In this article we undertake some conceptual clarification of the concepts of biopower and biopolitics, and argue for their utility in contemporary analysis. We consider Foucault's development of these concepts, and differentiate his view, which is close to ours, from the philosophical take-up of the terms by Giorgio Agamben and Antonio Negri. Biopower, we suggest, entails one or more truth discourses about the ‘vital’ character of living human beings; an array of authorities considered competent to speak that truth; strategies for intervention upon collective existence in the name of life and health; and modes of subjectification, in which individuals work on themselves in the name of individual or collective life or health. We argue that, while exceptional forms of biopower, especially in conditions of absolutist dictatorship, and when combined with certain technical resources, can lead to a murderous ‘thanatopolitics’—a politics of death—biopower in contemporary states takes a different form. It characteristically entails a relation between ‘letting die’ (laissez mourir) and making live (faire vivre)—that is to say strategies for the governing of life. Using examples from our own current research, we consider recent developments in biopower around three themes: race, population and reproduction, and genomic medicine.

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

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

The neurodiversity movement has so far been dominated by autistic people who believe their condition is not a disease to be treated and, if possible, cured, but rather a human specificity (like sex or race) that must be equally respected. Autistic self-advocates largely oppose groups of parents of autistic children and professionals searching for a cure for autism. This article discusses the positions of the pro-cure and anti-cure groups. It also addresses the emergence of autistic cultures and various issues concerning autistic identities. It shows how identity issues are frequently linked to a ‘neurological self-awareness’ and a rejection of psychological interpretations. It argues that the preference for cerebral explanations cannot be reduced to an aversion to psychoanalysis or psychological culture. Instead, such preference must be understood within the context of the diffusion of neuroscientific claims beyond the laboratory and their penetration in different domains of life in contemporary biomedicalized societies. Within this framework, neuroscientific theories, practices, technologies and therapies are influencing the ways we think about ourselves and relate to others, favoring forms of neurological or cerebral subjectivation. The article shows how neuroscientific claims are taken up in the formation of identities, as well as social and community networks.

In recent years, growing sociological interest has been directed towards patients’ organizations as key sites where practices of identity formation and socio-political activism intersect. This article focuses on one salient aspect of patients’ organizations: the increasingly important political and economic role they are playing in biomedical research. These forms of political activism and investment in science are often directed by the hope of speeding the processes by which cures or therapies are developed. For those affected by a range of human pathologies, the hope invested in science is not only an aspiration, but can also be thought of as having a political and economic materiality that seeks to bring to fruition the many future possibilities inherent in the science of the present. This realm of activity can be characterized as a political economy of hope in which becoming knowledgeable about science, in addition to activism, fundraising and heightening awareness of a particular disease are significant locales for helping to realize the objects of individual and collective hopes. Central to this political economy is how patients’ associations sponsor the value of transforming blood, tissue or DNA into resources for the generation of biovalue, as well attempt to shape the field of biomedical research in accordance with their collectively shared ideals.

We outline the framework of the new project of Critical Neuroscience: a reflexive scientific practice that responds to the social, cultural and political challenges posed by the advances in the behavioural and brain sciences. Indeed, the new advances in neuroscience have given rise to growing projects of the sociology of neuroscience as well as neuroethics. In parallel, however, there is also a growing gulf between social studies of neuroscience and empirical neuroscience itself. This is where Critical Neuroscience finds its place. Here, we begin with a sketch of several forms of critique that can contribute to developing a model of critical scientific practice. We then describe a set of core activities that jointly make up the practice of Critical Neuroscience as it can be applied and practised both within and outside of neuroscience. We go on to propose three possible areas of application: (1) the problems related to new possibilities of neuropharmacological interventions; (2) the importance of culture, and the problems of reductionism, in psychiatry; (3) the use of imaging data from neuroscience in the law as alleged evidence about ‘human nature’.

