How do we collaborate? Social science researchers&rsquo

Workshop Report

How do we collaborate? Social science researchers’ experience of multidisciplinarity in biomedical settings Barbara Prainsack a,*, Mette N. Svendsenb, Lene Kochb and Kathryn Ehricha a

King’s College London, Centre for Biomedicine & Society (CBAS), Strand Campus, Strand, London WC2R 2LS, UK. E-mails: [email protected]; [email protected] b

Department of Health Services Research, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014 Copenhagen K, Denmark. E-mails: [email protected]; [email protected] *Corresponding author.

Abstract In September 2009, a group of social scientists from the United Kingdom, Denmark, the Netherlands, Austria, the United States and Canada met in London to discuss their experiences with fieldwork in biomedical settings, and other forms of interdisciplinary collaboration. Rather than ‘trouble shoot’, however, the objective of the workshop was to explicate the effects that such interdisciplinary collaborations have on our work and our selfunderstandings as social scientists. Particular attention was paid to the effects of tacit disciplinary hierarchies and (mis)communication across disciplinary and epistemological boundaries. This article summarises the main issues identified at, and main insights obtained from, the workshop, both pertaining to particular stages of carrying out fieldwork (‘getting access’, ‘inside the field’ and ‘outside again’), and to the dynamics of social science research in biomedical settings more generally. BioSocieties (2010) 5, 278–286. doi:10.1057/biosoc.2010.7 Keywords: hierarchies

interdisciplinarity; fieldwork; social science; biomedicine; bioscience; disciplinary

Introduction On 24 September 2009, a small group of social scientists from the United Kingdom, Denmark, the Netherlands, Austria, the United States and Canada gathered at King’s College London to discuss their experiences of research in biomedical settings, and of collaborating with colleagues in biomedicine and the biosciences. The workshop’s objective was twofold: First, we sought to create a confidential space for the sharing of troublesome, ambivalent and/or productive experiences of interactions with life scientists and medical professionals. Second, our larger objective was to facilitate a wider and structured discussion of interdisciplinary issues which do r 2010 The London School of Economics and Political Science 1745-8552 www.palgrave-journals.com/biosoc/

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Social science researchers’ experience of multidisciplinarity

not have a disciplinary or professional home base for discussion. This contribution in BioSocieties seeks to achieve exactly that: to report some of the insights we obtained from our discussions at the workshop, and to pose the question to what extent the issues identified at the workshop are characteristic features of social science work in biomedical settings. Rather than setting out to ‘trouble shoot’ problematic interdisciplinary interactions, and develop recommendations to reduce friction points in inter- and multidisciplinary collaboration, we seek to explicate the effects that a number of factors have on our work and on our self-understandings as social scientists. We understand the term ‘collaboration’ very broadly to include both social science research in biomedical settings (studying of biomedical/bioscientific practitioners, practices and ideas) and research and publication collaborations with biomedical scientists (studying with biomedical/ bioscientific practitioners, and sometimes also practices and ideas). The workshop’s key note speaker, Mathieu Albert, had recently led two publications on biomedical scientists’ perception of the social sciences in health research (Albert et al, 2008, 2009). He addressed the gap between the recent attempts among health research funding agencies to mandate collaboration between social and biomedical sciences and the documented scepticism among biomedics towards the social sciences. Numerous health research funding agencies have tried to encourage the incorporation of social science and humanities aspects. Best known may be the Human Genome Mapping Project’s decision to allot between 3 and 5 per cent of its total funding to Ethical, Legal and Social Aspects (ELSA) of genome mapping (Human Genome Project Information, 2008), and the subsequent solidification of ELSA research as a discipline in its own right. The emergence of ELSA as a discipline was accompanied by criticism of its functioning as a remover of friction points between science and society (a role which Arie Rip tellingly referred to as a ‘lubricant’ (Rip, 2009, p. 666). For other discussions of this aspect, see Huijer (2006), Calvert and Martin (2009), Zwart and Nelis (2009).1 The increasing importance of social science and ELSA work in the biomedical field, however, does not seem to have changed the collaborative climate and the conditions for doing social science in the biomedical field dramatically. When trying to understand the reasons for this situation, Mathieu Albert pointed to the narrow understanding among biomedics and bioscientists of what counts as legitimate science. Within classical science one finds a hierarchy of methods where experimental science is ranked at the top and qualitative methods at the bottom. These negative perceptions naturally contribute to an unfavourable climate for interdisciplinary collaborations and to a widespread perception among biomedics and bioscientists that many methods employed by social scientists lack rigour, and their results lack validity. The negative effects that such perceptions have on the collaborative climate seem to be partly counteracted and certainly complicated by the aforementioned development that collaboration with social scientists has become a regular requirement in biomedical research in a growing number of countries1. In addition, social scientists and biomedics increasingly engage in peer-like relations in such projects. The acknowledgement that power issues shape the relationship between social scientists and their informants is not new (see, for example, Gold (1977); Strong

