The perspectives shared in individual posts on this blog do not necessarily reflect the views of the SKAT section, nor of the American Sociological Association. All posts are the sole responsibility of their author(s).
The Trump presidency and its relationship to science and truth have prompted both reflection and action by STS scholars, including contributors to a recent thematic collection published in early 2020 in Engaging Science, Technology, and Society. For this newsletter, we requested that the contributors to that collection re-visit the arguments made there in a series of brief commentaries in order to speak to our unfolding experience with the COVID-19 pandemic. Please visit the ESTS website to read the original collection, edited by Daniel Lee Kleinman, in addition to the commentary below.
Joseph Harris
By Joseph Harris, Boston University
President Trump has promoted unproven and dangerous therapies for the treatment of coronavirus, including hydroxychloroquine, UV irradiation, and injections of disinfectant. President Trump and Vice President Pence have eschewed the use of masks in spite of scientific evidence that shows they slow the spread of the novel coronavirus. With encouragement from the president, armed demonstrators have stormed state capitals in defiance of stay-at-home orders, and some citizens have actively sought to congregate in large crowds in the name of liberty. Where disdain for expertise was once more of a footnote tucked within a broader populist message, it has now become the lead rallying cry for a new brand of anti-science nationalism.
This is not the first time anti-science nationalism has reared its ugly head, nor the first time its cost has been told in terms of human lives. In the 1990s, South Africa was emerging from the shadows of apartheid, and the political culture was deeply influenced by nationalist ideas. Prominent anthropologist Didier Fassin noted that the country was charting a new course for itself, and that meant breaking from established Western orthodoxy. Unfortunately, one way this took shape was the alignment of policy with dissident non-scientific views about HIV. Under South African President Thabo Mbeki, government officials promoted home remedies such as garlic, beetroot, and olive oil as treatment for AIDS.
President Mbeki’s misguided policies had dire consequences: Harvard researchers concluded that the government’s delay in implementing a scientifically proven treatment program cost the nation as many as 330,000 lives, not including those lost due to poor prevention efforts. The economic and societal impacts are still felt today. In the United States, as the federal government actively stands by and allows coronavirus to disproportionately ravage the nation’s black and brown communities, more than 90,000 have died, and the end is not in sight.
What are we to make of a common phenomenon with explosive consequences arising in two radically different contexts, one guided by the actions of a racist president and another by a president seeking to free his country from the legacies of racism? In what other not yet explored contexts has anti-science nationalism taken shape? STS offers a powerful lens for helping us think about how phenomena, like anti-science nationalism, are forged, take hold and are maintained, and their consequences for democracy and science. It understands the relationship between politics and science and connects the views of experts with those of lay people. At a moment when the broader discipline turns its focus to global health, sociologists of STS stand to make important new contributions on this issue and others with critical ramifications for the broader world.
The Trump presidency and its relationship to science and truth have prompted both reflection and action by STS scholars, including contributors to a recent thematic collection published in early 2020 in Engaging Science, Technology, and Society. For this newsletter, we requested that the contributors to that collection re-visit the arguments made there in a series of brief commentaries in order to speak to our unfolding experience with the COVID-19 pandemic. Please visit the ESTS website to read the original collection, edited by Daniel Lee Kleinman, in addition to the commentary below.
Michael Lynch
By Michael Lynch, Cornell University
I expect that many of us frequently examine the continually updated maps and charts that plot the distribution of COVID-19 cases and deaths over time by nation and local region. One thing that I have noticed (and I’m sure that many others also have) is that numbers of cases in US states and counties tend to vary with the density of the local population. Reasons for this association are not difficult to fathom: the chance of exposure and the intensity of exposure are much higher for people in densely populated neighborhoods, where many economically struggling immigrants and racial/ethnic minority members live and work. The opposite is the case in places like upstate New York, where I live, where several nearby, predominantly white, sparsely populated counties currently register relatively few cases per 100,000 in population. Some of these counties continue to have zero recorded deaths attributed to the pandemic.
These geographical distributions roughly resemble those on maps compiled after recent elections, which show predominantly Democratic-voting precincts concentrated in inner cities and predominantly Republican precincts in outlying areas. The upstate counties in New York State tend to vote solidly Republican, unlike in the downstate metropolis. Although this correlation may be spurious, it is having real political consequences: residents of rural states and counties have less to fear from the virus (at least so far, and with some notable exceptions). One might say that rural/exurban residents already are partly “sheltered in place” from the pandemic as a consequence of where they live.
Of course, all this could change, but thus far this geographic advantage is fueling the divisive viral politics we have seen unfolding as a momentous election looms ahead. On April 27, President Trump responded in a tweet to a request by governors of hard-hit states for federal government aid to make up for revenue lost during the pandemic: “Why should the people and taxpayers of America be bailing out poorly run states (like Illinois, as example) and cities, in all cases Democrat run and managed, when most of the other states are not looking for bailout help?” A couple of months earlier, when he was downplaying the threat of the virus, he told his supporters in a South Carolina rally, “The Democrats are politicizing the coronavirus,” and that they were spreading a “hoax” in hopes of unseating him in the upcoming election.
Although Trump often seems too unhinged to merit criticism for being a calculating politician, it is hard not to see the calculus here. There is a sense that for Trump’s base the virus is less a part of their life-worlds than it is for inner-city residents of large apartment complexes, who hold jobs deemed essential and depend on public transportation to get to work. And, sad to say, in Trump’s ongoing reality TV show, the minority and immigrant populations who have been most exposed to infection, with non-existent or inferior social and medical support, are treated like the virus itself, as not quite “real”.
The Trump presidency and its relationship to science and truth have prompted both reflection and action by STS scholars, including contributors to a recent thematic collection published in early 2020 in Engaging Science, Technology, and Society. For this newsletter, we requested that the contributors to that collection re-visit the arguments made there in a series of brief commentaries in order to speak to our unfolding experience with the COVID-19 pandemic. Please visit the ESTS website to read the original collection, edited by Daniel Lee Kleinman, in addition to the commentary below.
By Anthony Ryan Hatch, Wesleyan University
Anthony Ryan Hatch
As the global scope and biosocial consequences of the COVID-19 pandemic were laid bare, an impressive parade of commentators and scholars, many of them sociologists, began to articulate and pontificate on the racist dynamics of the pandemic. State government agencies, news organizations, and university researchers have produced jaw-dropping morbidity and mortality data in ramshackle and patchwork forms. As a sociologist who had been thinking, writing, and speaking about the intersectional politics of health injustice, the pandemic should have been, in a horrible twist of fate, a real moment for me to join the professional cavalcade trained on the group-differentiated impacts of the virus on Black lives. The more epidemiological truth that’s out there about racism’s effects, the better, right? We have to shift the “policy” conversation, right? True to the grand tradition of liberalism, I also heard the call to enlist myself in the production and circulation of knowledge.
It should have been an ideal time for me to write a blog post about my research on the science of metabolic syndrome because many of the so-called preexisting conditions (e.g., heart disease and diabetes) that exposed Black people to heightened danger were things I knew about, both experientially and intellectually.
Equally, it would have been an instance where my thinking about unequal food systems would matter because of all the ways the virus is transforming systems of food production, distribution, and consumption, and their ecological and health consequences on Black communities.
It could have been an important moment for me to try to place a piece about my research on forms of carceral and institutional captivity, because prisons, nursing homes, and slaughterhouses were specifically designed to keep people warehoused—like Amazon fulfillment centers for wasted human capital—and were universally (and perhaps strategically) unprepared to mitigate the spread of a highly infectious virus in close quarters.
But I was unschooled in the measure and rhythm of Coronatime.