This paper analyses a remarkable transformation of global capitalism in recent years: that corporations claim to be ‘good citizens’ and are driven by higher aspirations than profits alone. It focuses on the lawsuit brought by the drug company Novartis against the Indian government over the patent for the anti-cancer drug Glivec. Novartis’ attack on Indian patent law caused an international outcry. Opponents of Novartis argued that the company was trying to destroy essential provisions in the Indian law that keep drugs affordable even after the country signed up to the World Trade Organization's agreement on Trade-Related Intellectual Property Rights (TRIPS). With reference to ‘the constitutional obligation of providing good health care to its citizens’, the High Court in Chennai, India, dismissed Novartis’ challenge in August 2007. While health activists celebrated the court's decision as a victory for anti-corporate citizens, this article argues that Novartis won a more important battle elsewhere: to protect its profits in European and North American markets. The article shows how claims to ‘citizenship’ were mobilized by both anti-Novartis and pro-Novartis groups, and how Novartis’ global corporate citizenship programme succeeded even when it seemed to fail.

This article is based on an illustrated talk I presented at the British Museum as part of the lecture series ‘Making things better’. The central exhibit in the newly opened Wellcome wing of the museum was ‘Cradle to grave’, a 40-foot table displaying in black net fabric the 14,000 pills taken by a British man and woman over their lifetimes. I trace the historical development of personhood in relation to psychotropic drugs over the last few decades in the US. ‘Pills’ or, more accurately, ‘tablets’ and ‘capsules’, are described as products of manufacturing, as means of enhancing personal capacities and as objects in exhibits. In particular, I analyze the underside of pills—their ‘side’ effects—in relation to fears and desires characteristic of contemporary US culture.

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

There has been much recent debate and controversy over the apparent expansion of the use of certain psychiatric classifications, and the treatment of those so diagnosed, in particular their treatment with psychiatric drugs. Some have suggested that this arises from ‘disease mongering’ by a pharmaceutical industry keen to sell its products. Others have implied that psychiatrists are the key agents, acting as ‘moral entrepreneurs’ claiming that society is ignoring an area of suffering that they are best placed to understand and treat. Others have suggested that the expansion is part of a social and cultural malaise, in which individuals increasingly define problems of living as disorders in need of treatment. This article reviews the evidence of the expanding scope of psychiatric diagnosis, focusing on depression, attention deficit hyperactivity disorder and personality disorder. It examines a number of arguments that seek to account for this expansion and suggests that we need a more complex approach to understand the growth of these diagnoses, not only addressing marketing of drugs by pharmaceutical industry and the role of doctors, but also examining the pressures and incentives that lead to the ascription of such diagnoses and their treatment with drugs.

Many researchers working in the field of human genetics in the United States have been caught between two seemingly competing messages with regard to racial categories and genetic difference. As the human genome was mapped in 2000, Francis Collins, the head of the publicly funded project, together with his privately funded rival, announced that humans were 99.9 percent the same at the level of their genome. That same year, the National Institutes of Health (NIH) began a research program on pharmacogenetics that would exploit the .01 percent of human genetic difference, increasingly understood in racial terms, to advance the field of pharmacy. First, this article addresses Collins’ summary of what he called the ‘vigorous debate’ on the relationship between race and genetics in the open-access special issue of Nature Genetics entitled ‘Genetics for the Human Race’ in 2004. Second, it examines the most vexed (if not always openly stated) issue at stake in the debate: that many geneticists today work with the assumption that human biology differs by race as it is conceived through American census categories. It then presents interviews with researchers in two collaborating US laboratories who collect and organize DNA by American notions of ‘race/ethnicity’ and assume that US race categories of classification largely traduce human biogenetic difference. It concludes that race is a practical and conceptual tool whose utility and function is often taken for granted rather than rigorously assessed and that ‘rational medicine’ cannot precede a rational approach to addressing the nature of racial disparities, difference and inequality in health and society more broadly.

