On Knowing and not Knowing 'Life'

On Knowing and Not Knowing “Life” inMolecular Biology and Xhosa Healing:Ontologies in the Preclinical Trial of a SouthAfrican Indigenous Medicine (Muthi)

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Seemingly distant practices of molecular biology and indigenous Xhosahealing have commonalities that I would like to bring into conversation in thisarticle. The preclinical trial of an indigenous medicine brings them together ina research consortium. In this instance, both sets of experts are meant tocollaborate in preparing a wild bush for it to pass the tests of the randomizedclinical trial (RCT) and to potentially become a biopharmaceutical to counterthe tuberculosis pandemic. I aim to tease out how the two sets of actors andtheir respective practices converge and diverge in their healing hopes and waysof managing uncertainty. Ultimately, I am interested in understanding howthe preferred process of making medicine “work” by each set of actors reliesupon particular ways of knowing and not knowing life, bringing someontologies into being, letting others wither away. The shared ways of knowinglife as a movement of opening at the edges of the RCT are proposed as pathsof recognition between one and the other practice.k e yword s : life, clinical trials, indigenous medicine, molecules, Artemisia afra

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i n troduct ion

Life, in short, is a movement of opening, not of closureTim Ingold 2011: 4

Anthropology of Consciousness, Vol. 25, Issue 1, pp. 1–31, ISSN 1053-4202, © 2014 by theAmerican Anthropological Association. All rights reserved.DOI: 10.1111/anoc.12018

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Molecular biologists and Xhosa izangoma1 involved in the preclinical trial ofan “indigenous medicine”2 shared preoccupations with knowing life in thehope of healing. It is through knowing life at the macromolecular level thatthe former partook in the process of developing a lifesaving biotechnology;more precisely, they partook in the process of searching for molecules thatwould inhibit, control, modify, and improve human physiological life in lightof its internal bodily encounters with tuberculosis. Izangoma participated inthe trial as part of the experts in indigenous knowledge providing “hints” or a“database for potential identification of sources that may yield lead com-pounds with bioactive properties” (Ntutela et al. 2009: S34). Beyond this,izangoma know life more broadly through intensifying their abilities toconnect in the medium or “open air.”3 The life to be known, inhibited, con-trolled, modified, and improved is “qualified” and undifferentiated from bio-logical life.4 Izangoma aim for a change in configuration in bodily processesthrough enhanced connections in the medium. Molecular biologists know,and can represent, molecular configurations in detail in individual cellswithin a controlled laboratory environment. Uncertainty prevails in one orthe other practice depending on the domain of expertise, whether by notknowing microscopic details in the first case or by not knowing the mediumoutside the laboratory in the second. Ultimately, the RCT was the researchmodel and legal instance that will decide upon the safety and efficacy of themedicine for it to fit global health networks. I argue that the RCT processbeholds yet another way of knowing and not knowing life; a notion of lifethat holds a promise of closure or at least temporary consensus through dem-onstration of a method to eradicate a disease by finding the proper molecule,while the two experts rather share a notion of life as a movement of openingor revealing paths along which it can continue (Ingold 2012). This movementof opening is further enhanced in the preclinical trial under study because inpractice it aimed to test a whole plant and its molecular synergies rather thanisolating a molecule. An interest in the “chemistry of life” by molecular biol-ogists further correlated with the work of izangoma. Notwithstanding thiscommonality, molecular biologist expertise currently benefited from the high-est legitimacy within the RCT while isangoma expertise, which was giventhe symbolic claim of “discovering” the medicine, is currently the most diffi-cult to translate within the RCT process, if it is translatable at all.I’ll first explain the phenomenological stance in anthropology that I

adopted to address issues in knowing and not knowing life. Second, I set thecontext to the preclinical trial that led me to think there is commensurabilitybetween these two participating groups of actors and their respective prac-tices. Afterward, I delineate what these respective practices entail and howthey fit (or don’t fit) within the RCT legitimacies. Finally, I bring both sets

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of actors and practices into conversation to highlight hopes and uncertaintiesin one and the other way of knowing and not knowing life. Shared ways ofknowing life as a movement of opening at the edges of the RCT are pro-posed as paths of recognition between one and the other practices.

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know ing and not know ing l i fe

With “knowing,” I here allude to attuned attention of the body-person in theworld, coherent with the anthropological approach I apply. Not knowingthus alludes to leaving skills of enhanced engagements in the world unat-tended. In doing so, I challenge a few commonly held assumptions of knowl-edge in Western scientific thought. First, I challenge the assumption thatknowing is progressively accumulated through empirical studies in highlycontrolled laboratory environments. Such statements as “we don’t know thisyet” or “we did not know this then” usually refer to knowledge beingacquired through scientific procedures, namely experiments demonstrating acause-and-effect relation as done in RCTs. Experiment has become the high-est mode of investigating life in positivist science, a way of knowing that hasprospered from Claude Bernard’s “control experiment” in his Introduction tothe Study of Experimental Medicine in 1865 (see Bernard 1966, [1865]) andhas become familiar to generations of scientists thereafter (Pickering 2000:13).“Controls” facilitated staging an experiment to observe the operation ormechanism of interest as well as becoming a means of gaining control overliving processes (Pickering 2000; :144). In this “operationalist view of science—the ability to control was the measure of knowledge” (Pauly 1987 in Pic-kering:145). I argue this ability to control through demonstration of a proce-dure is still the measure of knowledge in empirical practices as upheld bythe RCT model. “Clinical trials have become the dominant mode by whichthe value of interventions is judged by the profession” (Mol 2002:173). Trialsmake knowledge synonymous with the outcome of an experiment. As such,RCTs generate knowledge of precise biological mechanisms and pathways ina closed environment, at the price of losing sight of their interweaving inmediums. Second, I challenge the corresponding assumption that knowingalludes exclusively to the sole ability to represent the modus operandi or amechanism as “approximated through empirical data (elicited through scien-tific methods of detached observation and objectification)” (Hsu 2010:28).Rather, both the isangoma and the molecular biologist inhabit the world inmore or less skilled ways to “know it” as they attune their attention toward or“in” life processes. This positioning in terms of “knowing” leads us to revisethe notion of perception underlying the very idea of the possibility to be ableto represent life processes from an externalized standpoint, a discussion to

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which I will return shortly. I will first situate my stance with regards to workson knowing and not knowing in anthropology.Murray Last’s 1981 seminal article alerts us to the importance of knowing

about the not knowing of both anthropologists and the people they study inimagining medical “systems.” Littlewood’s 2007 book, On Knowing and NotKnowing in the Anthropology of Medicine, takes Last’s article as its point ofdeparture. The introduction attends to the need for anthropologists to notadd coherence, or suppose pre-existing coherence, in particular with relationto health, healing, and medicine. One reason not to assume pre-existentknowledge by members of social groups and their healers is that “In theextreme case, local treatments are seen as efficacious precisely because theirmode of operation is mysterious or even unknown” (Littlewood 2007: ix).While I agree we should not add coherence or suppose pre-existing coher-ence with what people know in medicine, I disagree with how Littlewoodseems to equate “not knowing” with a lack of interest with the modus ope-randi. Such a stance assumes there is a mode of operation “out there” to be“discovered” that can be equated with knowledge. This positioning is echoedin a familiar statement made by a pharmacologist explaining that the “Use ofherbal medicines is thus, widespread in the world and in South Africa, butstill very little is known about these medicinal plants” (Mukinda 2005:12).Knowing is here clearly measured in terms of empirical demonstration ofbiological mechanisms capable of being verified or disproved by observationin an experiment. If, however, knowing is also the ability to engage success-fully with herbal medicines for healing in everyday life, as I suggest, thenknowing empirically might not be so knowledgeable in this respect. Further,if empirical studies are conducted with an herbal medicine, it is preciselybecause very much is known about its benefits as used in the everyday aswell as in sophisticated practices unraveling in healing sessions. Herbariumsdocument some of these practices together with results of laboratory studiesshowing a plant contains such and such chemical elements. Further con-trolled studies may show the plant to have some bioactive mechanisms andpathways whose actions can be described in relation to a particular disease.In all cases, there has been attuned attention to one or another aspect, or tothe entirety, of the plant either in controlled environments and/or in the“open air.” Ways of knowing medicine are thus multiple and always beingdone through new engagements in the world.This leads to a last point of clarification of my positioning concerning

