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Technology, Medicine, and Modernity 297 herbs are taken to laboratories, analyzed for pharmaceutically active agents, and converted into drugs, usually with no royalties to the local medical tradition. Rather, biomedicine has moved more directly to incorporate whole CAM systems. A somewhat more detailed discussion of the incorporation of CAM may provide a clearer picture of the process that the third framework brings to attention. As I have found out in my long-term fieldwork in the CAM cancer community, in the late 1990s several of the major conventional cancer hospitals in the United States opened CAM clinics in order to meet patient demand for CAM cancer therapies. Likewise, some of the major oncology practices have moved to offer “integrated” or “compre- hensive” cancer care. On the one hand, the event of integration represents a victory for the social movement that called for more access to the less toxic cancer treatments associated with nutritional and mind-body therapies. Likewise, CAM providers have become increasingly mainstream as they have won licensing rights and insurance reimbursement, and with the advent of CAM clinics in conventional cancer hospitals, CAM providers are even gaining a foothold within the establishment. However, the appar- ent victories are also accompanied by limits on the scope of practice and status deprivation to the level of auxiliary health-care providers similar to nurses, dietitians, or physical therapists. Furthermore, the integration process selects CAM therapies that complement conventional medicine rather than provide alternatives to it; indeed, one major American cancer center now offers “CIM” therapies (complementary and integrative medicine) because it rejects “alternatives” to conventional therapies. The colonization of a social movement that I have witnessed during the past five years is familiar to students of the other science and technology- oriented social movements (see, e.g., Mol’s essay in chapter 11). Over time, grassroots activism has become increasingly institutionalized, and the social movement has fragmented as sectors have become increasingly integrated into the frameworks of former opponents. In the environmental movement, some organizations have become increasingly moderate, while the corporate sector has moved toward corporate greening initiatives (Jamison et al. 1990; Hajer 1996). In the AIDS movement, pharmaceutical companies have increasingly influenced patient advo- cacy organizations, which themselves have undergone a fragmented 6641 CH10 UG 9/12/02 6:21 PM Page 297 298 David Hess “expertification” process (Epstein 1996), and in the alternative energy movement, corporate resistance gave way to a strategy of incorporation and integration (Jørgensen and Karnøe 1995). In those and other cases, capital has played a strong hand in selecting which aspects of the social movement will grow and become prominent. Regarding the more general problem of technology and modernity, the political economy framework focuses attention on the question of which technological systems (or in the case of CAM discussed here, which therapy-practitioner systems) will survive in the wake of innovation driven by production for profit. The dynamics of capital expansion create new products and markets that threaten the extinction of some material entities and their accompanying social roles. Either via democ- ratic or nondemocratic means, and often after contributions from many communities, societies will decide that selected entities in the material culture and environment should exist and therefore must be protected, even if the expansion of the market would mandate their extinction. The resulting entity, the “protected entity,” is understood here to include technology as well as material and spatial culture that is protected by building codes, zoning restrictions, wilderness preserves, and animal treatment codes. 10 States and international organizations have increasingly been called upon to protect endangered entities, including technologies or desirable features of technology design, that otherwise might be swept away by the tides of technological innovation guided by the profitability concerns of global capital. Although protections may cover whole categories of entities (a wilderness preserve, a species, wind tur- bines, food supplements), they may also extend to design features that are protected parts of commodities. One example is the proliferation of safety regulations surrounding the design and use of consumer products, transportation vehicles, drugs, biotechnologies, workplaces, databases, guns, and food that permit or prohibit the movement of such commodities across national or regional trading boundaries. Another example is the emergence of privacy concerns around new information technologies, and the increasing demand for the protection of privacy through software designs (see Lyon, chapter 6 in this volume). The political side of the “political economy” framework for analyzing technology and modernization draws attention to modernization as a 6641 CH10 UG 9/12/02 6:21 PM Page 298 Technology, Medicine, and Modernity 299 process by which the regulatory laws of states and international organizations, together with voluntary standards set by international industrial and professional organizations, slowly redefine commodities as entities that are no longer mere products for markets. Commodities become protected entities whose existence is ensured by a code that at its best al- lows the perspectives of various types of communities to constrain the pure free play of market-oriented product design and innovation. In short, production for profit becomes encompassed by a broader logic of production to