Ordering Hope Representations of Xenotransplantation - An Actor/Actant Network Theory Account ______________ Nik Brown (BA jnt Hon's. MA) Submitted in completion of the degree of Doctor of Philosophy in The Centre for Science Studies and Science Policy at the School of Independent Studies, Lancaster University. 1998. Ordering Hope – electronic version 1 Contents List of Illustrations 5 List of Abbreviations 6 Abstract 7 Acknowledgements 8 Preface 9 Chapter 1: Introductions Preamble 12 Inceptions 1 - Questions / Problems 13 Inceptions 2 - ‘40 minutes’ and other Transplant Stories 14 Inceptions 3 - A 'keywords' Semantic Guide to Hope 17 Hope as a Keyword 18 From Hope in God to Hope in Nature 20 Hope, Emotion and the Future 20 Discourses of Hope in Modern Biomedicine 21 A Keywords Summary 24 Inceptions 4 - Xenotransplantation - An Overview of Histories, Actors and Actions 25 Inceptions 5 - Networks of Ambivalence - Values and Devalues 31 Summary and a Brief Thesis Profile 32 Chapter 2: Networks of Hope - Approaching Theory & Method Introducing Hopeful Networks 35 An Actor Network Theory Preamble 36 ANT Analytical Vocabulary 42 Conversations and Critiques 50 Another Conversation - Telling Actor Network Hopes 52 Xenotransplantation - An Actor Network Theory Account of Hope 59 Ordering Hope – electronic version 2 Chapter 3: The Hopeful ‘Breakthrough’ Introduction 71 Interpreting Breakthrough 74 Deconstructing discovery accounts 74 The Requirements of News 77 Kairos - towards a future 'the right time' 78 Constituting Intermediaries 81 Textual Intermediaries 85 Narrating historical analogies 86 Naturalising the Xenotransplantation route 86 Breakthrough and Anticipation - constituting hopeful suspense 88 Subverting breakthrough 90 Summary and Conclusion 90 Chapter 4: Embodying Anticipation - Hope, Affectivity & Representations of the Suffering Body Introduction 94 Approaching Affective Aspirations - Anthropologies of Emotion 97 Hopeful Discourses - Representing Xenotransplantation, Constituting Anticipatory Bodies 101 Texts 1. BBC 40 Minutes 102 Texts 2. Esquire 110 Texts 3. From Fear of Failure to Hope for Success - The September 1995 ‘Breakthrough’ 113 Hope as an affective property of scientists 114 Hope as an affective property of patients 115 Conclusion 118 Chapter 5: Switching Hopes & Other In/corp/orations of the ‘Donor’ Hybrid Introduction 123 Hybrids, Cyborgs and Monsters 127 Introducing the Organisation of Human and Nonhuman Identities in the 'Which Species' Debate 130 Distributing Sameness and Difference, Humans and Non- Humans Across the Expert’s Science and the Public’s Culture 132 A. Scientific and technical criteria in organising porcine-human sameness and non-public-expert difference 132 Ordering Hope – electronic version 3 B. Cultural and moral criteria in organising porcine-human difference and non-public-expert sameness 137 The Porcine DSC as objects of benevolent display 145 Characterising Animal Advocacy Opposing Hopeful Monsters - Where do Your Sympathies Lie? 149 The (Nearly) Benevolent Porcine 'Donor' 150 Discussion - The Opaque Hybrid 151 Conclusion - The Transparent Hybrid 157 Chapter 6: The hopeful Monster - ‘Yuk’, Pollution & the Correction of Displaced Matter Introduction 162 Conceptual Orientation 164 Matter Out Of Place 167 Headlines 167 Visuals 171 Science Fiction: Displaced Matter / Misplaced Motives. 178 Normalising Displaced Matter 182 The Impermanence of Disgust - The availability of Hope 183 Hope - Putting Matter Back in Place 187 Summary and Discussion 193 Chapter 7: Conclusion - Distributions of Hope - Ordering Similarities & Differences, Continuities & Discontinuities Preamble 197 Hope, Similarity-Continuity, Difference-Discontinuity 199 Scenario 1. 200 Scenario 2. 204 A Summary 210 Postscript 213 Bibliography 217 Ordering Hope – electronic version 4 List of Illustrations Fig 1. Cover page of Radio Times feature: ‘Operation Hope’ (James, 1993). 15 Fig 2. Cover page of New Scientist, 18.6.94 164 Fig 3. New Scientist, 18.6.94. p25 173 Fig 4. Esquire, Feb. 94. pp48-52 174 Fig 5. Review of ‘Test Tube Bodies’ in 20/20 Magazine, Feb/March. 1996. p34 176 Fig 6. 20/20 Magazine, Feb/March. 