empirical thought as it is currently made out to be the measure of knowl-edge. Testing theories against observations of the “natural world” in the dom-inant empirical stance relies heavily upon a particular notion of perceptionthat posits that the effects of external stimuli can be measured upon an other-wise passive body object. As such, biological bodies to be tested upon experi-


mentally are made into a passive body object simply awaiting the properstimuli or molecule to heal. I here rather endorse Merleau-Ponty’s (1945)phenomenology of perception that assumes mind and body are in continuousentanglements in their engagements in the world. In the latter notion of per-ception, there are no longer objects and mental programs preceding action;these are continuously being done through new involvements in the world.In this idea of continuous entanglements between seeing and moving, priorexperiences of seeing or knowing are always fed back through movement,making it so that we are always engaging in the world or medium in newways (Merleau-Ponty 1964). In this notion of perception, it is the activeengagement with the environment that elicits stimuli.An experiment that assumes a passive human body (or “intact” cell) upon

which to test the safety or efficacy of a molecule (or a fixed dosage of plant)thus appears as incomplete. The experiment is incomplete because it disre-gards the ongoing movement of the body in the world as well as its previousexperiences that will take part in the synergies between the person and theplant preparation or molecule in the inhabited world. The proposed phe-nomenological stance in anthropology is deemed appropriate to understandways of knowing life through both the empirical route (which implies activeengagement with the environment, even if this disappears in its results) aswell as through lived bodily experiences. It is with this approach that I aimto follow the ways ontologies are brought into being in practice.5

It is in dealing with the entanglements of people and things in the envi-ronment or in both natures and cultures that I situate my positioning. Assuch, I agree with Ingold stating that our task is not to take stock of the con-tent of assumed pre-existing entities, yet it is rather to “follow what is goingon, tracing the multiple trails of becoming, wherever they lead” (2011:14).These engagements are not preprogrammed yet are learned through doing,attuning ones attention in the world or what Ingold (2000) proposes we name“skills.” This heightened awareness or attuned attention is what I refer to as“knowing,” while “not knowing” refers to what is of lessened interest andengagement (which can apply as much to not wanting to know the mode ofoperation as to not wanting to know lived experience). This approachreverses or balances out some of the assumed hierarchies of knowledge, andit does not leave empirical knowledge intact; it is precisely the equation ofknowledge with a demonstration of the “mode of operation” as upheld in theRCT model that it dislodges (at least from its position of exclusivity as “know-ing”). The proposed approach corresponds more closely to what occurs inthe practices of the preclinical trial because the scientists (like the healers)are not completely in line with the RCT. Even in looking to standardize theplant as much as possible, molecular biologists are interested in all the com-pounds in constant interactions with the plant as well as learning from heal-


ers’ ways of using plants in the medium, thus enhancing a notion of life as amovement of opening along paths.Such a notion of life broadens a narrower notion of life as pre-existing bio-

logical pathways to determine and map out, as if life were genetically prepro-grammed independently from the inhabited world. Numerous medicalanthropologists have similarly aimed to broaden reductionist biologicalnotions such as those of disease (Young 1982; Fainzang 1989), of body (Lockand Scheper-Hugues 1990; Douglas 1996), and of efficacy (Young 1976; Nich-ter 1992), always keeping with an overarching agreement upon “true knowl-edge” as residing in the results of controlled studies. As such, they havemainly added layers of cultural, social, symbolic, and political understandingsto the core empirical data. The latter stance agrees with a modernist projectplacing cultural diversity on a background of natural universality, a backdropof One Nature in which diverse cultures play themselves out. Descola (2005)has named this ontology “naturalist”—namely Western thought, or science inits broad dominant positivist stance, equating knowledge with empiricalknowledge of “nature” as opposed to “culture.”

The point of this seemingly innocent divide is that it is a formidablepolitical ploy. The common world (of what the universe is really madeup) is known by the scientists, but invisible to the eyes of the commonpeople. While what is visible, lived, felt, is to be sure, subjectivelyessential but utterly inessential, as it is not how the universe is made up.This means that when the time comes to tackle the political work parexcellence, namely the definition of what sort of world we have incommon, scientists can say that the task is already completed as theprimary qualities are all summed up in one Nature. [Latour 2000:118]

It is the parts of Nature whose mechanisms are measured, demonstrated, anddescribed that are commonly equated with “knowing” (atoms, drugs, disease,systems, even if made open-ended and broader to encompass plural forms),while the lived and the felt in the world entangling with materialities areequally worthy ways of knowing, in particular when they are tailored anddeepened in mediums. It can also be argued that the lived and the felt make“knowing” anything possible to begin with. However, the point here is to atleast show how embodied knowledge often works in tandem with scientificknowledge as is made apparent in this case study. The problem lies in keep-ing with this hierarchy. The RCT is a research procedure specificallydesigned to filter out the immeasurable (namely the lived and the felt) into acategory known as the “placebo.” It thus attends solely to the measurable,which is considered to be what the world is really made of. This ontologicaldivide is, however, blurred in the case of the trial of an indigenous medicine


that simultaneously announces the search for a new molecule and the recog-nition of indigenous medicine whose healers excel in tailoring and deepen-ing those very lived and felt experiences in the world. RCTs are science’sprimary route followed to provide empirical knowledge of a part of “nature”for assumed universal biological bodies regardless of context (or solely in acontrolled environment), a path generally assumed as needed to fit globalhealth networks. Following a predesigned model is thus a process of closureto indigenous medicine rather than one of recognition, making it conflictwith its own double objective to simultaneously isolate a molecule (asrequired by the RCT standard) and recognize the dignity of a people (as rely-ing in the recognition of muthi).6 How this is made to cohere in practicesbecomes of utmost interest for anthropological inquiry. Attending to multi-plicity in the preclinical practices of an indigenous medicine has led to anopening of the black box of both “nature” and “culture” as neither ontologi-cal category exists in muthi, and not all scientists bring these into being inthe same way. Empirical knowledge in a controlled environment is thus mak-ing objects rather than revealing the properties of objects existing a priori.My proposal is to attend to the ontologies that are brought into being inpractices, sustained or left to wither away (Mol 2002:8). It is in this way that Iaim to grasp the kinds of life to which molecular biologists and Xhosa izang-oma attune their attention and those kinds of life that are left unattended intheir practices connecting in one way or another to the preclinical trial of an“indigenous medicine.” To do so I begin with delineating some of the trails Ifollowed in my fieldwork.7