standards. The commodity is therefore enmeshed in a complex, historical process, and I would suggest that the transformation of gift into commodity is not the central issue for a political economy of technology, even one of anthropological scope. Rather, regulatory law takes back some of commodity from the market by subjecting it to a double standard; not only must the commodity be profitable in the world of markets, but it must meet the legal standards of a regulatory code. Yet, regulatory law does not restore the gift to the commodity; no circle is formed. Capital reasserts itself in the battle over the structure of regulations. For example, the licensing of CAM providers may protect some of the local culture in the wake of biomedical hegemony, but such licensing also involves putting limitations on the CAM system and provider that locate it in a nondominant position within the medical field. One might argue that globalization works against regulation, that international competitiveness drives deregulation, just as it has caused the dismantling of costly welfare states, and that the regulatory process is not as deeply interwoven in the globalization process as is suggested here. However, this argument misses the modernization process that regulatory law is itself undergoing. Increasingly, the regulations of states are being supplemented by international standard setting in processes that entail participation from NGOs and some concern with issues of general good (Feng 2002). Globalization does not imply the wholesale dismantling of regulations and standards as much as their harmonization among nation-states, and the harmonization process itself involves the complex articulations and negotiations that are suggested here. Reg- ulation is necessary for capitalism to function, but it is also the doorway through which community can be redesigned into commodities. 6641 CH10 UG 9/12/02 6:21 PM Page 299 300 David Hess Conclusions The problem of technology and modernity as conceptualized here is not merely an analytical and descriptive one, but a deep normative question about the kind of global material-social world that should be co-constructed. The three frameworks presented here draw on different social theory traditions to direct attention to problems that require both empirical research and normative debate. The goals of sustainability, equality, and community emerge as three major criteria that provide viable points of reference for a general discussion of technological and social redesign (see Feenberg 1995; Fischer 1995; Sclove 1995; Van der Ryn and Cowan 1996; Lerner 1997; Rothschild 1999; and Schot, chapter 9, this volume). However, the goals bump up against each other and provide reference points for a triangulation of criticism. For example, communities can be full of particularistic and antiegalitarian social relationships, or they may have unsustainable ecological practices. Likewise, greening initiatives can be economically costly in ways that threaten communities or enhance in- equality. Concerns with democracy, equality, and human rights can be discussed in a language of the individual that ignores concerns of community or sustainability. Consequently, the three goals provide checks on each other for a political discussion that must be anchored in specific cases. In many if not all the technological fields, one can locate a set of complementary and alternative technologies, a CAT sector that is similar to the CAM sector described here for the case of medical pluralism. In the transportation field, there are bicycles, greenways, and public transportation systems; in the energy and chemistry field, renewable energies and alternatives to chlorine-based chemicals; in the waste-processing field, biological sewage treatment and recycling programs; in the agri- cultural field, organic farming and multicropping; in the computer field, privacy software and open-source systems; in the architecture and urban design field, feminist, community-oriented, and green design; and so on. Often, but not always, the alternatives can be constructed in ways that do not put the normative criteria in a zero-sum relationship. Yet even when that is achieved, the alternatives remain alternatives because they are not as viable from the perspective of the market. Consequently, the 6641 CH10 UG 9/12/02 6:21 PM Page 300 Technology, Medicine, and Modernity 301 state and, increasingly, nongovernmental organizations, are needed to intervene and guarantee the existence of alternatives through regulations and standards. When social movements mobilize to reconstitute complementary and alternative technologies as protected entities, the success of such political action usually occurs at a cost. A selection process operates on both the technologies and the movement organizations so that the complementary technologies are favored over the alternatives, just as the ac- commodationist organizations are favored over more radical voices. Integration leads to division as social movements are captured, old friendships and the sense of movement community are shattered, and manifestos are translated into partial policy victories. I have watched the process occur to some degree in the CAM cancer therapy movement in the United States during the 1990s. Yet, recognition of the reality of partial integration through incorporation should not lead to the paraly- sis of inaction. Instead, recognition merely highlights the process by which a new generation of social movements must be continually cre- ated within a new technological field with new contours of conventional and complementary and alternative technologies. In some cases and on some grounds there is progress. Notes 1. This definition would require splitting off other types of instrumental social action, such as psychotechnologies or social technologies. The definition was de- veloped in part in conversations with Torin Monahan, a doctoral student at Rensselaer who is working on a practices-oriented approach to technology (Monahan 2000). Some of the ideas presented here are discussed more completely in my electronic volume, Selecting Technology, Science and Medicine: Al- ternative Pathways in Globalization, Volume 1, at Ͻhttp://home.earthlink.net/ ~davidhesshomepageϾ. 