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People, other animals and health knowledges: Towards a research agenda
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Social Science & Medicine 64 (2007) 1970–1976 www.elsevier.com/locate/socscimed
People, other animals and health knowledges: Towards a research agenda Melanie Rock, Eric Mykhalovskiy, Thomas Schlich Community Health Sciences, Faculty of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alta., Canada T2N 1N4 Available online 2 March 2007
Abstract By serving as experimental models for human disease, animals have been instrumental to constructing biomedical knowledge. On the other hand, animals themselves increasingly benefit from biomedical expertise and technologies, as patients in their own right. Healthy companion animals have recently come to be viewed explicitly as potential sources of human health, which contrasts with the potential for animals to injure people or transmit infectious disease. In studies of biomedical and other health knowledges, nevertheless, only the animal model role has been explored in any depth. In this review article, we sketch and discuss three research concerns that currently inform studies of biomedical knowledge: medicalization and biomedicalization; constructing biomedical knowledge; and a concern with heterogeneity. We conclude that a more comprehensive and nuanced account of contemporary societies will result from further consideration of the importance of animals for how people understand health. r 2007 Elsevier Ltd. All rights reserved. Keywords: Anthropology of health knowledge; Sociology of health knowledge; History of health knowledge; Medicalization; Anthrozoology; Science and technology studies
Introduction Many people in Western countries have become preoccupied with the health of companion animals kept as pets, and there has been rapid growth in goods and services that promise to extend or improve the lives of these animals. Fifty years ago, dogs with broken bones were routinely ‘‘put down,’’ but today, many dogs with broken bones benefit from sophisticated surgical interventions that directly parallel the techniques used to treat human Corresponding author. Tel.: +1 403 210 8585.
E-mail addresses: [email protected] (M. Rock), [email protected] (E. Mykhalovskiy), [email protected] (T. Schlich). 0277-9536/$ - see front matter r 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2007.01.014
fractures (Schlich, 2002; Swabe, 2005). Dogs were sacrificed as experimental models in the research that led to insulin therapy (Bliss, 2000 [1982]; Schlich, 1993), but now, many diabetic dogs receive daily injections of insulin (Fleeman & Rand, 2001). These developments form part of a marked tendency to confer upon pets the status of full subject and to ascribe close kinship—a shift that has broad cultural, social, political and economic implications (Alger & Alger, 1999; Anderson, 2003; Fox, 2006; Franklin, 1999; Haraway, 2003; Irvine, 2004; Jones, 2003; Knight, 2005; Sabloff, 2001; Sanders, 1993, 1999a; Swabe, 2005). In social research on health and healthcare, however, the different forms of knowledge that inform pet health care have yet to be investigated in depth.
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Meanwhile, healthy companion animals have recently come to be viewed explicitly as potential sources of human health, which contrasts with the potential for animals to injure people or transmit infectious disease. While interest in the benefits of interacting with companion animals dates as far back as the 1940s (Bossard, 1944), since the 1980s a widespread research enterprise exploring the health effects of pets in terms of physiological and other markers has emerged (Beck & Katcher, 2003; Cutt, Giles-Corti, Knuiman, & Burke, 2007; Friedmann, Katcher, Lynch, & Thomas, 1980; Friedmann, Katcher, Lynch, Thomas, & Messent, 1983; McNicholas et al., 2005; Serpell, 1991; Wood, Giles-Corti, & Bulsara, 2005). At roughly the same time, a therapeutic practice known as animalassisted therapy (AAT) became popular with professionalized health service organizations such as group homes and nursing homes and, more recently, has been subject to numerous evaluation studies (Banks & Banks, 2005; Barker, Rogers, Turner, Karpf, & Suthers-McCabe, 2003; Bernstein, Friedmann, & Malaspina, 2000; Fine, 2000). In the context of growing efforts to base health care practices on what is seen as objective knowledge (Mykhalovskiy & Weir, 2004; Timmermans & Berg, 2003), the concern with evaluating the impact of bodily contact with members of other species merits investigation as a social phenomenon in its own right. As a first step in our collaborative investigation of nonhuman animals and health knowledges in Western countries, we have examined whether a place for nonhuman animals has been acknowledged in our respective specializations, namely, medical sociology, medical anthropology and medical history. Below, we sketch and discuss three research concerns that currently inform and often intersect in studies of biomedical knowledge: (1) medicalization and biomedicalization, (2) constructing biomedical knowledge and (3) a concern with heterogeneity. We have been led to conclude that scant attention has been paid, thus far in any of these literatures, to the diverse roles played by animals. Medicalization and biomedicalization Medicalization remains an influential concept in how many social science and humanities disciplines address health knowledges. According to Conrad (1992, p. 209), medicalization occurs when ‘‘non-
