Book Review: Magnetic Appeal: MRI and the Myth of Transparenc

BOOK REVIEWS
Reviews Essays

CT Suite: The Work of Diagnosis in the Age of Noninvasive Cutting. Barry F. Saunders. Durham, NC: Duke University Press, 2008; ix + 398 pp Magnetic Appeal: MRI and the Myth of Transparency. Kelly Joyce. Ithaca, NY: Cornell University Press, 2008; 208 pp. Julie Roberts University of Warwick Both CT Suite and Magnetic Appeal make important contributions to the vibrant and growing field of sociocultural studies of medical imaging. Reading the two books together demonstrates something about the range of disciplines with an interest in this topic. Saunders is a medical doctor and a cultural anthropologist whose writing is influenced by the humanities. Joyce approaches the topic from a sociological perspective, influenced by science and technology studies. Saunders and Joyce focus on different technologies: Saunders on computed axial tomography (CT) and Joyce on Magnetic Resonance Imaging (MRI). These differences aside, the two books offer complementary accounts of imaging technologies and their use in U.S. health care. Both authors describe U.S. society as “enamored” with imaging technology (e.g., Saunders, p. 3) and argue that it is accorded “sacred” status (e.g., Joyce, p. 149). Both authors underpin their analysis with an understanding of the close epistemological links between seeing and knowing in Western culture (to see something is to know that it is true) and acknowledge the common conception that imaging technology renders the human body transparent, allowing us to see inside in an apparently objective and un-

mediated way. Yet both authors challenge these tropes by describing the very complex ways in which knowledge is constructed in the interaction of the visual with social practices and norms. In CT Suite, Saunders aims to describe and analyze the diagnostic use of CT within and across a variety of sites in the day-to-day activities of the hospital and within the constitution of medical expertise. The chapters are named for broad domains of radiological practice: Reading and Writing; Cutting (referring to multiple “slice” images); Diagnosing; Curating; Testifying and Teaching; Exposition—and with each, the reader is transported to a different domain of the hospital and examines CT anew in each context. Saunders aims to join his accounts together with three principle threads: practice, death, and intrigue. The last of these is the most innovative perhaps. Saunders claims that the fiction of Edgar Allan Poe has shaped his “ethnographic sensibilities” (p. 10), helping him to tune in to the intrigue and puzzles of diagnostic work. Each chapter begins with a Poe quotation linked to the chapter’s focus. For example, the first chapter “Reading and Writing” (about the activities of the radiological reading room) begins: “‘If it is any point requiring reflection,’ observed Dupin, as he forebore to enkindle the wick ‘we shall examine it to better purpose in the dark’” (from The Purloined Letter, Saunders, p. 13) Although Saunders’s use of Poe is a point of interest, and it serves to highlight the uncertainties and twists and turns of diagnostic work, for me the quote remains a little disconnected from the main body of the text. However, Saunders’s focal thread of practice is strong and sustained and is represented in

431

432

Medical Anthropology Quarterly

dramaturgical style. An excerpt will illustrate this best: A tech enters the Body CT reading room and lays a film stack at the fellow’s elbow. Without shifting his gaze from the viewbox, the fellow registers the drop with a quiet groan. Tech, with mock solicitousness: “Such heavy sighs!” No response: the tech leaves, unoffended. The fellow, rapt at the board, silently nudges the film stack with his elbow, toward the resident. The resident takes the stack in his lap and rolls his chair (backward, long leg strokes) to the other view box. [p. 55] Everyday work practices are reported in remarkable detail throughout the book, and the level of detail gives the reader a sense of what it might be like to be there, in the reading room, scan room, or teaching conference. It is not just actions that are reported, but also the use of language is very important to Saunders’s account. He pays attention to rhetorical formations as well as terminology and style of delivery. For example, he draws attention to the way radiologists in the reading room use the present conditional—“could be, might be, may be” (p. 5)—to convey ambiguity in interpretation of an image. And Saunders, like Joyce, draws attention to the professional hierarchies of the hospital and the ways in which work practices around radiography reflect and shape these. However, it feels at times as though we are reading the researcher’s field notes and the analysis is sometimes lost among the details. Saunders acknowledges that his representations of the field site sometimes “far exceed what I can offer in commentary” (p. 7), leaving it to readers to tune in and draw their own inferences. This is perhaps also related to Saunders’s stated aim to work productively with juxtapositions and interruptions rather than to present a coherent account, an approach he believes provides a more apt representation of CT in practice although this may be true. For these reasons

the book is perhaps better suited to postgraduate students and to those who already have a good understanding of sociocultural perspectives on medical imaging. One important factor to bear in mind when reading CT Suite is that Saunders’s fieldwork was conducted 1996–97. This dates some aspects of his analysis, and he acknowledges the need to update findings and theorizing in relation to technological changes. For example, at the time of Saunders’s fieldwork, the mechanical film view box was the norm. He acknowledges that the shift to digital systems for reviewing and sharing images is making a considerable difference to the ways in which clinicians and images move through the different spaces of the hospital. That said, we might ask of any account how time and place imprint on the analysis presented so the date of Saunders’s fieldwork does not necessarily detract from the value of his analysis; it only points the reader toward more recent work for comparison Joyce’s aim in Magnetic Appeal is to examine MRI as “cultural icon” (e.g., p. 2). MRI images appear commonly and are widely referenced in popular culture while being considered “sacred object(s) on which revolve questions about personal health, identity and life’s many dilemmas” (p. 2). Like Saunders, Joyce bases her book on ethnographic fieldwork in hospital imaging units and radiology conferences, as well as interviews with key informants (radiologists, technologists, neurologists). The focus is on those human actors involved in the manufacture and clinical use of MRI. For Joyce, the proliferation of imaging technologies can only be understood within the widest possible context, including the “visual turn” in contemporary society, fear of litigation in medicine, health insurance policies and practices, and relationships between manufacturers and health care providers. Increased use of imaging technologies cannot be purely accounted for in terms of their efficacy or use in medicine but must also be understood as entangled with all of these elements.