1 Stegmaier (2009, p. 114) uses the term ‘convergence workers’, or ‘convergence researchers’, to signify the ongoing trend to ‘integrate social and humanist science programmes into large research programmes in the life sciences’. Especially in the field of genomics, ELSA researchers are no longer ‘glued on’ to projects seeking to advance the life sciences, but they have been adopted into the core of the project itself. r 2010 The London School of Economics and Political Science 1745-8552

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(1979) and Fox (2004) for a range of views on this relationship). What came to the fore in our workshop as a continuing and pressing problem, however, was the high level of ambiguity in the relationships between social scientists and biomedics, where the former often felt like underdogs in a foreign world, and like colleagues and peers, at the same time. The simultaneity of contradictory feelings and practices has created tangible tensions which many of our workshop participants did not know how to tackle. Also more generally, the complex reality of doing social science research in a biomedical setting has not received much explicit attention in contemporary publications at the interface of science and society. An exception is the aforementioned literature on the increasing adoption of ELSA work into scientific projects in genomics (for example, Calvert and Martin, 2009; Stegmaier, 2009). In the mainstream literature – especially in the life sciences, but partly also in the social sciences – social, ethical and legal aspects are predominantly referred to as ‘add-ons’ to the biomedical research. Differences in epistemologies, methodologies and critical obligations of the two research agendas remain under-articulated, even in some of the otherwise very helpful recent work on convergence work (Stegmaier, 2009). In this light we call for a re-engagement with Nowotny et al’s (2001) discussion of the epistemological core of Mode 2. They argue that when a wider network of collaborators are mobilised around creating reliable knowledge (for example, socially robust biotechnologies), the epistemological core becomes heterogeneous in the sense that it is crowded with many different norms and practices. What counts is that science ‘works’ (Nowotny et al, p. 199). The difficulties of collaboration which we discussed at the workshop contested this view of an unproblematic heterogeneous epistemological core. It was proposed that collaboration practices exposed contradictory understandings of what good science is and for whom science works, and to whom it appears reliable. Workshop participants suggested that social science epistemologies imply a critical approach which offers theoretically informed points of analysis and interpretation. Securing a space for criticality was seen as a vital element in our professional identity, although there were different understandings of the nature, goals and practices of critique among workshop participants. From among the wide range of issues which were discussed during the day, what emerged as one of the most salient issues at the workshop was the following: How can we as social scientists sustain our critical professional identity in collaborative projects with biomedics? And how do we handle the complexity of working in a field where biomedics are our informants and peers at the same time? The workshop was organised around short invited practice- and experience-based presentations. Our discussions revolved around three core ‘stages’ of social science research in biomedical settings: (1) Getting access; (2) Inside the Field; and (3) Outside Again. In the following short contribution we will highlight the most salient insights from the presentations and debate. The three following sections are structured as a series of questions followed by some of the answers which were provided during the discussion.

Getting Access Clinicians and biomedical scientists are often gatekeepers controlling access to the research sites that social scientists want to study. Negotiating access however is not a process in which social scientists are completely powerless. In light of increasing emphasis on interdisciplinary 280

