title: The good-enough science-and-politics of anthropological collaboration with evidence-based clinical research: Four ethnographic case studies.
abstract: The apolitical legitimacy of "evidence-based medicine" offers a practical means for ethnography and critical social-science-and-humanities-of-health theory to transfer survival resources to structurally vulnerable populations and to engage policy and services audiences with urgent political problems imposed on the urban poor in the United States that harm health: most notably, homelessness, hyperincarceration, social service cut-backs and the War on Drugs. We present four examples of collaborations between ethnography and clinical research projects that demonstrate the potentials and limits of promoting institutional reform, political debate and action through distinct strategies of cross-methodological dialog with epidemiological and clinical services research. Ethnographic methods alone, however, are simply a technocratic add-on. They must be informed by critical theory to contribute effectively and transformatively to applied health initiatives. Ironically, technocratic, neoliberal logics of cost-effectiveness can sometimes render radical service and policy reform initiatives institutionally credible, fundable and capable of generating wider political support, even though the rhetoric of economic efficacy is a double-edged sword. To extend the impact of ethnography and interdisciplinary theories of political-economic, cultural and disciplinary power relations into applied clinical and public health research, anthropologists - and their fellow travelers - have to be able to strategically, but respectfully learn to see through the positivist logics of clinical services research as well as epidemiological epistemology in order to help clinicians achieve - and extend - their applied priorities. In retrospect, these four very differently-structured collaborations suggest the potential for "good-enough" humble scientific and political strategies to work for, and with, structurally vulnerable populations in a punitive neoliberal era of rising social inequality, cutbacks of survival services, and hyperincarceration of the poor.
authors.affiliation: University of Pennsylvania, Department of History and Sociology of Science and School of Medicine, USA. Electronic address: lmessac@sas.upenn.edu.
authors.forename: Luke
authors.initials: L
authors.lastname: Messac
authors.affiliation: University of California San Francisco, Department of Family & Community Medicine, USA. Electronic address: Ciccaron@fcm.ucsf.edu.
authors.forename: Dan
authors.initials: D
authors.lastname: Ciccarone
authors.affiliation: Temple University, Department of Social Work, USA. Electronic address: jeffdraine@temple.edu.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Draine
authors.affiliation: Department of Anthropology and Department of Family Medicine & Community Health, USA. Electronic address: pbourgois@gmail.com.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bourgois
mesh_terms: D000884:Anthropology, Cultural / Q000458:organization & administration*; D002986:Clinical Trials as Topic; D003299:Cooperative Behavior; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D019982:Organizational Case Studies; D011057:Politics; D016032:Randomized Controlled Trials as Topic; D014481:United States; D035862:Vulnerable Populations
keywords: HIV prevention/treatment; Homelessness; Incarceration; Injection drug users; Participant observation ethnography; Politics of science and health; San Francisco, Philadelphia, United States; Structural vulnerability; Underserved populations