Does biosensing increase people’s control over their health, as it is often claimed? What is the connection between more data and health? Who is biosensing who? What is the relation between biosensing and people’s anxieties about their health? How do people subvert or reinvent biosensors to assure themselves of health? How does biosensing participate in making certain forms of selfhood and group viable? What socio-material networks do biosensing practices produce and rely on? Who is profiting from biosensing and who is not, and how? What new forms of work and care are produced in biosensing? How does the dream of continuous monitoring animate biosensing? How might collectives or communities thrive through biosensing? What, if any, policy framework might meet public concerns about health biosensors?
In the book ‘Living Data: Making Sense of Health Biosensing’, we offer some ways of responding to this panoply of questions and perhaps framing some new ones. We discuss a range of biosensors and biosensings, testing the boundaries of the technical definitions of biosensor in order to access emerging configurations and experiences that we consider relevant.
We want to make sense of areas of health – fertility, stress, genetic susceptibility, and ageing – that concern people’s sense of self, their sense of individual and collective agency, and their capacity to practically engage with the problems and potentials of their health. Each of the biosensing practices that we explore has power-lade regulatory, economic and epistemic facets, sometimes reaching deep into the institutions and experiences of gender, kinship, ageing, citizenship and ethnicity. Each has deep temporal structures within life-worlds. Each permeates embodies senses of selfhood and relationality.
In the book, we offer an understanding of biosensors as ‘layers of biosensing practice’. First, this means that biosensors are impossible to find in isolation. Like tools or bodies, they always belong severally to a collective or an assemblage. A fertility monitor, which could be a worn basal body thermometer, might be linked to a mobile phone app, a team of remote experts accessing a database of readings and an analytics interface, and an online discussion forum. None of these elements, not even the biosensing device ifself, is straightforward. It is not particularly useful, therefore, to regard biosensors as technologies in the sense of the engineering application of science to practical problems. Much of biosensing concerns what happens to the data, how they are understood, and how they interact with or escape other forms of knowledge and expertise. As we argue in the book, biosensors increasingly operate within platform environments in which problems of regulation, property, ethics, inclusion and control are writ large for self and other, for individual and collective, for citizen, customer, corporation and state.
Second, biosensing faces difficulties rooted deeply in health. Doctors and scientists, among other people, measure physiological states from time to time, such as temperatures or blood hormone levels. These are routinely understood as measurable signs of health. However, no exactness, comprehensiveness or sheer volume of physiological data can exhaust the existential inexactness of health. Experience of health or illness, even a life with chronic illness or disability, has no fixed constant, exact parameters or laws. The experiences of health may well diverge from physiological ‘constants’ or averages derived from accumulated measurements (usually of populations).
Third, bodies are so plurally entangled in the world that it sometimes hardly makes sense to speak of them as separate from an environment. The indeterminacy of body-environments cascades difficulties for the biosensors. Devices have to be coordinated with each other. Their results or indications have to be analysed, interpreted and re-situated amid experiences of health and disease, as well as programmes of action and different forms of expertise and judgment. The devices become products not in their own right, but within arrangements that depend on groups and communities of practice, especially in the form of platforms such as social media. Platforms, institutions, social groups and modes of knowledge are just some of the different facets that unfold around the devices, even if the devices often seem to be increasingly, sometimes disconcertingly, autonomous.
We have no simple way of conceptualing the diversity of biosensing practice because the lives that they pertain to, actually and potentially, are inherently diverse and indeterminate. This is not to say that biosensors and biosensing practices thwart normalisation. Biosensing often acts normatively; that is, acts to intensify existing norms defined by biopolitical and neoliberal governmentality with its population measures and controls. Even as they normalise bodies and experiences, biosensing practices that count or record some state of activity can diverge greatly from coordinated programmes of action executed more or less coherently by institutions or large organisations such as health-care providers or hospitals. A platform designed and constructed to gather, aggregate and circulate biosensing data, such as the online ovulation monitoring systems or the social media-enabled DNA genotyping services we discuss in the book, differ greatly from the clinical settings in which such biosensing might otherwise take place, creating niches in the broader formations of biomedicalization, normal and pathological, and disease and health.
In the book chapters, we discuss some of the emergences of biosensing in detail, but we have also create a table that serves to highlight the very different ecologies of biosensing, and to highlight the need for broad lines of questioning and re-conceptualisation of biosensors in which frequently used terms such as ‘health’, ‘device’, ‘body’ and ‘data’ are not treated as single or static concepts, but figured as plural and contingent.
|What is measured?||Steps, cycling||Sleeping, stress||Genetic risk, blood sugar, weight||Falls, enuresis||Air, water, mercury|
|What are users supposed to do?||Count, do more, do less||Map, chart, analysis||Test, monitor, contribute data, access clinics||Accept monitoring, trigger care||Count, record, aggregate|
|Devices and Platforms||Wearable, social media||Wearable, social media||Lab instrument, social media||Wearable, fixed sensors, call centre||Fixed sensor, apps|
|Role of Groups||Optional, competition||Optional, comparison, social group||Population, cohort||Client/customer service, relatives||Community group, social movement|
|Relevant Knowledges||Sport science, exercise physiology, military||Psychology, women’s health movement, military||Life sciences, genomics, reproductive medicine||Gerontology, physiology, health economics, public health||Ecology, toxicology, hydrology|
Living Data: Making Sense of Health Biosensing is published by Bristol University Press. Go to their website for a copy of the book.