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medical problems become defined or treated as medical problems.’’ Research and theorizing conducted since the late 1970s have clarified that the medical profession may not be centrally involved, or may be uninvolved altogether in certain medicalizing processes (see Conrad, 1992 for further discussion). Clarke, Shim, Mamo, Fosket, and Fishman (2003, pp. 161–162) have recently argued that ‘‘major, largely technoscientific changes in biomedicine are now coalescing into what we call biomedicalization.’’ By ‘‘biomedicalization,’’ they mean ‘‘the increasingly complex, multisided, multidirectional processes that today are being both extended and reconstituted through the emergent social forms and practices of a highly and increasingly technoscientific biomedicine’’ (Clarke et al., 2003, p. 162). Animal bodies could represent an important and contested site for medicalization and biomedicalization. The very concept of biomedicine presupposes that experiments performed using animal models have relevance for human health because people share a good deal of their biology with animals. Many biomedical innovations—to name but one example, transplant medicine (Einsiedel & Ross, 2002; Fano, 2001; Lundin, 1999)—could involve nonhuman animals. And the very existence of veterinarians suggests that nonhuman animals could represent a potent site for expanding both biomedical categories and the use of biomedical technologies (Dukes, 2000; Jones, 2003; Swabe, 2000, 2005). In addition, debates about the ethics of using animals as experimental models show that the reach of biomedicine did not expand in the twentieth century without contest (Lederer, 1992). In AAT, furthermore, animals serve as therapeutic technologies. In some AAT research, animals have been evaluated along the lines of a prescription that might substitute for pharmaceuticals. Contributors to the medicalization and biomedicalization literatures, however, have not explicitly acknowledged animals. Constructing biomedical knowledge Animals have played crucial roles in constructing biomedical knowledge. Their roles have hinged on a combination of contradictory status attributes. Animals could not function as valid models for human injuries and diseases without recognition of similarity (Tester, 1992). Nevertheless, animal experiments presuppose that people differ fundamentally from
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animals in terms of moral status. Human biomedicine in its current form contains this tension between similarity and difference (Birke & Hubbard, 1995). A tension between similarity and difference when comparing people with animals is also inherent to AAT. The construction of knowledge research agenda has made a crucial contribution to social studies of medicine by problematizing technical and scientific knowledge—not only in its applications (as in medicalization), but also in its very genesis. Several recent studies do not privilege human-centered explanations for technological and scientific developments. Instead, they emphasize that technologies have become integral to the on-going construction of societies, without determining their course (e.g., Callon, Lascoumes, & Barthes, 2001; Latour, 1987; Law, 2002). The constructionist research agenda breathed new life into fields such as medical sociology, medical anthropology and medical history, by showing quite clearly that Western science could be investigated along the lines of any other institutionalized way of understanding the world (Bury, 1986; Good, 1995; Lock, 1993; Nicolson & McLaughlin, 1987). The present brief report is not the place to argue for or against the tenets of various schools of thought on constructionism (Hacking, 1999; Mol, 2002). What we do want to point out is the very limited role accorded to nonhuman animals in this literature. Animals—more specifically, animals used as experimental models—have been subsumed in constructionist studies of biomedical knowledge under the very general category of the nonhuman. The work of Clarke and colleagues on biomedicalization, which adopts a constructionist approach to knowledge, illustrates this point: ‘‘We signal with the ‘bio’ in biomedicalization the transformations of both human and nonhuman made possible by such technoscientific innovations as molecular biology, biotechnologies, genomization, transplant medicine and new medical technologies’’ (Clarke et al., 2003, p. 162). Yet the use of animal products and animals themselves as food sources means that nonhuman animals help to make up (or construct) human populations, human health and human disease (Clutton-Brock, 1989; Diamond, 1998; Franklin, 1999; Hardy, 2003; Mintz & DuBois, 2002; Shanklin, 1985). Meanwhile, veterinary practice involves defining certain animals as patients; and treating animals as patients may entail specialized categories, tech-