Book Reviews

433

Although Saunders’s book was arranged by areas of practice, each chapter in Joyce’s book engages with her topic via a different theme or level of analysis. After the introduction, the second chapter presents a cultural history of the technology. The third presents some of the cultural narratives that position MRI as a technology of truth and generator of neutral, objective, infallible knowledge of the body. The fourth chapter describes MRI in clinical practice: the processes of image production and interpretation within an MRI unit are analyzed, including the management of patient flow and the professional hierarchies at work within the unit. The fifth chapter situates MRI in the wider political economy and examines the generation of capital from MRI for a range of industries, from imaging centers to radiologists and manufacturers of machines and consumables. Chapter six concludes. The chapters work well as a collection. They are relatively short and keenly focused on a line of argument with brief illustrative excerpts from field notes and transcripts. Frequent references to popular culture—the soap opera General Hospital, TV drama House, the exhibition Body Worlds—make the arguments accessible and easy to relate to. At times, the illustrations are briefer than I would like. The analysis is entirely convincing and the research methods are described in detail in the appendix. However, the text of the chapters primarily relies on the author’s perspective, and as a personal preference I would have liked more illustration of the data in which the analysis is grounded. Each chapter is capable of standing alone and is therefore very useful for student reading lists, although each also contributes to Joyce’s central argument. I would suggest that Magnetic Appeal is well suited to teaching at undergraduate and postgraduate levels. It conveys the key concepts in the field and gives a clear sense of how and why medical imaging is a social and political issue as well as engaging the reader with theoretical concerns. In my opinion, one of the most useful insights offered by Joyce is the identification of three tropes about medical

imaging that can be observed across sites, both within the medical community and beyond in the public realm. These are: image as transparent knowledge, MRI as progress, and MRI as agent (ch. 2). These tropes can be identified by students and scholars in their own examples, and perhaps extended. In particular, Joyce takes care to remind her readers about the consequences of the concepts and narrative constructions that she analyzes reinforcing the relevance and importance of her analysis. For example, Joyce argues that popular tropes represent MRI as a neutral technology, symbolic of progress and the gold standard of care, that renders the body transparent, implying that all health problems can all be visualized and, once visualized, remedied. These narratives help to sustain particular health care practices and policies such as the current U.S. policy that physicians need no specialist training to interpret radiographic images. This policy only makes sense, Joyce argues, within a society that expects radiographic images to be self-evident. Within this context, the current policy is difficult to challenge (p. 75). The two books are complementary in many ways. They work at different levels of analysis: Saunders immerses us in the hospital for the vast majority of the book, while Joyce presents MRI in its broader social, political, and economic context. The treatment of contrast agents—material injected into the patient to produce greater contrast between body parts in the radiographic image—by each author provides an illustration. For both authors, the financial cost of contrast agents is at issue. However, the focus in CT Suite is on the institutional management of the cost of contrast through guidelines for selective use that take into account not just patient characteristics but staffing levels; the result of this is that cheaper contrast can only be given when a radiologist can be in the room with the patient to monitor for adverse reactions. For Joyce, the focus is the multimilliondollar market in contrast agents. Those corporations that manufacture MRI machines also pursue “ancilliary marketing” (p. 115)

434

Medical Anthropology Quarterly

of coils, contrast, and other supplementary products. This means, as Joyce points out, that they have a financial interest in increasing numbers of MRI examinations. It is however notable that both books are almost entirely focused on the United States with no attention to how findings might compare in other countries. Joyce gives some clues to the local specificity of imaging in practice by detailing the regulatory frameworks of the U.S. system, and also relevant systems such as insurance reimbursement. Future work might usefully look at imaging practice beyond the North American context and to the global market in imaging technology and consumables. Patients are also almost completely absent from both books. Although we learn about the perspectives of health care staff, we learn almost nothing about what it is like to be a patient undergoing imaging in a U.S. hospital. This is beyond the stated remit of both books, but I would argue that the patient perspective has been neglected in recent sociological and anthropological studies of medical visualization and would be a welcome addition to the literature. Nonetheless, I commend both these books as very valuable resources for scholars interested in medical imaging and its use in health care. An Anthropology of Biomedicine. Margaret Lock and Vinnh-Kim Nguyen. Malden, MA: Wiley-Blackwell, 2010, xii + 506 pp. The Taste for Knowledge: Medical Anthropology Facing Medical Realities. Sylvie Fainzang, Hans Einar Hem, and Mette Bech Risor, eds. Langelandsgade, Denmark: Aarhus University Press, 2010, 258 pp. Hans A. Baer University of Melbourne Medical anthropology started out as an examination of indigenous or traditional medical systems and how biomedical health care could be delivered to indigenous and peasant populations and people in developing societies. But by the 1970s, medical anthropologists turned more and more of

their attention to biomedicine and how it, as a universally hegemonic medical system, interfaces with other medical systems, ranging from professionalized heterodox ones to folk and indigenous ones. Although the distinction between the “anthropology of medicine” and the “anthropology in medicine” may be somewhat simplistic, for heuristic reasons I believe that it still captures the essence of two rather different approaches taken in Anthropology of Biomedicine and The Taste for Knowledge. Anthropology of Biomedicine is an encyclopedic tour de force of biomedicine, the essence of which cannot be captured in a short review essay. In their introduction, Lock and Nguyen, following Clifford Geertz and Marilyn Strathern, defend the culture concept but also reject a simplistic “assigning individuals to named essentialized cultures” (p. 6), something that they successfully resist throughout their captivating book. Part 1 focuses on “Technologies and Bodies in Context” and contains four chapters that discuss biomedical technologies in practice, the biomedical notion of the normal body, anthropologies of medicine, and local biologies. As Foucault predicted, Lock and Nguyen observe that biomedical technologies are not confined to clinics and hospitals but have been increasingly promoted by private foundations, NGOs, churches, and religious bodies as part of a neoliberal agenda stressing individual responsibility for health, an approach that ignores the impact of a global economy under which the accumulation of wealth by the privileged few is contributing to growing social inequality and the continuation of poverty. Despite the hegemony of biomedicine, medical pluralism persists and exhibits hybridization under which biomedical and indigenous medical systems, both professionalized and popular or folk, interact and borrow from each other. Within this process, some nonbiomedical systems, such as Chinese medicine, Ayurvedic medicine, and Tibetan medicine, have also become “cosmopolitan” medical systems, a term that Charles Leslie in the 1970s applied to