2. The research also includes a book of interviews with women leaders of the complementary and alternative cancer therapy movement in the United States coauthored with Margaret Wooddell (Wooddell and Hess 1998). For a quanti- tative documentation of the extent of CAM in the United States, see Eisenberg et al. (1998). I borrow the term “field” from Bourdieu (1991), without necessarily accepting other aspects of his framework, such as the near absence of a political analysis of technological design. 6641 CH10 UG 9/12/02 6:21 PM Page 301 302 David Hess 3. I use the term “cultural ecology” loosely to refer to a variety of programs that can be distinguished more properly as cultural ecology, historical ecology, political ecology, and the new ecology (Biersack 1999). 4. The possibility that apparently noninfectious chronic diseases may turn out to be infectious has become more evident since the revision of the etiology of gas- tric ulcers in the early 1990s. On the infectious tradition for the treatment of cancer, see Hess (1997). 5. The formulation in this paragraph draws on the social theory research tradition that includes DaMatta (1991), Dumont (1986), Parsons and Shils (1951), and Weber (1978), as well as Habermas (1989) and his critics (e.g., Fraser 1989: chap. 6). 6. See Martin (1994) for a more general discussion of flexibility in the economy and the health field. 7. “Universal” design is never completely universal, in the sense of being applicable to everyone, but the principle is to redesign technology and material culture so that they are accessible to a wider number of users. Examples include easy- grip tools and buildings with ramp access rather than steps. Material culture maintains hierarchical social distinctions (e.g., older people with arthritis, people in wheelchairs), and universal design is intended to mitigate those distinctions by making one design that is applicable to different social categories. 8. The problem is further complicated by the fact that some of the features of the gold standard of clinical research design have built-in biases in favor of conventional, pill-oriented medicine. For example, it is difficult if not impossible to provide double blinds and placebo controls for dietary programs. The more one looks at the design problems for clinical trials of CAM therapies, the lumpier the image of a “level playing field” becomes. 9. As Baer (1989, 1995) and others have recognized, the term “pluralism” sug- gests an equality of actors that is misleading; rather, the structure of the diver- sity of medical fields is hegemonic, and biomedicine is the dominant healing system in almost every society in the world. 10. This approach differs somewhat from the European actor-network theory (Callon 1995), from which I borrow the term “entity,” in that I would maintain as desirable the normative distinction between humans and things (see Pickering 1992). The law distinguishes between the rights of humans and the protections of things, but increasingly it must grapple with the conflict between the two goods. 6641 CH10 UG 9/12/02 6:21 PM Page 302 For decades, environmentalists and their theoretical interpreters had a rather clear and undisputed position toward modernity and the project of modernization. Just 20 years ago the Dutch environmental sociologist Egbert Tellegen (1983) identified the common denominator of environmental movements around the world as their antimodern ideology. En- vironmentalists of the time, with their many distinct theories and practices, and widely varying tactics, shared an antimodern attitude. Whether they were small-is-beautiful adherents, Club-of-Rome critics, neo-Malthusians, or neo-Marxists, these environmental movements seemed united in attacking the basic institutions of modernity, such as capitalism, industrialism, modern science and technology, and the bureaucratic nation-state. In the past two decades, however, the attitudes of environmentalists toward modernity and modernization have changed dramatically. The landscape of “green” positions and ideolo- gies toward modernity has become far more complex, ranging from de- modernizers or antimodernists, through various kinds of modernists (including neo-Marxists) to postmodernists. If anything, we can con- clude that compared with the 1970s and 1980s, environmentalists have become more modernist or at least less hostile toward modernity. During the past two decades as well, social scientists and social theorists have identified the environment as one of the “battlegrounds” for understanding the changing character of modernity. While for a long time environmental studies flourished only at the margins of many social science disciplines, such major figures in sociology as Anthony Giddens, Zygmunt Bauman, and Ulrich Beck have recently focused on 11 The Environmental Transformation of the Modern Order Arthur P. J. Mol 6641 CH11 UG 9/12/02 6:22 PM Page 303 304 Arthur P. J. Mol environmental issues. A similar upsurge of academic activity can be seen in environmental history and environmental philosophy. This upsurge of interest was of course partly inspired by the reappearance of environmental issues on the international public and political agendas in the late 1980s and early 1990s. In addition, it has become clear that re- sponses to