Experimental Publics & The Problematics of
Government
Catherine Montgomery
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.
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
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
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)
MDP301 in Zambia
 Phase III trial conducted by
Microbicides Development
Programme (MDP), a large,
not-for-profit, AfricanEuropean 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
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
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
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
Sept 2006
MDP Zambia recruits first woman into phase
III trial
Associated British Foods acquires majority
stake in Illovo
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)



Furore erupts in Zambia
over trial result
Starts in blogs, spreads to
national press
Temporary suspension of
all microbicide trials
“A Zambian traditional
A Zambian traditional leader has fumed over
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/zam
bians-fume-over-failed-microbicide-gel/)
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
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