these different religiosities directly shaped IVF practice, especially in terms of personhood, kinship, and care. For instance, materialist Catholic practitio-ners in Quito avoided the cryopreservation of embryos, while IVF practitioners in Guayaquil tended to embrace it. this difference is based in the labor history in Ecuador. the practices of free labor and free trade on the coast produced spe-cific relations between God and persons, and more recently between God and embryos. In that context, people (and embryos) are seen as individuals who can circulate freely, whereas within the peonage hacienda systems in the sierra, peo-ple and embryos are seen as embedded in groups. thus Quiteños believed freez-ing embryos would facilitate their circulation outside families and racial boundar-ies, which they saw as undesirable. Guayaquileños, on the other hand, envisioned embryos as individuals with the right to a future less dependent on their family of origin. these are regional and religious differences influenced by economic prac-tices within Ecuador’s material reality

these practitioners mostly resided in Quito, where there were more clinics. although they did not subscribe to contemporary Church doctrine, their labora-tories were filled with emblems of God’s presence: crucifixes and religious images acknowledged their faith in his assistance. the God of these materialist Catholics played an active role in their daily affairs. He and his intermediaries were seen as deeply involved in personal, interdependent relationships that altered the mate-rial world

the whiteness of elite families was preserved through the guarding of its whiter women in order to make legitimate children, while criollo and mestizo patrons and overseers made lighter mestizos through the sexual domination of darker peon women. the practice of seeking out lighter skin in a sexual partner persists today.this racial and racist history is essential for understanding IVF in Ecuador.

In contradistinction to the liberatory claims made by the Gay International inrelation to what it posits as an always already homosexualized population, Iargue that it is the discourse of the Gay International that both produces homo-sexuals, as well as gays and lesbians, where they do not exist, and repressessame-sex desires and practices that refuse to be assimilated into its sexual episte-mology.6I show how this discourse assumes prediscursively that homosexuals,gays, and lesbians are universal categories that exist everywhere in the world,and based on this prediscursive axiom, the Gay International sets itself the mis-sion of defending them by demanding that their rights as “homosexuals” begranted where they are denied and be respected where they are violated. Indoing so, however, the Gay International produces an effect that is less than lib-eratory.

Al-Khazin’s conservative andprocensorship argument chastised Arab liberals who fight government control oftelevision and defended Arab governments as the bearers of “the responsibility toprotect their societies from the worst aspects of degeneration.” Al-Khazin, whooften espouses Western conservative opinion on social matters, concluded histirade by quoting Western sources that sexual deviants constitute no more than 1to 2 percent of Western society and by asserting that the focus of television rep-resentations on “violence without punishment or pain has led to the spread of violence in society. The danger now [lies in the possibility] that the focus ondeviance, among women and men, might lead to the acceptance of deviance as anormal, not a deviant, issue, its subsequent spread in the West, and then its reach-ing us.

Throughout his account, AbuKhalil refers to “homosexuals,” “gays,” “hetero-sexuals,” and “homophobia” as transhistorical identities and phenomena andanachronistically identifies people and practices with them. For example, he citesmedieval Arabic books that “contain collections of poetry and anecdotes by andabout gay men and women” (33). Unlike the ahistoricists, however, AbuKhalilbelieves that changes haveoccurred in the Arab world, but they do not concernidentities, which he sees as transhistorically present, but rather “homophobia,”which he believes is historically contingent: “The advent of westernization in theMiddle East brought with it various elements of western ideologies of hostility,like . . . homophobia.

Western feminist campaigns must not be confused with the hypocrisies of the colonial feminism of a Republican president who was not elected for his progressive stance on feminist issues, or of a Republican administration that played down the terrible record of violations of women by U.S. allies in the Northern Al-liance, as documented by Human Rights Watch and Amnesty In-ternational, among others. Rapes and assaults were widespread in the period of infi ghting that devastated Af ghan i stan before the Taliban came in to restore order. (It is often noted that the cur-rent regime includes warlords who were involved and yet have been given immunity from prosecution.

Most troubling for me was why the Muslim or Afghan woman was so crucial to this cultural mode of explanation that ignored the complex entanglements in which we are all implicated in sometimes surprising alignments. Why were these female sym-bols being mobilized in the War on Terror in a way they had not been in other confl icts?

This is true everywhere they occur, whether in sex traffi cking in Seattle, Tel Aviv, or Dubai; rape in Belgium, Cambodia, or Bosnia; or domestic violence in Chicago, Capetown, or Kabul. At the same time, we have to rec-ognize the everyday forms of suffering that women endure— from insecurity to hunger and illness— that are not always gen-dered or specifi c to par tic u lar cultures or religious communities. We have to keep asking hard questions about who or what is to blame for the problems that par tic u lar women face. What re-sponses might be most effective for addressing problems that we do fi nd, and who is best situated to understand or respond to these problems?