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context to the tr i a l

The quest for lifesaving technologies continues to drive biomedical research.Hope to heal, prevent, control, and cure disease within populations is theleitmotif of humanitarian aid and global health, with innovative biopharma-ceuticals playing a key role in concretizing this possibility. “Over the lastquarter of a century, for a molecule to become a medicine and be autho-rized on the market, pharmaceutical industrials are obliged to make it followa series of tests aiming to guarantee its innocuousness and its efficacy” (Dal-galarrondo 2004:21; free translation). These tests are those of the RCT, akinto a tunnel of demonstration or pipeline, and they are imposed by registeringagencies such as the World Health Organization (WHO), the U.S. Food andDrug Administration (FDA), and the National Institutes of Health (NIH).The RCT is the current “gold standard” to determine the safety and efficacyof medicines.8 However, “it is not the total effectiveness of a medication thatis being evaluated, but the extent to which the physiological component adds


significantly to the psychological component” (Lock and Nichter 2002:20).Further, it is not therapeutic efficacy that is of interest. The RCT hasbecome the demonstration of a method, one that represents “truth” beyondthis scope within the networks that endorse its results. As such, whole facetsof life in medicine and healing are essentially dismissed, generally namingthem “placebo effects.” What Merleau-Ponty (1945) had critiqued—in theopening quote to Eye and Mind—of operational thought, stating “sciencemanipulates things and gives up living in them,” is precisely what is beingdone in a RCT, placing these aspects of life in the placebo category as“bias.” It becomes of interest to grasp how this is done and, perhaps evenmore so, how this is undone, as “life” or “consciousness” is still made toappear. The secrets of life are implicitly assumed to be in molecules formolecular biologists, some with hopes of recognizing indigenous knowledgethrough the workings of molecules.To understand how this is done in practice, I followed the trails and trials

of an indigenous medicine as it was prepared to become a biopharmaceuti-cal. More precisely, I followed the preclinical trial of Artemisia afra (Jaqu.Ex. Willd.), a wild bush known as Umhlonyane in Xhosa and Zulu, Lenganain Tswana, Zengana in Southern Sotho, Wilde-als in Afrikaans, and WildWormwood in English. The epithet “afra” means from Africa. “Umhlonyaneis considered one of the oldest and best-known of all the indigenous medi-cines in southern Africa, and has such diverse and multiple uses that itshould be considered a significant tonic in its own right” (Van Wyk and Ger-icke 2007:142).9 In the preclinical trial, A.afra was tested for its effects againstmycobacterium tuberculosis (MTB), the causative agent of most cases oftuberculosis.10 When I began the study, toxicity of A.afra in aqueous extracthad been tested in mice, and a new formula was being tested in mice andhuman cells infected with MTB. These preparatory steps toward eventualtesting in humans are decisive for the realization of clinical phases. The fol-lowing preclinical trial was led by The International Center on IndigenousPhytotherapy Studies (TICIPS11), a research consortium founded in 2005,joining researchers from the USA and South Africa to do research on Africanmedicinal plants. TICIPS is financed entirely by the National Center onComplementary and Alternative Medicine (NCCAM), a branch of the NIHin Washington DC.TICIPS’ primary mission is to conduct scientifically ethical and rigorous

research on indigenous phytotherapies that are used to combat HIV/AIDS,tuberculosis, and cancer, in a unique partnership between traditional healers,medical doctors, and scientists.12 A.afra is qualified as “indigenous medicine,”which made healers and “indigenous knowledge” of utmost importance inthe trial. Making a medicine through the model of the RCT is generallyassumed to be a noncontroversial beneficial contribution to the “health and


well-being of mankind.”13 The promotion of indigenous African plants forwider scientific purposes, however, plays directly into the politics of SouthAfrica’s “Renaissance,”14 a political strategy that has been both about estab-lishing foreign exchange and redressing Africa’s dignity in the world. Thepromotion of African plants through an American initiative, however, defiesother national postapartheid South African politics that want African/indige-nous solutions or nationally funded projects with regards to health services.These sometimes conflicting interests may explain how the specific preclini-cal trial of A.afra aimed to study the whole plant in line with muthi practicesrather than isolating a single molecule as required by a standard RCT and itsregistration process with the Medicines Control Council (MCC) of SouthAfrica.15 The entanglements of sometimes opposing indigenous, national,and transnational hopes within the RCT make the initiative highly political,namely, a foreign process of making a potential technology around whichthe value of muthi can also be (re)configured.Following A.afra made me move through meetings, clinics, farms, gardens,

markets, festivals, homes, townships, valleys and mountains, offices, laborato-ries, and botanical gardens all mostly in and around Cape Town where thelarger part of the study took place, briefly in Durban,16 and in the U.S. Alongthe way I met with biochemists, pharmacologists, immunologists, plant syste-matists, farmers, and ethnobotanists all partaking of TICIPS through theirown institutional affiliations.17 TICIPS’ scientists living in South Africa allworked independently with various izangoma who they claimed influencedtheir research in one way or another. I initially met traditional healers duringa visit at Delft Laboratory of the Indigenous Knowledge System Branch ofthe Medical Research Council of Cape Town where more than 40 healersassembled, including Rastafarian bush doctors or inyangas (herbalists). I pur-sued research with izangoma who agreed to introduce me to their work andknowledge about A.afra. I simultaneously pursued further exchanges withRastafarian inyangas and their families, in Delft and Philippi townships, whowere the trusted partners of Xhosa izangoma in medicinal plant collection.In addition, I met with nature conservationists (Cape Nature), business con-sultants (IKS), and managers (Integrated Environmental Resource Manage-ment Department, City of Cape Town). While I should ideally bring all ofthese actors into conversation here (which I do in a forthcoming book), Imainly contrast and explain how molecular biologists and Xhosa izangomaprepare to make medicine “work.” The interest in understanding how A.afra“works” for molecular biologists on one hand and healers on the other hand,notwithstanding the RCT guidelines yet in relation with its standard require-ments, is in part a means toward challenging some of the ontological con-fines of RCTs, thus far the major venue through which indigenous medicinehas garnered international attention. I seek to move beyond the debates


about efficacy and into the question of life: molecular life of A.afra for themolecular biologist, embodied life for izangoma, and the implications ofthose two ways of knowing and not knowing life for the RCT currently dri-ven by the care for a universal biological body and welfare.

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l i f e in molecules

It is now at the molecular level that human life is understood, atthe molecular level that its processes can be anatomized, and at themolecular level that life can now be engineered. At this level, itseems, there is nothing mystical or incomprehensible about ourvitality . . . —Nikolas Rose 2007:4

Knowing life in molecular biology is knowing molecular configurations inhuman and plant cells as well as some of the effects of the latter on the for-mer, at least in the case of searching for plant molecules to counter a spe-cific human disease. As these cells are found throughout the bodies in whichthey travel, their modification or alteration should potentially transform thewhole body. Intervening upon life at the molecular level thus opens possibili-ties to modify bodies through and through, creating new forms of molecularlife. As such, much of the literature in the social sciences reporting onmolecular biology and the Human Genome Project is predictive. Paul Rabi-now (1992) for instance announces new forms of biopolitics18 that wouldemerge with the Human Genome Project. The modern forms of biopower,which he also calls disciplinary rationalities or sociobiology, refer to a processof discovering the laws of nature used to administrate populations. Postdisci-plinary rationalities or biosocialities would be new forms of biopolitics over-lapping with modern forms. Biosocialities imply a looping reflexive effectmaking it so that social desires feed back into ways of orienting biologicalresearch, social desires hence partaking in ways of administrating populations.In this paradigmatic shift,19 life at the biological level becomes malleable.This is also what Rose (2007) refers to as new emergent forms of life, lifemanipulated by genetic and molecular biological knowledge as orientedthrough perceived social desires. Rose describes the process as one of mole-cularization of life, part of 20th century politics of “life itself.”The preparation of an indigenous plant to be trialed in a RCT somewhat

embeds this overlapping of the two forms of rationalities to which Rabinowrefers; on one hand, it answers to social desires of recognizing indigenousmedicine to orient interest in new molecular forms of life; on the otherhand, it relies upon a modern form of biopower that I claim remains embed-

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ded in the RCT standard—a model designed to reveal the “laws” of nature.The overlapping of these two rationalities (disciplinary and postdisciplinary)opens more discussion with indigenous knowledge while at the same time itshuts this conversation out. Let us first see how preoccupations with lifereveal themselves within the science of molecular biology in contrast to pre-vious forms of biology presiding when RCTs initially emerged.20

The central dogma in early molecular biology is “that DNA contains thebuilding blocks of life” (Knorr-Cetina 1999:139). This…

Implies that the ordered variety of life, which biology had investigatedbefore, is really an endless variation in the same: permutations of fourkinds of molecules, the bases A, T, C, and G.21 All visible variations oflife can be traced back to different configurations of these building blocksof the DNA. [Knorr-Cetina 1999:139]

The Human Genome Project became one of mapping these configurations,however, setting aside 98% of the DNA, labeled “junk” DNA (Lock 2005: S47).When “junk” DNA was found to produce RNA (ribonucleic acid) and to beimplicated in gene expression and regulation, this multiplicity further openedto infinite possibilities of ways for bodies to come into being in their environ-ments. “Consequently, the research interests of molecular biology are no longerconfined largely to mapping structure but have expanded to unraveling themechanisms of cell and organ function through time” (Lock 2005: S47). Tounderstand the “essence” of life by reading and reporting the “laws” of naturein older forms of biology becomes in molecular biology an overwhelming com-plexity governed by a myriad of well-regulated biochemical steps.

