Health, Value, Technology, Prosthetic, Pharmaceutical in Context
Medical technologies are at their best when they remain hidden in the continuous flow of being-in-the-world. They can become spectacular when they are artificially foregrounded. At the Indo-US Gastrointestinal Endoscopy Workshop, a two-day event held at Kolkata's Oberoi Grand Hotel, the spectacular powers of medical technologies were put on full display. This transnational conference was organized by the Indian Society of Gastroenterology and cosponsored by the American Society for Gastrointestinal Endoscopy. In the main auditorium, a stage was built to accommodate a white-clothed table for eight panelists and four video screens. The screens displayed live images transmitted from two remote operating theaters (OT). One screen showed doctors and nurses working with a series of patients. The other screens provided live images from the endoscope, ultrasound machine, and X-ray machine. Through a master of ceremonies, panelists and audience could ask questions to the doctors at work in the OTs and discuss the demonstration in progress. OT procedures aimed to demonstrate how various types of new equipment enabled new types of diagnoses and surgeries. Audience questions focused on the specific uses of the endoscopic equipment; for example, if the prosthesis introducer manufactured by company X worked better than that produced by company Y (Ecks 2010). When demonstrations failed—and many of them failed—doctors often responded with humor. Having no success with staging a loop ligation, a doctor joked, "I guess I didn't have my cornflakes today." However, in many instances, they attributed the failure of the medical technology to the patients. Asked about the state of health of a sedated patient, one doctor answered that "the performer status of the patient is very poor"—as if surgery were a theater production and some of the actors were not putting in their best effort. The gastroenterologists doing live demonstrations often said that a patient did not have the "right symptoms" for the technology at hand: "This is not a good patient," they would say when a patient's problem did not fit the technological solution.
In India, gastroenterology has become one of the most demanded medical specializations. More powerful visualization techniques have engendered the field's rapid growth since the 1990s. Endoscopy centers mushroomed in the cities and spread to smaller towns. The centers typically advertise all the diagnostic techniques on offer on billboards visible from the street. In the patients' perspective, "getting a test" goes beyond a verbal consultation with a doctor and signals that something serious is going on. Diagnostic tests are perceived to be much more valuable than what a doctor can do by looking at outside symptoms. The value of scientific visualization and transformation of continuous bodily processes into quantifiable data appears as a self-evident good. The logic of high-tech diagnostics is so compelling that practitioners from all other Indian systems of medicine, including Ayurveda, homeopathy, and Unani, also routinely refer their patients for tests. Even humoral traditions that are focused on digestion for both diagnosis and treatment submit to gastroenterological technologies of spectacular visualization. It makes sense for educational events such as this endoscopy workshop to foreground the presence of medical technologies and background the living body of the patient. But the workshop presents the norm rather than the exception in how medical technologies come to appear. Why do discrete events of technological foregrounding feel as if they are the only moments when health value is created?
"Health" is the dynamic capacity of living beings to flourish across multiple mediations and temporal scales. There is no consciousness of health as long as continuous mediations are integrated (Gadamer 2018). Health is most fully present when five major mediations (sensing, being-with, dwelling, forming, and signing) cohere. The major mediations are always present in all valuing processes, though their relative salience varies from context to context (Ecks 2025). All attempts at isolating single mediations create systematic biases, distortions, and failed valuations. First, embodiment is multisensorial. Sensing engages sight and touch but also all the senses that we tend to ignore because they defy language. Interoception, chronoception, fatigue, and satiety are vital ways of sensing, but words and scales fail to capture them. Second, related to being-with, living beings, human and nonhuman, live in multispecies socialities. They live with each other and value each other in multiple ways. Third, in relation to forming (multimaterialities), objects, tools, instruments, architectures, and built infrastructures are made to make lives better. Fourth is multiversal dwelling, as living beings inhabit multiple, overlapping worlds simultaneously—geologies, geographies, climates, and cosmic dimensions afford different ways of multiversal dwelling. Fifth, for signing, multisymbolism allows for the encoding, expression, and communication of valuing. This comprises all forms of communication and sharing of information. Any disturbance of these mediations lets ill-being appear. Rather than a fixed state or a return to "normal," health is an ongoing metabolic flow in differential temporalities and in changing contexts. Multimediation is a continuous process of amplifying and muting, remediating, and demediating. Core concepts in medical anthropology can be reconceptualized and reintegrated through the five mediations. For example, "biomedical reductionism" is the illusion that all therapeutic value comes from material drugs (forming) and that all the other mediations (the patient's sensing, being-with, dwelling, and signing) do not matter (Ecks 2022, 119).
