Research

My first book, Biomedical Odysseys: Fetal Cell Experiments from Cyberspace to China (Princeton University Press 2017, ISBN 9780691174778), examines how the conjunction of Internet communication technologies and market-driven health care reforms has enabled thousands of people from more than eighty countries to undergo fetal cell transplantation in China. In a world in which technologies and risks are moving faster than our ethics and laws can keep pace, people grappling with neurodegenerative disorders have ignored the warnings of doctors and scientists back home to entrust their lives to Chinese neurosurgeons operating at the cutting edge of regenerative medicine. Biomedical Odysseys is an ethnographic account of the challenges of regulating experimental medical treatment in a globalized era, the ways in which digital communication technologies are transforming patient activism in both China and the U.S., and the unintended consequences of Chinese healthcare reforms. Based on long-term ethnographic research funded by the National Science Foundation in transnational hospital wards, laboratories, and online patient discussion forums, Biomedical Odysseys illuminates how poignant journeys for fetal cell cures become entangled in complex circuits of digital mediation, entrepreneurial frameworks of post-socialist medicine, and fraught debates about the ethics and epistemology of clinical experimentation.

Biomedical Odysseys opens up important theoretical and methodological horizons, making significant contributions to three key areas of scholarship at the intersection of sociocultural anthropology, STS, and China studies: (1) digital culture and virtual ethnography, (2) postsocialism and global capitalism, and (3) transnational bioscience and global health. The first part of the book, “Online Mediations,” theorizes the digital mediation of health-seeking by demonstrating how the embodied dynamics of illness and chronicity shape distinct modes of cybersociality. I pioneer innovations in ethnographic methodology to highlight the ways in which online discussion forums and blogs have transformed patient activism in a transnational era. The second part of the book, “Chinese Experiments,” intervenes in the analysis of the political economy of (post)socialist health care. I detail how the uneven privatization of health care, coupled with an unpredictable regulatory landscape, have transformed China’s urban medical system into a laboratory for entrepreneurial tactics that remake the boundaries between public and private, legal and illegal, ethical and unethical. The third part of the book, “Heterogeneous Evidence,” leverages an ethnographic perspective to address key debates on the ethics and epistemology of clinical experimentation. Although randomized controlled trials have become the global gold standard in clinical research, my work with Chinese clinician-scientists and their patients from around the world shows how these norms do not necessarily translate well across geographical boundaries and medical specialties.

Biomedical Odysseys is part of the Princeton Studies in Culture and Technology series edited by Tom Boellstorff and Bill Maurer, which “showcase[s] the best work in this exciting new field of anthropological inquiry” in order to “demonstrate the relevance of anthropology to some of the most consequential and cutting-edge social, economic, and technological phenomena of our day.” Summarizing my “path-breaking ethnography” as “one of the finest that I have read engaging China at the intersection of Medical Anthropology and Science, Technology, and Society Studies,” the reviewers highlighted the “stunning account of experimentality and hope texturing regenerative medicine,” the “unparalleled… level of ethnographic detail and nuance,” and the “innovative ethnographic methodologies and heuristics, which will be of importance to social scientists for decades to come.” The book is currently in production at Princeton University Press and will be published simultaneously in cloth and paper editions in spring 2017.

My long-term research on experimental stem and fetal cell therapies has also produced two articles that develop analytical frameworks or theorize ethnographic materials distinct from the book. “Biotech Pilgrims and the Transnational Quest for Stem Cell Cures” (Song 2010) was published in Medical Anthropology: Cross-Cultural Studies in Health and Illness, the top-ranked medical anthropology journal (JCR 2015 impact factor of 1.283 and 5-year impact factor of 1.656). I critique popular notions of medical tourism and develop the alternative concept of “biotech pilgrimage” to examine how faith intertwines with technology, travel, and the political economies of health care and medical research in a global era. This article brings together scholarship from the anthropology of religion with medical anthropology in innovative ways by drawing on insights from pilgrimage theory to question the assumptions of leisure embedded in claims of tourism while also illuminating new biopolitical practices.

I also developed another article to examine the extensive data I collected on stem cell therapies at other sites of experimental medicine in southern China. “The Proliferation of Stem Cell Therapies in Post-Mao China: Problematizing Ethical Regulation” (Song 2011) was published in New Genetics and Society, one of the main refereed European journals in science and technology studies. This article grew out of a collaboration with the University of Sussex anthropologist Margaret Sleeboom-Faulkner and her European BIONET colleagues studying the regulation of stem cell research in Asia. My work explains a seeming paradox: despite critical scrutiny from scientific experts and tightening guidelines regulating experimental medicine, unauthorized stem cell clinics targeting foreign clients have proliferated in China. These hybrid practices problematize the role of ethical regulation in governing transnational regimes of bioscience.

My second book project, The Culture, Ethics, and Political Economy of Critical Care in Urban China, develops my work on the ethical conundrums and social dilemmas posed by biomedical technologies in the context of a society undergoing rapid demographic transition and major transformations in the health care system. While my previous research focused on the efforts of terminally ill patients and their families to pursue experimental stem cell therapies in China, my current research goes beyond the pursuit of curative medicine to examine what happens when biomedical technologies are no longer able to restore health. This research agenda intensifies my engagement with analyzing biomedical technologies while bringing my scholarship in medical anthropology and STS into conversation with mainstream gerontology. My work provides a much-needed cross-cultural perspective on the institutionalization of care and the medicalization of aging in non-Western contexts. I examine how advances in biomedical technology are transforming familial, professional, and societal responsibilities in the context of China’s rapidly aging population and an increasingly privatized healthcare system.