1996. pp32-33 178 Fig 7. Radio Times, 20-26.3.1993. p30 186 Ordering Hope – electronic version 5 List of Abbreviations ANT Actor Network Theory BUAV British Union for the Abolition of Vivisection CPS Cervical Smear Programme CIWF Compassion in World Farming DSC Donor Species Candidate DNX Parent company of Nextran Corp. HGP Human Genome Project OED Oxford English Dictionary RHCG Research for Health Charities Group STS Science and Technology Studies SSK Sociology of Scientific Knowledge XTP Xenotransplantation Ordering Hope – electronic version 6 Abstract This thesis elaborates an Actor Network Theory account of the representations through which 'xenotransplantation' (a key facet of the 'new medical biologies') is narrated and extended. In particular, I address the performance (and distribution) of hope across and between xenotransplantation's key network participants. As both a means and a perimeter of network organisation, the temporal dimensions of ordering carry implications for the formation and implementation of Science Studies theory too. ANT, for example, has evolved in relation to a panoply of mainly spatial metaphors (spaces, topologies, differences and similarities etc.). This thesis, by contrast, has sought to respond to the temporal terms of reference which populate representations of xenotransplantation. Amongst other things, competing hopes, desires, right and wrong times, continuities and discontinuities all serve as the principal discursive means through which network management is exercised. My suggestion is that representations of time, as well as the timing of representations, are vital to understanding the production of networks. Also, such terms map onto the many other sense making boundaries which are evoked and challenged through the transpecies exchange of tissues and genes: self and other, human and nonhuman, science and culture, expert and public. Ordering Hope – electronic version 7 Acknowledgements This study was supported by a quota research studentship award from the ESRC joint committee on science and technology (1993). I also thank Sarah Franklin with whom much of the early thinking on hope and medicine during my Masters degree was rewarded with a successful entry in the ESRC competition studentship programme (1993). I especially wish to extend my appreciation to both my supervisors at Lancaster University: Mike Michael of the Centre for Science Studies & Science Policy (CSSSP) and Independent Studies; Greg Myers of the Departments of Linguistics and Culture and Communication. As well as providing exemplary supervision and fecund intellectual stimulus, Mike and Greg made a notoriously gruelling experience as cheerful and comfortable as it could be. Their careful attention to successive versions of this text have proved invaluable. Similar sentiments go out to CSSSP’s post graduate group who have, from time to time, offered insightful comments on seminar and conference papers associated with this research. I also wish to thank participants in the Dutch post graduate Summer School on Science, Technology and Postmodernism, held at the University of Enschede (1994); Participants in the Animals in Research Symposium at UCL’s Royal Holloway (1995); Regular attendees of CSSSP’s numerous seminars and symposia; as well as participants in many other Science Studies related events at the Universities of Lancaster, Keele and Manchester. Closer to home, I couldn't thank enough my family and lots of friends for their steady encouragement and practical support. Christine and Kate Morton were excellent proof readers. But my warmest thanks go to Lucy, without whose lively distraction this thesis would probably have been completed much sooner! Ordering Hope – electronic version 8 Preface Xenotransplantation1 is, as yet, an unrealised clinical innovation which promises the prospective transfer of organic tissues from one species into the bodies of another species. But it has yet to find anything like a firm footing in the wider clinical economies of established organ replacement. This objective has been made all the more difficult for promoters of xenotransplantation since conventional transplantation itself has been the subject of considerable criticism and widespread scepticism (Fox & Swazey, 1992; Calnan & Williams, 1992; Snowdon, 1991). The prospect of extending the 'donor pool' to animals whose immune systems have been genetically engineered for the purposes of human replacement surgery has engendered acrimonious debate and public scrutiny.2 Indeed, the exchange of tissues between different species' bodies is a charged traffic in meanings. A complex tangle of controversies and indeterminacies abound. For instance, xenotransplantation is embedded in disputes regarding the safety of high risk clinical applications, the precarious futures of patients awaiting transplantation surgery, the relative moral merits of using large numbers of animal body parts, varying versions of immune system processes, renewed sympathies for animals in research, shifting confidence in the integrity of medical practitioners, competing temporal targets for future clinical trials, debates over which 'donor candidate' will be most appropriate, the pressures of commercial biotechnology investment, how to negotiate a potentially disastrous public hostility to the anticipated trials, how to deal with technological challenges