niques or equipment (Dukes, 2000; Jones, 2003; Sanders, 1999b). One simply cannot learn much about such matters from the existing constructionist literature. Heterogeneity in health knowledges Terms such as ‘‘the biomedical model’’ can gloss over the extent to which different health professions or specializations within medicine ultimately work with very different factual realities, and also gloss over differences in how various patients and practitioners experience the world (Ferzacca, 2000, 2004; Mykhalovskiy, McCoy, & Bresalier, 2004; Timmermans & Angell, 2001). While many health researchers continue to focus on deficits in scientific knowledge among members of the public, sociologists and anthropologists have emphasized that ordinary people possess and put into practice various kinds of health knowledge (Bolam, Murphy, & Gleeson, 2003; Davidson, Kitzinger, & Hunt, 2006; Franklin, 1995; Lawton, 2003; Popay et al., 2003; Prior, 2003; Rapp, 2001; Shaw Hughner & Schultz Kleine, 2004; Williams & Calnan, 1996). Following these leads, we pose the following question: How do nonhuman animals participate in the emergence and transformation of diverse health knowledges? As illustrated in this brief report, we can point to rather few published answers to this question. Compared with studies of biomedical knowledge undertaken in Western countries, it seems that the importance of nonhuman animals has received somewhat more recognition in ethnoveterinary research conducted in non-Western settings (e.g., McCorkle, Mathius, & Schillhorn Van Veen, 1996; Nyamanga, Suda, & Aagaard-Hansen, 2006). Nevertheless, despite a long history in anthropology of examining the place of animals in everyday life and everyday language (Evans-Pritchard, 1960; Leach, 1964; Mullin, 1999, 2002), medical anthropologists have demonstrated surprisingly little interest in animals (Fleising, 2000; Franklin, 2001, 2003; Martin, 1995; Rock, 2005). Meanwhile, rather few historical studies exist of veterinary medicine (Dukes, 2000; Jones, 2003; Swabe, 1999). Historical studies of scientific knowledge have looked at animal models (Birke, 2003; Rader, 2004) and related debates, such as the anti-vivisection movement (Lederer, 1992; Ritvo, 2002). In addition, historians of public health have paid attention to the changing place of animals in nineteenth-century urban life (Hardy, 2002; Walton,
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1979). Sociological studies of health, illness and deviance have paid some attention to animal–human interactions (Arluke, 2002; Beirne, 2002; Kruse, 2002), but rarely from a sociology of knowledge perspective (Alger & Alger, 1999; Irvine, 2004; Sanders, 1999a). In thinking through how to tackle the question that we pose above, about the participation of nonhuman animals in constituting health knowledges, we have found it helpful to formulate four more specific lines of inquiry: How are boundaries between humans and animals challenged (and sometimes reinforced) as animals enter different sites and aspects of health knowledge production? What kinds of connections form between people and nonhuman animals in the production, circulation and consumption of health knowledges? To what extent do connections with animals elongate the cultural distance between different groups of people, or exacerbate social cleavages? To what extent does health knowledge whose existence hinges on specific animal bodies end up recasting relationships that people have with other animals? What we glimpse, in short, are novel forms of reciprocity and commensuration, but also of inequality (between people and animals, among animals and among people). To investigate these social realities, our existing theoretical repertoire can only take us so far. In fact, we must rethink what ‘‘social’’ means and involves (Alger & Alger, 1999; Descola, 2005; Haraway, 2003; Irvine, 2004; Kohn, 2007; Wolch & Emel, 1998) to accommodate the presence of animals in the creation, application and alteration of health knowledges. We cannot provide a theoretical roadmap for comprehending the diverse roles played by animals in constituting health knowledges, but we can point to some promising empirical strategies. One approach would be to look closely at the production, consumption, exchange and mutation of health knowledges in various physical locations. These locations could include veterinary clinics, laboratories, long-term care facilities and pharmacies, as well as grocery stores, private homes and public parks. A related approach would be to focus on textual resources, from the scientific to the popular. In addition, we think it will be fruitful to compare the status, roles and classification of specific animals in various health knowledge contexts. For example, depending on the context in modern Western cultures, dogs currently serve as laboratory models, therapeutic agents and patients. Questionnaires, in-
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depth interviews and life histories that attend to animal–human connections in health and health care might also prove to be revealing. Conclusion There now exists a large literature comprised of social studies of biomedical and other health knowledges, but these analyses have paid scant attention to the roles played by nonhuman animals. Studies of medicalization and biomedicalization have not dealt with animals at all; while in research on the construction of biomedical knowledge, attention has been limited to the use of animals as experimental models. We invite more research on how the heterogeneous roles played by nonhuman animals have permeated knowledges related to health and disease. Given the importance of nonhuman animals as a site for deriving and applying health knowledges, by professionals and by lay people throughout the