Experimental Publics & The Problematics of Government

1. Experimental Publics & The Problematics of Government Catherine Montgomery

2. Theorising publics • Rose & Miller (1992) ‘problematics of government’ • Modern forms of political power not located in nation state, but in technologies of government, including inscription devices, measurement and display techniques, systems for standardisation etc.

3. Trials as technologies of government • Management of trial participants includes observation, measurement, examination, notation, and statistical calculations comparing individuals to established population norms • Trials institutionalise surveillance and objectification of the body and create of particular types of subject in those whom they recruit • Trials create transient publics

4. Theorising publics • Rose & Miller (1992) ‘problematics of government’ • Modern forms of political power not located in nation state, but in technologies of government, including inscription devices, measurement and display techniques, systems for standardisation etc. • Epstein (2007) ‘inclusion & difference’ paradigm • Inclusion of under-represented groups in clinical research, based on categorical identities (e.g. sex, race) • Transposition of categories of political mobilization & bureaucratic administration onto biomedicine impacts policies & systems that prescribe biomedical practices

5. Microbicides “[M]icrobicides are a potential preventive option that women can easily control and do not require the cooperation, consent or even knowledge of the partner.” (WHO 2009)

6. MDP301 in Zambia • Phase III trial conducted by Microbicides Development Programme (MDP), a large, not-for-profit, African-European partnership • Funded by the UK government through DFID & MRC • In Zambia, conducted on and around the Nakambala sugar estate • Strong focus on community engagement; dedicated team of community mobilisers & Community Liaison Officer

7. Technologies of government Trial actively monitored and regulated women’s sex. behaviour Surveillance: blood/urine tests, genital exams, data collection Self-regulatory techniques: applicator return, coital diaries  Women became governable subjects, endowed with freedom and autonomy, as per their signed informed consent forms

8. Exclusion & Resistance “You find that here, they very much welcome women rather than men and when they are doing these researches of theirs, it’s just between the MDP and the women, but forgetting their husbands.” • Rumours of Satanism, witchcraft and blood stealing • Opposition by some men to their partners’ participation in the trial • Staff concerns about male violence and surveillance of their partners

9. Changes on the Sugar Estate April 2001 Illovo Group of South Africa buys controlling interest in Zambia Sugar March 2003 UK-funded MDP Zambia opens VCT centre on sugar estate April 2003 Illovo implements changes to pension scheme Aug 2006 MDP Zambia recruits first woman into phase III trial Sept 2006 Associated British Foods acquires majority stake in Illovo

11. Rumours “A way of talking that encourages a reassessment of everyday experience to address the workings of power and knowledge and how regimes use them” (White 2000)

12. A Zambian traditional leader has fumed over • Furore erupts in Zambia over trial result • Starts in blogs, spreads to national press • Temporary suspension of all microbicide trials • “A Zambian traditional leader has fumed over reports that a number of his female subjects who underwent a microbicides gel clinical trials have contracted HIV, the virus that cause AIDS” • (http://wiredproject316.wordpress.com/2010/01/06/zambians-fume-over-failed-microbicide-gel/)

13. Transient experimental publics • During its lifetime, the trial created a public of female ‘biocitizens’ • Through trial procedures, women became governable subjects, endowed with freedom and autonomy, as specified in their signed informed consent forms • After the trial, these technologies of government ceased • Response to the trial from those who were denied full participation suggests this form of public was a temporary one, ultimately supplanted by locally prevailing pathways of political representation

14. Conclusion • Biomedical difference and inclusion paradigm has effects beyond endpoint analyses • Recruitment of particular groups to clinical trials has deep social implications relating to citizenship and representation • Publics are not created once and for all time in a linear fashion, nor is governance of such publics monolithic • Rather than focusing only on the biological subjects which public health impels, we should broaden our analyses to include the constitutive outsides of public health’s publics