New opportunities for systematic collaboration between neuroscience and social science have opened up in recent years, and some of the potentials and the problems that accompany them are explored with reference to Damasio’s work. Systematic collaboration and integration might yield benefits for metatheoretical, theoretical and substantive inquiry, but will be impeded by language, conceptual and methodological problems. Strategies to facilitate collaboration are discussed, and it is concluded that methodological problems will be most difficult to resolve.

Despite the widespread consumption of stimulant drugs such as Ritalin (methylphenidate) for the treatment of children with attention deficit/hyperactivity disorder (ADHD), understanding of the differing national realities of the ADHD/methylphenidate phenomenon is especially impoverished. In this article, we give an introductory description of the scientific-historical, cultural and ideological factors that have shaped the diagnosis of ADHD and its treatment in Italy. Qualitative empirical analysis of the national debate on the use of methylphenidate and of parents’ experiences with the drug reveals that, in the Italian context, the evolution of the ADHD/Ritalin phenomenon has been largely shaped by dynamics within the country’s psychiatric practices and health system, as well as by attitudes towards mental illness. We suggest that in Italy, the current dynamics in the regulation of methylphenidate inscribe ADHD diagnosis and stimulant drug treatment as moral choices. On both the political and the familial level, these choices are grounded in sometimes opposing conceptions of vital civil rights and national ideals: the ‘right to medication’, the ‘right to mental health care’ and the ‘right to childhood’. Our study illustrates that close analysis of specific cultural contexts can be useful in understanding how attitudes towards mental disorders and the use of psychotropic drugs can be shaped by the social practices and medical habits of a country.

Examining the rise and fall of a public–private marine biotechnological enterprise in Hawaii, this article analyses how promises to make products and profits from marine microbes in archipelagic waters drew upon peculiarly American sentiments about the sea as a politically uncontested treasure-chest of biodiversity. I argue that attention to the material process by which lab and legal instruments are calibrated to one another to generate biotech exchange-value must be joined by consideration of how scientists and their interlocutors imagine the meaning of biology—as discipline and as corporeal substance and process. Without such symbolic analysis, theorizations of biocapital remain incomplete. To discuss the genre of capitalism evidenced in marine biotechnological endeavors in Hawaii, I develop the concept of blue-green capitalism, where blue stands for a vision of the freedom of the open ocean and for speculative sky-high promise, and green for belief in ecological sustainability as well as biological fecundity. I show that this vision, dominant in industry–university settings, ran into direct conflict with Native Hawaiian legal epistemologies of the sea.

The claims of randomized controlled trials (RCTs) to be the gold standard rest on the fact that the ideal RCT is a deductive method: if the assumptions of the test are met, a positive result implies the appropriate causal conclusion. This is a feature that RCTs share with a variety of other methods, which thus have equal claim to being a gold standard. This article describes some of these other deductive methods and also some useful non-deductive methods, including the hypothetico-deductive method. It argues that with all deductive methods, the benefit that the conclusions follow deductively in the ideal case comes with a great cost: narrowness of scope. This is an instance of the familiar trade-off between internal and external validity. RCTs have high internal validity but the formal methodology puts severe constraints on the assumptions a target population must meet to justify exporting a conclusion from the test population to the target. The article reviews one such set of assumptions to show the kind of knowledge required. The overall conclusion is that to draw causal inferences about a target population, which method is best depends case-by-case on what background knowledge we have or can come to obtain. There is no gold standard.

Over the last decade, many European countries have sought to capitalize on the promising opportunities of human embryonic stem cell (HESC) research. Italy, in contrast, has renounced this line of research. HESC research is not altogether forbidden in Italian laboratories, but restricted and not supported by public investment. In this article, I seek to make sense of Italy’s stance. I argue that the politics of human embryonic stem cell research in Italy has arisen as a consequence of the reordering of Italy’s biopolitics through the ‘nationalization’ of Italian embryos. This has deprived Italian laboratories of their research material and given Italian stem cells their particular meaning.

India, Indonesia, Malaysia, the Philippines, Singapore, Thailand and many other countries market themselves as major destinations for ‘medical tourism’. Health-related travel, once promoted by individual medical facilities such as Bumrungrad International Hospital and Bangkok International Hospital, is now driven by government agencies, public–private partnerships, private hospital associations, airlines, hotel chains, investors and private equity funds, and medical brokerages. ‘Medical tourists’ include patients trying to avoid treatment delays and obtain timely access to health care. Medical travellers also include uninsured Americans and other individuals unable to afford health care in their home settings. Destination nations regard medical tourism as a resource for economic development. However, attracting patients to countries such as India and Thailand could increase regional economic inequalities and undermine health equity. International medical travel might also have unintended, undesired outcomes for patients seeking affordable health care. With globalization, increasing numbers of patients are leaving their home communities in search of orthopaedic surgery, ophthalmologic care, dental surgery, cardiac surgery and other medical interventions. Reductions in health benefits offered by states and employers will likely increase the number of individuals looking for affordable medical care in a global market of privatized, commercial health care delivery.