Instead of jumping onto my University-owned laptop and typing in fevered pace about all of the things I knew about that could matter for how American society was responding to the virus, I was stunned. Shell-shocked. I don’t know about you, but I could not think three thoughts in sequence apart from existential fear, followed by mournful dread, and then an incessant need to clean things. At best, I was good for a solid quarter of my administrative and familial tasks for the day, only to face the same to-do list the next day. Slow and considered thinking? Deep critical analysis? I faced the possibility that these would have to wait until Coronatime passes, if it passes. No, this wasn’t going to be a moment for me to say anything smart about the pandemic. As I told my students, I’m not trying to overachieve the pandemic, I’m trying to survive the pandemic.
Counting each and every brilliant opinion piece that I don’t really want to read, flagging all of the powerhouse Zoom-based webinars I wouldn’t attend, and scrolling past one thought-provoking social media post about race, inequality, and COVID-19 after another, I withdrew further into myself and began to experience deep bitterness over all of it. It was not my moment and, to be painfully honest, I started feeling a confusing yet seething resentment over what I judged to be a cottage industry organized around responding to the pandemic. It wasn’t your moment either, damnit.
I held on to some resentment for the people I see in my everyday life, so many of whom don’t care enough to wear facemasks or practice physical distancing, even some of the lovely Zoomed-out children who live in my middle-class neighborhood in Connecticut. I reserve special judgement for them.
And yet, I reserved most of bitterness, resentment, and rage for the power elite who have largely sought to transmogrify the pandemic into an economic and political opportunity, who stand ready and willing to kill others to save themselves. The monster King/President and his enablers in and out of government including the financiers who bankroll the “Open the Economy” “protests.”
I encourage you to remember the tactics they deploy in necropolitical war. First, they dehumanize human beings by treating them as instruments/things/objects and repeatedly call them enemies who are killable. Then, they declare a state of emergency, and enter into a state of siege where they use extralegal practices to suspend rights and segregate enemy populations. Once territorialized, they use overwhelming technoscientific force to sabotage infrastructures for living. And, finally, they plunder economic resources directly through theft and indirectly by the debt/finance relation and through that avarice make the production of mass death a vital part of the national and international economy. Once they do all this, they are positioned to destroy threats to sovereignty with impunity and to kill those populations whose very death makes sovereignty possible and legible. This is what is happening to Black people in Coronatime. This has become a completely legitimate and normal mode of government. It is not accidental nor fixable.
Standing with Frank Wilderson and others, I am struggling with feelings of profound and nearly irrevocable pessimism about the possibilities for Black survival in Coronatime.
I say all of this because this short essay, which I have been graciously asked to write for the humble newsletter for the Section on Science, Knowledge, and Technology (SKAT) of the American Sociological Association, is the first thing I have written in 3 months. Writing is a privilege. Not writing is also a privilege. Being more-than-less safely quarantined with my spouse, kids, and one-eyed cat with enough income to balance our monthly budget (don’t look at the mountain of debt on which this so-called dream rests!) and NOT writing anything in Coronatime has been a real fucking joy.
I think it’s time to clean the doorknobs again.
This second meditation emerges from a much longer-term series of concerns I’ve had about the problem of racialized epidemiological data and Black lives. Despite my rage, I’m grateful that many of my colleagues have entered Coronatime ready to speak truth to power, if that phrase accurately describes the practices that have produced the proliferation of racial discourses about the virus. The problem is that I don’t think that the forms of power that govern life in the United States are capable of hearing the truth we peddle.
The painstaking calculation of the pandemic’s effects on Black people is a necessary but insufficient condition for saving Black people’s lives. The data will not save us. Counting the dead is not enough.
It is true that the production of racialized epidemiological data collection is a necessary feature of an antiracism because we have to generate a metric that is legible to the racial state—that mechanism is numbers. Numbers can force a reckoning with racial inequity, but sometimes that reckoning can be a liberal fantasy. Producing racialized epidemiological data is critical in the development of antiracist action plans to close gaps in experiences and outcomes between racial and ethnic groups. When we measure the effects of racism, we are remembering and documenting intergenerational patterns of violence enacted on the bodies of racism’s victims. The beautiful people at Data for Black Lives are trying to keep this ledger. By drawing on the political framing of Black Lives Matter, this group uses data science to create concrete and measurable change in the lives of Black people. Dr. Ibram X. Kendi and his team at The Antiracist Research & Policy Center at American University aim to counter this failure with the COVID Racial Data Tracker.
With my training in advanced statistics, I can appreciate how important plain and simple facts are (or should be) to health policy making and scientific debates. I sometimes joke with my students that I’m a recovering empiricist—I used to be a numbers addict. I endured advanced training in statistics and demography during graduate school and nearly convinced myself that I wanted to do statistical research on Black people’s lives. Then, I had a spiritual experience and wanted to tell different kinds of sociological stories. Now, I go to meetings a few times a week.
Part of my recovery program involves entering into questions of saving Black lives through the lens of science and technology studies (STS), an interdisciplinary field of inquiry that turns an analytic lens back on scientific and medical practices, technologies, and knowledge systems. Approaching science and technology studies as a sociologist means that I am interested in how people create and circulate knowledge, design and apply new technologies, and intervene in the world in ways that are patterned, shaped, conditioned by social and historical context. The content of any scientific knowledge is always directly related to the social contexts in which and through which it was produced. The kinds of questions that a science asks, the varieties of research methodologies used to collect data, including what kinds of evidence are considered valid and legible, and the array of interpretive practices that aim to make sense of evidence are all shaped by the social positions and lived experiences of scientists and their institutional contexts. These questions are fundamentally about epistemology and the politics of knowledge, or the systematic study of how power shapes the things we know, and, relatedly, why we don’t know the things we don’t know.
There are lots of ways to enumerate Black lives and deaths in statistical terms. An entire body of research in social epidemiology analyzes Black life from what I consider to be a necropolitical point of view—remember that the whole point is to instrumentalize Black life through the process of abstraction and counting. The entire field of knowledge and practice seems to operate based on the presumption that Black life will be shorter, more diseased, more painful, and there will generally be more death in and around Black communities. Here, the hyper-fixation on racist numerology: rates, numbers, percentages, risk estimations, abstractions, instrumentalizations. Often times, it feels like we’re not even talking about fleshy human beings. What all of these racialized differences mean is the subject of deeply political interpretive work within and without the human sciences.
As a STS scholar who uses interpretive methodologies that tease apart the cultural meanings that epidemiology draws upon and produces, I understand that we also have to be keenly aware of the social context and epistemological underpinnings of epidemiological knowledge production, particularly as it relates to racism’s effects on health. There’s no such thing as a plain and simple fact. Facts are complicated by their histories, and this is especially true in the context of racism. We have to measure the effects that racism creates, but scientists also have to interpret the data in the proper context that avoids the old traps of cultural and scientific racism.
Yes, we have to engage in sociological analysis of the intersecting social structures of racism, sexism, social class, sexuality, disability, age, and immigration status as they constitute the social determinants of health and shape the lived experiences of individuals and social groups. We also have to engage in systems analysis of the political economy of health sciences and health care as they impinge differentially on Black lives. But that will not be enough to stem the tide. I feel despondent because the reams of racialized epidemiological data have not amounted to much. To my mind, we have yet to confront the modalities of racial capitalism and racist government that establish the institutional contexts that require the cannibalization of Black bodies
On this point, the preeminent historian of medicine Vanessa Northington Gamble, who chaired the Tuskegee Syphilis Study Legacy Committee back in 1997, published a truly insightful article showing how African American communities in Philadelphia responded to the 1918 influenza pandemic.
