Abstract
Diagnostic devices do more than just passively register facts. They intervene in the situations in which they are put to use. The question addressed here is what this general remark may imply in specific cases. To answer this question a specific case is being analysed: that of the blood sugar measurement device that people with diabetes may use to monitor their own blood sugar levels. This device not only allows the patients concerned to better approach normal blood sugar levels, but alters what counts as normal in the first place. Using the device may shift people's attention away from their physical sensations towards the numbers measured, but it may also help them to increase their own physical self-awareness. Self-monitoring finally (something that the devices have made possible) makes patients less dependent on professionals, but it requires them to engage in self-disciplining and binds them to the outcomes of their measurement activities: their own blood sugar levels.
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NOTES AND REFERENCES
For their willingness to be informants, I would like to thank all patients, internists and nurses from the hospital where I've done the field work for this article. Special thanks go to Edith ter Braak, Yvonne de la Bye, Harold de Valk and Willem Erkelens. I thank Claar Parlevliet for conducting interviews and for our talks about these, Dick Willems for many discussions about small medical technologies, and John Law for his support and critique and for correcting my English.
These, moreover, have already been written a long time ago. See e.g. with examples from the natural sciences, Hacking I. Representing and Intervening, Cambridge: Cambridge University Press, 1983. And, in a more radical and sociological vein: Latour B. Science in Action, Milton Keynes: Open University Press, 1987.
After a day in the hospital I would write out notes the same evening or the next day. Quotes, therefore, are never literal. In writing I have moreover adapted them so as to make them fluid to read. As a check I always ask a few of my informants to critically read what I have written and to correct all errors and misunderstandings. Patient interviews were taped and transcribed, I have got them on paper. In translating their spoken Dutch to written English, however, I again smooth phrasings. This greatly increases readibility, but the reader should not use this material for subtle discourse analysis, that is not what it is made for. All names have been invented.
Among the great ancestors of the genre is obviously Michel Foucault. See e.g. Foucault M. La Naissance de la Clinique. Paris: Puf, 1963.
Even so: the analyses of the way the outcomes of diagnostic technologies only acquire their meaning through being compared to the outcomes of other diagnostic techniques, is crucial to understanding of what they 'know.' See e.g. Pasveer B. Shadows of Knowledge.Making a Representing Practice in Medicine: X-Ray Picutres and Pulmonary Tubercu-losis, 1895–1930. PhD thesis, University of Amsterdam, 1992; and Mol A. What is new? Doppler and its others. An empirical philosophy of innovations in: Lö wy, I. ed. Medicine and Change. Paris: Inserm, 1993.
In medical practice creating the conditions of a laboratory isn't always easy either. For this transportability problem, and a comparison of the transportability of laboratory medicine and clinical medicine, see: Mol A., Law J. Regions, networks and fluids. Anaemia and social topology, in: Social Studies of Science 1994; 24: 641–671.
For a great analysis of the specific way the so called 'economic aspects' were made relevant in British health care during the nineteen-eighties, see: Ashmore M., Mulkay M., Pinch T. Health and Efficiency. A sociology of health economics. Milton Keynes: Open University Press, 1989.
Differences that professional tools bring with them tend to be far more complex than tends to be expected, too. For this, with the example of decision support techniques, see: Berg M. Rationalizing Medical Work. Decision-Support-Techniques and Medical Practices. Cambridge, MA: MIT Press, 1997.
The normality strived after is also involved in a trade off between the long-term risks that come with a high blood glucose and the short-term risks of getting a hypogleamia, which, in their turn, are intertwined with various ways of living one may aspire or be forced into. See for that also: Mol A. Lived reality and the multiplicity of norms: a critical tribute to George Canguilhem in: Economy and Society 1998; 27: 274–284.
In the social studies of science and technology this co-depence of heterogenous elements has been stressed as an antidote to both technological determinism and social determinism. See e.g. the various contributions to: Law J. ed. A Sociology of Monsters. Essays on power, technolgy and domination. London: Routledge, 1991. For the specific case of small medical technologies, see the analysis of the peak flow meter (that comes with a note book, too) in: Willems, D. Tools of Care. Explorations into the semiotics of medical technology. PhD thesis, Maastricht, 1995.
And then the body may change its capacity to sense thanks to many other factors – the destructive effects of the disease being among them.
Here I do not go into the question how these effects may co-exist: by being different from one way of practicing medicine to another, from one group of patients to another, or by alternating in time. For an analysis presenting an example of the latter mode of coexisting, see the wonderful: C. Cussins Ontological Choreography: Angency for women patients in an infertility clinic. In: Berg M., Mol A. Differences in Medicine. Unraveling Practices, Techniques and Bodies. Durham: Duke University Press, 1998.
In some cases these are new tasks that some of the professionals are ignorant of. Doctors don't necessarily know how to practially go about measuring blood sugar levels, let alone one's own. See for this, with the example of asthma, also: Willems D. Susan's breathlessness. The construction of professionals and laypersons. In: Lachmund J., Stollberg G. The Social Construction of Illness. Stuttgart: Franz Steiner Verlag, 1992.
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Mol, A. What Diagnostic Devices Do: The Case of Blood Sugar Measurement. Theor Med Bioeth 21, 9–22 (2000). https://doi.org/10.1023/A:1009999119586
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DOI: https://doi.org/10.1023/A:1009999119586