Scholarship on midwifery in the North American context has tended to evaluate the recent legalization of the professional practice of midwifery across the United States and Canada as evidence of the success of women’s claims to broader reproductive rights concerning pregnancy and birth. This article, however, approaches the efforts to legalize midwifery in North America through the question of claims to reproductive autonomy, arguing that midwifery’s legalization is one effect of the entrance into modern scientific practice and state health policy of a new political subject: one whose emotional satisfaction is the target of reproductive health-care policy. As such, the ‘new’ midwifery in Québec encourages pregnant and birthing women to invest intimately in the project of staking claims for reproductive self-determination. Counter to claims that the ideal citizen of contemporary liberal regimes is ‘unattached and unbiased’, midwifery compels women to invest ‘deep down’ in claims to reproductive self-determination. An examination of policy and activist discourses circulating during the time leading up to the period of experimentation (1993–1998) and eventually to the legalization (1999) of midwifery in Québec provides a useful lens onto broader transformations in the liberal governance of pregnancy and birth.

This article addresses the offshoring of clinical trials to middle- and low-income countries, and the complicated ways in which they have become integral to public health and quality of care in these contexts. I focus on the operations of United States-based contract research organizations (CROs), which make up a specialized global industry focusing on the recruitment of human subjects and investigators; they are key players in an outsourced world of clinical development ‘service providers’. To get an on-the-ground understanding of the offshored clinical trial, I worked with regulators, health services administrators, and research clinicians in Eastern Europe and Latin America, two clinical trial market ‘growth regions’. By addressing the strategies of evidence-making that inform clinical trial offshoring, this article identifies the context-specific calculations by which experimental groups are being identified. It also addresses aspects of the clinical trial operational model, in which the failure to predict safety outcomes or a paradigm of expected failure is being exported along with the offshored trial. By highlighting the uncertainties of clinical research, this article points to gaps in systems of human protection as it considers new forms of accountability in private sector science and public health.

It is a striking feature of current biomedicine that it increasingly relies on access to various types of human biological material. Social scientists often criticize the exchange systems facilitating this access for causing a process of ‘commodification’. Though it is not always clear what commodification is thought to imply, a morally degrading transformation from something intrinsically human to an object of ownership seems to be at stake in most accounts. Enrolment in capitalist exchange is typically portrayed as (actively) changing the status of the (passive) body part from being part of a dignified human whole to be a mere fungible commodity. In this article I argue that the notion of commodification is inadequate for an analysis of the dynamics at play in the establishment of exchange systems for human biological material. In particular I focus on the development of the patent regime. The point is that rather than focusing merely on what capitalist forms of exchange do to biotechnology and the body, we might begin to appreciate what biotechnology and the socio-cultural significance of the body do to capitalism and its property structures—or, more precisely, how people’s engagement with, and concern about, biotechnology contributes to the shaping of multiple capitalisms.

The complex ways in which technical challenges of trial design provoke, and are provoked by, ethical, commercial and political factors are considered. It is suggested that the quality of the drug trial evidence base greatly depends on the how ethical, commercial and political priorities are set, and not merely on standardized techniques of data processing. Whether such standardized techniques are raising or lowering the quality of safety information about new drugs, and the protection of patients on clinical trials is explored. It is revealed that these international standards, intended to define valid evidence-based medicine for drug trials, are not themselves robustly evidence-based. It is argued that the internationalized regulatory standards developed to frame the evidence base for drug safety and efficacy are frequently inconsistent with furthering patients’ well-being and public health. Rather, those standards reflect a regulatory culture of neoliberal corporate bias, and have been powerfully shaped by the commercial and political interests of the pharmaceutical industry and regulatory institutions. It is questionable that regulatory agencies are thoroughly and robustly scrutinizing the claims that pharmaceutical firms make about their products. New political and regulatory arrangements that could facilitate more ethical drug trials in the interests of patients and public health are proposed.