world, we believe that a more comprehensive and nuanced account of contemporary societies will result if nonhuman animals are given greater attention. Not least, the divergent positions occupied by representatives of the same animal species, at different times and places, underscore that the distillation and application of knowledges involve close connections between classificatory schemas and cultural values (Appadurai, 1986; Eliss & Pedersen, 2002; Godelier, 2004; Graeber, 2001; Kopytoff, 1986; Werner & Bell, 2004). When studying health knowledges as social phenomena, researchers should, in short, acknowledge that human societies are not composed of human bodies alone. Animal bodies have always been part of the constitution of human societies, and thus—whether as food sources, as sacred entities, as goods ‘‘to think with’’ or as beloved companions (Mullin, 1999)—part of how human health is realized and perceived. Social studies of biomedical and other health knowledges, we contend, would do well to come to grips with the enduring importance of animals to humankind. Power in and over human lives, so crucial to the politics of health and health care, cannot be fully understood without reference to power in and over animal lives. Acknowledgements Our collaboration has been made possible with funding from the Social Sciences and Humanities
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Research Council of Canada (#410-2004-2152). Each of the three authors is leading a separate investigation, and we are pooling the results to enable comparisons and to advance theoretical work in medical sociology, medical anthropology, and medical history. The three cases under study are the creation and use of evidence in relation to animal-assisted therapy (Eric Mykhalovskiy), the diagnosis and treatment of diabetes in dogs and cats (Melanie Rock), and the roles historically played by animals and people in surgical innovations (Thomas Schlich). We do not contend that the significance of nonhuman animals to health knowledges pertains only to Western countries, or that biomedicine is a significant sociocultural phenomenon only in Western countries. We are restricting our investigation to select Western countries, however, given the time horizon of our funding and also the research expertise represented in our collaboration.
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Social Science & Medicine 64 (2007) 1970–1976 www.elsevier.com/locate/socscimed
People, other animals and health knowledges: Towards a research agenda Melanie Rock, Eric Mykhalovskiy, Thomas Schlich Community Health Sciences, Faculty of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alta., Canada T2N 1N4 Available online 2 March 2007
Abstract By serving as experimental models for human disease, animals have been instrumental to constructing biomedical knowledge. On the other hand, animals themselves increasingly benefit from biomedical expertise and technologies, as patients in their own right. Healthy companion animals have recently come to be viewed explicitly as potential sources of human health, which contrasts with the potential for animals to injure people or transmit infectious disease. In studies of biomedical and other health knowledges, nevertheless, only the animal model role has been explored in any depth. In this review article, we sketch and discuss three research concerns that currently inform studies of biomedical knowledge: medicalization and biomedicalization; constructing biomedical knowledge; and a concern with heterogeneity. We conclude that a more comprehensive and nuanced account of contemporary societies will result from further consideration of the importance of animals for how people understand health. r 2007 Elsevier Ltd. All rights reserved. Keywords: Anthropology of health knowledge; Sociology of health knowledge; History of health knowledge; Medicalization; Anthrozoology; Science and technology studies
Introduction Many people in Western countries have become preoccupied with the health of companion animals kept as pets, and there has been rapid growth in goods and services that promise to extend or improve the lives of these animals. Fifty years ago, dogs with broken bones were routinely ‘‘put down,’’ but today, many dogs with broken bones benefit from sophisticated surgical interventions that directly parallel the techniques used to treat human Corresponding author. Tel.: +1 403 210 8585.
E-mail addresses: [email protected] (M. Rock), [email protected] (E. Mykhalovskiy), [email protected] (T. Schlich). 0277-9536/$ - see front matter r 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2007.01.014
fractures (Schlich, 2002; Swabe, 2005). Dogs were sacrificed as experimental models in the research that led to insulin therapy (Bliss, 2000 [1982]; Schlich, 1993), but now, many diabetic dogs receive daily injections of insulin (Fleeman & Rand, 2001). These developments form part of a marked tendency to confer upon pets the status of full subject and to ascribe close kinship—a shift that has broad cultural, social, political and economic implications (Alger & Alger, 1999; Anderson, 2003; Fox, 2006; Franklin, 1999; Haraway, 2003; Irvine, 2004; Jones, 2003; Knight, 2005; Sabloff, 2001; Sanders, 1993, 1999a; Swabe, 2005). In social research on health and healthcare, however, the different forms of knowledge that inform pet health care have yet to be investigated in depth.