Classical biophysical, biochemical, and genetic techniques can all beseen as aiming at the construction of an experimental environment, inwhich it is possible to replace the milieu of the living cell in such a waythat starting with ‘model’ organisms, cellular structures and/or metabolicprocesses can be isolated and analyzed. [Rheinberger 1995:251]

While medical intervention had been restricted to the level of metabolic per-formance, the advent of recombinant DNA technologies22 in the 1970s opensto the possibilities of instructing metabolic processes (Rheinberger 1995:252).As DNA recombinants are themselves macromolecules,23 it becomes aboutknowing how DNA recombinants interfere with the organism as a whole asthey participate in virtually every process within cells. “From now on it is nolonger the extracellular representation of intracellular processes—i.e., the‘understanding’ of life—that matters, but rather the intracellular representa-tion of an extracellular project—i.e., the deliberate ‘rewriting’ of life”

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(Rheinberger 1995:252–53). Rose calls this “molecular biopolitics” because itis knowledge that opens “ways in which life may be mobilized, controlled,and combined into processes that previously did not exist” (2007:15). Hope indeveloping new technologies, or medicine, becomes one in life that can beculturally or politically manipulated, investing mind and body.Life in molecules blurs the boundaries between nature and culture as well

as between humans and nonhumans or between different forms of life; “gen-ome mapping showed that human DNA is closer to that of other livingorganisms than had been anticipated—we share more than 98% of our geneswith chimpanzees and about 35% with daffodils” (Lock 2005; :S49). Whatbiochemists study in A.afra are its molecules of “life” (molecular configura-tions, bioactive compounds, biomarkers, active principles) and how thosemolecules can invest human life to inhibit disease. Bioactivity in A.afra isstudied to understand how it instructs bodily molecular configurations inhumans. The science is in the selection of the right bioactivity to study withthe project of inhibiting TB. The first molecular biologist I met explainedhow he selected molecular designs based on his experience or intuition inthe field as well as through learning with izangoma. In particular, under-standing how izangoma collected and prepared A.afra helped him select themolecular configuration to study. Learning the different locations where thehealers preferred to collect the plant, at which times to collect them, and inwhich ways guided the quest to find the best variety of A.afra to study. Themolecular biologist then aimed to study the chemical composition of thoseplants in as broad of a sense as possible to find out if each variety was slightlymore or less effective than another. “Knowing” about molecular variabilitydepending on the plant’s setting and manipulations by healers, or any plantcaretaker, this complexity is reduced rather than embraced. Initially, A.afrawas grown on two farms for the trial, cultivated by two different farmers.They later decided that it was necessary to reduce to a single farmer becauseof the extreme variability the plant displayed at the molecular level whensubject to different cultivation techniques, soil, and ecology. The RCTdemanded genetically identical plants to facilitate finding and reproducingan active ingredient or preparation of the plant, an ingredient, or mixture(animal feed for instance) that could be “‘commoditized,’ transportedbetween laboratories and re-engineered by molecular manipulation, the prop-erties of the plants transformed, their ties to a particular individual livingorganism, type, or species suppressed or removed” (Rose 2007:15). While boththe isangoma and the molecular biologist somewhat embrace this variabilityin the sense of equating different uses to the plant depending on its place ofgrowth and its corresponding synergies, the RCT model aims to acquire thedemonstration of a specific bioactivity and its action on a specific disease,which I will try to briefly sketch out.


Two new studies on A.afra involving researchers from TICIPS’ appeared in2009 attesting to the preclinical phase. One looked into the antimalarialproperties of A.afra (Avula et al. 2009) and the other, of more direct interest,looked into the efficacy of A.afra phytotherapy in experimental tuberculosis(Ntutela et al. 2009). The 14 researchers coauthoring this article “investigatedthe inhibitory potential of A.afra extracts against M. tuberculosis” (Ntutelaet al. 2009:S34). In the paper, they report on antimycobacterial properties ofA.afra on M. aurum and M. tuberculosis, showing enhancement of immunityagainst TB when particular active fractions of A.afra were given in animalfeed. The aqueous extract tested for toxicity in a previous study (Mukindaand Syce 2007) had not shown this activity; rather, it had shown to regulatepulmonary inflammation during early infection. This unexpected finding issaid to support the merits of traditional use that includes treatment for respi-ratory ailments. Antimycobacterial activity was, however, not evident duringthe 2007 evaluation, possibly because the way to prepare the plant by boilingit 30 minutes, within other procedures, may have annihilated the antimyco-bacterial effects. The findings of the research “would suggest that such activeingredients would not be extracted in traditional practices where applicationis usually associated with boiling of plant material in water” (Ntutela et al.2009:S38). The 2009 study shows that a dichloromethane extract of A.afradoes contain antimycobacterial activity that can inhibit both rapid growingM. aurum and virulent M.tuberculosis replication. The researchers concludethat A.afra is a viable source for identifying antimicrobial compounds andcontains anti-inflammatory substances that may potentially be useful for clini-cal application. They propose a new application model where water-insolublephytochemicals can be applied successfully in therapy (Ntutela et al. 2009:S38).A few aspects of the study mentioned above are of interest to my discus-

sion. First, the initial consultation with izangoma disappears within the study,as do all of the researcher’s presences in the results of the study. Knowledgeacquired “in life,” whether through intuition or with izangoma, is dismissedentirely from the written account; a classical objectivist stance is fully main-tained, informing only briefly how it can confirm or infirm the benefits of“traditional use” that are never described in detail. A second point of interestis the way the question is formulated, showing the idea of malleability of“life” within the organism, providing intracellular representations of howextracts of A.afra prepared in such and such a way inhibit replication of TBor regulate pulmonary inflammation during early infection, hence potentiallymodifying human relations with TB (orienting processes that occur throughtime regardless of direct manipulation). A third point of interest is that thevery precise procedures followed to investigate a very specific process led totwo new “discoveries”: the first is unexpected anti-inflammatory activity of


the made aqueous extract, and the second is a new model to test hydropho-bic phytotherapies in animal feed. This flexibility relies upon awareness ofmultiple potentials of a same plant depending on the ways it is prepared, sci-entists stating the RCT to be restraining in the latter matter.The very first thing the head South African biochemist explained to me

was the need for a different kind of trial. The current closed pipeline of theRCT was drawn out on a piece of paper as needing to be filled with perfora-tions that would maintain the research process “in the inhabited world”throughout its four phases. He explained that we should, for instance, takeinto consideration the other products that people consume in the everyday,as those can inhibit the “actions” of found molecules or medicines; this wasstated in relation to the consumption of wild garlic inhibiting the effects of aplant remedy against HIV/AIDS as well as is applied in the quest for mole-cules against MTB, considering its interactions with antiretroviral therapyagainst HIV/AIDS often consumed when TB emerges. A new model of clini-cal trial is envisioned to override some of the current limitations of RCTs(Johnson 2011): a translational validation model as proposed by Bhushan Pat-wardhan and Raghunath Anant Mashelkar (2009) to test the efficacy of ayurv-edic remedies. Essentially, the model is a proposition for reversedpharmacology, one that reverses the routine “laboratory to clinic” with “clinicto laboratory” (Patwardhan and Anant Mashelkar 2009:806) and in this waymaximizes inspiration from “indigenous medicine” or “life in context.” It iswithin the new paradigm of molecular biology that indigenous knowledge isrevived and that a critique of the current RCT model is made. It is througha desire to bring more of the world into the laboratory.Life in molecules, the plasticity of life the molecules behold, may blur the