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collaboration in academia in general, gaining access happens through the back as well as through the front door (Webster, 2007, p. 463). In such research collaborations, social science fieldworkers are not simply strangers – although this feeling was widespread among the participants – but they enter into peer-like relationships with clinicians and biomedical scientists: We may be colleagues at the same universities, may be partners in the same projects, and may share our funding. However, the connotation of equality and ‘eyelevelness’ implied by the concept of peer-ship often masks tangible differences in (social and financial) power and status. And the issue of scientific and methodological legitimacy is always present. So what is in collaboration for the biomedics? Do they collaborate with us because it makes them ‘look better’? Does collaboration with social scientists serve legitimation purposes for them? Does it allow them to demonstrate sensitivity for the social ‘implications’ of their work, and/or are they interested in an outsider’s reflection of their practice? Do they hope for high-impact publications resulting from the collaboration? And do they adjust their conduct to suit their understandings of what we want or need to see and hear? Alternatively we may turn the question around since we are also eager to be accepted into this foreign world. To what extent are our research agendas or our arguments employed to obtain access, adapted to anticipations of what ‘the other side’ wants? At the workshop, participants voiced the view that for the social scientist it can be productive simply to acknowledge the power differences and asymmetries inherent in work relationships. These differences, in turn, may not (solely) derive from different social and academic ‘value’ ascribed to medical sciences versus social sciences (as shown by Albert et al, 2008, 2009) but also from the fact that the latter typically tend to intrude into the fields and premises of the former. It was a commonly shared experience among workshop participants that, as social scientists, we rarely contribute to the science of our biomedical colleagues on their terms, for example, by contributing technical/medical scientific knowledge that leads to a new ‘discovery’ or invention. Instead, besides promoting reflexivity about the social dynamics of their work practices and its social context, what we offer is a contribution to the legitimisation of their work and the provision of a ‘connection’ with the public sphere: a connection that is increasingly seen as valuable, and even necessary, in an ethically informed cultural climate. Thus, even if our collaboration is acknowledged as having the effect of increasing reflexivity and critical engagement of our biomedical colleagues with their work, it is difficult to avoid the possibility that our engagement with them will also have effects that legitimise or help advance these scientific fields in question (see also Macilwail, 2009).

Inside the Field Once inside the field the social scientist realises that she/he is a guest, and may engage in a series of trade-offs to retain positive relations with informants. Politeness, self-censorship and unease may compete with the desire to be open, honest and critical. What does one do if one observes something problematic, irregular or unethical? Can we broker informal mechanisms to harness differences in status and ‘power’? Although formally engaging in a colleague-like relationship (for example, when sharing funding), informally we are – inevitably, to medics and other actors in the biomedical setting – positioned as guests. To what extent does this role shape our behaviours and habitus in biomedical settings? Understandings of common courtesy r 2010 The London School of Economics and Political Science 1745-8552

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with regard to what can be expected of a ‘guest’ may play a bigger role in shaping our conduct as social scientists to larger extents than is often explicated. To what extent are these factors prone to influencing the quality and ‘validity’ of our work? In our discussion, we considered how the current emphasis on maximising the impact and policy relevance of our research – which has arguably become as important as the recent imperative to work in multidisciplinary teams – can make it difficult to retain room to manoeuvre. Funding and institutional demands such as these can mean that our space for criticality shrinks. Similarly, our contribution as social scientists may incorporate an assumption that problems are unavoidable in any field, so that identifying them is potentially less ‘the problem’ and more part of the solution. This position is not always understood from different perspectives and criticality may simply be seen as threatening. Workshop participants also voiced some more mundane issues which many of us are concerned with on a daily basis when we do fieldwork. How one moves around (including in the literal sense) in various settings demonstrates tacit and explicit knowledge of the setting, and is understood as such by others in the field. Handling who you ‘are’ in the field can include the danger of being seen as something or someone one does not wish to be. The fact that it seems to be a regular occurrence that social science researchers in biomedical settings are mistaken – by peers, patients or others – for biomedical experts is symbolic of the fragility of our ability to freely align ourselves with other actors. Similarly, outside of the field, the social science researcher doing fieldwork in a particular biomedical or bioscientific setting may be treated as an expert not only on the social science side of her study, but also on the scientific underpinnings of the field. Our positioning within or in relation to ELSA research was another topic in the discussion, illustrating that how we handle roles we take up or are assigned to in the field can be seen in terms of a tension between instrumentalisation and exclusion. For some, taking part in collaborative research had involved trade-offs between getting access to collect empirical data and supporting and promoting the research field studied. This positioning can impact on trust building: ‘who do they think we are?’ Such trade-offs put demands on our ability to perform our roles convincingly and at the risk of compromising our personal sense of integrity. This may also influence our relationships with other actors in the broader field: patients, publics, ethics committees. The discussion of these issues was linked to the notion of ‘studying up’. ‘Using’ biomedics as our informants rather than working with ‘ordinary people’ or patients configures questions of consent and control over data in a very different way. Again, the difficulty of being dependent on and interviewing powerful peers, who might eventually dislike our results, entailed a range of problems specifically associated with the need to retain our professional integrity and the critical potential of our work. Which promises – informal or formal – should be made regarding publishing, commenting on manuscripts, permissions to quote directly or indirectly? How should undue pressures from the side of our biomedical and bio-scientific ‘peers’ be handled?