Human Embryonic Stem (hES) cell research has met with a mixed reception internationally, but in the UK remains a significant national priority. Management of what is called the ‘national embryo supply’ in the UK involves new forms of governance at the ‘IVF-Stem cell Interface’, where questions about the provenance of donated embryos, including the ethics of their sourcing, are at a premium. This article explores the question of embryo donation to stem cell research from the perspective of the increasing proximity of IVF and hES cell derivation, using a model of ‘double reproductive value’ to explore what forms of exchange and flow are occurring, and how these are defined and negotiated in the context of a national hES cell coordination network of practitioners.

Umbilical cord blood has proved an effective substitute for bone marrow in the treatment of blood disorders, and most nations in the developed world have public programmes for the harvesting and storage of cord blood for allogenic transplantation. Private cord blood banks have sprung up alongside public banks, offering parents the opportunity to bank their child’s cord blood for later personal use. Private cord blood banking has been largely condemned by bioethical and medical professional bodies, on the grounds that the likelihood of any particular individual needing a cord blood transplant is very low, and that public, redistributive banking is a more efficient use of resources. This article investigates the appeal of private cord blood banking in the face of such condemnation, and the social norms implied in public and private cord blood banking. It locates cord blood banking in the field of regenerative medicine, and considers the two different models of biological regeneration implied in public, gift-based banking and private, autologous banking. In the first case, regeneration of sick bodies is an effect of social redistribution and intercorporeal generosity between citizens. In the second, regeneration is promised by the retention of cord blood as a form of personal property. The private cord blood account appeals to certain neoliberal norms of entrepreneurial embodiment, acting as a kind of asset or venture capital invested in the future of biotechnological innovation.

In this article I address the interactions between biological knowledge and ideas about the kinds of entity that are suited to appropriation. I start by arguing that commodification and reductionism are closely linked, and that patenting suits entities that are discrete and isolable, such as those that are the focus of molecular biology. I then turn to the new field of systems biology, which recognizes that traditional reductionist approaches to biology are no longer adequate and attempts to provide a more integrative understanding of biological systems. In doing this, systems biology has to deal with emergent phenomena. But patenting does not suit the dynamic and interactive complexity that is the object of study in systems biology. If systems biology rejects reductionism where does that leave commodification? I examine attempts to commodify predictive computational models in systems biology. I then turn to systems biology's sister discipline, synthetic biology, which deals with emergence by reducing the complexity of biological systems. By factoring out messy contingencies, synthetic biology is, in theory, well suited to commodification. Drawing on both these examples I explore how ideas about appropriation, including open source, are influencing the nature and course of research in biology.

In the article we report on the findings of an EU-funded research project, Paganini (Participatory Governance and Institutional Innovation), that investigated the question of whether ‘politics of life’ themes have led to the emergence of new forms of governance in Europe. The focus of our research was on human embryonic stem cell research, genetic testing, GM crops, and BSE in the United Kingdom, Germany, Austria, the Netherlands, and on the EU level—hotly contested topics at the intersection of society, politics, nature and the human body. We argue that, in the domain of life-political issues, the notions of participation and governance have become intermingled to an unusual extent. Our case studies demonstrate that the concept of participation needs to be rethought. While ‘spontaneous’ public participation certainly still is a political fact, increasingly participation has turned into a ‘technology’ that is based on the construction of publics. Different participatory technologies are linked to a changing landscape of political subjects considered relevant to the debate. As the case studies have shown, the design of any formal participatory arrangement involves a considerable amount of ‘engineering’, including arrangements seeking to invite a ‘representative’, disinterested, ‘pure’ public. There is no such thing as ‘the public’ waiting for pure representation. Formal participatory arrangements are inevitably based on a process of active construction, involving goal setting, selection, decision making and prioritization, including the decision to prioritize the pure public at the expense of engaged publics. What seems to be occurring today is that ‘old’ definitions of social order no longer hold and various groups try to impose new (partial) definitions of a new order on others. A new, postmodernist logic seems to be spinning new relations among citizens/consumers and scientists and administrators. Thus, there is no single New Way of governing Europe.