boundaries between the clinic and the laboratory. As the organism somewhatbecomes the laboratory, life that surrounds and permeates the organismbecomes more relevant. It may in this way break with a model that shuts outthe world. South African molecular biologists are further highly aware of thepolitics involved in their research, not only in manipulating life at the molec-ular level yet also in manipulating life at sociocultural and economical levels.Becoming a biochemist was stated as a way to acquire legitimacy in largernetworks. Doing molecular biology in the Cape is thus doubled with a politi-cal desire to increase the dignity of an African people, especially within atrial meant to show the merits of indigenous medicine. In either case, theRCT is described as deceiving because it is a process of closure to the inhab-ited world. RCT’s current designed models cannot account for molecularcomplexities in the environments. Most scientists involved in TICIPSreferred to the constant back and forth between laboratory and “real life,”and to how much is learned in the process. These desires to bring more of“life” in the laboratory fit in an idea of multiple natures/cultures, while it


strays from some of the restrictions of a standard RCT concerned by “nature”as separate from culture. The desire to ground research in life-making pro-cesses beyond the confines of the laboratory converges with izangoma waysof knowing life.

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l i fe embod i ed

Izangoma are involved in rewriting life’s story in the midst of life-making pro-cesses in the “open air” in its broader sense. Most of their practices aim toreach preobjective states of being in the world and rid one of mundane stan-dards to heal by making way for new orders. Izangoma specialize in plantcombinations with sounds, song, dance, trance, evocation, and enactment,all of which work toward modifications of the complexities of bodily configu-rations through various manipulations and intensively staged circumstances.Life in plants, and of muthi in general, or their efficacy, appears to be one inmovement, which can be activated by spirits and applied at a distance, lifethat can be enhanced or lost, never restricted to its objective materiality. Assuch, healers refuse the A.afra cultivated for purposes of the RCT. Theyclaim that the plant has lost its “life” or efficacy in its farmed form, affirma-tion in line with a comment by another healer walking through a laboratoryseeing a plant in a pot, remarking in this instance that the plant was being“choked.” Plants are rather to be found in places seen through visions andcollected with specific intentions or grown and tended to as kin in the yard.While izangoma ways of knowing do not fit in the RCT per se, their prac-tices at the edges of the preclinical trial helped me understand how makingmedicine work in the inhabited world can be accomplished. In these ways, itis not explicitly through macromolecules that the whole organism is invested,rather it is through life embodied, accessed, or activated by the healer whoaims to change, reorient “bodies in the world.” The activation of life inplants relies upon izangoma abilities to make them “work.”My understanding of what izangoma do is that they enhance their abilities

to feel the world and that, with this ability, they help a (dis)eased person ben-efit from these relational skills to reorient their own state or life within theworld. Koen Stroeken’s explanations of Sukuma healing through anthropol-ogy of the senses correspond to my general understanding of izangomamaneuvers:

Analogous to clinical synesthesia (colors generating sounds), magic, andritual may be seen to generate meaning by operating on a ‘synesthetics’that couples fairly discrete semantic codes with specific bodily sensations


… healers, in particular, have a knack for further codification of thesenses. A patient’s insertion into a healer’s particular synesthetics ofturning meaning into matter is part of the healing process. [2008:467]

The emphasis in isangoma healing relies upon acquired skills to modify bod-ily configurations of others within the inhabited world; it is more about turn-ing meaning into matter than relying upon “matter itself.” Molecularbiologists and their insights into micro worlds of molecules provide thoroughrepresentations into potential specific intracellular and extracellular processesthat can modify bodies genetically, notwithstanding the inhabited world.Healers are not confined to the molecule per se in knowing how to manipu-late life. Izangoma ways of knowing or letting me “know” was to make me“feel” with them to understand what they were achieving.When I asked how A.afra works, I received a bodily gesture as an answer.

The isangoma threw his arms down along his body pointing to his navel areaand afterward to drums nearby. He then invited me to a drumming sessionthe following Sunday. What he explained on the spot was that A.afra worksif one has the acquired abilities to make it work. A first step toward becomingan isangoma is through “a calling,” which typically follows a form of “illness”that stops the person from functioning “normally” in the everyday. The heal-ers appeal to ancestors who they invite to move through their bodies with thehelp of repetitive drum sounds in a highly orchestrated performanceintended to open space for improvisation as the ceremony progresses. Theisangoma “is one who (i-) does (sa) ngoma” (Janzen 1992:108). Doing ngomais doing the song–dance performance. Ngoma aspires not to health but to“fruition”: “a wider state of well-being than health, or healing, which alsoincludes procreation and the growing of crops. It also connotes the enjoy-ment of performance, of art. It is identified as social reproduction” (Janzen2000:166). According to Janzen, “these are the hallmarks of a clarifying,defining work that helps us understand a classical institution of great flexibil-ity” (2000:166). Ngoma corresponds to particular ways of “knowing life” andacquiring the skills to become an isangoma in the townships of Cape Town.The drumming session I attended was the first of seven initiating an

apprentice to become a healer. Around 40 people sat around the room in atin house of Khayelitsha township near Cape Town, with the healer leadingthe session and the apprentice (a woman) in the center, along with her closerelatives and another woman drumming at her side. The opening songs wereChristian (later explained as a way to incorporate the influences of colonialmissionaries). After the Christian God was acknowledged, the rhythms chan-ged. There are specific rhythms to praise the idlozis (ancestors), shiftingwhen it is time to ask the ancestors to connect with this healer-to-be andshifting again when communication was established—enticing a communica-


tion pattern of song through which divination may occur. Central to con-necting with ancestors is a substance known as ubulawo (dream foam), amixture of medicinal plants and water. A prong-like stick is used to twirl themixture to form a white froth, demonstrative of a successful connection tothe ancestors through dreams. Foam on top of the liquid shows that all isgoing well. Necklaces also acknowledge new connectivity between the hea-ler, the healer-to-be, and the ancestors. As the rhythms shifted, apprenticeand accomplished healers alternated into the center of the circle, singing,dancing, and talking in tongues. As Ren�e Devisch describes for healing cultsin Yaka culture, what is being played out, “are a ‘shape of life’ and habitus,that is a tradition and skills that develop and manifest themselves withoutreferring to a script” (1993:37). The lack of script leaves the possibilities ofthe performance open. Through patterned rhythms, call and response, andnarrative performative songs, “ngoma brings together the disparate elementsof an individual’s life threads and weaves them into a meaningful fabric”(Janzen 1992:110). Similarly, speaking in tongues initially calls into questionconventions of truth, logic, and authority:

By a semiotic account, then, glossolalia ruptures the world of humanmeaning, like a wedge forcing an opening in discourse and creating thepossibility of creative cultural change, dissolving structures in order tofacilitate the emergence of new ones. [Csordas 1990: 24]

The ritual practices thus set the stage to make way for transformation of“bodies in the world.” With regards to Navajo healing ceremonials, Kapchutksuggests “that ritual healing not only represents changes in affect, self-aware-ness, and self-appraisal of behavioral capacities, but involves modulations ofsymptoms through neurobiological mechanisms” (2011:1849). This is achievedthrough developing enhanced sensitivities in the world.Scientific inquiry moved away from the senses since its earlier forms of

experimentation. According to Knorr-Cetina:

Two factors aided in the ‘disembodiment’ of science. One is the inclusion,into research, of technical instruments that outperformed, and replaced,sensory bodily functions. The other is the derogatory attitude importantscientists developed toward the sensory body. [Knorr-Cetina 1999:94]