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Meanwhile, healthy companion animals have recently come to be viewed explicitly as potential sources of human health, which contrasts with the potential for animals to injure people or transmit infectious disease. While interest in the benefits of interacting with companion animals dates as far back as the 1940s (Bossard, 1944), since the 1980s a widespread research enterprise exploring the health effects of pets in terms of physiological and other markers has emerged (Beck & Katcher, 2003; Cutt, Giles-Corti, Knuiman, & Burke, 2007; Friedmann, Katcher, Lynch, & Thomas, 1980; Friedmann, Katcher, Lynch, Thomas, & Messent, 1983; McNicholas et al., 2005; Serpell, 1991; Wood, Giles-Corti, & Bulsara, 2005). At roughly the same time, a therapeutic practice known as animalassisted therapy (AAT) became popular with professionalized health service organizations such as group homes and nursing homes and, more recently, has been subject to numerous evaluation studies (Banks & Banks, 2005; Barker, Rogers, Turner, Karpf, & Suthers-McCabe, 2003; Bernstein, Friedmann, & Malaspina, 2000; Fine, 2000). In the context of growing efforts to base health care practices on what is seen as objective knowledge (Mykhalovskiy & Weir, 2004; Timmermans & Berg, 2003), the concern with evaluating the impact of bodily contact with members of other species merits investigation as a social phenomenon in its own right. As a first step in our collaborative investigation of nonhuman animals and health knowledges in Western countries, we have examined whether a place for nonhuman animals has been acknowledged in our respective specializations, namely, medical sociology, medical anthropology and medical history. Below, we sketch and discuss three research concerns that currently inform and often intersect in studies of biomedical knowledge: (1) medicalization and biomedicalization, (2) constructing biomedical knowledge and (3) a concern with heterogeneity. We have been led to conclude that scant attention has been paid, thus far in any of these literatures, to the diverse roles played by animals. Medicalization and biomedicalization Medicalization remains an influential concept in how many social science and humanities disciplines address health knowledges. According to Conrad (1992, p. 209), medicalization occurs when ‘‘non-
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medical problems become defined or treated as medical problems.’’ Research and theorizing conducted since the late 1970s have clarified that the medical profession may not be centrally involved, or may be uninvolved altogether in certain medicalizing processes (see Conrad, 1992 for further discussion). Clarke, Shim, Mamo, Fosket, and Fishman (2003, pp. 161–162) have recently argued that ‘‘major, largely technoscientific changes in biomedicine are now coalescing into what we call biomedicalization.’’ By ‘‘biomedicalization,’’ they mean ‘‘the increasingly complex, multisided, multidirectional processes that today are being both extended and reconstituted through the emergent social forms and practices of a highly and increasingly technoscientific biomedicine’’ (Clarke et al., 2003, p. 162). Animal bodies could represent an important and contested site for medicalization and biomedicalization. The very concept of biomedicine presupposes that experiments performed using animal models have relevance for human health because people share a good deal of their biology with animals. Many biomedical innovations—to name but one example, transplant medicine (Einsiedel & Ross, 2002; Fano, 2001; Lundin, 1999)—could involve nonhuman animals. And the very existence of veterinarians suggests that nonhuman animals could represent a potent site for expanding both biomedical categories and the use of biomedical technologies (Dukes, 2000; Jones, 2003; Swabe, 2000, 2005). In addition, debates about the ethics of using animals as experimental models show that the reach of biomedicine did not expand in the twentieth century without contest (Lederer, 1992). In AAT, furthermore, animals serve as therapeutic technologies. In some AAT research, animals have been evaluated along the lines of a prescription that might substitute for pharmaceuticals. Contributors to the medicalization and biomedicalization literatures, however, have not explicitly acknowledged animals. Constructing biomedical knowledge Animals have played crucial roles in constructing biomedical knowledge. Their roles have hinged on a combination of contradictory status attributes. Animals could not function as valid models for human injuries and diseases without recognition of similarity (Tester, 1992). Nevertheless, animal experiments presuppose that people differ fundamentally from