The sparse data collected about that pandemic suggested that Black people were less likely to contract and die from influenza compared to White people, perhaps as a direct consequence of Jim Crow which may have functioned like a “de facto quarantine” that protected Black populations. Black health professionals, disallowed from White medical spaces, cared for their Black patients in nascent Black-only hospitals and repurposed schools. White health professionals, medical researchers, and insurance companies crafted medical theories that tried to force fit the limited epidemiological data to white supremacist models that emphasized all of the wrong things about the differentials in influenza mortality. White people did not see and perhaps could not see how their survival was linked to the survival of Black people, even though the crisis offered precious few opportunities for a vision for racially integrated medicine and public health. And yet, as the pandemic abated in late 1918, Gamble notes that
“The epidemic also did not prompt white people to develop any major public health or medical initiatives to improve the continued poor health status of African Americans. It also did not overturn racist scientific theories about the inferiority of African Americans or conceptualizations of black people and their neighborhoods as disease threats to white people.” (p. 121)
One of my great fears is that the normal to which our so-called leaders want us to return will feel just like this. I’ve read the commentaries suggesting that the Trump administration backed off its already “inconsistent and incoherent” pandemic response once it learned that non-Whites, migrant workers, and prisoners were dying in large numbers. Perhaps, in this case, racial data are the very thing that enable targeted mass killing.
The Trump presidency and its relationship to science and truth have prompted both reflection and action by STS scholars, including contributors to a recent thematic collection published in early 2020 in Engaging Science, Technology, and Society. For this newsletter, we requested that the contributors to that collection re-visit the arguments made there in a series of brief commentaries in order to speak to our unfolding experience with the COVID-19 pandemic. Please visit the ESTS website to read the original collection, edited by Daniel Lee Kleinman, in addition to the commentary below.
Abby Kinchy
By Abby Kinchy, Rensselaer Polytechnic Institute
During the COVID-19 pandemic, many of us are closely watching debates about competing models, possible (and dangerous) treatments, and the accuracy of death counts. It is infuriating to see political leaders facilitating the spread of misinformation and suppressing knowledge that runs counter to desired policy goals (such as reopening meatpacking plants). As sociologists who study science, knowledge, and technology, we are familiar with these dynamics, even if the situation is unique. Throughout Trump’s term as president, environmental sociologists and STS scholars have been analyzing his administration’s “anti-science” (or “post-truth”) tendencies. At the start of the Trump Administration, it was evident that environmental protections were being slashed and environmental science was being suppressed and erased. Many social scientists quickly took action to resist these moves, joining efforts like the Environmental Data and Governance Initiative (EDGI) and the March for Science. My own reaction was to collaborate with “pro-science” environmental activists, but also to question the novelty of Trump’s actions so that we could more fully understand the social forces in play. During the presidency of George W. Bush, there were heated debates about “politicized” science and the censorship of scientists whose work was inconvenient for powerful industries or the religious right. Then, as now, I was concerned that responding to these moves with calls to “listen to experts” or base decisions solely on scientific criteria was actually playing into the hands of the corporate interests who want to displace crucial public issues into the narrow domain of professional science.
In the past few weeks of the pandemic, it has been heartening to hear sociological perspectives amid the (justified) anger about Trump’s ill-informed and reckless response to the pandemic. Of course, we must add our voices to the vigorous advocacy for investment in medical research that can bring this pandemic to an end. At the same time, we can respond to calls to “listen to experts” with a sociological analysis of the medical and research institutions that failed to produce timely testing and treatment, the patterns of racial oppression that put some bodies at much higher risk of disease and death, and the reasons why opening up “the economy” is increasingly prioritized over the protection of lives. Our own expertise as sociologists is necessary for making sense of this situation. At the same time, we all know that these problems will not be solved by experts alone.
My reaction to the Trump Administration’s attacks on environmental science was to call on environmental sociologists and STS scholars to explore relationships with social movements that were pushing back. Not only could we document the work of social movements, but we could also conduct research that assists advocacy organizations, helping activists navigate the policy process, understand the history of science funding, and critique the ways that corporations cultivate strategic ignorance. In the midst of this COVID-19 crisis, sociologists of science can make the same kinds of alliances, joining online resistance to misinformation, amplifying the voices of health justice advocates, and contributing to a growing understanding of the power relations that shape the pandemic. Our understanding of the social dynamics of knowledge production can add practical value for groups that are resisting efforts to undermine our hard-won knowledge about preventing disease.
The Trump presidency and its relationship to science and truth have prompted both reflection and action by STS scholars, including contributors to a recent thematic collection published in early 2020 in Engaging Science, Technology, and Society. For this newsletter, we requested that the contributors to that collection re-visit the arguments made there in a series of brief commentaries in order to speak to our unfolding experience with the COVID-19 pandemic. Please visit the ESTS website to read the original collection, edited by Daniel Lee Kleinman, in addition to the commentary below.
Chris Rea
By Chris Rea, Ohio State University, and Scott Frickel, Brown University
As we wrote recently, the Trump administration looks to us like an anti-science disaster (Frickel and Rea, 2020). The White House response to the novel coronavirus pandemic largely confirms our assessment.
But as we also wrote, characterizing a disaster requires grappling with the difficult problem of baseline measurement: absent the opportunity to carefully pre-plan their research, how should scholars characterize the Trump anti-science disaster, and in this particular case, its effects on the federal government’s response to the COVID-19 pandemic?
Scott Frickel
One instructive path—and one we have been carefully pursuing in relation to environmental agencies—is to systematically assess the expertise and capacity of federal agencies through time, so as to better understand the baseline from which scientific expertise in the federal government are being eroded by the Trump Administration. Figure 1 compares aggregate employment change among agencies that protect the environment and manage natural resources against agencies at the center of the federal government’s response to the novel coronavirus.
For more than 20 years, and more than in almost any other substantive area of governance, federal environmental agencies have steadily hemorrhaged employees. This suggests declining capacity to produce basic knowledge, craft well-designed regulations, and monitor and enforce existing rules and laws. Health related agencies have fared far better. From 1980 to 2018, NIH increased its employee corps by more than 40%, while the FDA doubled and CDC tripled their workforces. In these and other health agencies, the proportion of employees holding PhD degrees has increased several-fold as well.
There is more to unpack in these trend data – about state capacity, about expertise and autonomy, and about the erosive and accretive power of neoliberalism – than we have space to develop in this comment. So, the point we make here is a simple one. In the context of COVID-19, the Trump Administration anti-science disaster makes landfall upon a highly heterogenous landscape of government agencies.
For the long-eroded environmental state, COVID-19 presents yet another opportunity to gut regulations and push anti-science policies that agencies themselves are poorly equipped to resist.
For medical and public health-related agencies, however, the Trump anti-science disaster pushes up against robust, well-staffed, and highly scientized public organizations. Caveats aside, we strongly suspect that this administrative robustness is key to understanding why the federal response to COVID-19 has so far been driven to a remarkable degree by science and epidemiology in particular—even with an overtly anti-science administration at the helm.
This situation is dynamic; daily headlines make clear that the politicization of science as it relates to the novel coronavirus is only gaining steam. Still, a full assessment of the role of science in the U.S. response to the global COVID-19 pandemic must be rigorously attentive to baselines—and to the political and administrative histories that have produced them.
Katherine Darling
By Katherine Darling, University of Maine at Augusta
In the chaos of a pandemic, how do we teach the virus? Ann Fausto-Sterling laid down this challenge on Twitter as we were all flung into “emergency remote teaching” in March 2020. The pedagogical and logistical challenges of closing our universities and going online were compounded by much deeper societal, ethical and existential quandaries about how to best support our students as they struggled to make sense of the COVID-19 pandemic.