Book Reviews

435

biomedicine. At the same time, biomedicine seeks to contain competing medical systems by integrating them only when their knowledge and practices become standardized according to biomedical regulations and practices. Part 2 focuses on “The Biological Standard” and contains three chapters that discuss the biomedical notions of the “right population” and “colonial disease” and clinical trials as a means for comparing human populations, sometimes as a part of an effort to create markets for biomedical technologies in developing countries and testing biomedical interventions, particularly those for HIV, for the world’s poor. The emergence of chronic diseases among the poor and “not-quite poor” is providing a new market for the pharmaceutical industry, a biomedical approach that continues to ignore the impact of ongoing deprivation and hunger. Thus, just as biomedicine had functioned as a tool of colonial empires, it is now serving as a tool of neoliberalism. Part 3 focuses on “Moral Boundaries and Human Transformations” and consists of three chapters that discuss the commodification of organs, tissues such as eggs and sperm, and even cell lines. In keeping with Baudrillard’s observation that the corpse constitutes a reference point for biomedicine, bodily organs, whether from dead people or living ones, have resulted in an international market that capitalizes on the poor in both legal and illegal ways. Biomedicine has promoted ARTs (assisted reproduction therapies) to such an extent that the Euro-American conflation of biological and social parenthood has broken down. Part 4 focuses on “Elusive Agents and Moral Disruption” and consists of four chapters that touch on the resocialization of the biological self, the growing emphasis on the genetic codes as the primary driver for life expectancy, individual development, health, and disease and genes as “embodied risk” factors, the mapping of the human genome as a “Holy Grail” that will deliver human beings from their natural deformities and defects, and how molecular genetics

and genomics have rekindled earlier debates about race and ethnicity. Lock and Nguyen end their book in the epilogue by stating: “The time is long overdue for the implementation of a radically new approach, one preceded by public deliberation that transcends disciplinary and factional boundaries, brings unexamined assumptions to light, seeks to drastically reduce inequalities and, at the same time, attends studiously to local voices and local contingencies, biological and sociological” (p. 364). Such a call is consistent with the notion of praxis—the merger of theory and social action—to which critical medical anthropology and even critically interpretive medical anthropology subscribes. However, the book does not provide us with any guideline as how to frame the “radically new approach” that Lock and Nguyen espouse. Although it focuses primarily on biomedicine, The Taste for Knowledge is a very different book—one that harkens back to Kleinman’s assertion in the 1970s that medical anthropologists have a “clinical mandate” and the dialogue and debate between clinical anthropology and critical medical anthropology that occurred in the late 1980s and early 1990s. Whereas this debate (between those focused on the study of, and those focused on study in, medicine) occurred primarily in North America, The Taste for Knowledge suggests that many of the same issues have been occurring in European medical anthropology, as manifested in the struggle between fulfilling a clinical mandate while not becoming handmaidens of biomedicine or glorified social workers. This book is the result of the Medical Anthropology at Home (MAAH) conference that occurred in Denmark in May 2008. MAAH is a network of medical anthropologists who conduct research in their own societies. Some of the contributors are based primarily in social science programs, including anthropology departments, and others are based primarily in biomedical and public health schools. In the introduction, Fainzang, Hem, and Risor observe that

436

Medical Anthropology Quarterly

European medical anthropology is “still in the making and that medical anthropology is becoming increasingly important in the fields of medical research and public health” (p. 11). Conversely, as the editors point out, medical anthropology per se has its roots more in European anthropology than North American anthropology as is exemplified by Evans-Pritchard’s 1937 book on Azande witchcraft and Ernesto Di Martiono’s 1958 book on the healing ritual of the tarantella in southern Italy. Part 1 consists of seven chapters in which the contributors reflect on medical anthropology as a “collaborating science” with various actors, not only biomedical practitioners but also patients. In “Should Physicians and Psychiatrists Also be Ethnographers? Toward a Future Agenda for Medical Anthropology,” Cornelles writes approvingly of the work of Paul Farmer as a physician–anthropologist. However, his suggestion that one way medical anthropologists can avoid the dominance of the biomedical profession is perhaps by working in “business and trade fields connected to the industry of services to the body, in pharmacy and parapharmacy, or in the communications industry” (p. 36) is a worrying one. It is such industries along with health care corporations that have come to exert an ever-greater power over healthcare than biomedical practitioners have ever had. Perhaps more helpful, then, is Fainzang’s observation in “Anthropology and Biomedicine: A Dangerous Liaison? Conditions for a Partnership” that anthropology “must develop a margin of freedom” (p. 52) in its collaboration with biomedicine. This holds true for functioning in other institutions as well. The rest of the chapters in this section are more topical. Whereas there is a long tradition in the medical social sciences of examining patient “non-compliance,” Anderson examines “patient delay” in two case studies of cancer patients. Her chapter should prompt other medical anthropologists to examine the phenomenon of “patient delay” in the case of other diseases. Middleton, Moen, and Hostmark blend both anthro-

pological and biomedical insights in seeking to unravel the discourse on “bad fat” and “good fat” in contemporary discussion on food and health. Van der Geest examines the benefits and dilemmas associated with including patients, some of whom have demanded “patient power” by being involved, in research that focuses on their well-being. Fortin explores how the clinic functions as a “social and relationship space in which norms, values, and professional, social, and cultural models intersect” (p. 115). In his chapter, which shifts the discussion from the “clinical mandate” to what might be called an “individualistic public health mandate,” Hem discusses the possibilities that exist for anthropologists in contributing to the growing field of health promotion. I fear, however, that a narrow focus on health promotion is already distracting people from examining the political, economic, and social structural sources of their illnesses. Part 2 consists of seven chapters that explore patient strategies in addressing their diseases primarily within the corridors of biomedicine but also in plural medical settings. Indeed, most of the contributions to this part indicate that medical pluralism or “multiple medical realities” is or are well and alive in various European countries and probably in ascendancy. For instance in her work with people with medially unexplained symptoms (MUS) or somatization in Denmark, such as those of fibromyalgia, Mech Risor discovered that nearly all of her subjects sought out a wide arrangement of specialists, not only biomedical ones but also psychologists, spiritual counselors, masseurs, and chiropractors, as well as of medicines, including medicinal herbs. MUS patients often embark on new forms of employment and education as a way of confronting their condition. Johannessen’s chapter compares and contrasts the ways in which cancer patients in Denmark and in Tuscany employ complementary medicine in treating their condition. In that Danish law has provided more space for complementary practitioners than has Italian law, she found that Danish cancer patients are much more likely to turn to