environmental concerns, at many levels, have begun to change the basic institutions of modern society. This chapter deals with this shifting relation between modernity and environment. More precisely, it explores how environmental considera- tions and interests are contributing to the transformation of modernity. I start with a brief overview of the major schools of thought in academic environment and modernity studies. Then I elaborate one specific perspective, ecological modernization, which spotlights the social transformation processes and dynamics concerning environmental questions. Next, I use this perspective in showing how environmental considera- tions are reshaping the business strategies of chemical producers and consumers. Finally, I examine sectoral and national variations in the environmental transformation of the modern order. Modernity and the Environment: An Overview Scholars in environment and modernity studies can be grouped into four schools of thought: neo-Marxists who especially criticize the capitalist ordering of the modern economy but not necessarily modernity itself; scholars who are rather critical toward modernity and modernization processes (demodernization or counterproductivity adherents); scholars who argue that modernity has been changed beyond recognition (postmodernists); and scholars who stress the significant changes of modernity’s institutional order (reflexive modernization theorists). Neo-Marxism as Modernization In the 1970s, neo-Marxist studies of the modern capitalist economy were particularly influential in bringing to light the origins and logic of the environmental crises. Focusing attention on the internal economic contradictions of capitalism, neo-Marxist environmental sociologists such as Ted Benton, Peter Dickens, Allan Schnaiberg, and James O’Connor 6641 CH11 UG 9/12/02 6:22 PM Page 304 The Environmental Transformation of the Modern Order 305 analyzed the end of the capitalist economic order, as it would jeopardize the resource base of the production and consumption treadmill. These scholars combined the idea of aggressive global expansion of the capitalist economy with the continuing and intensifying (global) environmental crisis to formulate a hypothesis about the “second contradiction of capitalism”: the economic growth and expansion inherent in the global capitalist economy will run up against environmental boundaries that will in the end upend and transform the global capitalist economic order beyond recognition. In their analyses of the modern environmental crises, neo-Marxists were keen to focus on the capitalist economy rather than on modernity as a whole. In contrast to their critical views on the capitalist market economy, these neo-Marxists maintained that the modern bureaucratic state, modern science and technology, and modern norm and value systems were important elements of a sustainable society—only under different (noncapitalist) relations of production. In this sense these neo- Marxist environmental sociologists were modernists. Yet even among neo-Marxists today, there persists disagreement about the environmental consequences of (global) capitalism and the repercussions of the environmental crisis on global capitalism. A leading American neo-Marxist, James O’Connor (1998: p. 235), recently con- cluded that, “a systematic answer to the question, ‘Is an ecologically sustainable capitalism possible?’ is, ‘Not unless and until capital changes its face in ways that would make it unrecognizable to bankers, money managers, venture capitalists, and CEOs looking at themselves in the mirror today.’” Peter Dickens, a renowned European neo-Marxist, has a more balanced assessment (1998: p. 191): “According to this second contradiction argument, nature will continue to wreak ‘revenge’ on society as a result of capitalism. Several related questions remain, however. First, will capitalism be able to restructure itself once more, this time in the form of what has been called, ‘ecological modernization’?” Leff takes the discussion of ecological modernization one step further. From a neo-Marxist perspective, he initially resists simply incorporating environmental concerns into global capitalist development (through standard economic means such as the internalization of externali- ties), but finally reaches the conclusion that an environmentally sound 6641 CH11 UG 9/12/02 6:22 PM Page 305 306 Arthur P. J. Mol development is not “totally incompatible with capitalist production” (Leff 1995: p. 126). Demodernization and Antimodernization Perspectives Scholars adopting demodernization and antimodernization perspectives, often building on neo-Marxist analyses, also focus on contradictions in the capitalist economic system. If these demodernization scholars depart from neo-Marxist perspectives, it is because they claim that neo-Marxist analyses are incomplete. A group of counterproductivity theorists have criticized neo-Marxist analyses from a “radical” demodernization perspective (Spaargaren and Mol 1992; Mol 1995). These authors include Murray Bookchin, Ivan Illich, the later André Gorz, the earlier Rudolf Bahro, Otto Ullrich, Wolfgang Sachs, and Hans Achterhuis, and their ideas have resonated throughout the environmental movement from the 1970s to today. Otto Ullrich (1979), for example, in his book Welt- niveau, criticized Marxists for their preoccupation with the social relations of production, and their corresponding inattention to the forces of production. In Ullrich’s view, the analysis of environmental crises ought to incorporate the “myth of the great machine” embodied in the organi- zation of the industrial system, to understand why the effects of the system of production are contradictory to the goals for which it was designed. The industrial system is