In late 1980s and early 1990s ‘breast cancer on Long Island’ emerged as a distinct object characterized by higher than average incidence rates that some speculated could be explained by environmental factors. The scientific community and its discourses have played an authoritative role in delimiting what is officially ‘known’ and ‘not known’ about this specific disease ontology. This article moves beyond an epistemological focus towards what Annemarie Mol calls a ‘praxiographical’ inquiry into the everyday practices that produce complex disease objects. We consider how multiple and multi-sited practices of mapping breast cancer on Long Island—by activists, scientists and the state—contributed to the emergence of this new object, and to its multiple and shifting enactments over time. We explore the tensions and power relations between the ‘lay’ public and scientific ‘experts’, and how these influenced mapping practices and produced ‘breast cancer on Long Island’ as a complex and ongoing politico-scientific event.

This article engages with the frequently made claim that the UK has a transparent, accountable and strict but permissive regulatory approach to research using pre-implantation human embryos created in vitro and that this approach provides reassurance to the public in a particularly emotive area, has the full confidence of the scientific and medical research communities, and gives the UK a competitive advantage in the international field of stem cell research. Aborted fetuses are another controversial source of stem cells although their use is less widely known. The paper uses Jasanoff’s conceptual tool of framing to analyse the history of the legislative and governance arrangements for the collection of aborted fetuses for use in stem cell research and therapies in Britain. We argue that the arrangements are confused, lack transparency, are out of line with current good practice on seeking consent, and that non-compliance with regulations is condoned. Furthermore, in our view, the separation of legal and governance arrangements for collection and use of pre-implantation human embryos and aborted fetuses will increasingly become problematic, and we conclude by proposing that there is increasingly a potential for conflict between them.

‘All of this study of genotypes will have profound consequences on our understanding of race and ethnicity’, Francis Collins, Director of the National Human Genome Research Institute, warned his colleagues in 2003. At BioSocieties, we have been committed to bringing the perspectives of the social sciences to bear on the charged issues at hand. In September 2006 (Vol. 1, Part 3), we published our first forum on race and genomics, where we focused on larger questions raised by the decision of Nature Genetics to publish a special open-access supplement—Genetics for the Human Race—in November 2004, concerned with the topic of human genome variation and the continuing validity of the concept of ‘race’. In the forum, sociologist Andrew Smart and colleagues analysed the contributions to that supplement, as well as interview material from the three editors behind it, to tease out the larger methodological, scientific and ethical dilemmas that scientists in the thick of genomics and race research perceived themselves to face. Charmaine D.M. Royal, one of the contributors to Genetics for the Human Race, then responded to the issues raised by Smart and colleagues.

Concern that advances in predictive genetic testing might result in increased numbers of individuals being denied access to life assurance has led many countries to restrict insurers’ historic ‘right to underwrite’. Critics of the insurance industry present genetic discrimination as a threat to the social values of equality and inclusion. However, by unpacking the foundational principles of private insurance, and adopting a more critical approach to genetic information, discrimination, fairness and inclusion, this article suggests that the normative values underpinning life assurance in Britain are unlikely to engender widespread exclusion in an age of increased genetic knowledge, but over-regulation of industry might itself create unacceptable inequity within the market. This suggests that we ought to link the legitimacy of regulatory constraint to the type of social good particular forms of insurance exemplify, and instead of focusing narrowly on genetic information consider the broader implications of risk assessment for the privatization of welfare.

This article concerns the challenges faced by pharmaceutical researchers seeking to develop novel antidepressants. Based on ethnographic and documentary research into the drug development process, it shows how researchers try to manage the problem of the placebo response in antidepressant trials. The high rate of placebo response in these trials makes it difficult to demonstrate efficacy and often leads to trial failure. According to researchers, a major reason for high placebo response rates is the inability of standardized rating scales to define a coherent group of ‘drug responders’. They have developed alternative means of classifying patients in order to circumvent this problem and thereby improve the chances of trial success. In their search for ‘the right patients for the drug’, pharmaceutical researchers also provide an incisive critique of the epistemological assumptions underlying the clinical trial process.

Foot and mouth disease (FMD) ceased to be endemic—continually present—in Britain in 1889. It is reasonable to suppose that all subsequent outbreaks have had the importation of virus as their starting point. So when on 3 August this year two cases were confirmed in cattle on a farm in Surrey the origin of the virus was an immediate question. Surrey is commuter belt country. Its farms are small. They are dotted between medium-sized towns and large villages and so are not the loci of the kinds of intensive agriculture thought to be particularly at risk from exotic and imported animal diseases. But a potential source was close by, at Pirbright, only about 6 kilometres from the farm.