Medical technologies are made to make human lives better. These technologies always engage all five major mediations but foreground or background them in different ways. The word "technology" itself combines two of the major mediations, forming and meaning. It brings together Greek tekhnē (art, craft) and logia (knowledge, science, systematic treatment). "Technology" came into wider use in the English language only in the sixteenth and seventeenth centuries, as a meta-recursive way to see meaning in the accelerated emergence of made materialities. Technologies can be distinguished from each other by how coherently mediated they are and what kinds of recursive effects they have. The more advanced a technology is, the more coherent will be its mediations at different levels of recursion. Remedies-as-mediations are amplified when experienced as health-enhancing or are muted when they do not improve health. Since health is so deeply multimediated, there are many possible cross-mediations, which include substitutions and compensations. Prostheses are multimaterial crossmediations of missing body parts.
Medicine is deliberate forming. Latin medicina comes from the root *med-, "to take appropriate measures." Medicine has the same root as "meditation," "measure," and "moderation." Medicine is a measured, moderated, meditated mediation in a continuous flow of life. In its original sense, "medicine" is not a targeted high-tech intervention but a moderate remediation. When medicine-as-mediation makes life better, it shares health's phenomenological hiding. Just like health is most fully present when it is most coherently mediated over time, medicine is also at its best when it supports ongoing multisensory, multisocial, multimaterial, multiversal, and multisymbolic mediations and creates coherence.
Health, Value, Technology, Prosthetic, Pharmaceutical in Practice
Anthropologists study how medical technologies are used by different people in different places. They look at how access to medical things is unevenly distributed across different socioeconomic dimensions. They explore ways of forming: who makes these things, where are they made, where are they used. Regional and cultural differences are key concerns. Some studies are structured comparisons of how people in different cultural regions interact differently with medical artifacts. Diagnostic technologies do not give direct access to the real; instead they are meta-meta-recursive mediations that work only through local mediation. Margaret Lock's (2001) study of brain death in Japan and North America is a good example. Clinicians in the United States, Canada, and Japan do the same diagnostic tests and take the same measurements to determine whether a person has suffered irreversible loss of consciousness and should be declared brain dead. But the way these diagnostics are mediated differ by contexts. In North America, once a patient is declared as brain dead, other vital signs are deemed irrelevant. Aided by a ventilator, a person may continue to breathe and metabolize food, but this is not counted as a continuation of life. Public opinion in North America is supportive of the brain death definition and puts a high value on organ donation. By contrast, public opinion in Japan is skeptical of reducing bodily life to brain activity. The idea is that the person lives as long as breathing and metabolism continue. As Lock shows, the majority of Japanese physicians sided with public opinion. Until 1997, brain death was not even legally recognized in Japan. Lock's study is exemplary for its comparative approach that looks for stark differences in how medical technologies are mediated in local contexts. It is also exemplary for showing that technologies are always locally looped into contexts: "Ethnography makes it possible to examine how scientific knowledge is selectively deployed in different contexts by drawing... on historically, politically and culturally informed moral economies in local settings" (Lock and Nguyen 2018, 38). Biologies are local because they are always multimediated.
