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133 In this appendix, I describe my methodological orientation and debts, the practical methods used to collect the data used in this book, and the data itself. I conclude with a section noting my own place in the communities that took me in, taught me, and offered up professional and personal experiences for this proj­ect. Methodology This proj­ect is an inductive, qualitative, comparative study of the plurality of biomedicine (Kleinman 1995) that used an inductive “grounded theory” approach to producing and interpreting so­cio­log­i­cal knowledge from interview data. In grounded theory, data collection tools are continually reevaluated and redeveloped throughout the collection pro­ cess (Charmaz 1983, 1990, 1991; Glaser & Strauss 1967; Lofland & Lofland 1984; Strauss 1987). As a comparative, case-­based study, it relied on data from a variety of sources, including themes and categories emerging from ­ these interviews, to generate a clearer understanding of the relationship between biomedicalization, globalization, biomedical practice, and context. Grounded theory can mean many ­ things. ­ There are three major approaches to grounded theory to choose from, not to mention a variety of alternative approaches (Miller & Salkind 2002). Even among the three best-­recognized approaches, ­there remain significant differences in epistemological commitment and assessment of methodological rigor. Of ­ these three, the most rigid approach embraces a systematic design, with prescribed data analy­sis steps that include open coding, axial coding, selective coding, and fi­ nally the production of an explicit, visual repre­ sen­ ta­ tion of the theory generated (Strauss & Corbin 1990; Miller & Salkind 2002). The more flexible emerging design formed as a critique of this rigid procedural approach. Glaser (1992) emphasizes that the point of grounded theory is to allow categories to emerge from the data, rather than to rely on preconceived categories and constantly submit to rigid procedures. A third and final approach, constructivist design, rejects clearly delineated analytical stages, diagrams that “obscure” experience, and overdetermined theoretical constructs (Charmaz 1990, 2000; Miller & Salkind 2002). My approach was closest to that of Charmaz (2000) or Lamont (2000), but combines ele­ ments of all three of ­ these variants. Though the size and linguistic complexity of my data led me to rely on a methodical approach ­ toward organ­ izing and analyzing, including open and axial coding along the lines of Strauss and Corbin (1990) for the first 143 interviews, I believe that the flexible, interpretive approach of Charmaz (1990, 1991, 2000) is more sensitive to the subjective experience of participants. To the extent pos­ si­ ble in a proj­ ect with a single researcher for hundreds of participants sharing their ideas in two languages, I attempted to emulate Charmaz’s close attention to Methodological Appendix 134 Methodological Appendix the subjective meanings shared by participants and rejection of obscure language and theoretical constructs (Charmaz 1990; Miller & Salkind 2002). I subscribe to the claim that a good analy­sis and ensuing theory ­will “fit the realities in the eyes of participants, prac­ti­tion­ers, and researchers” (Miller & Salkind 2002). Methods Before beginning the interview pro­cess in the Japa­nese field sites, I interacted with health care providers, patients, and the laypeople I interviewed in unstructured encounters outside the context of the interview, which many participants in Japan treated as a formal occasion. I shared offices with physicians and shadowed them on their rounds and clinic hours for several months. I sat in nurses’ stations and chatted over lunch. I attempted (unsuccessfully) to make myself useful at the reception desk of a busy suburban hospital, and wore a sash as a greeter in waiting rooms, giving directions to patients seeking a par­ tic­ u­ lar clinic or ward. I participated in diabetes education classes and clinical examinations, seeing the same patients week ­after week ­until we ­ were fixtures in one another’s schedules. I had the point system and the financial organ­ ization of the Japa­ nese health care system explained to me countless times by medical administrators and se­ nior physicians gravely concerned about the ­ future of Japan’s unique health system. Participation in and observation of the “natu­ral discourse” of physicians and patients was especially impor­ tant ­ because interviews alone are less constrained by the realities of actually working with patients. They thus allow physicians and other biomedical professionals to talk about medical practice in a “more abstract or idealized fashion” (Loewe & Freeman 2000). In this proj­ect, interviews ­were “time-­out” moments where physicians and patients could pres­ent idealized depictions of the patient-­provider relationship and their own...


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