While the molecular biologist’s body remains a precondition to conductexperiments (Merleau-Ponty 1945), it is not sensory skills that are brought tothe forefront as crucial, even if they do participate in scientific inquiry. Theperformance of the biochemist is of prime importance in making the medi-cine “work” according to the desired verification process of the plant for the


trial or not. The biochemist may or may not succeed in finding the relevantmolecular structure within the plant at that particular moment or in relationto the disease on which the plant is aiming to have an effect. Their intuition,tacit knowledge, or experiential knowledge decisively shapes their success orfailure in designing the relevant molecular configuration. These skills are,however, not part of the requirements of the RCT; rather, they are explicitlyasked to disappear. The intensity of bodily expertise developed by the healersis astounding, yet, as with the biochemist, it will not become part of RCTlegitimacies given the resistance of bodily experience to causal logic. Thistakes most of izangoma legitimacy away as it is precisely how they excel; thebiochemists can, however, still represent their knowledge and maintain, evengain, in legitimacy. While bodily apprenticeship is central in Xhosa healing,what disappears, in contrast to biochemists’ work, is “the medicine itself,”which becomes part of a combination of gestures and things, one that canplay different roles and that is never reified as a cure in itself. This is howA.afra fits into this picture.A.afra is mundane or “of this world,” in contrast with other plants such as

ubulawu, which belongs to the ancestors, A.afra is part of everyday life. Itcan be put under the bed sheets the day before a healing ritual to “purify”the person of “evil” spirits or to “prepare” them before an initiation or a heal-ing session. How this will work depends on the abilities and skills of the hea-ler preparing and activating the plant for these purposes. The relation of thehealer with the plant, ancestors, and medium enables its effects in anotherperson or body. An isangoma I met lived with the dried A.afra in her house,explaining that her knowledge of the plant came from living with the plantin the everyday. It is less about the life in plants that is useful than the waysthe plants are embedded in life. Rastafarian bush doctors also keep A.afrahandy for daily domestic uses, occasionally cutting branches to sell at theirstalls in the market. When the plant is required in its materiality, there is ashared sense by Rastafarian inyangas and izangoma that the plant gatheredfrom uncultivated areas can do more for the body. I traveled far distancesoutside Cape Town to reach “pristine” locations (“uncorrupted by civilizationor Babylon” in Rastafarian terms) where the plant was deemed useful. Culti-vated fields of A.afra are associated with colonial invasion of the land byDutch (later Afrikaan-speaking Dutch or Afrikaner) and English farmers,hence not a neutral ground. As with izangoma, Rastafarian healing perfor-mances are mediated by certain ways of being in the world that involveembodying sounds (Laplante 2009b, 2012). The “healers” unite their quest forhealing by redressing African dignity and valuing African solutions. Tradi-tional medicine, although having important cues for knowing the efficacy ofa plant in a RCT, is also in this context a practice that speaks to postcolonialstruggles. Biomedicine was a means of colonial domination in South Africa


and explicitly so since 1948, marking the beginning of the apartheid era. Itmarked the decline of African healing associations and their struggle for legalrecognition within Natal and Zululand (Flint 2008:ix). The inauguration ofan interim Traditional Health Practitioners Council of South Africa on Feb-ruary 12, 2013, can be understood as part and parcel of the promotion of“indigenous knowledge” along the thrust of the African Renaissance. Theemerging codes of ethics, association permits, and regulations that come withsuch a process of standardization move along the lines of the RCT, whichcontinues to marginalize these “indigenous” ways of knowing life and medi-cine, even if they appear to share commonalities with highly prized biomo-lecular knowledge in a notion of life as a movement of openingLife as movement of opening I have mostly discussed in positive terms of

healing, renewal, growth, and paths along which life can keep on going.However, movement is also about falling down, destruction, or dying, whichare also paths of becoming something else. In such movements, izangomapromise the riddance of malignant spirits or current bothersome “body-in-the-world” orientations. Molecular biologists, for their part, promise the elim-ination, destruction, or slowing down of the replication of targeted bacte-rium. A nuance between the two may rely in the controlled study holdingpromise of defining a determined pathway that should apply to all biologicalbodies, notwithstanding the inhabited world. The isangoma will generallyleave these possibilities open to life’s indeterminacies, with a promise of thepossibility of enhancing skills to deal with life’s intricacies. These ways ofknowing in life are explicitly what withers away in an RCT, asserting insteadthat approved medicines can travel to “work” on any biological body, regard-less of particular engagements within the world.

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hope and uncerta int i e s

At the edges of the RCT model holding a promise of closure, the dynamicsof knowledge within TICIPS’ trial lead, on one hand, toward an optimalmanagement of life at the molecular level and, on the other hand, towardan optimal management of life embodied. The political and moral implica-tions of knowing life in molecules and embodied life lie in the envisionedpossibilities of rewriting life’s stories. Life, as a movement of opening, turnsour concerns toward the future rather than toward the assessment of the con-tent of bonded objects such as universal biological bodies or “discovery” of aplant’s efficacy. The implications of a notion of life as a movement of open-ing for the process of making medicine “work” become ones of composition,orientation, and activation of desired effects all in hope of better health andwell-being. This is where commonalities between izangoma and molecular


biologists are found, albeit done through very different routes. Divergencebetween ways of knowing life in molecular biology and isangoma healingrelies on possibilities of representation of one and the other practices in theRCT requirements and, correspondingly, in methods of detached observationfrom the knowledge produced to enable it to travel. The two areas of exper-tise further diverge in their current relations with legal possibilities—local,national, and transnational agencies accepting certain truths and not others.The overall political economies of hope, which I have found to move

through the preclinical trial, I have qualified elsewhere as poetic, romantic,and humanitarian (Laplante forthcoming). I have here mostly dealt withpoetics, or with molecular biologists’ and izangoma practices as they areentangled in both natures and cultures, opening to multiple possibilities oforienting life through attuned attention in either the secrets of life in mole-cules or in the medium. Izangoma and inyangas perform their relations withmedicines when asked how a plant works, relying upon their abilities toengage with them as well as with others. These ways of knowing may dwellin poetics in line with some of their political histories. Rastafarian inyangasare, for instance, part of a movement that “emerged as one of the most artic-ulate alternative philosophical paradigms to modern capitalistic imperialism”

(Niaah 2003:824–825), namely against forms of British colonialism in Jamaicain the 1930s. As such, their “word-sound-power” philosophy is particularlytelling of the antithesis of rational thought that it aimed to bypass. In theirtravels to South Africa, Rastafarians have thrived together with muthi in amovement of liberation from apartheid through “livity” or ways of being inthe everyday largely to be achieved with and through healing sounds andplants (Laplante forthcoming). “The categorization of inyangas and izang-oma/isanuses or the conjoining term ‘traditional healers’ adopted in the twen-tieth century is a manifestation of African’s colonial experience, which onlyfurther intensified encounters with healers from various areas” (Flint2008:66). These ways of knowing in life as the most powerful means againstdisciplinary rationalities may also be part of izangoma histories before coloni-zation, to which the Rastafarian movement also turns for inspiration in areturn to African roots.As is the case, today, with RCTs working together with governmental, ethi-

cal, and legal instances supporting their practices and evidence as legitimate,muthi practices were similarly accomplished in accordance with the politicaland the judicial systems during the precolonial period. Some of the historiesof the Zulu and Xhosa kingdoms, both establishing themselves in SouthAfrica in the 1400s, can tell of other social arrangements insuring some con-trol over forms of healing and ways of knowing and not knowing life. Thejudicial system of the Zulu kingdom for instance, whose language and tradi-tions are very similar to the Xhosa nations, consisted of two branches: the