We know that SKAT scholars are uniquely positioned to rise-up to reach the pandemic’s challenges: the conceptual and theoretical tools we’ve applied to public health, digital spaces, data and misinformation, expertise, infrastructure and inequities all seem custom-fit to this moment. And we’re attempting to do our best work at a time when our students, families and communities are stretched too thin. While students are struggling, professors are also attempting to carry out our professional responsibilities in the midst of new challenges: from caregiving, childcare, homeschooling, and grieving to mutual aid and community organizing. And that’s if we didn’t get sick ourselves. In all, we’re facing enormous challenges with extremely limited bandwidth and constantly triaging.
For this COVID-19 edition of SKAT’s series on teaching, we rounded up just a few of the curated teaching resources for helping students and faculty make sense of the inequities, uncertainties, anxieties and disinformation surrounding the pandemic. I also had the chance to ask leaders of two COVID-19 syllabus projects a few questions via Zoom and e-mail. The Q and A’s are linked below.
These syllabi projects highlight lessons learned from past epidemics, SKAT classics and core sociological insights on medical information and health inequities. In the deluge of commentaries and critiques that seem to have a doubling rate that rivals the virus, these collaborative projects are helping us grapple with COVID-19 with a careful and critical SKAT lens.
Here are a few of the many crowd-sourced and curated resources for teaching the virus:
Q&A with Alondra Nelson
Alondra Nelson
Alondra Nelson of the Institute for Advanced Study and the Social Science Research Council was kind enough to Zoom with me to discuss the #Coronavirussyllabus. Rajat Singh (SSCR) edited the transcript for clarity and brevity.
KD: What sparked the idea for the Coronavirus Syllabus? How and why did it start, and what did you hope would come out of it?
AN: It began with a tweet from Anne Fausto-Sterling, who has been a friend and mentor since I was an assistant professor, when I met her at the Cambridge (MA) race and science group meetings. When I was on the faculty at Yale, there was a group of historians and sociologists of race and science, convened regularly by Evelynn Hammonds, who came from as far south as New York and as far north as Boston. So I have known Anne for nearly two decades.
In early March, we were coming to the realization that literally everything was going to stop or change dramatically, including teaching and research. There was dialogue online about how to proceed. Some were asking: “What are we going to do? I had this plan for my class and this now seems impossible or irrelevant given the current situation.” Anne tweeted, “Teach the moment, teach the virus.” The epigram for the coronavirus syllabus is “teach the virus,” which was Anne’s suggestion to us, and I think the right suggestion.
For me, this initiative was also a way to say to myself and to others: We actually have tools for thinking about this. Nothing on this scale and scope has happened since the 1918 flu, over a century ago. But even in this unprecedented moment, we soon saw that scapegoating, and stereotyping, anti-immigrant foment, critiques of science, and support for science —things that we had seen happen in other moments of infectious disease concern and pandemics, were happening again. Comforting is not exactly the right word, but there was a sense that yes, this thing that’s never happened before is happening, but we also have tools for thinking about what’s quickly happening around us.
I would add that the other inspiration was of course the intellectual contribution of Black women scholars like Marica Chatelain who started the Ferguson syllabus and Keisha Blain who started the Charleston syllabus. These were efforts to help not just us as scholars, but others who are feeling kind of unmoored by current events and who are seeking ballast and illumination. I think a modicum of this can be provided by demonstrating that people have been dealing with events like this, thinking about social shocks like this, living through things like this, for a long time. So as best I can, I’ve been prioritizing curating and collecting scholarship, literature and music—that are either open-source resources or things that are widely available. And thankfully, many of the scholarly presses have opened up access to some or all of their catalog pertaining to issues of science and society, medical discrimination and pandemic. The syllabus is crowd-sourced and literally emerges out of the community of scholars, but I hope that it’s a contribution to a larger conversation, another form of pedagogy.
KD: That leads straight into the second question. So, I’ve been personally navigating this tension between teaching the moment and managing the crisis in my classes. How do I do damage control and crisis management, and make space for the struggle and trauma that my students are experiencing, and teach? And then, on top of that, how do I unpack this moment, and “teach the virus effectively at the same time? I think there’s a huge tension here.
AN: Many of us who are professors are in positions of profound privilege, and teaching is a job that for some of us — though definitely not all of us! — provides benefits and economic security. But I think in this moment it is critically important to remember that teaching [and] being a scholar is also a kind of vocation. That drive, that aspiration, that instinct, for me is the true north of our work and it has always had a pastoral element that is being intensely called upon now. There are important questions about the value of higher education spinning around us, “Will this shift change higher education forever? Are teachers working hard enough? Are students working hard enough and getting, in a consumerist framework, what they paid for?” I think that as teachers, what we can do in this moment is be alive to our vocation and recognize that it extends well beyond the brick and mortar classroom. The liberal arts tradition is about equipping students with critical thinking skills for living in the world. In a time that not just feels but is uncertain and hard, helping people have ways to apprehend and transform their current reality is what we should be doing. That’s what we’re called to do as teachers, much more than credit hours. The #coronavirussyllabus is very much a gesture of arts and letters, of the liberal arts. It includes music, novels, cinema and academic scholarship. It includes empirical social science but also works about the sentiment of living and being, about the meaning of life and about the common good.
KD: We know COVID-19 is clarifying the existing social crises and systemic inequalities – the digital divide being one. Reflecting on these inequalities within and beyond the university, I’m wondering what you and the contributors hope that we’ll learn and take forward from this moment.
AN: I think the hard question in response to your question is: “What haven’t we learned?” Some of us were surprised by this wide chasm of racial health disparities in the context of a moment of already dramatic inequality. From Charles Rosenberg’s Cholera Years and Eric Klinenberg’s Heat Wave to more recent work on Hurricane Katrina, we know that social shocks exacerbate existing inequalities. We have had study after study, monograph after monograph, one award-winning journalistic essay after another. There is a gesture towards forgetting, an agnotology of vulnerability. There’s now been a kind of awakening amongst a large group of us, globally, and all at once. I hope that we’ll be hard-pressed to forget again so easily.
I hope the questions about inequality, racism and vulnerability that many of us have been trying to place in the middle of STS, for example, will become more central to the work. One lesson of this time is that these matters are not merely theoretical or abstract. And also, that core questions about credibility and truth and scientific knowledge are always questions about equality, inequality and power.
KD: Are there two or three top recommendations that you would recommend from the syllabus?
AN: There are too many great choices and hard to have favorites. But for the sake of this conversation, I’d certainly choose Stephen Epstein’s book on HIV/AIDS, Impure Science, an important book full stop and a particularly important one for this moment. The book accomplishes so much. But I’d like to highlight that he’s writing about the HIV/AIDS crisis in its formative moments, and it’s a reminder of the uncertainty inherent to the science of a new disease. It’s also a reminder that, as much as I think many of us are appalled to see the kind of politicization of science taking place around COVID-19, we should expect to see politicians, scientists and the public engaged in claims-making and gatekeeping around science. It’s critical to be reminded of the politics of science, even as we’re appalled by aspects of how this is playing out in this moment. And, of course, a younger Dr. Anthony Fauci features in the Epstein book.
Vanessa Northington Gamble, a great historian who helped us to know so much about the relationship between inequality and medical science, has a fantastic article from 2010 in Public Health Reports: “There Wasn’t a Lot of Comforts in Those Days: African Americans, Public Health, and the 1918 Influenza Epidemic.” In this piece, she he helps us to see how residential segregation that was overlayered by racial segregation, impacted how the flu epidemic moved in space or didn’t move in space. One of the more interesting findings that remains a bit of a puzzle at the end of that article is that the 1918 flu wasn’t as remarked upon in the Black community, in the Black press, as one might have suspected. One hypothesis she offers to explain this is that African Americans actually might have been quite impacted by the flu in an earlier wave a year prior, when the mainstream press and public health authorities did not notice or care, because it was affecting a marginalized segment of the community. For me, this suggests that we need to bring temporality to bear on how we conceptualize racial health disparities and it is instructive as we are coming to think about the future waves of this particular coronavirus. We are learning that some evidence might suggest that COVID-19 was present in France as early as December 2019. Were there earlier cases in the US as well that weren’t apparent because who it impacted?