These examples from different parts of the Muslim world il-lustrate the variety of situations in which Muslim women fi nd themselves, the sorts of debates and strategies they engage, and how frequently their experiences are misunderstood and the complexities of their situations ignored. These analyses of what’s wrong with the simple story of Muslim women’s oppression hold cautionary tales for us. Abuses and infringements of wom-en’s rights must be acknowledged.

Each country in which Muslims live has inherited a different history. In some countries, Muslims are minorities; in others, they are majorities. In a few countries, most are wealthy; in others, they are poor. The careful ethnographies that anthropologists and sociologists have writ-ten; the vivid documentary fi lms that have been produced; the historical studies that those who work in the archives have pub-lished; the fi ction, poems, and essays that women from these communities have created; the studies of law and legal reforms that experts have contributed— all confi rm the tremendous diversity

Because of the terms in which Muslim women’s lives are rep-resented and debated in the West, no book about women in the Muslim world can avoid confronting the question of how to think about choice and what it means to assert freedom as the ultimate value.

That said, some of my interlocutors do attempt toresolve these sorts of tensions, notably Janice, a small-business owner and a proud Southerner. Janice critiquedthe repugnant other stereotype of the Trump Voter by as-serting,“I’mverypro–female rights, I think for myself,I care about people, I care about immigrants, I’medu-cated,”and by expressing her disgust with Trump’sbrashconduct, explaining that his various misogynist and xe-nophobic statements“made it difficult to vote for him.”Ultimately, she voted for the candidate that she thoughtwould support“fiscally conservative”values and helpsmall businesses, but she also rationalized this decisionin various other ways to seemingly ease the tensions be-tween her“pro-female”and“pro-immigrant”views onthe one hand and her misogynist, xenophobic candidateof choice on the other.“None of us are perfect,”she ex-plained,“and a lot of the things he said weren’talignedwith what he’s actually done in his career.

Toward this end, I will now highlight three ethno-graphic insights from anthropological literature that candeepen our understanding of how the unique contoursof this political moment intersect with various contradic-tions endemic to subjecthood to create particular politicalproclivities often simplistically attributed to“the”TrumpVoter. I will draw from my encounter with Candace andmy supplemental interviewsto contextualize these in-sights. While these insights are ripe for a deeper ethno-graphic project on the United States’particular politicalupheaval, I want to suggest that they could also enableus to link this political moment with other ostensibly dis-parate moments of social turmoil and, more generally,with the workings of human societies across time andspace.

Was the media’s“unfair”treatment of Trump reallythe only reason she voted for him? For all of her social-democratic leanings, she was by no means ideologicallycoherent, and contradictions, illegibility, and inconsisten-cies reigned supreme in her explication of her politics.While affirming her support for the safety net, she ex-pressed an interest in libertarianism and said that shewants to learn more about it. She actively and consciouslydenounced extreme Republican politics while affirmingher support for the legislative champions of those politics,notably Speaker of the House Paul Ryan. And contraryto liberal diagnoses of the Republican voter,she was wellaware that the politicians that she supported directlychampioned policies that she disdained, including but notlimited to the privatization of social security, the aboli-tion of Obamacare, and rollbacks on environmentalprotection, among many other things. At the same time,she bemoaned the incrementalism of the DemocraticParty, she cited that incrementalism as one reason whyshe was reluctant to support Democrats, and she calledfor a more radically progressive politics than what theparty had to offer.

Both acquisition and reorganization re-quire large-scale retrenchment. There are consequences here both for work-ers and for patients; for those patients who need drugs, as well as those who are imagined as always already needing drugs; for those who die due to a lack of therapeutic access, and for those who might die due to therapeutic excess. But the power of the speculative terrains upon which the pharmaceutical industry operates and to which it has increasingly come to be beholden

First, the particular dynamics of American speculative capital are both specific and differentiated. In other words, the logics of financialization that capture the industry are particularly American materializations of the logics of capital. Many larger Indian pharmaceutical companies, for instance, are also publicly traded, but Indian financial mar-kets do not structure the ways they are valued to the degree and intensity that American financial markets do for the big multinational companies.

The ability to make so much money from these compounds was secured through strong intellectual property pro-tection. Three historical, institutional factors make this configuration a structure that is potentially ridden with crisis: the place of the pharmaceuti-cal industry in the speculative marketplace, pipeline problems, and the patent cliff. I elaborate

Without a doubt, global pharmaceutical politics has come to be deeply con-tested, often with polarized positions around a range of issues.

herefore, on the one hand, value is simply an attribute (something that a commodity has: its utility, its beauty, its ability to be worn or eaten; some-thing that money has: its ability to circulate itself, to mediate and measure other kinds of circulations, to quantitatively express circulation itself ). But on the other hand, value itself performs the various materializations

t stake here is a conceptualization of poli-tics. Undergirding and articulating forms of and relations between value and politics are ways of knowing, and questions of what kinds of authorities are vested in particular ways of knowing. At stake here is a conceptualization of knowledge in its interactions with value and politics. These conceptualizations cannot occur in the abstract. They have to emerge out of concrete empirical substance: historical trajectories, critical events, institutional structures, po-litical economic formations.