Book Reviews

437

complementary medicine than are Tuscan cancer patients. Menaca illustrates the fact the medical pluralism is often “enhanced with the ‘traditional’ practices imported from migrants’ countries of origins” (p. 167). Ecuadorian migrants to Spain easily continue on with the practice of self-medication because this is a common practice in both countries. Conversely, although pharmaceuticals are cheaper in Spain, despite the fact that it is a developed country, because it has a public health system, Ecuadorian migrants often purchase their pharmaceuticals in their home country because they are easier to obtain without a prescription. In discussing self-care and management of chronic patients under the provisions of the new Dependency Law in Spain, Bofarull observes that, “in addition to the public and private medical systems, chronically ill persons often have recourse to various forms of complementary and/or alternative medicine” (p. 205). Unfortunately, in Spain, as is the case in other developed countries, including the United States and Australia, low-income patients, chronic or otherwise, often cannot obtain complementary treatment because it generally is not covered under the provisions of the public health care system and only on a limited basis under private health insurance. In a related chapter, van Dongen reports that cancer patients not only rely on a larger social support network but also on more complementary and alternative therapies than healthy people. In contrast to these chapters, Arnaiz (“Obesity as a Social Problem: Thoughts about Its Chronic, Pandemic and Multi-Factorial Character”) and Foley, Papadaniel, Kaech, and Rossi (“From Curative to Palliative Care: Confronting the New Realities in a Hospitalised End of Life”) examine obesity and the need for palliative care within the context of biomedical settings. Obviously medical anthropology around the world has grown and flourished and intersected with other disciplines and fields as Anthropology of Medicine and The Taste of Knowledge illustrate. In contrast to its focus in the 1960s and 1970s, medical an-

thropology as a subdiscipline now examines a wide arrangement of issues, including biomedical technologies, local biologies, organ transplants, genomics, chronic diseases, and the clinical experience in numerous guises. These two books constitute ongoing efforts to illuminate various issues in the anthropology of biomedicine and anthropology in biomedicine. Conversely, one must bear in mind that biomedicine around the world is situated in larger national health care systems. Unfortunately, those who have contributed to the two books under review have not engaged with the literature on comparative national health systems, one to which a small but growing number of medical anthropologists have contributed. That endeavor has been dominated by public health, health policy studies, and medical sociology. Perhaps this is an area to which more medical anthropologists should now begin to contribute and add insights. Of the two books under review, An Anthropology of Biomedicine will have a wider appeal because it touches on many recent developments in biomedicine around the world. Conversely, clinical anthropologists in North America will find The Taste for Knowledge useful because it will create an awareness of developments in an important subfield of medical anthropology on the other side of the Atlantic. AIDS, Culture, and Gay Men. Douglas A. Feldman, ed. Gainesville: University Press of Florida, 2010; ix + 285 pp. E. Michael Gorman San Jose State University Douglas Feldman provides readers an interesting potpourri of articles in his edited volume, AIDS, Culture, and Gay Men. The book is nothing if not wide ranging. Based primarily (although not exclusively) on research and varying sociological, social epidemiological, and anthropological perspectives from the U.S. East Coast, especially greater New York, the volume provides the reader with a sense of the many

438

Medical Anthropology Quarterly

kinds of experiences and perspectives accrued especially in first two decades of the HIV epidemic in respect to men who have sex with men (MSM), including gay men. Structurally, the book is organized into 15 chapters, including an introduction and a very brief postscript by the editor. It is generally well and clearly written. Feldman’s introduction provides a decent literature review about the period. Feldman was among the first anthropologists to be involved in the HIV epidemic, and he therefore has a unique perspective in terms of the big picture as well as many of the details about dynamics on the east coast. He also provides a firsthand account of his own experience “in the trenches” as a leader of a communitybased organization on Long Island, which provides insight into the at-times ruthless politics of HIV/AIDS. Of the 13 other chapters, several are primarily or in part summaries of surveys or analyses, or comparisons of HIV interventions targeting MSM or summaries of previously published work. Among these are chapters about diffusion of effective behavioral interventions, HIV risk, and intervention among Latino MSM in Connecticut, a comparison of U.S. versus Australian interventions, and the history of the gay movement in Flanders and HIV-prevention efforts in that part of Belgium. One of the more intriguing chapters deals with perceptions about the varieties of recovery from methamphetamine addiction (MA), which has plagued the gay male community for nearly two decades. One could not have a book about AIDS and MSM or gay men that did not include some reference to this significant health issue. One thoughtful chapter describes the process for developing ethical guidelines for ethnographic fieldwork on sexual behavior among Latino MSM in greater New York. Given the dearth of existing guidelines from professional organizations, the authors do a great service in articulating the context of their work, their process, and their own standard for ethical research in the settings where they were working. Munoz˜ LaBoy and Parker’s chapter on bisexual-

ities, sexual cultures, and HIV-prevention programs in the Latino MSM communities of greater New York provides the reader with a unique theoretical perspective that draws on sentinel theoretical work by Parker. Another theoretically sophisticated chapter from a similar point of view is Slavin and Ellard’s piece, “Substance, Kinship, and the Meaning of Unprotected Sex.” This chapter, from Australia, draws on the writing of David Schneider, whose important theoretical work on kinship is underappreciated and unfortunately rarely cited today. Stanley’s chapter on HIV-treatment adherence and self-preservation provides the reader with insights into an emic perspective of HIV positive individuals, albeit from an earlier time in the epidemic. Overall, the book is a bit ambitious and as such evinces strengths as well as limitations. Strengths include that it is generally well written and the fact that the editor attempts to provide readers with a sense of the complexity and breadth of detail regarding the epidemic’s impact among gay men and MSM, especially on the east coast. Another strength is the inclusion of several very good and innovative theoretical chapters that address not only HIV/AIDS, per se, but also speak to the notion of culture and gay men. By the same token, the book is so very wide ranging that one senses an effort to cover too much of the waterfront from perhaps too many perspectives. Some topics, such as the aging of the gay HIV cohort, and indeed the aging of the gay community, go unmentioned, and there is virtually no inclusion of material from the U.S. West Coast, despite the emergence of epicenters in San Francisco and Los Angeles, and the development of the much touted “San Francisco Prevention and Treatment Model” by the late 1980s and early 1990s, which included the establishment of the first HIV ward and treatment center in the world and the establishment of the first AIDS hospice in a former convent. There are times when the book loses focus and wants for structure. Also, as noted, only a few of the chapters really address culture per se, and