KD: Anything else you think we should highlight for the SKAT community?
AN: I would just say that I hope the SKAT community feels some sense of pride or accomplishment about the intellectual tradition in which we work which has provided quite valuable resources for helping all of us understand the current situation. But there’s so much more work to be done!
Q&A with Teaching and Learning Anthropology Editors
Nina Brown, Angela Jenks, Katie Nelson and Laura Tilghman were kind enough to answer my questions about Teaching COVID-19: An Anthropology Syllabus Project.
KD: How did the syllabus project come about? What sparked the collaboration and how did you launch it? What do you hope will come out of it?
Editors: The editors of the Teaching and Learning Anthropology journal meet every month and during the March meeting the COVID-19 pandemic was a top concern. Our colleges were moving abruptly to online teaching and we perceived that there was an urgent need to gather materials that could be used to address the pandemic in our anthropology courses. Angela Jenks (Editor-in-Chief of the journal) was in the midst of teaching a Medical Anthropology class and was already collecting relevant resources. The mission of the Teaching and Learning Anthropology journal is to create a gathering place, both through our website and in the journal itself, where people can exchange resources and ideas. As we discussed the materials Angela was finding, it became clear that there was a need for a centralized resource that could collect and curate resources. We decided to crowdsource the COVID-19 syllabus using a Google Doc so that we could gather ideas from as many contributors as possible.
KD: What teaching struggles and successes have you heard from contributors?
Editors: In the early phase of the pandemic response, many instructors perceived that COVID-19 was going to be the dominant topic of concern for the foreseeable future and there was a lot of interest in how to make it a central focus of their courses. More recently, as we have all been living this pandemic 24-7, we are hearing from instructors who are backing away from that approach a bit. Because we are all feeling disrupted and anxious, there is a growing awareness that a lot of people want to be talking about something else.
All of us have also seen the negative impact of this crisis on our students. Unfortunately, in many cases students are falling apart at the seams as they struggle with anxiety, lack of income, insecure housing, and the weight of family obligations. It’s not reasonable to expect them to have perfect focus or attention on academic matters. Even getting stable Internet access to join a Zoom meeting can be an impossible obstacle for some. The most consistent message we hear from instructors, which also resonates with our own teaching experience, is that it’s essential to give students options in the way they engage with COVID-19 related topics. Some students might find it therapeutic to think through these issues academically, but others will not.
KD: In this public health crisis, faculty are torn between stretching to meet this deeply “teachable moment” and engaging in “crisis management” or “damage control” in remote teaching. How are you all navigating that tension? Can we effectively “teach the virus” when our students are in crisis?
Editors: As cultural anthropologists, one of the tensions we have experienced in our own classes is the difficulty of teaching something that we are all embedded in, particularly since this is still an emerging and rapidly changing situation. In our classrooms, we are accustomed to teaching about other cultures: societies and populations from which we and our students tend to have some emotional distance. With COVID-19, we are all completely immersed together, which makes it more difficult to think in the abstract or to use our experiences as a basis for theorizing.
While the pandemic is definitely presenting us with a “teachable moment,” it’s also important to recognize that this is a really “bad” moment, meaning all the news around us all the time is terrible. In such a grim environment, it is not a good idea to keep focusing students only on all the bad news happening around them. We have to try and get them to think more along the lines of “what can we do about it.” Anthropology has many insights that can be useful for exploring how we go forward in addressing the cultural and structural dynamics that led us to this moment.
KD: We know the pandemic is laying bare social crises and systemic inequities – in our classrooms and far beyond. What do you hope faculty and universities take forward from this semester? What do scholars of Science, Technology and Medicine Studies (STMS), need to carry forward post-COVID-19?
Editors: None of these systemic inequalities or social crises are new to scholars of STMS so the challenge is really an educational one: how to communicate to students the way that diseases and health are connected to other areas of life such as food, education, and work. We are living in a time when we can see this interdependence more clearly, but it is still a challenge to bring students to an understanding that the vulnerabilities that COVID-19 has exposed are structural. Angela Jenks, who is currently teaching a Health Inequalities course, described the situation this way: “The history of colonialism, history, slavery, and redlining are in people’s bodies. When we talk about disease, we cannot fall back on explanations that emphasize diet, exercise, or ‘lifestyle choices.’ What needs to be brought forward is an understanding that these inequalities are systemic.” Another area where we need to use research from STMS to challenge student thinking is around the rhetoric we hear every day such as “the virus does not discriminate” or “we’re all in this together.” The reality is that we are not “all in this together” in the sense that all of us have the same level of vulnerability.
KD: What are your top two or three recommendations from the syllabus?
Editors: All the material in the syllabus is fantastic and we have enjoyed watching the syllabus itself develop over time. The syllabus has changed quite a bit since the early days and it has been interesting to see the content develop as the resources have gone from being predominantly news items to material that is more ethnographic, comparative, and with more academic theory. We have also enjoyed reading the collaborative syllabi created by others and seeing the way other disciplines are looking at this issue. Our version is what anthropologists are finding interesting, but there are many other disciplinary perspectives.
Angela Jenks has used the “Write a Letter to a Public Official” assignment. She asked students in her “Disease, Health, and Inequality” class to identify a specific public official and write a letter describing 1) how the COVID-19 pandemic is affecting their life or the lives of others they care about and 2) what they want the official to do in response. Students wrote to their state governor, representatives, and mayors. Some described their own and their loved one’s experiences as essential workers in grocery stores and hospitals, where they lack masks and other protective equipment. Others pointed to the needs of undocumented individuals, asking state officials to include them in financial assistance programs and support a moratorium on ICE raids. Several students wrote to the university president and the heads of campus-affiliated housing associations, describing how the sudden closure of campus had affected them and asking for exemptions from early lease termination fees. In their letters, students connected their own pandemic experiences to the structural vulnerabilities we had been discussing in class. A main goal of the assignment, though, was to confront the sense of helplessness that many of us feel right now, giving students a chance to advocate for themselves and their communities.
Angela will be teaching “Medical Anthropology” this summer and plans to include either the “Keep a Pandemic Journal” assignment developed by Lance Gravlee or the “Day in the Life of a Pandemic” assignment developed by Natalia Molina as an option for students. (Visit the syllabus for details.)
Katie Nelson has used an ethnographic interviewing assignment for her American Culture course, called “What’s Your COVID-19 Economy?”. Students interviewed someone they live with about how the COVID-19 crisis has affected them economically. In their write up, students were asked to reflect on the rapid cultural and economic shift caused by the crisis. The assignment gave students the opportunity to use an anthropological lens to examine a phenomenon affecting them intimately, but in a way that allowed some space for reflection by focusing on another person. Some students explored how certain low status jobs were suddenly viewed as essential and highly valued culturally, even while monetarily they continue to be underpaid. Other students made connections with David Graeber’s insights on the phenomenon of “bullshit” jobs and questioned if the existence of these jobs would continue after the crisis. One student wrote about the death of her grandfather and how the loss would impact the family economy and cultural traditions. Another student discussed strategies her mother was taking to shore up the family restaurant business by collaborating with a neighboring restaurant, something she would never have considered before. On the whole, the assignment resulted in some surprisingly insightful papers.
Coordinated by Danielle Giffort
Joanna Kempner
Joanna Kempner is an associate professor in the Department of Sociology at Rutgers University. She studies, speaks and teaches about the politics of medicine, science, the body, and inequality. She is the author of Not Tonight: Migraine and the Politics of Gender and Health, an award winning book that examines the gendered social values embedded in the way we talk about, understand, and make policies for people in pain. The SKAT Mentoring Committee asked Dr. Kempner to talk about her experiences publishing in STS and her advice for junior scholars navigating the publishing world. The discussion has been edited for clarity and brevity.