Outside Again Following the above, a crucial issue addressed at the workshop was the ‘right’ way to deal with controversies. Several workshop participants told stories of misunderstandings between them and their biomedical colleagues regarding planned collaboration outputs. In one case, 282


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for example, despite the fact that bio-scientists had given their permission to the social science researchers to quote from interviews with them in a publication, the bio-scientists were shocked when reading the manuscript and sought to veto the publication of the article. Such problems may of course stem from epistemological differences between the social sciences and biomedicine (especially clinicians), where the former seek to describe and understand and where the latter seek to improve health care and cure diseases. But they may also come from a fear of public ‘punishment’ of allegedly ‘unethical’ practices. Some of the workshop participants felt that the objective to improve health care is sometimes implicitly projected onto biomedical practitioners’/scientists’ social science colleagues, resulting in genuine ‘shock’ that the social scientists could have an interest in publishing anything that portrays the work of biomedicine as ‘messy’, or anything else deviating from the ideal of the heroic doctor. We operate with different research agendas at large: While biomedics typically want to improve health (application agenda), we seek to analyse and understand (critical academic agenda) (see Mechanic, 1995; Clair et al, 2007). Most workshop participants felt that it was neither a feasible nor desirable solution to try to avoid these conflicts by drawing up formal contracts listing mutual rights and duties, or provisions on who controls data. Although contracts would represent a variant of ‘ethics in advance’, ethnographies and ethnographically inspired fieldwork are characterised by a continuous development of research questions and analysis; it is difficult to determine in advance the character of the work (Parker, 2007, p. 2252), and the ethical issues or powerstruggles that may arise. Many workshop participants felt that contracts or professional codes would not take into account the emergent and creative relationships of fieldwork and the fact that the ethnographer’s mere presence is always an intervention whose scope and nature cannot be anticipated in advance. Still the process of drafting of such codes may facilitate important adjustments of expectations and agendas between collaborators.

Concluding The drawing of clear boundaries between ‘inside’ and ‘outside’ when doing fieldwork is notoriously problematic. The fieldwork experience never leaves us unchanged; our experiences, encounters and exposures have become part of how we think, who we are, and how we write up our findings (Kondo, 1984; Okely and Callaway, 1992; Duncan and Ley, 1993; Hastrup, 1995). A point raised in the workshop was that it is not only the ethnographer who does fieldwork, but also fieldwork that ‘does’ the ethnographer (Simpson, 2005). At a more mundane level, we often start our analysis or even the writing up processes while we are still collecting data in the field. Thus, the ‘inside’ and the ‘outside’ of a field is more a conceptual/notional one than a matter of space and time. However, there are some issues pertaining to the process of transforming experience into text, and into publishable text in particular. To what extent does our anticipation of how our colleagues in biomedicine and the biosciences may react to our account of what they are doing influence what we choose to write about and what we choose to leave out? How have the terms of the collaboration with them impacted on the terminologies and concepts that we use? Do we feel that we need to make ourselves ‘understandable’ for them? To what r 2010 The London School of Economics and Political Science 1745-8552