Another influential approach compares medical technologies within the same clinical settings. Annemarie Mol (2002) demonstrates this in her study of a Dutch hospital, where atherosclerosis takes on multiple identities depending on diagnostic and therapeutic practices. For a pathologist, it manifests as the narrowing of arteries under the microscope; for a radiologist, it appears as variations in blood pressure across limbs; and for a clinician, the patient's reported pain experience is primary. According to Mol, technologies do not merely reveal a unified pathology but shape its ontology—what it "is." Technologies, in her view, are performative enactments that bring pathologies into being. Mol's focus on the performative nature of medical technologies overemphasizes the role of technological mediation and overlooks the processural multiplicity of living-valuing-remediating bodies. The body is always already multiply mediated, regardless of clinical settings or technological interventions. The body's multiplicity is not created by technologies but is an inherent condition of living. Furthermore, while Mol critiques the fragmentation of medical practices, she confuses technological multiplicity with ontological multiplicity. By framing discrete technological enactments as constitutive of the body's reality, she reinscribes a logic of transactive dualism where moments of technological mediation appear as the only true value creation. Mol mistakes the fragmentation of medical technologies for a fragmentation embodied living-valuing.
Value is what makes life better. Every living being engages in valuing, from the simplest organism orienting toward sunlight, to expert committees arguing about bioethics. Any form of living-valuing is recursive, that is, experiences from valuing are continuously looping back into the valuing process. What distinguishes living beings from each other is not the ability of valuing, but different abilities for meta-recursion—more abstract valuations of valuing. All animals show meta-recursivity in the sense that they can step back from the flow of valuing, figure out what is off, and remediate. Phenomenology describes these moments as dys-appearance (Heidegger [1927] 1993; Leder 1990). Humans are further capable of levels of recursivity where awareness of valuing processes as valuing processes emerges. Humans can critically reflect on valuing, historicize it, decontextualize it, and project it into the future in ways that most other animals cannot. Medical technologies are form of extensive, collaborative meta-recursive engagements with the world.
Medical technologies are still best when they stay hidden in a continuous flow of remediating rather than being spectacularly foregrounded. Take, for example, an endoscopic technology called peroral endoscopic myotomy (POEM), which was developed by Japanese gastroenterologists in the late 2000s. POEM enables submucosal surgeries in the esophagus without making incisions. POEM emerged from clinical meta-recursions that prompted a meta-meta-recursive rethink of the core assumptions about esophageal treatments. Since its widespread adoption, POEM transitioned into primary recursivity—becoming routine and unremarkable as it blended into everyday workflows. The technology no longer occupies the conscious attention of clinicians unless complications arise. Such meta-recursive disruptions force practitioners to reengage with the design, potentially triggering improvements or more radical redesigns in the future. To date, social theories of technology have struggled to fully see how medical technologies are products of multileveled recursive processes and how their spread and use changes the levels in which they come to the foreground of attention or recede.
Levels of recursion shift constantly and vary by who is doing the valuing. Multimediation emphasizes that medical technologies do not exist as inert entities prior to their integration into social and ecological systems. As Hardon and Sanabria (2017) argue for pharmaceuticals, "There is no pure (pharmaceutical) object that precedes its socialization." Instead, social practices, market dynamics, and experimental regimes mediate and reshape their potentialities and effects. Med tech is part of a vast web of mediations, where living and nonliving systems continuously cocreate and transform one another.
Some medical technologies are easy to produce. White coats and stethoscopes are simple to make and cost little, but are still effective in conferring authority and in helping to evaluate bodily symptoms. However, most medical things take high levels of expertise to make, market, and maintain. Most of them are expensive to develop and manufacture. Med tech items are objectified outcomes of meta-meta-recursive valuations, and their market value is justified by the highly recursive work that went into making them. "Intellectual property rights" are legal protections for the meta-recursive labor that went into them, rather than protections of the material artifacts. In the twenty-first century, practically all medical technologies, prosthetics, and pharmaceuticals are produced by private, for-profit companies. Pharmaceutical corporations have been called "law firms with a manufacturing arm" for this reason.