One part of the task of understanding pharmocracy then is to elucidate the political economy of the appropriation of health by capital. At stake here is a conceptualization of value. The complementary part of this task is to recognize that logics of capital are not seamless.

Th e Prenatal Care Assistance Program and sites such as Alpha Hospital are fairly understood as eff orts to ameliorate the eff ects of this country’s his-tory of racism and racial in e qual ity by ensuring that an individual’s ascrip-tion as a racial “minority” or “Black” does not determine whether she lives or dies or whether she is healthy or sick. And so the program, and the hospital that eff ects it, should be celebrated for its laudable purposes. But, at the same time, it must be recognized that such programs and institu-tions are not self- eff ectuating; people give them life. Moreover, people who harbor problematic ideas about race and culture can undermine the goals of these programs and institutions. If we are really committed to ensuring that a person’s racial identity does not overdetermine her health status, we must demand that the persons caring for them do not harbor dangerous beliefs. Accordingly, physicians and other health care providers ought to be interrogated about their ideas concerning race and culture.

It seems a bit peculiar to believe that a woman will not in-form her physician or caretaker of her massive blood loss. Th e hypothesis that Black women will silently endure such frightening episodes probably says less about Black women’s actions under such circumstances and more about discourses of Black women’s fantastical stoicism and strength. More-over, the authors also partly attributed the disparity to “diff erence in his-tory taking on the part of the physician”— an obscure phrase explaining very little

Other factors named in the literature also contribute to racial health disparities— such as the disproportionate levels of poverty among Black people, which increases the likelihood they will also suff er from poor nu-trition and obesity. Moreover, disproportionate levels of poverty increase the likelihood Black people will lack access to regular medical care, which, in turn, decreases the likelihood that medical problems will be caught at an earlier, treatable stage.

Racial disparities in maternal mortality in the United States are equally lamentable. Black women die from causes linked to pregnancy and child-birth at more than three times the rate of white women. In New York City, the maternal mortality rate for Black women was more than fi ve times that of white women. “In fact, 1 of every 2,500 black women in New York City who becomes pregnant dies.

At present in the United States, the infant mortality rate for Black babies is nearly two- and- a-half times higher than for white babies. Th is disparity has persisted despite the overall decline in infant mortality rates over the years. Th ere has not been even a narrowing of the racial gap; although fewer infants died last year, the rate at which Black babies died remained twice that of white babies.

Shauntay had been referred to Alpha from Delta because Delta was unequipped to handle the severity of the condition from which Shauntay’s baby suff ered. Th e Delta ultrasound had revealed that one of her twins (referred to as Twin B in her medical rec ords) had anechoic structures overlying both of his kidneys— an ominous fi nding. Moreover, the ultra-sound detected hydronephrosis (a swelling of the kidneys that occurs when the fl ow of urine is obstructed) as well as hydroureter (a swelling of the ureter). Both conditions imply that the ureter and the connection of the ureter to the kidney have been overfi lled with urine. Th e severity of this condition was exacerbated by Twin B’s growth having shown restriction (a condition called IUGR, or intrauterine growth restriction). Moreover, Shauntay’s physicians also noted that Twin B suff ered from AEDF, or absent end- diastolic fl ow, indicating that the placenta was not working properly and the fetal heart was struggling. A diagnosis of IUGR with AEDF is a dire one, and most fetuses with the condition do not survive absent immediate delivery.

Miller is one of the many who are enthusiastic about what they under-stand as a profound transformation that traditional Chinese medicine is bringing to more authoritative understandings and practices of science. Li Fengyi, for his part, takes part in producing and transforming science through classroom education. During a lecture for (rst-year students at <=!>5 Li said, “We need to raise the level of the discussion of traditional Chinese medicine to the discussion of ‘science.’ Science is about rational explanations of nature, and these explanations are represented by scienti(c theory.