2 0 anthropology of consc iousnes s 2 5 . 1

ibandla ceremony (king’s council of elder statespersons) and the umhlahloceremony—both of which were presided over by the isangoma (Flint2008:79).24 It was the second process, the umhlahlo ceremony, seeminglymore opaque and arbitrary, that the British colonial administrators eventuallybanned. The umhlahlo ceremony dealt with most cases of death and sick-ness, with national umhlahlos being organized in cases involving death orsickness of important subjects, often based on the suspicion of umthakathis(witches) aiming to threaten political orders. These large trials attest to thefact that izangoma have partaken officially in healing the body nation, evenif always in a fragile balance with other leaders. Flint (2008) points out thatthey put various strategies into place to limit the power and influence of cer-tain healers. In some cases, the leaders themselves claimed to be powerfulhealers, often limiting who was allowed to practice by incorporating powerfulhealers into their running elite. Xhosa izangoma acting as arbitrators of jus-tice are mentioned to have “successfully claimed a power base independentof their rulers” (Flint 2008:84). With the fall and disintegration of the Zuluand Xhosa kingdoms, izangoma both gained autonomy and saw their politi-cal power and legitimacy diminish at the national level. This may help usunderstand in part how isangoma practices have thrived and continue tooperate under their own rules in the Cape’s townships. Wreford’s (2008:160)powerful testimony of her own passage into the role of the isangoma in 2001shows how the umhlahlo is very much in place in the township of Khayelit-sha in the Cape, namely in the township where I met most of the izangomawho informed this research. Current hopes in healing and managing uncer-tainty bring some of these histories into being, including placing hope inabilities to entangle even further within life processes to know them.I found that a second “romantic” political economy of hope moved

through the preclinical trial, with which I dealt with only slightly, was linkedwith partisans of the “workable dream” of the African Renaissance. The Afri-can and American scientists mainly upheld it, albeit with different emphasis,playing itself out in an idea of singular nature linked with a singular culture.Hope dwelt in molecules that would maintain their indigenous roots as theytraveled in global networks, a dream also initially shared by a few izangomapartaking in the trial. In this organizational performance, A.afra was reifiedin the transnational concern of finding a cure for tuberculosis with the hopethat Africa, or South Africa, would be recognized for this innovation. Thisdouble objective is what initially drove the coming into being of the preclini-cal trial. Demonstrating A.afra’s safety and efficacy, or bioactive life, in a waythat would be recognizable within a RCT carried hope (for some more thanothers) for an access or opening to the “rest of the world.” It was, however,rather a third “humanitarian” political economy of hope that ultimatelydefined this legitimacy, one that will be stripped to the method used to


demonstrate the mode of operation “of life” at the molecular level. The sci-entists participating in the trial who played on all three fronts (molecular,national, as well as transnational interests) upheld it. Yet, it was mostlyupheld by the infrastructures and distant legal and institutional agencies suchas the WHO, the FDA, the NIH, and the MCC—ethical committees andclinical trial monitors that enforced a sole preoccupation with “natural” lifeas separate from culture as designed in the RCT model. Life is here to be“known” from an externalized standpoint.In this political economy of hope, vital biological mechanisms are hierar-

chically primary, while qualified life, fruition, or life in context is secondary ifnot altogether absent. The humanitarian reasoning is that if one remains bio-logically alive then other forms of life can thrive and prosper, hence theemphasis on physiological processes, a quasi-sole preoccupation with biologi-cal life with a promise of closure in knowing its mode of operation. Medicinein this approach is a closed object with a well-defined physiological effect thatcan travel and heal. The “humanitarian” objectives of the RCT were set onsolving the TB pandemic in molecular terms that take precedence over thecomplexities of bodies in the world, including the “indigenous” issue. It wasthrough the molecule that both sets of issues were to be addressed, althoughunequally. Hence, the dream to redress African dignity through an RCT maynot turn out as hoped and may rather become “randomized controlled crime”or the criminalization of traditional practices as Adams (2002) has shown inthe case of testing Tibetan medicine. The case of the Hoodia gordonii cactusused by the San in the Kalahari and patented by Pfizer in 1986 shows suchrepercussions in South Africa. Even though the patent concerned only theprocess of the extraction of a bioactive compound (substance P57), thegrowth, use, and sale of the cactus have been made to feel illegal (Gruenwald2005). Results from a safety trial such as those found by James Mukinda andJames Syce’s (2007) that indicate A.afra is inefficacious when boiled couldhypothetically lead to monitoring the use of the plant if patented. Scrutinizingtraditional practices can lead to their partial “recognition,” yet forms of stan-dardization, codification, legalization, and regulation may simultaneouslycomplicate their everyday usage and access. In the end, the molecule carriesthe burden of truth about the efficacy of a medicine, closely monitored by dis-tant RCT protocols. Molecules are thus both moral and political.An activist botanist largely responsible for the translation of the usefulness

of A.afra in botanicals explained that managing uncertainty in medicinedepends on its intended use; “the more serious the indication, the morehuman responsibility to give something safe, effective as done through regu-latory authorities and forms of standardization.” This would apply to anintended use of A.afra to deal with the TB world pandemic. The botanistfurther stated that “if it is for ritual use, then it doesn’t matter if current


regulatory authorities and forms of standardization are applied” (field notes:February, 2007). However, it appears through this study that the RCT is anincomplete standard as it is only preoccupied with physiological life, notwith-standing the inhabited world and also notwithstanding therapeutics. Further,if it does not matter that such authorities be applied to isangoma practices, itis not because they have a less serious indication, yet it is perhaps because iz-angoma already do assure some forms of management over uncertaintythrough proximity and involvement in knowing life “in life.” Proximity or“being with” plants in life may be a way to control potential hazards as dotraveling standards and protocols. Knowing plants as kin, or “from the inside”(Ingold 2012), is an intimate relation that may insure safety as well asintended efficacy through deepened connections and care.Izangoma make medicines work in the inhabited world and as inhabitants

in a world we all inhabit, acquiring efficacy in life. Molecular biologists aimto understand how A.afra molecules may enhance immunity of the body topostpone the development of TB. Izangoma aim to understand how to con-nect with medicines in the inhabited world as a transformative process ofopening bodies toward new potential orders in the world. It is through stan-dardized ritual forms intended to rid oneself of current standardizations (tomake ways for new ones) that healing is pursued, making the RCT standardsimply inadequate. The RCT may be an anachronistic model set in disciplin-ary rationalities, perhaps hindering not only the possibility of recognizing mu-thi and its experts but also the rhythm of innovation investing body andmind, nature, and culture through a notion of life as a movement of openingas also found in molecular biology. More than ever today, with both newmolecular biology and a revival of “indigenous” healing, a good revision ofwhat the RCT leaves astray needs assessment. Essentially, the assessment ofall that we call placebo, which comprises of intention, relation, environment,meaning, evocation, enactment, performance, embodiment, poetics, and soforth. The research agenda at hand for anthropology does not seem to relyupon adding new “social” or “cultural” qualities to core “natural” ones but toattend to the lived and the felt in mediums as people and things becomeentangled in moving life.

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note s

1. Izangoma are “diviner-healers who achieve their diagnosis and remedies throughcommunication with ancestral spirits” (Wreford 2008). The term isangoma is ofZulu origin, its isiXhosa equivalent is igqirha or amagqirha. The term isangoma isnevertheless the title generally used throughout South Africa, Cape Town, and bythe Xhosa healers encountered in the study.


2. The terms “indigenous,” “indigenous medicine,” or “indigenous knowledge” are notwithout their histories of troublesome connotations and resulting politics of exclu-sion. Traditional medicine (TM), indigenous knowledge (IK), indigenous knowl-edge systems (IKS), and more recently complementary and alternative medicine(CAM) are all terms used more or less interchangeably to refer to all forms of medi-cine that are not scientific, or more precisely, in my argument, are not supported by“scientific proof” nor defined and demonstrated through experimentation in a ran-domized clinical trial (RCT). Arun Agrawal argues that “attempts to draw a strictline between scientific and indigenous knowledge on the basis of method, episte-mology, context-dependence, or content… are ultimately untenable” (2002:293).Further, “perhaps the most damaging use of the term ‘indigenous knowledge’ is thatit sets IK in opposition to ‘scientific knowledge’” (Green 2008:134). The term “indig-enous” is thus here used as the preclinical trial evokes it, as well as it is in use toqualify muthi, which adds a national flavor to “indigenous knowledge.” I, to the con-trary, do not use the term “indigenous” in opposition to scientific knowledge. I aimto show its affinities with molecular biology in sharing a notion of life as a move-ment of opening. In this case, “indigenous” refers more precisely to the forms ofknowledge that are not currently found legitimate in the RCT model with hopes tomake them recognized as worthy ways of knowing in and beyond the RCT model.

