There has been a continuing and growing interest in critically reflecting on historical and contemporary perspectives of medical research practices and ethical processes. In The Experiment Must Continue, Melissa Graboyes contributes to this literature with lessons of caution. Guided by her own background in public health and history, and drawing on archival research and ethnographic fieldwork in Tanzania, Graboyes discusses key aspects of medical research and the challenges of everyday ethics in the field. Detailing medical research in East Africa from 1940 to 2014, the book ‘speaks to the potential misuse of people, historically and in the present, and asks hard questions about why we do medical research, at what cost, who benefits, and whether those benefits are worth the risks we ask some people to bear’ (p. xxi).
A range of medical research is discussed, including lymphatic filariasis elimination attempts, a tuberculosis drug trial, a male circumcision trial and malaria interventions. The book is divided into sections, each dealing with a part of the process of research: from perceptions of medical research, the arrival of researchers into an area, the conduct of research and recruitment of participants, to finalising research and the remnants of what is left behind after field research is completed. Graboyes deftly illustrates these aspects by juxtaposing historical and contemporary vignettes of research experiences before discussing the implications and highlighting cautionary lessons that emerge from the analysis. Presenting the material in this way illuminates the continuities of adverse research practices over time, and, providing historical depth to contemporary practice, how previous experiences continue to shape responses to medical research.
Throughout the book, disparities become evident, some of which echoes other work in this area. Firstly, there are deviations between formal research practices and processes and the realities of translating these into practice. Secondly, there are divergences between the researchers’ and participants’ perspectives on the research itself. Yet on reading the book, further contradictions also become evident. On the one hand, Graboyes discusses how the provision of additional medical treatment through the research can be beneficial to participants’ response to the medical research. On the other hand, she later cautions against the blurred line between treatment and research, describing risks of coercion through ‘an offer that is too good to turn down, and thus inhibits truly voluntary participation’ (p. 115). This contradiction, grappled with in the middle of this book, adds an additional layer of dilemma and further highlights the complexities of doing medical research and ethics.
The scope and breadth of medical research in East Africa today is vast. This book provides a timely reflection on previous medical research encounters in East Africa and adds to anthropological literature critiquing historical and contemporary medical interventions more broadly. The historical ethnographic analysis raises important lessons to be learnt from previous research endeavours, lessons that, as the material in this book illustrates, are unfortunately all too often overlooked. The discussions on past research encounters remain relevant with the findings applicable to research today.
A further aspect of the book that is therefore of particular interest given the subject of the book is in fact in the preface, where Graboyes writes a reflexive account of her own experience of fieldwork; of the methods she used for collecting data and her reflexions on negotiating ethics in the field. Some readers may want to read more about these processes, as this account provides an immediacy of the impact and realities of the subject matter of the book.
Covering a lot of ground, this book provides an insightful analysis of some of the social consequences of conducting research. While providing a critique of medical research endeavours, Graboyes work also demonstrates an approach to research that engages in this critique. Methodologically, therefore, the book invites reflexivity in research methods and ethics. This book, relevant for people interested in the history of medical research and interventions in East Africa, is especially valuable for those embarking on research in East Africa and elsewhere. While the book focuses on medical research, with the expanse of transnational research in other fields, the lessons from the analysis bear resonance to research practices more generally.