On the importance of identifying your audience
JK: I always start by identifying the audience I want to reach. I know that when you are a junior scholar, it’s hard enough to get papers out and in print, but it’s helpful to think about who you want to reach: which subfield in sociology? Do you have something to say to the scientists you study? Can your research help people understand a policy debate, and if so, would it work as an op-ed or for a blog written for a popular website? Publishing is about picking your audience. That’s always the first question you should ask yourself.
On publishing STS work as a sociologist
JK: I’m often unclear about when to publish my research in an STS journal and when to publish my work elsewhere. STS journal editors often bounce my work on biomedicine to medical sociology journals even when I think the research is squarely about knowledge production. I sometimes wonder whether this is because my work tends to be motivated by social problems, rather than by questions about theory—and that this social problems approach has historically been less interesting to STS scholars than it has been in other subfields of sociology. But I think that’s changing for at least two reasons. First, although understanding the social and political context in which science operates remains vital, scholars are increasingly concerned about the social problems raised by post-truth movements and publics’ decreased trust in science. Second, STS scholarship is now being done by an increasingly diverse group of scholars who are rightfully directing attention to questions about inequality in science, medicine and technology. Ultimately, I hope this will lead to the publication of STS research in a broader range of publications, which will, in turn, allow STS to become a more central area of sociology.
On public sociology & publishing in non-academic outlets
JK: Not only are STS scholars becoming more engaged in social problems but the public is also increasingly attuned to the role that science, medicine and technology play in their lives. The public is savvier about science and technology than we give them credit for, and—especially now, given how are lives have changed as a result of COVID-19, public audiences are seeking clarity on these very issues. Now, more than ever, STS scholars ought to be engaging the public, helping people understand issues like how scientific evidence is created and interpreted, how surveillance operates, and how trust in expertise matters.
I’d also like to encourage sociologists to think about public sociology as something that can occur on a small, more targeted scale, than say, an op-ed published in the New York Times or Washington Post. Much of my impact as a scholar has come from working within biomedicine, by talking to doctors about how they can improve their care, and by talking to people in pain about how they can better understand their experiences. I’ve always believed that sociology is at its most powerful when it helps people see their personal issues as social problems. That’s why I started to write for Migraine.com, a website that features blog posts by various experts and advocates. The blog posts I write for Migraine.com don’t carry much status on my CV, but they do reach millions of readers who have migraine, and a broadly-circulated blog can reach more readers than many prestige outlets. There’s power in being able to explain to people, “I see you have experienced this thing, and what you’re feeling has a sociological name. We call it stigma. Here’s what you can do.” Just defining a term like stigma sometimes gives readers a reason to advocate for themselves. Public sociology is not just twitter or the New York Times. When publishing, think about under what circumstances public sociology matters.
Daniel Lee Kleinman, Associate Provost for Graduate Affairs at Boston University, is a widely published scholar in STS. He is also the founding editor of Engaging Science, Technology, and Society (ESTS). The SKAT Mentoring Committee asked Daniel to talk about his experiences publishing in STS and his advice for junior scholars navigating the publishing world. This interview has been edited for clarity and brevity.
On persistence and digesting reviewer feedback
Q: When you’ve had experiences of rejection, how have you decided whether something is worth pursuing in a different space or just letting it fall to the wayside?
DK: Probably success in anything demands persistence and as somebody who works in STS, and probably even if you did other areas in sociology, you’d be aware that there’s a lot of arbitrariness. It’s not really meritocratic. That’s all the more reason to be persistent and often to be strategic. Okay, I want to write this kind of piece, where is this likely to fly? There’s an outside chance that AJS (the American Journal of Sociology) might be interested in it. Should I give it a shot, or not? So I’d say, at least a third of the scholarly papers I’ve published were rejected places before I got them into journals. Others, maybe two thirds, ended up with a revise and resubmit and got published. But one third were rejected before they were accepted elsewhere. I remember hearing an excellent story by Beth Popp Berman when she received one of the SKAT awards for a paper that it was ultimately published in Theory & Society. It won the award, but had been rejected three times before. And I just think that that’s pretty common. So I think you should read the reviews, and they might say things that would help you make the paper better. It’s also possible that they won’t. Sometimes it is just clear that it wasn’t the right venue for the work. So, sometimes you’re going to get stuff that’s going to be helpful and it’s going to help you make a stronger paper or book or whatever it is. And sometimes you’re not. And I actually, I think learning how to make those judgments is part of becoming a scholar – when the critique is something that you really need to take into account.
Q: How do you learn to make those determinations?
DK: Let’s say you submitted a kind of STS paper, but you thought maybe it was going to be of interest to the broader social audience and you submitted to AJS and it gets rejected and the reviewers have substantive critiques about the way you use evidence. Well, okay. Think about those. Are those critiques compelling? Maybe you show it to a friend, maybe you show it to your advisor. See what they think. Are they saying something like really you need to engage the literature in organizational sociology and you’re thinking, “Man, no, that’s not really what I want to do.” I think if there are compelling substantive critiques, then you have to think about them. If there are critiques about genre and literatures, that’s less likely. One of the things that happens in the scholarly world is, especially with the bigger journals, is you could end up with two, three, four reviews and they might say very, very different things. And if there’s a good editor, the editor will say, “Hey, you’ve got four reviews. They contradict each other, pay attention to reviewer A.” If they don’t say that, you’re in a difficult spot. And it may be that that’s not the journal.
On pursuing new genres of scholarly writing at ESTS
Q: In terms of thinking about placing empirical pieces, how do you think about shorter forms of writing (e.g. ESTS “Critical Engagements” and “Considering Concepts”) versus the longer empirical, research article?
DK: So I think what we trying to do is to kind of push scholarly discussion in a little bit different direction. To say: “Not everything needs to be a research article.” I think we know that that’s happening because people have blogs and there are all sorts of ways that scholars are communicating. I think in 2019 for a junior scholar, if you’re seeking an academic position or you have one depending on where you are, the research article is going to be the thing people are still going to pay attention to, which in my opinion is just messed up. But it is a reality. So if I were guiding a junior scholar who was, let’s say at a research one (R1) university, I would say only do the “Considering Concepts” or the “Critical Engagement” if you feel you have some extra time. You know, don’t allow it to [distract] from what will be a dossier that your colleagues will be looking at in a few years. If you’re at a liberal arts college, for example, I would say talk to your colleagues and say, “Hey, there’s this journal. They’ve published these different things. How will you think about that when I come up for tenure?” So that said, we have had junior scholars who’ve done both of those things. And I’m glad about it. I think among other things they require less investment, right? So it is possible–depending on how fast a writer you are, I think, you could do these things without hurting your other work.
The critical engagement pieces are meant to be more or less like scholarly op-eds, translating what you’re doing into something that is of public and policy relevance. They are about using an STS lens to talk about something topical. Let’s say bias in, in algorithms for example, would be a good example. And you can say some things that draw a little bit on scholarly literature, aren’t too deep, get the point pretty quickly. And you can do that in — it shouldn’t take too long to do it. Although we push on the writing quality somewhat more than we do on the research articles.
Regarding the considering concepts genre, I think a lot of scholarly work is too long. It’s repetitive. It meanders a lot. It doesn’t get to the point. I’ll just say, I have rarely an experience where an editor said to cut 20% where I haven’t cut it and thought the paper was better. In other words, [the papers have] been better when they’ve said to do that because I’ve cut off stuff that was unnecessary. But in this case, the idea is that, a lot of us may have made a presentation at a conference where we’re developing a concept, we have data, we haven’t really worked all the way through it, but why not get it out there as a concept and provide a brief discussion of the data, and how the concept would apply to the data. We don’t sort of hold it to the same standards that we do a research article. It’s like, is this an interesting concept? Is it well articulated? Is it appropriately applied to the data?