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animals in terms of moral status. Human biomedicine in its current form contains this tension between similarity and difference (Birke & Hubbard, 1995). A tension between similarity and difference when comparing people with animals is also inherent to AAT. The construction of knowledge research agenda has made a crucial contribution to social studies of medicine by problematizing technical and scientific knowledge—not only in its applications (as in medicalization), but also in its very genesis. Several recent studies do not privilege human-centered explanations for technological and scientific developments. Instead, they emphasize that technologies have become integral to the on-going construction of societies, without determining their course (e.g., Callon, Lascoumes, & Barthes, 2001; Latour, 1987; Law, 2002). The constructionist research agenda breathed new life into fields such as medical sociology, medical anthropology and medical history, by showing quite clearly that Western science could be investigated along the lines of any other institutionalized way of understanding the world (Bury, 1986; Good, 1995; Lock, 1993; Nicolson & McLaughlin, 1987). The present brief report is not the place to argue for or against the tenets of various schools of thought on constructionism (Hacking, 1999; Mol, 2002). What we do want to point out is the very limited role accorded to nonhuman animals in this literature. Animals—more specifically, animals used as experimental models—have been subsumed in constructionist studies of biomedical knowledge under the very general category of the nonhuman. The work of Clarke and colleagues on biomedicalization, which adopts a constructionist approach to knowledge, illustrates this point: ‘‘We signal with the ‘bio’ in biomedicalization the transformations of both human and nonhuman made possible by such technoscientific innovations as molecular biology, biotechnologies, genomization, transplant medicine and new medical technologies’’ (Clarke et al., 2003, p. 162). Yet the use of animal products and animals themselves as food sources means that nonhuman animals help to make up (or construct) human populations, human health and human disease (Clutton-Brock, 1989; Diamond, 1998; Franklin, 1999; Hardy, 2003; Mintz & DuBois, 2002; Shanklin, 1985). Meanwhile, veterinary practice involves defining certain animals as patients; and treating animals as patients may entail specialized categories, tech-
niques or equipment (Dukes, 2000; Jones, 2003; Sanders, 1999b). One simply cannot learn much about such matters from the existing constructionist literature. Heterogeneity in health knowledges Terms such as ‘‘the biomedical model’’ can gloss over the extent to which different health professions or specializations within medicine ultimately work with very different factual realities, and also gloss over differences in how various patients and practitioners experience the world (Ferzacca, 2000, 2004; Mykhalovskiy, McCoy, & Bresalier, 2004; Timmermans & Angell, 2001). While many health researchers continue to focus on deficits in scientific knowledge among members of the public, sociologists and anthropologists have emphasized that ordinary people possess and put into practice various kinds of health knowledge (Bolam, Murphy, & Gleeson, 2003; Davidson, Kitzinger, & Hunt, 2006; Franklin, 1995; Lawton, 2003; Popay et al., 2003; Prior, 2003; Rapp, 2001; Shaw Hughner & Schultz Kleine, 2004; Williams & Calnan, 1996). Following these leads, we pose the following question: How do nonhuman animals participate in the emergence and transformation of diverse health knowledges? As illustrated in this brief report, we can point to rather few published answers to this question. Compared with studies of biomedical knowledge undertaken in Western countries, it seems that the importance of nonhuman animals has received somewhat more recognition in ethnoveterinary research conducted in non-Western settings (e.g., McCorkle, Mathius, & Schillhorn Van Veen, 1996; Nyamanga, Suda, & Aagaard-Hansen, 2006). Nevertheless, despite a long history in anthropology of examining the place of animals in everyday life and everyday language (Evans-Pritchard, 1960; Leach, 1964; Mullin, 1999, 2002), medical anthropologists have demonstrated surprisingly little interest in animals (Fleising, 2000; Franklin, 2001, 2003; Martin, 1995; Rock, 2005). Meanwhile, rather few historical studies exist of veterinary medicine (Dukes, 2000; Jones, 2003; Swabe, 1999). Historical studies of scientific knowledge have looked at animal models (Birke, 2003; Rader, 2004) and related debates, such as the anti-vivisection movement (Lederer, 1992; Ritvo, 2002). In addition, historians of public health have paid attention to the changing place of animals in nineteenth-century urban life (Hardy, 2002; Walton,
