Summary:
This is an important
contribution that analyzes, critiques, and aims to correct structural
inequalities (racism, sexism, capitalism) that influence contemporary medicine,
with particular attention to the technical influences of computers, “big data,”
and underlying values of neoliberalism, such as individualism, exceptionalism, capacity,
and progress through innovation.
Introduction:
Theorizing Communicative BiocapitalismBanner writes,
“biocapitalism is comprised by the new economies and industries that generate
value out of parts of human bodies” (p. 12). Parts include DNA, ova, and
organs, but there’s also data from medical care, where patients are reduced to
their physical bodies and/or to their “digital status” in medical records,
research, even personal information volunteered on the Web, all which is indicated
by the term “communicative.” As an example, Banner cites the large realm of patient on-line
groups that are exploited by large companies as free labor, thus reducing the
voice of the patients. Approaches of narrative medicine and medical humanities have
not dealt with digital health, market forces, and the implied power
relationships. Perhaps the new subfield of health humanities has promise to do
so, if not also captive to “the logic of the market” (p. 17).
Ch. 1. Structural Racism and Practices of Reading in
the Medical Humanities
Banner writes,
“Medical racism is a product of structural and institutional racism” (p. 25). She
finds that current approaches from interpretive reading are insufficient
because “the field’s whiteness has contoured its hermeneutics” (p. 25). Instead
of the “reading-for-empathy” model, we should read for structures of racism,
sexism, privilege, as well as economic and political inequality. She
illustrates such reading with texts by Junot Dìaz, Audre Lourde, and Anatole
Broyard.
Ch. 2. The Voice of the Patient in Communicative
Biocapitalism
Patients have
flocked to networking websites, voluntarily posting much personal information. Banner
analyzes how technocapitalists mine these sites for data to use or sell.
Patients’ information, given voluntarily, amounts to free labor and, even,
work-arounds for companies that avoid expensive double-blind controlled
studies. Rhetoric for these sites speak misleadingly of the “patient voice,” “stakeholder,”
or “story sharing” and hide the exploitation involved. The chapter is specific
for websites, drugs, and drug companies.
Banner discusses
(1) the “feminized labor” involved with sites for fibromyalgia and chronic fatigue
syndrome (both “contested diagnoses”) and (2), more abstractly, the
medicalization of the clinical gaze on patients who participate in websites and
yearn for “an imagined state of purity,” and/or “an ableist vision of norms and
reparative medicine” (p. 61). Overall, the digitalized-patient voice is
colonized by forces of whiteness and should be decolonized. She discusses writing
by Octavia Butler and Linda Hogan, both women of color.
Ch. 3. Capacity and the Productive Subject of
Digital Health
This fascinating
chapter describes and critiques “digital self-tracking,” or the use of devices
such as Fit-Bits that help create and maintain the so-called “Quantified Self”
(or “QS”). Banner finds this fad within the tradition of the Enlightenment (Ben
Franklin) so that “exact science” may “optimize” individuals by being “responsibilitized”
in a “self-sovereign” way. QS users understand that “Everything is data” (p. 83).
She argues that this trend emphasizes “masculine objectivity” while “disavowing
debility” (p. 85). Collected data may contribute to a “worried well” status or
conditions of “precarity” or “misfitting.” She writes, “QS practice remains an
inscription of the self as a self-surveillor, engaged in masculinized practices
of neoliberal self-management” (p. 91). She discusses the technologies of the
devices Scanadu, Melon, and Scarab. She provides and interprets photos of visual
arts representations by Laurie Frick, who is a “self-tracker.”
Ch. 4. Algorithms, the Attention Economy, and the
Breast Cancer Narrative
Banner discusses
Google Analytics, later Alphabet, which includes Calico and Verily, which have
partnered with pharmaceutical companies. Such combinations of algorithms,
capitalism, and media aim to capture the public’s attention, especially online.
Messaging about breast cancer becomes reductive, emphasizing medical solutions,
not prevention, and it avoids discussion of causes such as environmental
pollution. Some critics decry “pinkification” of breast cancer. Public stories,
such as Angelina Jolie’s, emphasize individual empowerment, a “hegemonic
construction of illness”’ (p. 112), and these are amplified by mass media, both
print and electronic. More diverse messages would value “heterophily over
homophily” (p.121).
Ch. 5. Against the Empathy Hypothesis
Drawing on
several commentators, Banner critiques the notion of empathy as a goal for
caregivers as condescending to the patient and suspect when allied with
productivity and efficiency for institutions. Further, the notion of “resilience”
(in a “bleed” of neoliberal rhetoric into health humanities) has been misused
in applied literature, parallel to notions of self-help and self-management.
Some hermeneutics still support values of “state and capitalism” and ignore
writers of color. Banner discusses the work of African-American poet Claudia
Rankine, some of whose work is “postlyric,” and J. M. W. Turner’s painting “The
Slave Ship” that illustrates “necropolitics.”
Conclusion
Throughout the
book Banner illustrates reading “for structure” in her interpretation of texts
and visual images but also in medical institutions and practices and, still
further, in the enormous and pervasive world of government forms and programs,
big data, computers, and beyond. She finds structures of capitalism, sexism,
and neoliberalism within existing “heteropatriarchal, ableist, and racist
frameworks” (p. 154) despite claims of neutrality. She urges medicine and the
humanities to develop new methods. She mentions specific collectives and
communities that now challenge such norms (such as Gynepunk and CureTogether), and she calls for thinkers in many
disciplines to confront demeaning technology and to “engender spaces in which
care is more just, and more humane” (p. 156).
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