Public secrets in public health: Knowing not to know while making scientific knowledge

Abstract

Unknown knowns—or “public secrets”—may play an integral part in publicly funded medical science. In one large transnational field research site in Africa, such unknowing pertains to vital material inequalities across the relations of scientific production. These inequalities are open to experience but remain often unacknowledged in public speech and scientific texts. This silence is not usually achieved by suppressing knowledge but through linguistic convention and differentiation between places and moments of knowing and ignorance. Switching between known and unknown according to situation and interlocutor is an important, largely implicit skill that maintains relations necessary to conduct clinical research—linking bodies, lives, institutions, and technologies across differentials of resources, expertise, and power. Unknowing, then, facilitates research; and it shapes the resulting work and perpetuates the political and economic contradictions that pervade the context and the research endeavor itself. Unknowing thus poses a challenge for conventional anthropological modes of critique and engagement.

Family Medicine in Ethiopia: Lessons from a Global Collaboration

“…In a critique of international public health collaborations, the anthropologist Wenzel Geissler describes the "knowing unknowing" that takes place in collaborations around issues of resources and power. 24 Geissler observes that partners are aware of, but may not acknowledge, the power and resource differentials. These differentials can generate animosity that may be misattributed to personality or cultural differences.…”

Stuck in Ruins, or Up and Coming? The Shifting Geography of Urban Public Health Research in Kisumu, Kenya

“…Like other government bodies at the time (such as those for agriculture, livestock, wildlife, fisheries or water), it integrated scientific investigations and interventions, and collaborated with other ministries (see Ombongi 2010;Malowany et al 2011). In the late 1960s Kisumu, one of the largest of over 50 DVBD stations (see Geissler 2011), employed 80 lifelong civil servantscleaners and subordinates, technicians and technologists. Based in laboratories and offices in the city centre, neighbouring other healthcare and government institutions, DVBD workers conducted street-level fieldwork across the entire city and its environs.…”

Anthropologists in Global Health Experiments

“…Outcomes of these trials are considered valid if they have been measured with sufficient statistical power (a large enough n) against a comparative case, and if results are shown to be reproducible (Adams 2013). Social scientists have criticized these trials for ignoring the social and infrastructural conditions that impinge on how technologies work, and for their optimistic belief in generalizability (Adams 2013;Geissler 2013;Epstein 2004). What if contexts actually determine which interventions work?…”

“…We call for new conceptual frameworks that acknowledge how efficacy is mediated by contexts and influenced by expectations and user practices. As Geissler (2013) suggested, global health researchers are well aware of these complexities, but tend to simplify matters in order to make trials feasible.…”