3. I borrow these notions of “medium” and “open air” from Ingold, mainly in histhoughts that go with the grain of Jakob von Uexk€ull’s notion of medium andGilles Deleuze and F�elix Guatarri’s “lines of becoming.” Thus, medium alludesto “the dynamic processes of world-formation in which both perceivers and thephenomena they perceive are necessarily immersed” (Ingold 2008:26). With thenotion of “open air,” I correspondingly refer to “the openness of a life that willnot be contained, that overflows any boundaries that might be thrown around it,threading its way like the roots and runners of a rhizome through whatever cleftsand fissures leave room for growth and movement”(Ingold 2011:83).

4. Aristotelian premises have distinguished zoe (physical life) from bios (political,qualified, experiential, existential life). The hierarchy placing biology life as pri-mary is an ontological divide that Descola describes as recent and unique to Wes-tern scientific thought (2005). As such, izangoma do not work through thisopposition between biological and qualified life. Instead, they deal with bothsimultaneously as ongoing life in the medium. Molecular biologists are led to doso in their written accounts of research results while also embedded in lifethrough the process of knowing A.afra; they are thus led to bring the distinctionbetween biological and qualified life into being in some instances while the heal-ers do not (precisely because the healers do not partake to the RCT in an officialmanner as recognizable experts).

5. I here follow Annemarie Mol’s (2002) ontology of a multiple object.

6. Umuthi, which means tree or bark in Zulu, also means medicine. The word isrendered as muti or muthi throughout South Africa. It includes plants as well asanimal fats, skins, bones, and minerals (Flint 2008:3).


7. Fieldwork between 2006 and 2010 was financed by Max Planck Institute for SocialAnthropology in Halle/Saale, Germany as part of the Biomedicine in AfricaGroup. I am most grateful to this institution as well as to The International Cen-ter for Indigenous Phytotherapy Studies (TICIPS), the University of the WesternCape, and to the scientists and healers who shared their time and experienceswith me.

8. For a more detailed description of RCTs, consult Sebastien Dalgalarrondo (2004),and for more information regarding the implications of testing indigenous medici-nal plants, consult Adams et al. (2005) and Laplante (2009a). In regards to the his-tory of RCTS, also see Ted Kaptchuk (1998) and Mark Sullivan (1993).

9. The list of uses of the plant in South Africa covers a wide range of ailments fromcoughs, colds, fever, loss of appetite, colic, headaches, earache, and intestinalworms to malaria, diabetes, and influenza; the plant is to be taken in enemas,poultices, infusions, body washes, lotions, smoked, snuffed, or drank as a tea (VanWyk and Gericke 2007:142).

10. Tuberculosis is considered a global health burden, “with more than 9 millionnew infections annually and a mortality of 1.5 million individuals” (WHO Report2008). At the time of this study, the market was open to new pharmaceuticalproducts because of the emergence of multidrug-resistant strains. Tuberculosis isone of the main secondary causes of death caused by HIV/AIDS.

11. Recently renamed The International Center for Innovation Partnership in Sci-ence, TICIPS (Johnson 2011)

12. TICIPS statement, http://www.wlbcenter.org/ticips.htm. Accessed on November,19 2013

13. Also taken from the online TICIPS statement.

14. The African Renaissance was formulated by Nelson Mandela in his inauguralspeech as the first black President of South Africa on May 10, 1994. PresidentThabo Mbeki of the African National Congress of South Africa popularized theAfrican Renaissance during his term in office (1998–2008), and it remains a keypart of the postapartheid political agenda.

15. The MCC has a regulatory policy framework delineated for traditional medicinethat is not yet implemented. The preclinical trial of A.afra thus unfolded as ifthe plant was a pharmaceutical and not an herbal medicine. Solely the WHOand the FDA recognize historical use as testimony of “safety” while the NIH andthe MCC follow guidelines for pharmaceutical trials notwithstanding these histo-ries (Van Wyk 2005; :3). A molecule was thus identified as a biomarker for theA.afra trial, namely luteolin, a flavonoid that modulates the immune system andis also anti-inflammatory (see Mukinda 2005). While luteolin may or may not bethe “proper molecule,” in this case it was selected because it has already beenfound in A.afra and is relatively easy to measure and standardize. The single mol-ecule is thus “standardized” for the purposes of its approval by the MCC while


the interest is with the whole plant, bringing the study closer to everyday “indige-nous” uses of the plant.

16. TICIPS is also leading a clinical trial of Sutherlandia frutescens R.Br. (syn. Less-ertia frutescens Goldblatt & J.C. Manning) in Durban, trial in Clinical Phase 2with adults infected by HIV/Aids. Phase I of the trial was underway in Durban,South Africa at the time of study and I visited the premises in December 2007 toadd comparative value to my research on the preclinical of A.afra.

17. The experts belonged to at least one of the following institutions: the South Afri-can Herbal Science and Medicine Institute and Department of Anthropology atthe University of Western Cape, Missouri University–Colombia, the Nelson Man-dela School of Medicine in Durban, Institute for Infectious Diseases and Molec-ular Medicine at the University of Cape Town, University of Texas MedicalBranch, Grassroots Group Inc., William L. Brown Center for Plant GeneticResources in St-Louis Missouri, the NCCAM of the NIH, the IndigenousKnowledge Systems’ Branch (IKS) of the Medical Research Council of CapeTown (MRC) in Africa and/or in the US.

18. The notion of biopolitics and biopower are initially provided by Michel Foucault(1976) with reference to modern forms of governmentalities that rely on the disci-plines (knowledge acquired on the body in biology, for instance) to make deci-sions on ways of administrating populations. Biopolitics are concerned withpopulation as a political and scientific problem, as a biological issue to the exer-cise of power.

19. It can be argued that social desires have always informed biological researchand fed into ways of administering populations. However, that observation wasnot portrayed as such throughout modernity, but it was made apparent subse-quently.

20. The first published RCT appeared in 1948 in the name of “Streptomycin inTuberculosis Trials Committee.”

21. Living cells would use the four basic molecules (adenosine, thymine, cytosine,and guanine), each composed of atoms named nucleotides. Genes are the align-ments of these nucleotides in a precise order. A single gene can align thousandsof nucleotides, attesting to the endless possibilities of orientation of life at themolecular level (Reeves 1986).

22. DNA sequences created in the laboratory through molecular cloning.

23. Nucleic acids, proteins, carbohydrates, and lipids are the four conventional mac-romolecules.

24. A typical national umhlahlo ceremony could take up to four days. Issues ofobjectivity and fairness led to a preference for healers unfamiliar with the case athand. Doctors came with a group of armed followers to protect them from thoseinvolved. The umhlahlo began as the disputants and representatives of the com-munity gathered in a circle. Each isangoma then entered the circle separately in


an effort to divine the nature of the problem, with the most celebrated isangomaentering last. Ideally, this method was intended to keep the izangoma fromknowing what the other doctors had divined; in practice, however, this was notalways the case.

The results of either the ibandla or umhlahlo would then be told tothe king, who acted as final arbitrator and determined a settlementor punishment. Those “sniffed out” as umthakathis were considereddangerous and unredeemable and often faced imminent death,particularly in the early years of the kingdom. [Flint 2008:80]

Crampton also reports that during the 17th century, powerful Xhosa divinerscould be summoned to “smell out” the person responsible for the “bewitching”(2006):212), attesting to the centrality of the olfactory sense, perhaps the mostdifficult to measure yet considered the most telling in solving political issues.

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