Book Reviews

439

likewise only a few really talk about gay men, as opposed to “MSM”; while that might seem trivial, there is a difference—and the title suggests that the book is primarily about the former. Some 30-plus years into the experience of the epidemic, one might have expected to see more chapters addressing either or both of these themes more cogently and explicitly. Also, along these lines, the book moved back and forth between synchronic and diachronic perspectives, rather than grouping these different kinds of chapters. In short, the book might have benefitted from tighter organization as well as a more narrow focus. Some of the chapters seemed to be summaries of previously published work, without much effort to situate those data in a more current cultural, political, social epidemiological context. In conclusion, the book offers readers an interesting if broad view of different kinds of research on and reflections about primarily the U.S. HIV/AIDS epidemic as it affected MSM and gay men, especially in the last years of the 20th century. Several of the chapters, particularly those noted above, would serve as good material for teaching about the HIV epidemic, the development of the gay community, applied or medical anthropology, and sexuality and health. In his postscript, Feldman implies that past is present and future, noting HIV prevalence among MSM in 39 low- and middleincome (GDP) countries (which he lists) is nearly 13 times higher than comparable heterosexual adult population figures for those countries. He could have noted that even in the high-income United States the HIV/AIDS epidemic continues to ravage the gay and MSM communities and that additional work is called for. He reminds the reader that male same-sex behavior remains criminalized in some 79 societies and seems implicitly to call for looking at homophobia as a context for the spread of HIV itself, as it most certainly does. At the end of the day, he writes that applied medical anthropology continues to have a critical role to play in addressing prevention and treatment and caregiving needs of gay men, and MSM,

worldwide, and on that point this reviewer could not agree more.

Biomedicalization: Technoscience, Health, and Illness in the U.S. Adele E. Clarke, Laura Mamo, Jennifer Ruth Fosket, Jennifer R. Fishman, and Janet K. Shim, eds. Durham, NC: Duke University, 2010; ix + 498 pp. Stefan Timmermans University of California, Los Angeles. If this edited book were a building, it likely would be a museum of the future, housing a collection of all things medically fascinating. The Biomedicalization Museum, Inc. (it would be a corporate rather than public entity, likely a spinoff from a pharmaceutical company) does not focus on medical heroes, pioneering patients, or astute clinicians; it does not showcase iconic dying children brought back from the brink of death. I imagine one small room covering the period between 1890 and 1945 with traditional medical relics (amputation kit from the Civil War, penicillin and insulin, doctor’s bag). This space leads into a slightly larger room narrating the period between 1940 and 1990. This second small room is characterized by a focus on medicalization—the definition of social problems in medical terms—with an exhibit about the spectacular rise of the Attention Deficit Hyperactivity Disorder diagnosis, and the story of the medicalization, demedicalization, and lingering remedicalization of homosexuality in psychiatry. These two rooms offer the contrast for a hangar-size exhibit space devoted to biomedicalization, the contemporary moment that started around 1985. The focus of biomedicalization is on emerging connections between substances, procedures, instruments, software and hardware, regulations, flows of capital, nomenclatures, statistical tables, and biomarkers. Here, everything feeds into new arrangements, generating endless recursive transformations. In thematic side exhibits, the curators

440

Medical Anthropology Quarterly

highlight clever new assemblages of technologies targeting as yet unknown conditions, hyped-up drugs aiming to put race and sex on a biological foundation, and the most creative ways of capitalizing on life and the biosciences. The space is cramped full with memorable signs, images, and elements of health, illness, and biological enhancement, but these familiar views combine in novel ways with profoundly defamiliarizing effects. The imagery decenters the role of patients and clinicians in medicine and health and instead locates health agency in objects, procedures, regulations, and forms of knowledge generation and processing. Visually, the museum displays what Clarke calls “healthscapes,” iconic representations of biomedicine. A visitor strolling through the cavernous exhibit hall becomes a node in a dense network of corporal and technological connections aimed at measuring, estimating, and improving health. The museum curators seem keen on tracing the connections to their most remote influence: every aspect of public health, medicine, biological sciences, and health care is claimed as a manifestation of biomedicine. The overall effect is disorienting but also profoundly provocative. Now, let’s turn to the book and unpack both the disorientation and the provocation. Biomedicalization contains three major parts: the first part consists of a theoretical and historical situating of the notion of biomedicine, and the second and third parts comprise nine case studies exemplifying biomedicalization. Case studies in part 2 focus on the process of differentiation through medical means, and those in part 3 highlight various ways in which medicine focuses on biological enhancement (e.g., using growth hormones to gain height), rather than cure or care. The editors explain in chapter 2 how they came to conceptualize biomedicine. They charted an expansive chronology of changes in health in the broadest way possible. They included known historical changes and interdisciplinary explanations of these changes. They distilled five key processes that form the core of biomedicalization: the political economy

of biomedicine; a focus on health, risk, and surveillance; the increasing technological and scientific nature of biomedicine; transformations in the production, distribution, and consumption of biomedicine; and transformation of bodies and identities. The edited volume further expands the concept to engage with transnationalism, globalization, bioeconomy, neoliberalism, biocapital, vital politics, biopiracy, biological citizenship, and so forth. Consequently, the notion of biomedicalization has to do so much conceptual work that its specificity keeps fading. Although the case studies individually are superb, none forms a complete prototype of biomedicalization as the editors describe it. Each chapter elucidates partial aspects. For example, the central role of drug regulation in Kahn’s account of BiDil, the first “ethnic” drug, is absent in Fishman’s history of the making of Viagra, which focuses more on knowledge practices. Mamo highlights the role of commercialization in lesbian reproductive practices, but Boero’s account of bariatric surgery does not examine the economic forces making this obesity surgery an archetype of lucrative consumerism. Sensitive to the hegemonic nature of the biomedicalization concept, the editors attempt to distinguish “countertrends” to biomedicalization. In line with their poststructuralist sympathies, however, countertrends such as complementary and alternative medicine or end-of-life care tend to become appropriated by biomedicine. The one-size-fits-all aspect of biomedicalization is also stimulating. The editors make a compelling case that there is something different about the current multisitedness and complexity of culturing medicine and wellness. Compiling the most exciting work of science studies and medical sociology and anthropology, biomedicalization is agenda setting in exactly the way that it still requires further articulation and appropriation. The editors offer a first sort through of promising tracks to pursue. The concept has a definitive added value over the notion of medicalization. In sociology, medicalization became a victim of its own success: originally part of a social

