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173 Politics and Medical Progress Early development of the cochlear implant was motivated by scientific curiosity, by desire to help people whose loss of hearing caused them suffering , by dreams of vanquishing deafness. Progress then depended crucially on developments extraneous to the field: the emergence of microelectronic components and biocompatible materials, political interest in artificial organs, the increasing familiarity of the idea of an “implant.” The implant’s early years were marked by a variety of competing designs, each based on a distinctive set of assumptions about its functioning and its intended function . Despite professional skepticism, despite insistence that design of an implant had to be based on thorough scientific understanding, despite disputes regarding the readiness of the technology for use with patients, it was clinical success that attracted attention in the early years from colleagues as much as from the mass media. Cries of “caution” from basic researchers notwithstanding, House’s early successes with a simple implant aroused the interest of clinicians in many countries, as well as of potential manufacturers . As interest and commitments grew, networks were extended and FDA approval was secured. New manufacturers entered the field, and they began both to collaborate in establishing a market and to compete for domination of it. Convinced of the economic potential of this innovative technology, governments too played an important role. The Australian government brokered the collaboration between Clark’s university research group and the Nucleus medical technology company. Seeing this as a field in which French technology could prove itself, the French government similarly provided support for Chouard. As the technology matured, the initiative passed from the early surgeon-entrepreneurs to industrial corporations, competing for shares of a growing market. Further innovation then took place largely in Chapter 7 174 the artificial ear their laboratories, in collaboration with networks of medical centers using their products. Neither a theorist of innovation nor an historian of technology would find anything surprising in such an account. It shows the emergence and functioning of a “distributed innovation system” involving hospitals, laboratories, and manufacturers such as economists have found to be characteristic of innovation in the field of medical devices more generally. It shows the triumph of determination, an unwillingness to be thwarted by the fainthearted, evergrowing numbers who have been helped, the evolution of the implant from esoteric device to global product: precisely the history that innovators want to see written and, not infrequently, write. Accounts like this are part of the culture of all medical (or scientific) specialities. They are also part of the common culture: resources to be used politically and socially. Precisely because of the way it resonates with the countless other such stories that form our picture of medical progress, an account like this is in course of becoming the dominant and familiar history of the cochlear implant. Because of the familiarity of such accounts, because of their hopefulness, they provided the template on which media accounts of the “bionic ear” were almost always based. And these media accounts, in turn, played a vital role in making cochlear implantation possible. Whether in search of research funding in France in the 1970s, of support for local implant programs in 1980s Britain, or of potential patients in the Netherlands or Sweden, pioneers all turned to the local press and television. Encouraging people who had already been implanted successfully to tell their stories in public was a vital part of each of their strategies. The publicity they received, the headlines such as the French “Victory over total deafness” or the Dutch “Deaf woman amazed to hear sounds again after implantation” (that initially drew my attention to the implant) helped surgeons secure the resources and the patients they needed. With their tendency to present developments in biomedicine as “breakthroughs ,” the mass media arouse the hopes and expectations of people for whom current medical practice can do little or nothing. Stories like these, the sense of history on which they are based, and widespread faith in that history provide medical science with a vital resource. It is not, however, the only history of medical innovation that can be written. Some anthropologists have found their ethnographic work led them to “unsettle” the scientists and clinicians they studied, and that the hierarchical relations between the ways in which illness is known and understood justified their doing so. Something similar can be said of the writing of medical history.1 In this final chapter, I propose to sketch out a...

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