Channeling hope: An ethnographic study of how research encounters become meaningful for families suffering from genetic disease in Pakistan

Un/Diagnosed: Family Experience of Genomic Diagnoses and the Re-Making of (Rare) Disease in the UK

Drawing on three years of ethnographic engagement with the rare disease community in the United Kingdom and Europe, this article explores the experiences of families who seek and (sometimes) receive a genomic diagnosis. I trace how families learn to enact unexplained symptoms and common disabilities as rare, genetic disorders, and how they coordinate genomic and non-genomic ways of "doing" disease within and beyond the clinic. These experiences shed light on the socio-material processes through which genomic variants become "diseases" (or fail to do so), and on the implications for those whose lives have become entangled with the genomic agenda.

Dealing with complicity in fieldwork: Reflections on studying genetic research in Pakistan

Health-related ethnography undertaken in a context marked by social inequalities and colonial legacies requires critical attention to power imbalances in the fieldwork. In this paper, I draw on my own experiences from studying genetic research in Pakistan. As a Danish-born female researcher with roots in Pakistan, I have followed genetic researchers and families dealing with genetic conditions in Pakistan. Through examples I unearth how encounters in the field were shaped by complicities of being in-between the Danish and the Pakistani, of studying and doing international research at the same time, and of my inaction towards suffering families. I base my analysis on the notion that complicity manifests in a generative, and unavoidable, engagement with both complex structures of inequality and interlocutors. We can never fully understand the specificities or consequences of complicity-whether moral or epistemic-when entering, engaging with or representing our fields. However, by staying constructively with the tensions, instead of attempting to move beyond the discomfort that they might create, we can learn how to deal with the consequences and in that, build further the value of ethnographic activity.

Impact of Critical Success Factors on Project Success Through the Mediation of Knowledge Creation

Several factors affect health project success. This research aims to examine the impact of critical success factors on health project success and show how the essential factors of success interact with knowledge creation to impact health project success. The self-administered questionnaire was distributed to collect data from 246 managers, supervisors and zonal supervisors of DHQ hospital Attock and PIMS hospital Islamabad. The analysis was done using Smart PLS to understand the effect of exogenous variables over endogenous variables and the impact of mediating variables between two constructs. The results show that all critical success factors (MGTRF, DRF, CRF, PMRF, CLRF) are significantly affecting project success, in addition, tacit knowledge creation mediate the association between critical success factors and project success. In contrast, explicit knowledge creation does not mediate the relationship between critical success factors and project success. This study intends to expand the theoretical understanding of process improvement by providing practical insights into the impact of strategies used by project managers to develop new knowledge by capturing explicit and implicit information. This study also reinforces past findings and increases awareness about using knowledge creation to gain a competitive advantage in the health sector.

Precision patients: Selection practices and moral pathfinding in experimental oncology

This paper addresses selection practices in a Danish phase 1 unit specialised in precision medicine in the field of oncology. Where precision medicine holds the ambition of selecting genetically fit medicine for the patient, we find that precision medicine in the early trial setting is oriented towards selecting clinically and genetically fit patients for available treatment protocols. Investigating how phase 1 oncologists experience and respond to the moral challenges of selecting patients for early clinical trials, we show that inclusion criteria and patient categories are not always transparent to patients. Lack of transparency about inclusion criteria has been interpreted as morally problematic. Yet drawing on social science studies of 'unknowing', we argue that silence and non-transparency in interactions between oncologists and patients are crucial to respect the moral agency of patients at the edge of life and recognise them as belonging to the public of Danish health care. In the discussion, we consider the practice of placing 'unfit' patients on a waiting list for trial participation. Rather than representing an ethical and political problem, we argue, the waiting list can act as a valve enabling oncologists to navigate the scientific and as well as the moral uncertainties in phase 1 oncology.

More than sample providers: how genetic researchers in Pakistan mobilized a prenatal diagnostic service for thalassemia

While unequally resourced partners from the so-called global South are often considered ‘mere sample providers’ in larger international genomics collaborations, in this paper, we show how they strategically work to mobilize their role in a global system of tissue exchange to deliver services for local communities. We unpack how a prenatal diagnostic service for thalassemia in Pakistan emerged out of the maneuvering efforts of internationally connected Pakistani researchers. By tracing the distributed capacities that emerged and circulated as they set about improving medical genetics in Pakistan, we outline some key conditions that led to the establishment of the service: first, the scale of unmet needs that geneticists faced when collecting data as part of their research that made medical genomics a relevant field; secondly, joint efforts between researchers and physicians that were engaged with the challenge of decreasing disease prevalence through diagnostics and abortion; and finally, the ways in which international research collaborations helped generate resources to improve medical genetics in Pakistan. To understand how genetic research and medicine is currently being developed in Pakistan, we need to ethnographically re-center our analyses in ways that allow us to identify the resourceful ways in which researchers maneuvre to secure locally relevant outcomes.

Collective Care Amid US Individualism Through COVID-19 Vaccine Trial Participation

We analyze interviews with participants in a COVID-19 vaccine trial to show how Americans navigate conflicting discourses of individual rights and collective responsibility by using individual health behavior to care for others. We argue that interviewees drew on ideologies of "collective biology" - understanding themselves as parts of bio-socially interrelated groups affected by any member's behavior - to hope their participation would aid collectives cohering around kinship, sex, age, race and ethnicity. Benefits (protecting family, representing one's group in vaccine development and modeling vaccine acceptance) existed alongside drawbacks (strife, reifying groups), to illustrate the ambivalence of caregiving amid inequality.