Book Reviews

441

problems–based critique of medicine, social scientists in recent years used the term descriptively to point to the expansion of medical power. In spite of Peter Conrad’s recent theoretical infusion of medicalization through his inclusion of new engines, repeated usage has rendered medicalization too unidirectional and obvious to clarify emerging biomedical forms. Biomedicalization may be erring on the side of overcomplexity and multicausality, but reading this edited volume will surely stimulate new theoretical musings and analytical insights. Biomedicalization, then, may also demonstrate a new way of academic conceptualization. In this, it will be most useful reading for scholars working at the intersection of science–technology studies and medical anthropology–sociology. Previously, concepts abstractly pinned down phenomena. Biomedicalization shows the futility of such an endeavor. Any attempt at defining conclusively what biomedicalization is risks forgetting critical aspects of the processes it entails. The concept, like the phenomena it aims to capture, rests on growing connections linking a sprawling multiplicity. Biomedicine’s conceptual contours keep morphing in fluid, unpredictable ways. The medium is the message. In a Younger Voice: Doing Child-Centered Qualitative Research. Cindy Dell Clark. New York: Oxford University Press, 2011. ix + 230pp. Lisa M. Mitchell University of Victoria This is a timely book; child-centered studies in anthropology and other social sciences are becoming much more common, and it is time for researchers to take stock of how they might improve their research methods. Dell Clark’s book is, as she suggests, an “invitation to do qualitative research with children that amplifies their voices, [and] to reap the benefits of knowing children better” (p. 4). Written with evident enthusiasm for and enjoyment about conducting research with children, Dell Clark is pas-

sionate in her concern that “adults [need] to bear witness to the full humanity of children” (p. 194) and see them as much more than either adults in the making or “miniature adults.” Drawing from her many years of child-centered research, Dell Clark argues that researchers do not need to discard their adultness but should learn new norms of interaction and conversation so that they can share power with children and create opportunities for children to share their stories, ideas, concerns, pleasures, and secrets (pp. 80, 81). This is not a call for researchers to dumb down adult methods. Rather, Dell Clark suggests that working with children and understanding their perspectives and interpretations of the world requires a distinctive set of research skills, personal qualities, and methods training. Focusing on observations, interviews, focus groups, and visual methods, Dell Clark’s book offers many suggestions, general and specific, to help researchers “to directly and openly engage children” and to acquire what she calls “the double vision [needed] to see both the child’s and the grownup’s vantage points” (p. 11). Early on in her book, Dell Clark summarizes recent changes in the conceptualizations of children and childhood in U.S. research and policy and follows those changes through applied consumer research, research ethics, and youth participatory approaches. These sections underscore several of Dell Clark’s central messages about working with children: doing so requires thinking in non-adult-centric ways about them, being reflexive about one’s social position as an adult, and being very attentive to children’s local discourses. These messages are not new to cultural anthropologists, but Dell Clark works hard to translate these general principles into specific methods and strategies for interacting with children. To do so, Dell Clark draws from familiar anthropological methods, but she also finds expertise on child-centered inquiry in a range of other disciplines. Notably, she draws extensively on applied consumer research, or studies done to enhance the marketing of products and services to U.S. children. This reviewer would

442

Medical Anthropology Quarterly

have liked to see a more critical discussion about the application of this methods literature to research with children whose lives may be less or diversely shaped by toys, television, and Happy Meals. Nonetheless, Dell Clark’s multidisciplinary approach enables her to offer instruction regarding a wide range of child-centered methods. The writing style in this book is accessible, and Dell Clark has sought to itemize and summarize the main points and findings in each chapter. The breadth of her topics is comprehensive from recruiting children and explaining the research to them to analyzing data and getting adults to listen to the results of child-centered inquiry. Her discussion of each main category of method—observation, interviewing, focus groups, and visual methods— reviews what has tended to work and what has not and pays particular attention to the challenges of being an adult conducting research with children. Dell Clark has some good insights about qualities that exemplify a skillful child-centered researcher, noting among other things the importance of risk taking, enjoying play, ambiguity, and contradiction. She has an especially interesting discussion of the ways children may signal their acceptance of or resistance to adult researchers. There are many suggestions about helping children understand the value of their participation, considering the interview setting, asking childfriendly questions in interviews and focus groups, engaging children of different ages, and ways to give children more control over their involvement in research. Her chapter on visual methods discusses drawing and photo-elicitation and a method that this reviewer had not previously encountered: the metaphor sort technique in which children select pictures to describe and talk about their experiences. The chapter on analysis would benefit from more concrete examples of data (transcriptions, observational notes, images) to clarify discussion of what Dell Clark calls the “scissors” methods of data sorting and management and learning to see through the “kaleidoscope,” or using reflective inductive analysis. A closing sec-

tion on “getting adults to listen” notes the importance of identifying “relevant, impactful conclusions” and insisting that “children be taken seriously” (pp. 192–93). Several of the chapters end with an “Apprentice to Master” feature suggesting how one might acquire, practice, and master skills in childcentered inquiry. In a Younger Voice does not have a specific chapter or section for anthropologists working with children on health- and illness-related topics, but there is much here that will be of value. Dell Clark refers freely to her own studies among children with chronic diseases, and she cites from a variety of other child health research. Of particular interest for medical anthropologists are her discussions of ethical issues in doing child health research, the “synergy between drawing and speaking” (p. 147) as a means for children to express illness and bodily experiences, focus groups as a form of support for children living with illness, and photo-elicitation for empowering children and indicating often overlooked details in how they live with an illness. Overall, this is a valuable addition to the growing corpus of sources on child-centered methods. Dell Clark does include examples of research from a variety of cultural contexts and stresses the need to do “culturally anchored research” (p. 37); nonetheless, the book will be most relevant for research with children from about five years of age to early adolescence in U.S., U.K., and Australian contexts. This reviewer would have liked to see a fuller discussion of the issues surrounding research with working with children in diverse social, political, and economic contexts. For example, matters of compensation when working with children in resource-poor communities, the complications of informed consent and voluntary participation in communities where children have very low status and little autonomy, and the challenges of working among children living on the street or who are working long hours might have been covered. Anthropologists employing participatory methods may feel there is not enough here about specific strategies to involve

Book Reviews

443

children in designing research projects, developing research priorities and questions, or selecting or designing methods. Those matters aside, In a Younger Voice will certainly be a useful guide and resource book for anthropologists and graduate students seeking to conduct research with children, rather than on them.