Medical things extend beyond human control and agency, participating in broader cycles of mediation. Pharmaceuticals, for example, are not merely consumed; they alter human bodies, are excreted into wastewater systems, and then recirculate into local ecosystems, impacting water supplies, plants, and animals. As Murphy (2008, 696) observes, these substances flow back into collective bodies, highlighting how living and nonliving systems are mediated through recursive processes that dissolve boundaries between them. These flows can escape human designs and affect entire ecologies. The One Health approach seeks to address this complexity, acknowledging how the pharmaceuticals and technologies used for animals reciprocally affect human health, and vice versa. This interplay reflects the porous and dynamic boundaries between being-with multiple lives and multiple materialities.
Medical technologies are engineered to function as "immutable mobiles" (Latour 1987), enabling their transport, circulation, and standardized use across diverse contexts. Innovation in this field often revolves around enhancing speed, reducing size, and ensuring the seamless mobility of these entities (Cerulo 2009). Pharmaceuticals exemplify this principle; their global prevalence stems more from their immutable mobility than from their therapeutic effectiveness. The process of forming materials into immutable mobiles aligns perfectly with the logic of transactive dualism. However, this logic is rarely questioned; instead, it is often uncritically rearticulated in the language of social science, leaving the deeper value cosmology that underpins it unexamined.
The histories of various medical technologies are deeply interconnected. Until the mid-twentieth century, individuals with severe limb injuries often relied on prostheses, as surgical interventions were limited to amputation and pharmaceutical options to save such limbs were nonexistent. War veterans have historically been, and continue to be, among the primary users of prosthetic limbs (Messinger 2003). Anthropologists have examined how the experience of limb loss and the use of prostheses intersect with social, economic, and political dynamics. Açıksöz (2019) explores how Turkish veterans who lost limbs in the Kurdish conflict are both celebrated as national heroes and socially marginalized because of their disfigurements. Prostheses come to mean masculinity, citizenship, and national belonging. Similarly, Milosavljevic (2013) investigates how Serbian veterans from the Balkan wars become "prosthetic citizens" through the provision and maintenance of artificial limbs. Prostheses are multimaterial remediations that are recursively looped into all other mediations.
The illusion that medical technologies are the sole source of health care value emerges from transactive dualist presuppositions. This is the core value cosmology, or "episteme" in Foucault's sense, of all modern institutions. Transactive dualism holds that true value is realized only in discrete, measurable moments of exchange, with the transactants as entirely separate beings and the items of exchange as entirely separate from the transactants and from each other. Transactive dualism systematically suppresses the recognition of continuous mediation and constant recursivity. Transactive dualism merged ideas from Descartes, Locke, and Smith's market economics. During the nineteenth century, all institutions were remodeled in its logic. The era's "laboratory revolution" embedded it deeply within medical institutions and practices. As core episteme, transactive dualism remained firmly hidden from explicit theorization. All social theories, including all current theories of medical technologies, were founded upon transactive dualism and, lacking recursive insight into their own emergence, remained blinded to its influence. Even those who argued forcefully against a Cartesian mind/body dualism remained stuck in transactive thinking. For example, Haraway (1997) rejects boundaries between human bodies and medical technologies but still takes transactive "encounters" as the sole source value creation.
Transactive dualism foregrounds spectacular moments of technological intervention and backgrounds recursive flows of living-valuing-remediating. Diagnostic technologies abstract dynamic bodily processes into quantifiable data points. They position technological meta-meta-recursions as the sole source of health value. Continuous remediations appear as irrelevant, unreliable, unbillable noise.
Medical anthropologies of pharmaceuticals, prosthetics, and technologies are embedded in complex economic, political, and legal dynamics. Medical things work the best when they operate in the background, but frictions in how they are being valued in different ways make them come to the fore. Like medicine, economics, politics, law, and ethics are also multimediated, multirecursive systems looped into each other. Medical technologies are so deeply contested because they cannot be reduced to a single domain. These things are matters of concern because they are always legal, commercial, political, ethical, and medical entities at the same time.
