Last week I attended a fantastic symposium at the University of Cambridge on Theorising Personal Medical Devices which was organised by Conor Farrington and Rebecca Lynch and supported by the Wellcome Trust.
This was, to my knowledge, the first event with a theoretical focus on personal medical devices (PMDs) and had a programme packed with diverse papers that demonstrated the richness of ongoing work in this area but with some strong themes and consistencies.
Perhaps the most significant commonality was a calling for, or a demonstration of, the necessity of taking account of practice and the importance of meaning. A concern with the material relations people have with devices and how such devices mediate relations with the self and others cut across many of the papers.
In his plenary which helped to set the tone for the event Steve Matthewman drew on the mantra of Science and Technology Studies that whenever we think about technology we must remember that “It could be otherwise”. He also asked questions such as “To what extent does technology make us?”
Furthermore, Matthewman highlighted some of the largely undiscussed consequences of the close integration of our bodies with digital technologies. Following Charles Perrow, he suggests that any concentration of power is likely to lead to catastrophe if unchecked. As we see the concentration of information in few hands and everything from the security of our biological data to the running of pacemakers integrated with digital networks significant consequences could result from a breakdown.
In the first panel Ava Hess presented ethnographic work on the use of automated insulin pumps. She sought to understand the relationship between people and pumps as material and active. She found that while initially the pumps tended to be seen as external, gradually the boundaries between person and pump began to dissolve. However, their presentation of the pump was acutely monitored with various tactics used to hide it, sometimes to themselves, through attaching it to their back and others decorating and personalising them. Hess posed the question of whether the dissolution of boundaries between body and machine is required for personal wellbeing.
In their paper Kate Weiner, Catherine Will and Flis Henwood focused on some of the mundane practices in which people engage when using PMDs and in particular the collective aspects. They showed some of the ways in which devices are used collectively, by a family for instance, and the meanings attributed to them are negotiated between actors. Furthermore, they highlighted how quantifying practices are sometimes rejected in favour of more affective measures.
In the second plenary address Alex Faulkner asked some fundamental questions such as “What makes a technology a medical device?” and “What makes a PMD personal?” In answering these he tackled some of the ways in which industrial infrastructure, policy and regulation impact on how we define devices and questioned the sometimes assumed associations such as that between personalisation and de-medicalisation.
From a design perspective Anthony Kent sought to transcend the simplistic dichotomy between design-centred or user-centred devices to instead think on the generative level of the skilled practices which are used in order to design and use PMDs. Here the form of devices is not considered to be imposed on inert matter by a designer but generated and dissolved by various processes of formation and dissolution. The meanings which users attribute to devices are thus often radically different from those perceived in the realm of the market.
Peta Bush proposed some ways to integrate the concerns of users into design through questioning why more account of people’s affective and embodied relationship with personal medical devices is not built into them. While PMDs are part of people’s everyday lives often the medical, rather than lifestyle, issues take precedence. Bush drew on analysis from studies of ‘contemporary jewellery’, which challenges traditional notions of wearability and aesthetics, to throw light on the design of PMDs. She asked how we can better implement design to take account of not only the practicalities of using PMDs but also the relationship they have to identity and the visceral experience of using them.
Nick Fox, in the final plenary drew on the work of Deleuze and Guattari and new materialists such as Rosi Braidotti and Elizabeth Grosz to propose an analysis in which our relationship with PMDs is understood as an assemblage. He demonstrated some of the ways in which devices have particular interested designed into them in order to show how they could be used to resist neoliberal health policies and biomedical discourses through enabling collective responses.
Rebecca Lynch presented an analysis of the construction of e-cigarettes in which she showed how there have been two opposing policy constructions of e-cigarettes as fundamentally dissimilar to cigarettes (eg. as a medical device) and as similar to cigarettes (merely another form of nicotine delivery). Alternatively, she proposed that they are neither and actually function as a Baudrillardian simulacrum, they do not have the aura of the real thing (in the Benjaminian sense) and therefore will not replace them. Nevertheless e-cigarettes may be serving as a route of governmentality through which smoking can be controlled rather than eradicated.
Conor Farrington presented a framework for understanding PMDs influenced by the “sensemaking” tradition which helps to show how technologies are often used in ways other than what was intended by their designers. By seeking to understand the “frame of mind” of users their meaning seeking action can be seen for the ways in which it constitutes how devices are made meaningful.
One poster was presented by Alison Prendiville on the interactions people have with glucose monitors. Her fascinating work showed how monitoring devices mediated relationships between patients and doctors with negotiations taking place over what levels could be achieved. She also showed that while the practice of monitoring helped to stimulate people to be active patients it also often made them feel like monitoring was was itself tackling their diabetes.
In his poster Patrick Slevin showed how the use of home monitoring impacted on people with dementia and their carers. He showed that “connected health” both helped to make the bodies of people with dementia “dys-appear” as their bodies often became less problematic in a day-to-day sense but generated new relations as the body of the cared-for was re-presented to carers as biometric measures.
On the basis of this event there are the beginnings of a cross-disciplinary consensus that one of the best routes towards understanding and engaging politically with PMDs is through taking a fuller account of their material, affective and meaningful co-construction.