Pretty Modern: Beauty, Sex, and Plastic Surgery in Brazil. Alexander Edmonds. Durham, NC: Duke University Press, 2010, 1 + 297 pp. Sara Ackerman University of California, San Francisco Pretty Modern is an eloquent and compelling ethnography of the culture of beauty in Brazil. The book is consistently rich in theoretical complexity and historical analysis, with ethnographic vignettes skillfully woven throughout the text. Edmonds’s thesis is that the enthusiastic consumption of cosmetic surgery among Brazilian girls and women both reflects and shapes emerging forms of social belonging in a period of rapid cultural, economic, and political transformation. Interestingly, cosmetic surgery consumption is not limited to middle-class and affluent Brazilians; lowincome Brazilian women line up for free cos´ metic surgery (plastica ) in public hospitals in an attempt to improve their “self-esteem” and their chance of a better life, in a milieu in which the social value of appearance is increasingly embedded in competitive, sexualized consumer markets; it is not just rich women who participate. Throughout the book, Edmonds’s nuanced portrait of beauty’s starring role in Brazilian modernity is situated in a broader analysis of plastic surgery and popular culture. Readers interested in plastic surgery more generally will find an excellent account of its historical emergence in Europe and North America and an examination of its increasing interdependence with medical specialties that manage reproduction and sexuality. First and foremost, however, the book

is a complex ethnography of contemporary Brazil, which serves as a unique and instructive site to explore plastic surgery as a popularized practice through which “the self is imagined as a domain of biological activity that can be regulated or enhanced with medical techniques” (p. 243). Tying together the myriad historical, political, economic, and social forces that comprise the Brazilian passion for “beauty work” (e.g., p. 16), Pretty Modern belies popular assumptions that cosmetic surgery is a trivial, superficial, or uniformly oppressive practice. Through engaging accounts of the experiences of public and private sector plastic surgeons and their patients, Edmonds illustrates how the association of technology with progress and modernity in Brazil, and a popular ethos in which beauty is linked to national identity, underpin the state-subsidized provision of plastica in un´ derfunded public hospitals as well as surgeons’ claim that the poor have the “right to beauty” (p. 14). This “aesthetic nationalism” (p. 41) calls on a long tradition of fetishization of the female body, particularly in regard to the notion that racial mixture produces more beautiful (feminine) bodies. Brazilian beauty cultures are also shaped by the waning of patriarchal control over women, both inside and outside the home, and the influence of Brazilian and global popular media on local desires and consumption practices. Thus, a woman working as a maid in a middle-class home may read the same beauty magazines, watch the same popular dramas on television, and participate in many of the same beauty regimes (incl. plastica) as her employer, returning ´ home to a favela every night with the dream that a more beautiful body may afford her greater socioeconomic mobility and access to sexual pleasure. One of Edmonds’s most provocative arguments, and perhaps the most controversial for readers sympathetic to feminist critiques of cosmetic surgery, is that plastica is ´ not simply a normalizing practice through which other forms of power operate. Feminist accounts of plastic surgery have long struggled over the question of whether

444

Medical Anthropology Quarterly

cosmetic surgery is a means through which an individual can express agency and self-determination via corporeal recasting, or whether surgical enhancement merely reinforces cultural norms valuing feminine, youthful appearance. Distancing himself from both these positions, Edmonds argues that plastica’s framework of health is less ´ insidious and more positive, encompassing a therapeutic logic of self-improvement and well-being. This is not to say that gender, class, race, and age hierarchies are not implicated in the widespread appeal of cosmetic surgery in Brazil. Indeed, Edmonds concedes that aesthetic “defects” that are “corrected” through medical intervention may be expressions of “other forms of distress in the body politic” (p. 21). Moreover, he points out that the expansion of medical intervention in healthy bodies actively contributes to the commodification and subordination of women. However, he argues that plastica is also bound up in the produc´ tion of new forms of self-governance and even operates as a “democratic leveler” (p. 133). Thus, Brazilian women want cosmetic surgery not (only) because they are subject to gendered, medicalized, aestheticized forms of bodily control but (also) because the results of surgery make them feel happier, more desirable, and more able to cross otherwise impenetrable social barriers. Aesthetic surgery becomes a strategy through which women express their “rights” and their subjectivity in a context in which everyday life is increasingly aestheticized and consumption oriented. This is a convincing analysis, and one that is bolstered by numerous stories told by informants for whom Edmonds clearly has a great deal of respect. However, as a woman who has been subject to interpellation as a potential consumer while conducting research on cosmetic surgery, I felt a sense of disquiet with the author’s limited attention to the feeling of the relentless grip of beauty culture on women’s lived experience—presumably even among women who claim to desire and enjoy the results of invasive beautifying techniques. A

reflexive account of the author’s position as a man conducting research on a highly feminized practice would have been a welcome addition to the book. In the same vein, I would have found helpful a closer examination of men’s participation in Brazil’s beauty cultures (30 percent of all cosmetic surgeries are now performed on men, Edmonds reports on p. 231). Although perhaps beyond the scope of this book, men’s growing consumption of cosmetic surgery in Brazil raises questions about cosmetic surgery as both tyranny and liberation. One of these questions is whether men will increasingly be drawn in as competitors—rather than merely judges and consumers—in what Edmonds describes as Brazil’s “libidinal economy” (p. 67). For the author, plastica also embodies a ´ specifically Brazilian intersection of racial hybridity as an aesthetic ideal and persistent eugenics-inflected notions of racial improvement. These seemingly paradoxical cultural forces inform the popular surgical “correction” of features such as the “Negroid nose” and the justification of these procedures as aesthetic, rather than physical or racial, interventions. Plastic surgery thereby offers a useful lens through which to examine the historical trajectory of race in Brazil, which differs greatly from that in North America. The Brazilian embrace of mestic ¸ agem (miscegenation), focused in particular on the aesthetics of racial mixture, suggests not only that appearance is a crucial aspect of racial identity in Brazil, but also that national aesthetic ideals do not necessarily mimic persistent racial hierarchies. This helps to explain why Edmonds’s account of racially inflected plastic surgery in Brazil differs from cultural analyses of cosmetic surgery outside of Brazil. Although aesthetic ideals in Brazil reflect a national embrace of racial mixture or hybridity, and cosmetic surgeries aim to bring bodies closer to this national ideal, Anglo-American beauty standards predominate in many other countries and contribute to the alteration of ethnic-identified features to approximate these standards or to allow people to “pass” as white.