Clinical success continues to be career de(ning in contemporary prac-tices of traditional Chinese medicine in China and in the United States. In contrast to previous periods, however, clinical success in traditional Chinese medicine is o'en mediated by (and in turn marks) its marginality in rela-tion to the biomedical mainstream. Indeed, the marginality of traditional Chinese medicine has transformed everyday e*cacy into something out of the ordinary and at times even miraculous. For example, when I asked the herbalist Pang Panchi how she became a famous cancer specialist, she told me that it was “by coincidence.” She tells the story as follows

Marginalization is much more than the simple act of excluding traditional Chinese medicine from the proper domain of science and biomedicine. Marginality is not a stable structural position but rather the contingent outcome of a set of relational processes by which “traditional Chinese med-icine,” “biomedicine,” and “science” are produced as their boundaries and relative positions are fought out.

y the late #$%2s, however, acupuncture anesthe-sia had largely disappeared from both biomedical and traditional Chinese hospitals. )e reason for this decline, I was told by acupuncturists and sur-geons who once worked together to perform the procedure, was that it was “less effective” than biomedical techniques.7 More importantly, according to these acupuncturists and surgeons, two decades of laboratory and clini-cal research had failed to produce any conclusive “scienti(c” explanation,

The pharmaceutical industry is a massive elephant. Like the blind men of the famous parable, we each catch hold of a tiny piece of it—leg, tail, trunk—and think we have a handle on it: it is strong and solid, it is hairy, it moves like a snake. From about $880 billion dollars of sales for 2011, the industry is expected to growapproximately 5 percent a year in the future.

Mass health is both necessaryand insufficient

Explaining this continual growth in drugs, diagnoses, costs, and in-securitycan take many forms.One keyapproach involves following the moneyand tracing connections between the profits of pharmaceutical companies and disease expansion. Even though the fdAhas probably the safest regulatory standards in theworld, it also controls the largest mar-ket in theworld. So the incentives to cheat are staggering

Diabetes is regularly invoked as a paradigmatic template for many conditions that were previously not thought of as illnesses.The older notion and examples of chronic illness are not gone; these notions co-exist, and we are quite good at inhabiting and switching between the paradigms. But the new notion of illness is more prevalent because it is now promoted to us in advertisements and in awareness campaigns throughout ourdaily life.

Because they see clinical trials as investments, pharma companies start with the question of how to research a treatment so it can be in-dicated for the largest possible market.Theydo this because they mea-sure thevalue of clinical trial research via the total numberof potential treatments that can be sold over the patent life of the drug.This has a numberof consequences

One may experience discomfort in the face of profound human differ­ences, some of which challenge our cultural notions of the "normal" and the "ethical." But to attribute "sameness" across vast social, economic, and cultural divides is a serious error for the anthropologist, who must begin, although cautiously, from a respectful assumption of difference.

A second goal of this discussion is rather more abstract and theoretical. It represents an attempt to forge a dialogue between competing views of maternal thinking and practice. My analysis and findings challenge the psychological infant attachment and maternal "bonding" theorists and those cultural feminists who argue for a singular conception of women's goals, interests, and moral visions. I am referring to those who emphasize an essentially "womanly" ethic and ethos of maternal responsiveness, atten­tiveness, and caring labor.

I am not arguing that mother love, as we understand it, is deficient or absent in this threatened little human community but rather that its life history, its course, is different, shaped by overwhelming economic and cultural constraints. And so I trace the gradual unfolding of maternal love and attentive, "holding" care once the risk of loss (through chaotic and unpredictable early death) seems to have passed. This discussion is embedded in an examination of the cultural construction of emotions, and it attempts to overcome the distinctions between "natural" and "socialized" affects, between "deep" private feelings and "superficial" public sentiments, between conscious and unconscious emotional expressions. In its attempts to show how emotion is shaped by political and economic context as well as by culture, this discussion can be understood as a "political economy" of the emotions.

I called for help because the rest wouldn't come and Lordes' s insides had gone slack. The old women were gathered around the baby now, tying it up in scraps of satin, ribbon, and torn lace. So little I could not look. Outside, Va ldimar's shovel again scraped against rock. My hands forced down on her soft belly, while Antonieta tugged. Lordes' s mout h was still open, but no sound emerged as the rest finally slid out. I took it up in my hands, whole, yet still in parts where it folded in toward the center, and handed it to the old women, who wrapped it in a cloth, cleaner than what we had used to stop up Lordes's bleeding, and they passed the placenta through the opening to the waiting Va ldimar. As if he were the fat her, so tender he was for he

Etic perspectives refer to explanations for behavior by an outside observer in ways that are meaning-ful to the observer. For an anthropologist, etic descriptions typically arise from conversations between the ethnographer and the anthropological community. These explanations tend to be based in science and are informed by historical, political, and economic studies and other types of research. The etic approach acknowledges that members of a culture are unlikely to view the things they do as notewor-thy or unusual. They cannot easily stand back and view their own behavior objectively or from another perspective. For example, you may have never thought twice about the way you brush your teeth and the practice of going to the dentist or how you experienced your teenage years. For you, these parts of your culture are so normal and “natural” you probably would never consider questioning them. An emic lens gives us an alternative perspective that is essential when constructing a comprehensive view of a people.