Contemporary neuroscience links together soma and society in complex ways, casting the brain as the locus of a matrix of reciprocal interactions between soma and society. Accordingly, critiques of such research which revolve around its perceived ‘reductionism’ and ‘determinism’ are rendered somewhat problematic. That is not to say, however, that a critical sociology of neuroscience is redundant. Drawing on interviews with different kinds of neuroscientists investigating psychopathologies associated with antisocial behaviour (specifically, antisocial personality disorder and psychopathy), this article draws attention to the degree to which, by assigning roles to both ‘biology’ and ‘environment’ in the development of antisociality, neuroscience complicates the ontology of these categories, while at the same creating possibilities for the emergence of new kinds of deviancy, and legitimating social intervention in ‘risky’ children. In aligning somatic and societal narratives for the development of psychopathology, contemporary neuroscience may resist older sociological criticisms of biological reductionism, yet, in so doing, generate new claims with novel ethical and political valence.

The autism spectrum disorders are a group of neurodevelopmental syndromes of communication, behavior and social cognition. Over the past decade, they have received increasing attention from scholars in the social sciences. This research has been motivated by the prospect of critiquing and improving support services and therapies, by self-advocates who have argued that autism should be tolerated as a form of difference rather than treated as a disorder, and by the interest inherent in syndromes that seem to affect many of the attributes that we use to define personhood. In this commentary, I review social science research on the autism spectrum. I identify some key approaches in the work, including the idea of autism as a culture, transcultural comparisons, studies based on treatment strategies, investigations of subjectivity and interpersonal relations, and research on social movements. In the process, I suggest some further directions for this area of research. I also consider some reasons why the autism spectrum disorders are a particularly interesting site for studies of the ways that biomedical information is used to craft individual and group identities.

This article locates the beginnings of a synthetic biology network and thereby probes the formation of a potential disciplinary community. We consider the ways that ideas of community are mobilized, both by scientists and policy-makers in building an agenda for new forms of knowledge work, and by social scientists as an analytical device to understand new formations for knowledge production. As participants in, and analysts of, a network in synthetic biology, we describe our current understanding of synthetic biology by telling four tales of community making. The first tale tells of the mobilization of synthetic biology within a European context. The second tale describes the approach to synthetic biology community formation in the UK. The third narrates the creation of an institutionally based, funded ‘network in synthetic biology’. The final tale de-localizes community-making efforts by focussing on ‘devices’ that make communities. In tying together these tales, our analysis suggests that the potential community can be understood in terms of ‘movements’—the (re)orientation and enrolment of people, stories, disciplines and policies; and of ‘stickiness’—the objects and glues that begin to bind together the various constitutive elements of community.

Who controls indeterminacy in the doctor–patient encounter defines the nature of professional power. Evidence-based medicine (EBM) is one such control strategy claiming to reduce uncertainty by identifying effective (and efficient) interventions and by removing ineffective treatments from clinical practice. EBM, however, as a means of keeping some autonomy for a profession beset by increasing government control, has had to compete with other professionalizing strategies within medicine. And, despite its promise, EBM is shown not to have reduced indeterminacy but to have shifted the problem into a wider policy arena that involves interpreting evidence. Moreover, in an era of concern for patient safety, EBM is proposed as part of a solution (through its claim to reduce uncertainty about the effect of interventions) but remains itself a potent source of danger and increased indeterminacy.

This article explores the changing expectations and contested identity of blood stem cells (haematopoietic stem cells or HSCs). While much social science critique has of late been focused on embryonic stem cells, relatively little attention has been given to the historical emergence of stem cell biology, especially the importance of blood innovation stretching back through the middle of the twentieth century and beyond. Present-day stem cell networks inherit much from the historical engagement of medical technology with blood, especially in the contexts of blood processing, bone marrow transplantation and, more recently, gene therapy. In making sense of the shaping of blood stem cells this article draws on perspectives in the ‘sociology of expectations’ in exploring the way current expectations of stem cells are historically constituted. In this way we examine the way biological entities—HSCs in this case—become the focus and bearers of future value in contemporary global stem cell economies.