, R. & Jordan, J. (eds) (2005) A Handbook of Wisdom. Psychological Perspectives.
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Walsh, R. (2015) What is wisdom? Cross-cultural and cross-disciplinary syntheses. Review of
General Psychology 19(3), 278–293.
Debate 565
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