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1979). Sociological studies of health, illness and deviance have paid some attention to animal–human interactions (Arluke, 2002; Beirne, 2002; Kruse, 2002), but rarely from a sociology of knowledge perspective (Alger & Alger, 1999; Irvine, 2004; Sanders, 1999a). In thinking through how to tackle the question that we pose above, about the participation of nonhuman animals in constituting health knowledges, we have found it helpful to formulate four more specific lines of inquiry: How are boundaries between humans and animals challenged (and sometimes reinforced) as animals enter different sites and aspects of health knowledge production? What kinds of connections form between people and nonhuman animals in the production, circulation and consumption of health knowledges? To what extent do connections with animals elongate the cultural distance between different groups of people, or exacerbate social cleavages? To what extent does health knowledge whose existence hinges on specific animal bodies end up recasting relationships that people have with other animals? What we glimpse, in short, are novel forms of reciprocity and commensuration, but also of inequality (between people and animals, among animals and among people). To investigate these social realities, our existing theoretical repertoire can only take us so far. In fact, we must rethink what ‘‘social’’ means and involves (Alger & Alger, 1999; Descola, 2005; Haraway, 2003; Irvine, 2004; Kohn, 2007; Wolch & Emel, 1998) to accommodate the presence of animals in the creation, application and alteration of health knowledges. We cannot provide a theoretical roadmap for comprehending the diverse roles played by animals in constituting health knowledges, but we can point to some promising empirical strategies. One approach would be to look closely at the production, consumption, exchange and mutation of health knowledges in various physical locations. These locations could include veterinary clinics, laboratories, long-term care facilities and pharmacies, as well as grocery stores, private homes and public parks. A related approach would be to focus on textual resources, from the scientific to the popular. In addition, we think it will be fruitful to compare the status, roles and classification of specific animals in various health knowledge contexts. For example, depending on the context in modern Western cultures, dogs currently serve as laboratory models, therapeutic agents and patients. Questionnaires, in-
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depth interviews and life histories that attend to animal–human connections in health and health care might also prove to be revealing. Conclusion There now exists a large literature comprised of social studies of biomedical and other health knowledges, but these analyses have paid scant attention to the roles played by nonhuman animals. Studies of medicalization and biomedicalization have not dealt with animals at all; while in research on the construction of biomedical knowledge, attention has been limited to the use of animals as experimental models. We invite more research on how the heterogeneous roles played by nonhuman animals have permeated knowledges related to health and disease. Given the importance of nonhuman animals as a site for deriving and applying health knowledges, by professionals and by lay people throughout the world, we believe that a more comprehensive and nuanced account of contemporary societies will result if nonhuman animals are given greater attention. Not least, the divergent positions occupied by representatives of the same animal species, at different times and places, underscore that the distillation and application of knowledges involve close connections between classificatory schemas and cultural values (Appadurai, 1986; Eliss & Pedersen, 2002; Godelier, 2004; Graeber, 2001; Kopytoff, 1986; Werner & Bell, 2004). When studying health knowledges as social phenomena, researchers should, in short, acknowledge that human societies are not composed of human bodies alone. Animal bodies have always been part of the constitution of human societies, and thus—whether as food sources, as sacred entities, as goods ‘‘to think with’’ or as beloved companions (Mullin, 1999)—part of how human health is realized and perceived. Social studies of biomedical and other health knowledges, we contend, would do well to come to grips with the enduring importance of animals to humankind. Power in and over human lives, so crucial to the politics of health and health care, cannot be fully understood without reference to power in and over animal lives. Acknowledgements Our collaboration has been made possible with funding from the Social Sciences and Humanities
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Research Council of Canada (#410-2004-2152). Each of the three authors is leading a separate investigation, and we are pooling the results to enable comparisons and to advance theoretical work in medical sociology, medical anthropology, and medical history. The three cases under study are the creation and use of evidence in relation to animal-assisted therapy (Eric Mykhalovskiy), the diagnosis and treatment of diabetes in dogs and cats (Melanie Rock), and the roles historically played by animals and people in surgical innovations (Thomas Schlich). We do not contend that the significance of nonhuman animals to health knowledges pertains only to Western countries, or that biomedicine is a significant sociocultural phenomenon only in Western countries. We are restricting our investigation to select Western countries, however, given the time horizon of our funding and also the research expertise represented in our collaboration.
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