The most profitable technologies are the most disputed. A good example is the anticancer drug Glivec. The drug remains the flagship product of Swiss pharmaceutical giant Novartis. The Glivec patent is worth billions of dollars every year. The Swiss patent application was filed in 1992. In 1997, Novartis filed new patent applications for an improved beta version. In 2006, Novartis applied for an Indian patent for the beta version. The Indian Patent Office rejected the application, arguing that the beta version of Glivec did not show significantly better efficacy compared to the original, which was already produced in a much cheaper generic form by several Indian companies (Ecks 2022). Novartis's application was denied in reference to Section 3(d) that says that any two medications will be treated as the same substance unless they have significantly enhanced efficacy: "the mere discovery of a new form of a known substance which does not result in the enhancement of the known efficacy of that substance or the mere discovery of any new property or new use for a known substance" are insufficient grounds for being granted a new patent. That is, meta-recursive extensions of appearance or use indication are not sufficiently valuable to deserve patent protection.
The case went through different courts and Novartis eventually lost the battle. In its 2013 verdict, the Indian Supreme Court found that the beta version of Glivec was not "new" enough when compared to the generically available alpha version. The legal struggle over Glivec was so intense because Novartis targeted central provisions in India's patent laws, especially Section 3(d), which tries to ensure that lifesaving drugs can be produced in generic form immediately after the expiration of a patent. India's status as "pharmacy of the world" and key supplier of affordable generics to countries of the Global South was at risk in the Glivec case. Legal, political, and ethical concerns disrupted the industry's commercial strategies.
Technologies, prosthetics, and pharmaceuticals present themselves as technical solutions to bodily problems, with the problem preceding the solution, and existing independently of the solution. However, key works in medical anthropology show that technological solutions can coconstitute the problem they are meant to solve in the first place. As with any mediation, medical technologies have unforeseen consequences and unwanted side effects. Technologies pose as many risks as they promise improvements. The history of remedial interventions is as much about their potentials as about the ways their risks are assessed and regulated.
It makes a significant difference to the definition of a disease if a therapeutic technology is available to make it better. For example, the rise of depression would not have happened without the rise of antidepressant drugs. There are many reasons why depression emerged as the world's leading chronic health condition over the past three decades. One reason was the global marketing of SSRI antidepressants, starting with Prozac in the late 1980s. SSRIs were advertised to general physicians as safe to use and free of side effects, in contrast to previous types of drugs that were difficult to dose and potentially lethal (Dumit 2012). The notion of depression as a widespread, almost normal ailment was tied to the wide spread of SSRIs. In Japan, antidepressant sales were nowhere near to North American sales until companies found a new way of marketing drugs as a treatment for the "common cold of the soul" (Kitanaka 2016). In India, prescribers try to deflect patients' resistance against psychopharmaceuticals by saying they are "mind food," tapping into the deep cultural salience of eating and digestion (Ecks 2013). Disorders are not fixed, natural entities but interactive categories that change with how they are diagnosed. They also change with how they are treated. Sometimes compounds used to treat one disorder are found to work on an entirely different disease. For example, imipramine, a first-generation "antidepressant," used to be an antituberculosis drug. One of the most harmful pharmaceuticals ever, Grünenthal's Contergan (thalidomide), used to be an antianxiety drug, then was marketed as a remedy for morning sickness in pregnant women. Tens of thousands of babies were born with severe deformities in the 1950s and 1960s because of the drug. In the 1990s, thalidomide made a startling comeback, this time as an antileprosy drug. The very notion of depression, tuberculosis, anxiety, and leprosy changed with the different kinds of medical substances that appeared to be effective in their treatment. Medical technologies present themselves as solutions to preexisting problems, but often coconstitute the very problems they claim to solve.