This project is based on 12 months of ethnographic fieldwork that I conducted in emergency rooms and critical care settings in Beijing, Shanghai, and Henan province during the 2014-2015 academic year. I analyze fraught debates among clinicians, patients, and family members over the use and termination of costly life-sustaining technologies. This book maps the institutional contours and affective dimensions of caring for those suffering from end-stage conditions in the context of a society undergoing rapid demographic, cultural, and politico-economic transformation. While some anthropologists have written movingly about caregiving as a foundational moral practice with the potential to challenge the dehumanizing and technocratic logic of biomedical treatment (Kleinman 2009), others have mapped the institutional contours of a darker politics of care (Mol 2008, Kaufman 2015) in contexts of scarcity and failure. By shifting the focus from cure to care, my second book illuminates the ways in which Chinese health professionals and family members negotiate the practical and moral challenges of care at the limits of medicine. I am also developing several articles related to this research, including an analysis of assaults on Chinese medical care workers, the culture of emergency medicine in urban China, and the medicalization of death in Chinese hospitals.

I am also collaborating with a multidisciplinary team at Fudan University in Shanghai on a joint research project on “Eldercare and Old Age Support in Shanghai.” While my book project focuses on end-of-life care in Chinese hospitals, this collaborative work extends beyond hospital walls to investigate how caregiving intersects with processes of aging and dying in urban community settings. China has the world’s largest elderly population and is also one of the most rapidly aging societies in the world, posing a critical problem for China’s elderly care system. Although the family traditionally has been responsible for taking care of aging elders, institutional forms of elder care are beginning to emerge. Both the public and private sector are experimenting with services such as nursing homes, community health centers, aging-in-place models, hospice facilities, and geriatric medical programs, among others. We have assembled a team of faculty researchers and graduate students in anthropology, sociology, social work, and public health to map eldercare practices and policies in five Shanghai neighborhoods. Our research has been supported by grants from the Ford Foundation, the China National Social Science Foundation (国家社会科学基金项目), and the Harvey A. Friedman Center for Aging at the Institute for Public Health at Washington University.

Based on our interdisciplinary research, my Chinese collaborators and I are publishing several co-authored articles written in English and Chinese on a variety of topics including the professional identity of community-based caregivers for older adults, an analysis of eldercare policy implementation in Shanghai, and the challenges of developing an eldercare workforce in urban China.

To deepen my engagement with the role of new communication technologies in health care practices, I am in the preliminary stages of developing a third book project on digitally-mediated health-seeking in China. My previous research examined how American and European patients utilized online discussion boards and personal blogs to facilitate their transnational quests for experimental stem cell therapies. I am extending this research to consider how Chinese patients are utilizing social media and microblogging platforms to cultivate novel forms of “cyber-biosociality.” These online health-seeking practices are not only jumpstarting patient activism and creating alternative modes of knowledge production, but also generating new risks and regulatory quagmires in the context of state-sponsored media censorship and vested business interests. I have already begun to lay the intellectual and methodological scaffolding for this third book project. During my 2014-2015 sabbatical in China, I collected data on the ways in which family members and clinicians utilized various digital communication platforms to coordinate care for patients in intensive care units and emergency rooms. I also conducted a pilot study on the feasibility of using WeChat (the most popular messaging and social networking app in China) as a research tool. I developed a smartphone-based WeChat survey of Chinese clinicians’ experiences with end-of-life care, which attracted over 800 respondents. I will hone this new research focus into an ethnographic investigation of Chinese patients’ and clinicians’ social media practices over the next few years.

As part of my long-range research trajectory on the social and ethical consequences of transnational biomedical technologies, I see opportunities for expanding my scholarship to new theoretical and ethnographic terrains. I am collaborating with a group of medical anthropologists at Washington University School of Medicine, Copperbelt University Medical School in Zambia, and Webster University to formulate a new research study on how Chinese influence is transforming health care practices in Africa. This project expands my scholarship on transnational medicine and hospital-based ethnographic research to consider the implications of so-called South-South relations. We are developing a multi-sited research proposal that will involve on-the-ground ethnographic fieldwork in hospitals and clinics in Zambia as well as medical schools in China. Our research will examine the following related strands of inquiry: the training of Zambian physicians in China and their subsequent clinical practice and trajectories after returning home; an institutional ethnography of a general hospital in Lusaka built by the Chinese government in 2011; and the experiences of Chinese clinicians working in Zambia (including entrepreneurial practitioners who have opened private clinics and medical personnel serving on official medical missions orchestrated by the Chinese state). I have already conducted some interviews and exploratory fieldwork in Henan, where the provincial health bureau is involved in several long-term projects to staff Chinese-funded hospitals in Zambia and other African countries. My individual contribution to this project will focus on how the exchange of biomedical, infrastructural, and informatics technologies between Chinese and Zambian medical practitioners is reconfiguring social relations, generating new experimental practices, and transforming possibilities for health, wealth, and life.