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extent, and in what forms, do we explicate the purpose of our accounts, and in a broader sense, what the social studies of biomedicine and the biosciences set out to achieve? Moreover, how do we ourselves understand the roles, functions, purposes and effects of our analysis and publications? Do we represent, intervene (Hacking, 1983), describe, improve, interpret, debunk? How do our professional inquiries interact with the articulated or tacit interests and needs of patients, professionals, policy makers and agendas, and/or the biotechnological and pharmaceutical industries? And what roles do our knowledge projects – the knowledge and insights we seek, how, and with whom – play in furthering our own careers? What dilemmas are posed when science journalists become interested in commenting upon collaborations? We strongly believe in a need for more accounts in the social studies of medicine and biosciences that address those questions explicitly. In addition, how can researchers engage with collaborators about their interpretations while retaining control over dissemination? How do we use our critical perspective and at the same time remain sensitive to the way in which our analysis may put others and their research projects at risk? Some workshop participants viewed the critique that we, as social scientists, offer to our biomedical and bioscientific colleagues, and that we articulate in our publications, as lending a voice to the underprivileged, while others saw the primary function of our critiques as exposing and problematising the categories and governmental logics of biomedical institutions. In cases of joint publications with our biomedical and bio-scientific colleagues, how are decisions about desirable outlets for our publications to be negotiated? The act of publishing raises a question of belonging. There are a number of actors, and positioning oneself is not only a question of solidarity with a particular actor/field, but also a question of epistemology. To what extent can we, and do we, co-author publications with them strategically? How are such publications evaluated and assessed by our colleagues? Workshop participants discussed the scenario that once a social scientist has established herself as an ‘expert’ on ELSA work with regard to a particular biomedical or bioscientific topic by publishing in prominent life science journals, she often obtains the role of an ‘obligatory passage point’ (Callon, 1986) for her biomedical colleagues who need or want to cover ‘society and ethics’ dimensions in a grant proposal or in an ongoing project. Thus, by publishing with or without bioscientific and biomedical colleagues in ‘their’ journals we obtain power and influence. How do we deal with this effect? To what extents do we use such publications strategically for our own research agendas? Are such processes of gaining power problematic instances of ‘going native’, or are they legitimate ways of putting our own research questions on scientific agendas? Many of these question concern tensions between criticality and engagement/collaboration. To answer these questions we need to also ask ourselves what the stakes are in these collaborative relationships, for us and for our collaborators. How does collaboration shape criticality, and how do collaborative relations express and reflect knowledge politics? For many social scientists working on medical and scientific topics, collaborations with biomedics and bioscientists are a necessity, and good collaborative relationships are a desirable goal for everybody involved. In order to achieve such satisfying collaborative relationships it can be useful to discuss explicitly with biomedics and bioscientists to what extents they are willing to share responsibilities for outputs with us, which can entail, for example, the co-authoring of papers. This can help to broaden the scope of criticality that we 284


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value so highly, not merely by expecting biomedics and bioscientists to accept our problematising research agendas, but by inviting them to engage in the production of reflexive feedback which may enrich the research experience and outcomes for both sides. Differences in epistemologies and power are often not problems that can be ‘solved’, but issues that can be addressed in productive ways. Workshop participants included: Mathieu Albert, University of Toronto, CA; Michael Arribas-Ayllon, University of Cardiff, UK; Milena Bister, University of Vienna, AT; Kathryn Ehrich, King’s College London, UK; Nathan Emmerich, Queen’s University, Belfast, UK; Lotte Huniche, Institute of Public Health, University of Southern Denmark, DK; Jyotsna Agnihotri Gupta, University for Humanistics, Utrecht, NL; Lene Koch, University of Copenhagen, DK; Shelley Lees, London School of Hygiene and Tropical Medicine, UK; Ursula Naue, University of Vienna, AT; Barbara Prainsack, King’s College London, UK; Josh Reno, Goldsmiths College, UK; Bob Simpson, Durham University, UK; Mette N. Svendsen, University of Copenhagen, DK; Ayo Wahlberg, LSE, UK/Copenhagen University, DK; Bernhard Wieser, IFZ – Inter-University Research Centre for Technology, Work and Culture, Graz, AT.

Acknowledgement The authors are grateful to the Foundation for the Sociology of Health and Illness for their financial support.

About the Authors Barbara Prainsack is a political scientist and Senior Lecturer at the Centre for Biomedicine & Society (CBAS) at King’s College London, UK. She is interested in the ways in which science, politics and religion constitute each other, and how they affect understandings of personhood and citizenship. Mette Nordahl Svendsen is an anthropologist and Associate Professor at the Department of Public Health, University of Copenhagen, Denmark. Her research concerns the complex relationships that unfold between health policies, clinical practice and patient lives. Lene Koch is a historian and professor at the Department of Public Health, University of Copenhagen, Denmark. Lene is the author of a range of books and articles about the history of eugenics and new reproductive and genetic technologies. r 2010 The London School of Economics and Political Science 1745-8552

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Kathryn Ehrich is a medical sociologist/anthropologist and Research Fellow at King’s College London, UK. Her research interests encompass social, cultural, moral and ethical issues for parents and health-care professionals that arise in reproductive, genetic, and child and women’s health services; and the social study of science and technology in health.

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