Diagnostic technologies can also reshape illness experiences. They can transform health-seeking, selection of therapies, and perceptions of efficacy. Diagnostic value can exceed therapeutic value, a point underscored by the rise and fall of Theranos. The company's name, a blend of "therapy" and "diagnosis," reflected its ambition to revolutionize blood testing. In the mid-2010s, Theranos's valuation soared to nearly $9 billion, driven by its promise of a portable, affordable, and comprehensive blood-testing device. Theranos claimed its "Edison" machine could perform over 240 tests using just a single drop of blood from a finger prick. The company planned to deploy these devices in numerous pharmacies and retail locations, aiming to make blood testing more accessible. However, subsequent investigations revealed that the Edison device produced unreliable results and indeed that it is impossible to carry out so many tests from so little blood. Theranos's downfall highlighted the immense market value and demand for comprehensive, accessible, and affordable diagnostic tools, as well as the potential consequences when such technologies fail to deliver on their promises.
Anthropological work has looked at how people deal with the knowledge afforded by diagnostic technologies. The availability of diagnostic technologies does not mean that people always want to know. Sometimes they prefer to forget, especially if the problem is not experienced yet, will only become manifest later in life, or might never become manifest. Diagnosing neurodegenerative and genetic disorders exemplifies this. The will to know about a risk that might never become reality can be in conflict with the will not to know, or the will to forget about the diagnosis. An ethnographic study with a large cohort of participants who were tested for genetic risks of developing Alzheimer's disease (Lock 2013) found that remembering their risk status proved to be difficult. One year after people had been tested and told about their genetic risk status, three-quarters of them had forgotten or misremembered their diagnoses. This was particularly striking because nearly all of the subjects had participated in the trial with an expressed will to know their risk. These entanglements raise further ethical questions, for example, what is the use of diagnosing risk when nothing can be done about it therapeutically? Participation in trials for incurable genetic disorders, such as Huntington's disease, often hinges not on a desire to know one's risk status but on a more general sense of altruism: while there will be no gain for one's own life, trial participation might make future lives better.
Polyiatrogenesis—the cumulative harm caused by multiple medical treatments—exemplifies a deeper systemic flaw in biomedicine (Ecks 2021). Each medical intervention is treated as an isolated transaction, disconnected from others, as though each prescription or procedure operates independently. This logic assumes that every item of medical exchange is discrete, with no consideration of its relationship to other treatments or the broader context of the patient's life. The result is a fragmented approach to care that often exacerbates suffering rather than alleviating it. While medical technologies aim to improve lives, they frequently have the opposite effect when applied in isolation. Anthropological research has highlighted the wide-ranging adverse effects of medical interventions—not only on physical health but also on social, cultural, economic, and ecological levels. Chronic polypharmacy offers a particularly stark illustration of this issue.
In wealthier countries, the use of multiple medications has become the norm, even for younger populations, as health care systems rely on a piecemeal, transaction-driven approach to treatment. Fieldwork in one of the United Kingdom's "most deprived" areas (Ecks 2021) brings this into sharp focus. Patients in the clinic I studied often suffered from multimorbidity—a complex web of chronic illnesses, pain, mental health challenges such as depression and anxiety, and histories of trauma and violence. Multimorbidity was prevalent not only among the elderly but also among people in their thirties and forties. Despite having consistent access to health care through the National Health Service, including doctors, surgeries, and pharmaceuticals, these patients were not improving. Instead, they were routinely prescribed five to ten medications, each aimed at treating a specific symptom in isolation. Over time, these isolated interventions compounded their suffering, with the treatments themselves becoming sources of harm. This phenomenon—polyiatrogenesis—reveals the limitations of a biomedical system rooted in transactional thinking. Each prescription addresses a narrowly defined symptom or diagnosis, with little consideration of how these interventions interact or affect the patient as a whole. The longer patients remain in treatment under this model, the more entrenched and compounded their suffering becomes. The medical system, designed to heal, actually deepens the very conditions it aims to resolve. Polyiatrogenesis is not merely a failure of practice; it is a structural issue embedded in the logic of treating symptoms as isolated problems.