Q: I think that maybe something that a lot of junior people feel is that there is this big thing happening and you kind of want to get it right. It almost feels risky to put something out there in a public space when it’s almost like there hasn’t been enough time or something to watch it play out…
DK: I’ve been alive and active as a scholar long enough to have contradicted myself. My views have changed. I don’t think that that’s terrible. Sure, if you said something really stupid, but that’s what the screen is for! That’s why we send them out for peer review. You have to have said something that we and the reviewer [thought] was worth saying, otherwise it won’t get published.
On publishing in the mainstream media
Q: What sort of outlets have you published in, especially in mainstream media?
DK: I’ve published books with university presses, and at least one, maybe two with commercial presses. I’ve actually mostly published in STS journals as far as journals go, although I have published in a few sociology journals, including Theory and Society, Socioeconomic Review, Sociological Quarterly, Sociological Forum. I’ve published in The Guardian, Chronicle of Higher Education, [and] Technology Review. When I was at the University of Wisconsin, I published kind of regularly in their local newspapers, meaning once every other year.
Q: Was this [publishing in the mainstream media] something that you had thought about throughout your career? Was it something that you came to later?
DK: Yeah. even as I was getting started and before this term — became a thing — I wanted to be a “public intellectual.” Obviously I’m not as public and as extensive as some people, but it was a thought of mine from the very beginning. And in fact, I think as a graduate student, [there was] the Technology Review piece I coauthored with my advisor and I think we published an op ed piece or two when I was a grad student.
Q: In terms of selecting what work to place in more public spaces versus academic ones, how do you decide whether it’s something that you want to put out there?
DK: I think the answer is it has to be pretty topical and, you know, I’ve submitted pieces that haven’t been published too. Both scholarly pieces and mainstream media kind of pieces. I think you need to tie topical things to something that really grabs people that’s really relevant, or pretty likely we’ll become dated. So, I wasn’t able to put as much effort into this as I would’ve liked, but when the Trump administration recently changed some policies on honeybees, my collaborator and I used that opportunity to, to try to talk about this issue. We weren’t actually successful. But I do think the strategy we used is exactly the right one, which is, “Hey, there was something that was just in the news” and then use that thing that was in the news as a way to speak more generally.
I hope people who are in younger generations as scholars will do this kind of work. I think it’s really important. I think that people in STS have things to say that would be valuable. I also think that higher education and the scholarly world is changing and that kind of stuff is becoming more valued and valuable.
BIO
Daniel Lee Kleinman’s research has focused on the social organization of scientific research and the transformation of higher education in the US. He has multiple published books, including Politics on the Endless Frontier: Postwar Research Policy in the United States (Duke University Press, 1995), Impure Cultures: University Biology and the World of Commerce (University of Wisconsin Press, 2003), and Science and Technology in Society: From Biotechnology to the Internet (Wiley-Blackwell, 2005). Most recently, he co-authored Vanishing Bees: Science, Politics, and Honey Bee Health (Rutgers University Press, 2017) with Sainath Suryanarayanan. Throughout his career, Daniel has published in scholarly outlets as well as in the mainstream media, including articles in The Guardian and the Chronicle of Higher Education.
Daniel spent most of his career at University of Wisconsin, Madison where he served as Senior Associate Dean (and previously as Associate Dean for Social Sciences) in the Graduate School and was Professor in the Department of Community and Environmental Sociology. He holds a BA in Social History from Haverford College and an MS and PhD in Sociology from the University of Wisconsin, Madison.
In June 2018 we were pleased to announce the recipients of the 2019 SKAT Section Awards, which will be presented at the SKAT business meeting on Saturday, August 10th at 5:30pm in the Central Park West room (2nd Floor) at the Sheraton New York.
In this Q&A, we highlight the winner of the 2019 Robert K. Merton Book Award, Dr. Miranda Waggoner. Her book, the Zero Trimester: Pre-Pregnancy Care and the Politics of Reproductive Risk (University of California Press, 2017), was also named a 2017 C. Wright Mills Award Finalist by the Society for the Study of Social Problems. In it, Waggoner explores why a “healthy” pregnancy now requires care and attention across a woman’s entire reproductive life. Below, in conversation with SKAT’s Emily Vasquez, Waggoner explains what the rise of the “zero trimester” can tell us about contemporary reproductive politics in the United States, offers advice for STS scholars embarking on ethnographic research carried out among biomedical experts, and shares details of her new research.
A. The “zero trimester” is the time period before pregnancy, when women today are urged to prepare their bodies for a healthy pregnancy. It is a term I came up with when studying the scientific, medical, and cultural emergence of the pre-pregnancy care model (also known as preconception care).
Some quick context: In the early 2000s, the CDC began an initiative to improve the pre-pregnancy health of women in order to improve birth outcomes in the United States. Previously, the primary policy and medical approach to improving birth outcomes was improving prenatal care (that is, care during pregnancy), but despite improved prenatal care, the U.S. continued to be plagued by terrible maternal and infant health statistics as compared to other wealthy nations. Prenatal care is essentially surveillance—it can diagnose and treat problems that arise during a pregnancy, yet it does nothing to prevent these problems in the first place. Don’t get me wrong, prenatal care can be important care for individual women, but widespread utilization of prenatal care hasn’t actually resulted in improved population health. So, this pre-pregnancy model was intended to be a primary prevention paradigm. The idea was that if women can get healthy before pregnancy, then maybe the risk of adverse birth outcomes will be reduced.
What sparked my interest in this topic—and this is something I address in the book—is that this idea lacked an evidence base. When I looked for evidence, I found that the pre-pregnancy model was based on the “common sense” that healthier women will make healthier babies. In other words, weak science was turned into conventional wisdom through the work of medical scientists and health experts, and this approach had consequences for medical and cultural thinking about risk and responsibility.
When clinicians and public-health messages started calling on women to optimize their bodies for pregnancy, they were essentially encouraging women to act as if they are pregnant before they are pregnant, and this created a new kind of “responsible motherhood” that was defined in terms of pre-pregnancy lifestyle and behaviors. This approach has often translated into recommendations about an actual trimester, as women are told to be as healthy as possible for three months prior to conception. But as I show in the book, the scope of the zero trimester is more expansive than this three-month frame. Experts today tout healthy behaviors from menarche to menopause in order to ensure best health outcomes for future babies—and these recommendations are given to women who might not even yet know whether they want to pursue motherhood in the future. So, essentially, all women of reproductive age are within the “zero trimester” during their non-pregnant years. In the book, my principal aim is to examine the pre-pregnancy period as a socially produced trimester and what it means about our shifting ideas about risk and reproduction.
When I was doing background research on the topic, I came across a poster produced by the March of Dimes that said: “It actually takes 12 months to have a healthy baby.” I wanted to know where this idea of a 12-month pregnancy came from. How did we begin to think that pregnancy should last longer than 9 months? What does this shift in the definition of pregnancy mean for how we think about and provide pregnancy care? What does this shift mean for how we think about the temporality and scope of reproductive risk and responsible motherhood?
A. The move among health professionals toward focusing on pre-pregnancy care was precipitated not just by an idea in medicine and science; it was also a case of medical thinking being tied up with cultural ideals and political imperatives.