Book Reviews

445

A secondary theme introduced by the author, and one that warrants more extensive exploration, concerns the “demedicalization” of biomedicine, in which medicine is disentangled from the state and “medical technology becomes infused with the desires of consumer society” (p. 117). But ultimately, this is a book about beauty’s embeddedness in understandings and operations of nation and self. Edmonds adeptly traces how Brazilian understandings of corporeal beauty have emerged historically through other forms of national belonging and exclusion, such as slavery, the family, and class hierarchies. Beauty, he argues, is a kind of social equalizer that enables its bearer to cross otherwise impenetrable structural barriers, which helps explain the widespread desire to become a supermodel among Brazilian girls, particularly those living in poverty. The book’s excellent social and historical analyses of beauty’s meaning in Brazil, however, leave unanswered questions about how we define beauty and why some physical traits are widely considered more attractive than others. Toward the end of the book, the author gestures to (and is critical of) sociobiologists and evolutionary theory in his explanation of how the “biological stratum” of human experience contributes to beauty cultures and medical interventions in bodily aesthetics. This seemed to me an unnecessary flirtation with a nature–culture dualism in a book that otherwise demonstrates that the biological cannot be conceived outside of the social. Pretty Modern will appeal not only to those interested in contemporary Brazil and global beauty cultures but also to readers seeking an example of fine ethnographic craftwork. Early in the book, Edmonds describes the influence that Brazilians’ embrace of impurity, melodrama, and “historical pastiche” have had on the form and style of his book (p. 24). This influence is particularly evident in Edmonds’s masterful cultivation of a panoply of theoretical sources. Some readers will perhaps find themselves desiring a more sustained engagement with particular concepts and theoretical argu-

ments. But this is not Edmonds’s project, and his consistently readable text never resorts to the esoteric language that some of the theorists he deploys are known for. Consistently accessible and challenging to its readers, the book would be an excellent addition to graduate and undergraduate courses in anthropology, globalization, cultural studies, gender studies, or Latin American studies. Edmonds’s analysis of plastic surgery practices will be of particular interest to medical anthropologists and medical sociologists. Edmond’s Pretty Modern is an exquisite ethnography that will be widely read and appreciated. Abortion in Asia: Local Dilemmas, Global Politics. Andrea Whittaker, ed. New York: Berghahn Books, 2010; xii + 253 pp. Fang-tzu Yen National Defense Medical Center; Taipei, Taiwan In regard to studies on the politics of reproduction in the field of medical anthropology, birth control, reproductive technologies, and reproductive disruptions have been in the spotlight. Whittaker’s collection further invites anthropologists and activists from Asia to report on abortionrelated research. The resulting book reveals the threats that local and global politics (in terms of the Asian economy, poverty, violence, and gender inequality) have on abortion and reproductive health. Because half of the world’s deaths owing to unsafe abortions take place in Asia, there is absolute need for a public health approach to abortion, such as this book advocates. Furthermore, this book demonstrates that Asian women’s viewpoints should be included in the discussion on reproductive rights and global health. The contributions make it a significantly important reference book for the areas of politics of reproduction, gender, and development, as well as gender, culture, and heath. It would be particularly useful in medical anthropology in public health, anthropology and reproductive health, as well as gender and health courses.

446

Medical Anthropology Quarterly

On the basis of fieldwork in Asian countries, this book discusses the impacts of ethnogynecology, local power, and national intervention on women’s experiences of motherhood. It covers three main themes: local definitions of abortion; plights, agendas, and outcomes related to gender and development; and legal reforms and politics. In regard to local definitions of abortion, the ethnographic research reveals that women in this region define abortion as washing out the uterus, removal of a mere lump of blood, or restoring blocked menstruation through Menstrual Regulation (MR). Such conceptualizations entitle women to utilize abortion as a form of contraception; in the meantime, they reduce their moral burden. Although the criminalization of abortion in the modern history of Asian countries and the colonizers’ imposition of Western laws in Asia are not covered in this book, Asian countries’ control of population in the cause of modernization and in the influence of foreign aid is discussed. Thereby, abortion has become the subject of domestic and international politics. In-depth exploration of this, from the perspective of micropolitics of gender relations, enables readers to better understand the plights of women who seek abortion services in Asian countries. Although the powerful establish the legality of abortion and the permission to abort, the Asian women represented here speak out regarding how they feel about the fetus—either as a thing or as a human being, or with or without a soul—as well as how they and their families remember and commemorate the existence and loss of their unborn. Gender and development researchers included in this book provide the women’s viewpoints on health-seeking experiences. Although abortion is legal in some countries such as Cambodia, women who seek abortion in medical institutions often face financial constraints, fear, lack of information, misunderstanding, uncertainty, discrimination, blame, lack of support, and lack of postabortion care. Their experiences also include individual and institutional violence, making it necessary for

health care providers to enhance sensitivity toward women who undergo abortion. Furthermore, the issues raised by Burmese women on the Thai border and Bangladeshi adolescent women in urban slums highlight the agendas that the NGOs and governmental departments should be devoted to as they advocate for the reproductive rights of the local women and those from refugee camps. Some advocates have adopted the strategy of promoting regional legal reforms in support of reproductive rights; in this, Thai activists have facilitated the availability of high-quality services and safe abortion. The research on these strategies presented in this book enriches the global discussion of abortion rights and reproductive rights, thus promoting agendas most beneficial to the local gender and development. The book also shows that health and development programs that focus on reproductive health have resulted in different outcomes in terms of women’s health. For example, this book reveals that, as representatives of a nation’s birth control monitoring system, midwives in Cambodia discourage women from seeking help and thereby cannot guarantee the quality of care and safe abortions. The authors also discuss how conservative religious movements strongly limit the provision of reproductive health related services so that, for example, the Indonesia Women’s Heath Coalition’s introduction of abortion law reforms in Thailand has been in vain. Thailand’s antiabortion religious forces construct abortion as “manslaughter,” while international health organizations, through reformists’ nationwide unsafe abortion investigations, frame abortion as a public health issue. The Medical Council has therefore redefined “health” to meet women’s abortion needs and has urged the government to amend the Thai Criminal Code to enable medical practitioners to engage in therapeutic abortions. Because of this input from medical professionals, laws were amended. However, as abortion is a public health issue, it involves more than legal maneuvers; there is an urgent need for women and the medical professionals to

Book Reviews

447

fully understand abortion rights and adopt safe abortion services. These findings make this book important for the discussion of global health. Last, foreign aid and global medical technology may enhance state and medical professions’ control over women’s bodies, thus depriving women of their autonomy. However, this book did not discuss science and technology studies (STS) perspectives on the

development of invasive abortion surgery in Asia, disputes among lay people and medical professionals, or disputes among the different health care systems, all of which ought to be taken into consideration before introducing safe abortion care services. The inclusion of an STS perspective would have enhanced the book’s value in terms of the exploration of abortion in Asia.