Resistance to medical technologies reflects complex processes of valuing where the criteria for what is a good or a bad technology far exceed the domain of biomedicine. The Australian government's push to eliminate new HIV infections in the 2010s through free antiretroviral medications (ARVs) for infected but asymptomatic individuals exemplifies this (Persson 2016). While framed as a life-affirming initiative, the program imposed a transactional logic equating good pharmaceutical citizenship with adherence to a medication regimen. For many of the HIV-positive people targeted by the government program, ARVs mediated not only infectious processes but also symbolic meanings tied to social belonging, stigma, dependence, and personal autonomy. Compliance with the state's ARV policy created intense value conflicts that some resolved through refusing to take the mandated medications. For asymptomatic HIV-positive individuals, the absence of symptoms mediated a lived experience that challenged the necessity of ARVs, framing treatment as a disruption to embodied well-being rather than an enhancement. By rejecting ARVs, these people actively navigated a maze of physical, emotional, and symbolic mediations, resisting the biopolitical demand to define their worth through compliance. Their decisions reflect a deeper negotiation of value and agency, illustrating how living beings resist being reduced to isolated transactions and instead assert their interconnected, context-sensitive processes of valuing.
Refusals of medical technologies reflects dynamic valuing processes that resist reductive notions of pathology and remediation. Prostheses are designed to remediate a lack, but designated "patients" can reject this framing of difference as a deficiency. Contestations of pediatric cochlear implants in the Deaf community exemplifies this. For many in the Deaf community, accepting cochlear implants reinforces the idea that hearing is the norm and that deafness is an abnormal state requiring correction. This framing conflicts with Deaf culture, which values deafness as a unique and complete way of being. For Deaf parents, cochlear implants seem to alienate their children from them by creating a divide between their embodied experience and the child's altered sensory world (Friedner and Kusters 2020). Ethnographic research shows that clinicians have begun to reframe cochlear implants, presenting them not as prostheses that replace a missing sense but as gateways to the brain that afford new ways of engaging with the world through hearing (Mauldin 2014). This shift in conceptualization reflects a broader mediation of values, where the implant is positioned no longer as a "cure" but as a tool for reshaping embodied and cognitive possibilities, navigating the tensions between medical, cultural, and individual valuing processes.
Horizons of Health, Value, Technology, Prosthetic, Pharmaceutical
One of the most important shifts is the integration of big data technologies and medical technologies. Well into the nineteenth century, health assessments were rooted in clinical interactions between doctors and patients, with no systematic data collection beyond these encounters. The rise of population-based epidemiology marked a moment when data technologies began to coconstitute definitions of health and to guide interventions. More recently, the collection, linkage, and analysis of health data have expanded far beyond the clinic, encompassing behavioral traces from online interactions, location data from mobile devices, and surveillance from CCTV cameras (Fiske et al. 2022). New consumer technologies that track, store, and share personal health metrics have further amplified this datafication, creating new mediations of value and health.
However, this expansion in data collection and health technologies remains constrained by value being imagined as arising from discrete, billable moments of technological intervention, performed by specialized experts and isolated from the continuous processes of living and valuing. This logic obscures how health emerges from the ongoing, recursive processes of living beings maintaining and mediating their well-being, with discrete transactions of medical technologies as rare events.
Med tech producers, health activists, government agencies, and patient groups disagree on the value of specific technologies because there is no common language to discuss value outside the transactional logic of isolated exchanges between distinct actors. COVID-19 brought these tensions to the forefront, as debates raged over the value of pharmacological versus nonpharmacological interventions (e.g., physical distancing, lockdowns), over the different forms of expertise (social science was largely ignored), over how to finance vaccine development (Erikson and Johnson 2020), and over health data mobilized during the pandemic (Ecks 2022).
These contestations revealed not only competing interests but also a deeper confusion about what value is and how it emerges. This confusion stems from the exclusion of continuous value creation in dominant frameworks. Living beings are constantly engaged in valuing, whether through self-regulation, relational engagement, or ecological mediation. Health value arises not from the application of medical technologies alone but from the interplay of living systems with these technologies and their broader environments. Medical anthropology, with its focus on pharmaceutical markets, global health interventions, and health datafication, must ground its analyses in a concept of living value that recognizes these continuous, recursive processes. By doing so, it can challenge the reductive frameworks of transactive dualism and offer new ways of valuing health.
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