What I found when researching this book is that the impetus for pre-pregnancy care was not just about improving maternal and child health, but also about improving reproductive care. Before the Affordable Care Act, the only time that a low-income woman got comprehensive health care coverage was during pregnancy, and women’s health practitioners have long been frustrated by this fact—that they can’t provide optimal care for women before or after pregnancy, only during. Also, pre-pregnancy care was supposed to bridge two areas in women’s health care: reproductive care, which has long been associated with contraception and abortion (and thus considered contentious), and maternal and child health care, which has long been associated with prenatal and maternity care (and thus considered politically “safe”). By defining pregnancy as lasting longer than twelve months, experts could argue that women need pregnancy care coverage for much longer than just the nine months of pregnancy. And this strategy also meant that the field could avoid talk of abortion—the logic being that with proper pre-pregnancy care, the rate of “accidental” pregnancies will drop and most pregnancies will be planned. Of course, this approach is shortsighted, as women will still need access to the full gamut of reproductive-health services even if they receive pre-pregnancy care. But it reveals just how difficult it is for health practitioners and policy makers to talk about women’s reproductive health care needs in a climate that is increasingly hostile to abortion.
Focusing medical and public-health attention on the zero trimester was supposed to be a safe move because it defined pregnancy as encompassing more of a woman’s life, and it has historically been more politically palatable to focus on pregnancy health rather than on pregnancy prevention—an area that, again, includes contraception and abortion.
One of the things I find so interesting, though, is that in recent years both reproductive health care and maternal health care have come under attack from conservative politicians. One example of this is the Republican-led argument that maternity care services should not be defined as “essential” health care. Pregnancy care is no longer a “safe” zone. Since the book came out, we have seen increased hostility to maternal and reproductive health care, so this will be an ongoing area of concern for scholars, clinicians, and policy makers.
A. It is part of increasing medicalization, as more of a woman’s reproductive life is brought under the purview of pregnancy care in the pre-pregnancy care framework. But only seeing it as a case of medicalization is too simple because this is a case that hinges on risk mitigation of a putative health risk that might or might not become an actual risk in the future. So it is about biomedicalizing the potentiality of risk. STS scholars have beautifully documented other cases of preemptive clinical interventions and the scientific and medical trend toward harnessing future risk, but I argue that pre-pregnancy care is unique in that it is characterized by its future-body focus. Much of the previous work on future risk has concerned extant bodies, but pre-pregnancy care targets two bodies, one present body and another future body: the potentially-pregnant woman and her future fetus. This attention to a not-yet-conceived, non-existent being is part of a broader trend of anticipatory medicine, but it is also possible because of increasing political and scientific visibility of the fetus in recent decades. Scientists and health professionals now think in terms of future fetuses, and they are urging reproductive-aged women to do the same.
A. They are related, for sure. The rise of the pre-pregnancy care model was fueled by scientific and public-health interest in epigenetics, especially frameworks like DOHaD (Developmental Origins of Health and Disease) that link life-course health outcomes to the womb environment or even to the mother’s lifetime exposures and experiences. One expert told me that it is important to remember that, “a woman is a mother from the time of her own conception.” I find this statement terribly problematic, but it is in line with a lot of epigenetics research.
However, the pre-pregnancy care model pre-dated the scientific rise of epigenetics. One chapter in the book analyzes medical thinking about pre-pregnancy care from the nineteenth century to today, and what this analysis reveals is that pre-pregnancy care is not a new idea. It’s been mentioned in the medical literature for over a century. But it was re-discovered in the late twentieth century by physicians and health experts, and it was promoted as a “new” idea to address reproductive risk (and the politics of such risk) for the twenty-first century. The CDC then codified this idea into an actionable set of recommendations and care model.
Also, it’s worth noting that the scientists and physicians and public-health experts I spoke with did not tend to put pre-pregnancy care in the same scientific bucket as epigenetics. Interestingly, some respondents clearly explained that the pre-pregnancy care model is concerned with goals such as reducing unintended pregnancies, which do not figure much in the scientific interest in epigenetics. So, I write in the book that pre-pregnancy care definitely intersects with key strands of epigenetics thinking, but it also kind of stands on its own as a historical and epistemological phenomenon.
A. First, I think it is important to find a person in the field with whom you can establish a good rapport, as this person can anchor your fieldwork: they can help you connect to other experts as well as help you with technical questions about the scientific area along the way. I benefited greatly from having such a person at the CDC during my research for the book. More to your question, I find it very helpful to consider that expert respondents often are very interested in what you are studying—typically, these are individuals who have spent much of their professional life researching or working in this topic area, and they are often invested in discussing it, even with someone who might come at the topic from a different angle. I was always pleasantly surprised in the field when respondents genuinely wanted to know more about my research and how it might interface with what they were doing. In a similar vein, I found it very fruitful to understand and acknowledge that we are all, to some degree, on the same page. In this case, that page was about advancing social justice for women, mothers, and children. In the book, I acknowledge that the science and health professionals I spoke with might not (probably don’t) agree with my arguments, but that we are all part of the important conversation of trying to advance maternal and child health. So, I have often found it useful to approach the research, the experts, and my writing in terms of synergy between my work and theirs—and to remember that this synergy moves forward critical dialogue.
A. This is a great question! I do embrace complexity and nuance in the book, which can be a risky approach for communicating with policy makers, as not everything I write can be easily translated into bullet-points or tweets.
But I think it’s so important in a scholarly treatment of a subject to pay attention to the complicated and the complex, because this approach helps us grasp what all needs to be understood and attended to in order to craft smart solutions. Simple fixes that do not take into account complexity are myopic. For example, the pre-pregnancy model has focused primarily on improving the health behaviors of individual women. Ignored, then, were other approaches that would substantially improve maternal and child health. Maternal and child health in the U.S. would greatly benefit from robust, broad-based policies and programs that aim to reduce poverty and protect the environment. By only focusing exclusively on women, the pre-pregnancy model also advanced the unhelpful notion that women’s bodies are the only ones that matter for reproduction and child health. Of course, men’s health is crucially important, too. The approach also didn’t address the root causes of racial disparities in maternal and child health, and these disparities are wide and deeply troubling.
What I want the book to do is expand our thinking about solutions, especially because we know that individually based solutions just don’t work at a population level. And, in this case especially, such an approach has the potential effect of increasing anxiety among women and exacerbating the culture of mother-blame that has been so detrimental to women and their children in our society.
A. My current project is about the exclusion and inclusion of pregnant women in biomedical research. Pregnant women have long been deemed a “vulnerable” population and so are typically excluded from clinical trials. This “vulnerable” designation has impeded knowledge production about pregnancy, leading to a level of ignorance in pregnancy care that is stunning: clinicians often treat and prescribe medicines for pregnant women without reliable safety information.
The interesting pivot point here is that recent changes in the regulatory landscape remove pregnant women from the “vulnerable” populations list, meaning that clinical research with pregnant women now has the potential to expand and fill knowledge gaps about reproductive risk. I am tracing this history of exclusion and production of ignorance with regard to pregnant women and biomedical knowledge, and then I am also following the current shift toward inclusion and production of knowledge. This project includes interviews with scientists, clinicians, regulators, and patients to understand how various actors are shaping and responding to changes in ethical guidelines and categories. As in my first book, I’m also paying close attention to the social and political factors involved in this cultural shift in biomedicine.
I recently received a career development award for this project from The Greenwall Foundation, which will provide me with mentorship in bioethics as well as with funding for research time. I’m very excited about the potential for this work to advance dialogue between science studies and bioethics in the areas of reproductive risk, research ethics, and meanings of human difference and vulnerability.
![Waggoner Photo[1]](https://asaskat.files.wordpress.com/2019/06/waggoner-photo1.jpg?w=199&h=300)
Miranda Waggoner is an assistant professor of sociology at Florida State University and affiliated with FSU’s Center for Demography & Population Health. Waggoner’s research examines the social, ethical, and cultural dimensions of biomedical knowledge production. For more details visit http://www.mirandawaggoner.com/.
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