What do we fear in life? We fear disease and death, the disintegration of the mind, and the degeneration of the body . Where do we look for alleviation? Most of us turn to medicine, expecting biomedical knowledge , products, and treatments will provide the cures for ourselves and our family members. Many of us also think that medicine is a collective project in the sense that we might agree to participate in medical research to assist in developing better therapies and new ways of retaining or regaining health. Science, in the form of biomedical research , thus takes part in addressing our fears of disease, suffering, and death.
French philosopher and historian of science Georges Canguilhem has suggested that knowledge is the daughter of fear. In Knowledge of Life (2008, p. xix), he writes âif knowledge is the daughter of fear, this is for the domination and organization of human experience , for the freedom of lifeâ. This means that knowledge, and above all biology in Canguilhemâs view, is one of the ways in which humans seek to take control of their destiny. A major characteristic of generating new knowledge on life is the dual effort of âexperimenting on manâ for the sake of theoretical understanding of biology and âtherapeutic interventionâ for the sake of alleviating anxiety and pain. Acknowledging the difficulty of defining the boundaries between experimentation and therapeutic interventionâof basic science and translational research in current termsâCanguilhem contends that such difficulty arises directly from the philosophical dilemma that man is both the subject of knowledge and the object of action. Therefore medicine, a more or less scientific technique for healing diseases, is coextensive in space and time with humanity and humansâ efforts to know life.
Contemporary biomedical research conjoins in intriguing ways the duality of experimentation and intervention in humans. Among professional and lay peoplesâ hopes and expectations directed at medicine, stem cell science has been playing an increasing role since the end of the twentieth century in paving the way for better medical treatment in the future. As a special type of biological material derived from the human body , stem cells are said to hold great potential for bringing new therapies to presently incurable diseases. Expectations of new stem cell-based cures to a host of diseases such as Alzheimerâs disease , Parkinsonâs disease , spinal cord injury , heart diseases, and diabetes circulate among scientists, clinicians, regulators, investors, and patients . However, stem cells as living biological substance are also a source of concern and fear for many. In medical use, pluripotent stem cells may cause unwanted effects such as tumors and chromosomal mutations, and when administered to the human body , they may migrate to unexpected and harmful locations. Consequently, tuned between a multitude of hopes and fears, researchers try to make basic stem cell experiments work to endure in the global race for success in science. National and supranational regulators make every effort to control but also to facilitate the transfer of stem cells into clinical use and pharmaceutical market . Meanwhile patients are faced with the question of whether and on what grounds one should agree to donate oneâs own cells for biomedical research and innovation.
This book reports an ethnographic study about the making of a new biological research tool , called the induced pluripotent stem (iPS ) cell technology . Human iPS cells are artificially created pluripotent stem cells, usually derived from a donorâs skin biops y or blood sample with the help of genetic manipulation . Pluripotency means that these cells can be used to create almost all cell types in our body . Indeed, biomedical research generates many different types of patient-specific cell lines in order to study various disease mechanisms in laboratory conditions . In simplified technical terms, iPS cells are created by inserting into somatic cells copies of three or four genes known to be important for prompting fully developed cells to re-acquire the state of pluripotency . Through genetic manipulation , cells are thus forced to turn back their developmental clocks whereby a process called cellular âreprogrammingâ takes place. The generation of iPS cells was first reported in mice in 2006, and a year later in humans. In 2012, a little over a year after I had begun this study, the Nobel Prize in Physiology or Medicine was awarded jointly to John B. Gurdon and Shinya Yamanaka for their groundbreaking work in cellular reprogramming . According to the Nobel Assembly (2012), reprogramming of cells has revolutionized our understanding of biology in general and the development of cells and organisms in particular.
Over the past few decades, stem cell research has given rise to heated regulatory, religious, ethical, and public discussions. To untangle what is at stake in contemporary stem cell-based biomedicine politically , economically, and ethically, this book offers three perspectives to how biology is turned into technology in new ways. The perspectives are clinical translation , experimental research, and tissue donation . These regimes of stem cell science are co-existent and co-constitutive while functioning according to rather specific logics, expectations, and tensions. Navigating across these regimes, the book discusses relations between human-derived cells and scientists, which form the basis of what I call the craft of biomedicine. Craftwork conducted with stem cells illustrates not only how biology is modified and manipulated for the benefit of science, innovation, and patientsâ health but also how biomedical knowledge production entails skilled practice of using human cells and tissue in research, and ethically conducted enrollment of patients as voluntary donors, to facilitate such craftwork. Thus, stem cell research offers a timely case of scientific labor that involves manipulating biological entities and processes to cater for human needs.
The Oxford Dictionaries (2018) defines âcraftworkâ in this way: it means the making of decorative or practical objects by hand as a profession or leisure activity. While general definitions of the term âcraftâ tend to be vague and often unhelpful, defining craft as a process over which a person has detailed control (Dormer 1997) is another way to understand what is meant by skilled practice. I define scientific craftwork as the enactment of practical skills concerning knowledge production that involves âthe hands and brainsâ of researches, quoting the head of a stem cell laboratory where much of my fieldwork was based. Furthermore, I see scientific craftwork as performative of embodied engagement and affective investment with research materials that underpin experimental biomedicine even in its current high-tech modality.
It must be acknowledged up front that the decision made in this study to focus on craftwork or hands-on labor of cell line production might be viewed an alarming step away from critical analysis of the biopolitics of stem cell science. Admittedly a major part of previous social studies of the field and its entanglement with medical and commercial efforts has developed along two lines of inquiry: on political economy and the analysis of neoliberal, market-centered appropriation of stem cell biology and on governance and the study of regulatory policy formation. Interconnections between regulation, standardization, and commercialization are crucial in understanding current expectations of clinical use of stem cells, as the scholarly discussions I engage with towards the end of this Introduction and across the rest of the chapters show. However, practical connections between the regimes of clinical translation , experimental research, and tissue donation have received considerably less attention, partly due to the perceived discrepancy between basic and applied, or translational, research in stem cell science. My aim is to show that the perspective of scientific craftwork proves useful in investigating the regimes of clinical translation , research, and donation, whereby the connections between these regimes can be foregrounded in novel ways. Although not always in explicit or evident ways, the perspective of craftwork provides the thread that binds the regimes together.
Historically, the word âcraftâ has connoted to power and power relations more than it does today. In the last three centuries, the term has changed its meaning in the sense that for a long time, it was not related to a particular way of making things but rather a way of doing things, particularly in politics. âCraftâ was invested with the meaning of power, as in political acumen and shrewdness (Dormer 1997; Greenhalgh 1997). This historical link between craftwork and power, in its modern configured form, underlies my discussion on scientific craftwork. Taking the concept to study biomedical research , I argue that politics does not get lost with focusing on the characteristics and conditions of embodied skilled practice. The issue of scientific craftwork is not apolitical, quite the contrary. Using it as an analytical lens provides leverage to critically examine contemporary ways of turning human biology into technology and trace concrete links between knowledge production, technology development, and value creation. For me, craftwork is a crucial cornerstone of what I have chosen to call the material politics of science . This politics concerns materials and the practical ways of crafting, modifying, and manipulating them in and for science and for larger benefit. It also concerns regulatory effort and public debates revolving around such...