minutely administered, Ullrich argued, in an ever more centralized, hierarchical way, which reflects the impera- tives of the technical systems that are omnipresent in the system of production, but that are no longer adapted to the demands of humans and nature. The solutions that demodernization or counterproductivity theorists advocated did not emerge from an analysis of existing tendencies in con- temporary society. Most scholars in this tradition agreed that we were and still are moving further into modernity, creating catastrophic side effects. The core of the demodernization ideas focused rather strongly on the normative and prescriptive analyses of the changes and transfor- mations necessary to maintain society’s resource base. What the normative stances of demodernization theorists have in common with environmentalists in the modern traditions (discussed later) is their call for upgrading environmental criteria and introducing environmental 6641 CH11 UG 9/12/02 6:22 PM Page 306 [...]... realism become the greatest This is also the point where debates on modernity and postmodernity often lose their way in a nihilistic type of relativism (see Lyotard 1 984 a, 1 988 , 1993; Derrida 1 981 , 1 988 ; Rorty 1 989 ).3 One way out of the impasse is to take the idea of freedom as a key feature of technology, modernity, and development (Sen 1992, 1999; Khan 19 98) As we will see, we are by no means free... historicity and social construction of the very idea of the “safety bicycle” in the Technology, Modernity, and Development 329 nineteenth century during a protracted process of problem formulation, stabilization, and (social) closure Thus, they point out: The “invention” of the safety bicycle was not an isolated event ( 188 4), but a nineteen-year process ( 187 9– 98) For example, at the beginning of this period the. .. in these concepts a visceral response to modernity both in the West and in the East Technology, Modernity, and Development 331 Yet what is often lost in the intense heat of such debates is the intuition that the notions of technology, modernity, and development all have to do with enhancing a complex sort of freedom It is only through clarification of the meaning of freedom and its connection with the. .. details: They were taken for granted as the essential “ingredients” of the safety bicycle (Pinch and Bijker 1 987 : p 39) If technology as a theoretical term and its empirical correlates are thus shown to be socially contested and constructed over significant time intervals, the connections between technology and modernity are twice problematized In the first place, the ensemble of attitudes and institutions... some analysis of the theoretical connections among technology, modernity, and development in a nonwestern context The discussion here is intended to suggest some methodological aspects of connecting theories of modernity with empirical approaches in the context of technology and development Of particular significance are the modern and postmodern aspects of technological development in the newly industrialized... How does one give the study of technology, 3 28 Haider A Khan modernity, and development an “empirical turn” under such circumstances? Reflection on this question soon leads to another How does one offer a theory of technology, modernity, and development so that correct empirical applications are indeed within reach? Therefore, the first task is to take seriously the tensions within the theoretical terms... see the “safety bicycle” but a wide range of bi- and tricycles and, among these, a rather ugly crocodilelike bicycle with a relatively low front wheel and rear chain drive By the end of the period, the phrase “safety bicycle” denoted a low-wheeled bicycle with rear chain drive, diamond frame, and air tires As a result of the stabilization of the artifact after 189 8, one did not need to specify these... increasingly able consciously to reflect on the premises of their own and others’ commitments and knowledge claims.” However, Beck et al (1994) acknowledged the possibility of an automatic and blind reflex For Beck, risk societies are led by the riskiness of large-scale chemical, thermonuclear, and other technologies to an abyss beyond calculability If reflexive modernity is limited in this way to a nonpredictive... to explore the connections between this approach and reflexivity as a socially embedded relation In the next section I critically discuss the relationship among technology, growth, and development in the context of reflexive modernity and reflexive development Technology, Modernity, and Development: Refractive Reflexivities Ulrich Beck’s (1992) contrast of a “simple modernity with reflexive modernity has... for the future, there is a new “grand narrative” in the making When formulated in this way (de Ruiter 1 988 ), it becomes clear why postmodern authors are among the fiercest critics of modernist approaches to environmental problems They see many schemes for dealing with environmental problems, as remnants of the old modernization theories that dominated the 1950s and 1960s and as an extension of the much . those and other cases, capital has played a strong hand in selecting which aspects of the social movement will grow and become prominent. Regarding the more general problem of technology and modernity, the. the late eighteenth century, Great Britain and later Germany took over in the nineteenth century. Today, the United States, Germany, the United Kingdom, Japan, Italy, Switzerland, and the Netherlands. imply the wholesale dismantling of regulations and standards as much as their harmonization among nation-states, and the harmonization process itself involves the complex articulations and negotiations

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