"...biopower, to use Foucault’s language, is characterized by the molecular and the population as ‘‘two poles of development linked together by a whole intermediary cluster of relations.’’ The work that is required, therefore, for scholars in STS and related fields is the tracing and understanding of this cluster of relations." (Raman & Tutton, 19)
But what particular relations make up this cluster? Or, to phrase the question differently: In the context of the "power from above" vs. "power from below" debate, who and/or what constitutes the "middle"? The answers, of course, are many, but one of the more interesting "middle" figures is the general medical practitioner -- that is, the figure who, for most people, serves as an interface between the complicated, technical world of biological/medical innovation and the lay person's existence. As trained professionals, they are by necessity more in touch with and more able to make sense of advances in biotechnology than the average citizen; but at the same time, most general practitioners are decidedly not specialists in the field of biotechnology. General practitioners stand, in a sense, with a leg in each world.
This means that GPs are often the real-world focal points for the legal and ethical dilemmas that are regularly debated by bioethicists. It is GPs who negotiate the balance between promoting length of life and quality of life (for example: should one administer chemotherapy to the exceptionally elderly? i.e. possibly extend their life by a couple years, but at the cost of greatly reducing their quality of life?).
Although GPs are often the site at which biopower and biopolitics comes in contact with the average citizen (for example, a GP urging his or her patient to quit smoking is a tangible enactment of an increasingly normative push for a certain kind of health-oriented behavior), it is also important to remember that GPs are as much subject to the forces they enact as are their patients. GPs are members of a (disciplinary) profession. This means that ethical injunctions (initiated by the new development of technologies) quickly become professional/legal requirements for GPs. Since the work of biopolitics is necessarily a procedure of normalization, subjective judgments with regard to health are necessarily tossed aside. The "goal" of medicine -- whatever it may be -- must be standardized. To return to the chemotherapy example, an extensive biopolitics/biopower simply cannot leave the use of chemotherapy up to the patient's discretion; increasingly, the GP, to protect him or herself legally (and the legal is always connected to the discretion of the profession), is obligated to encourage a particular treatment, precisely because of the standardizing and normalizing effects of biopower/biopolitics. In other words, the middle level is increasingly obligated to obligate the lesser level.
This chain of obligation seems to run parallel with Raman and Tutton's critique of Rabinow and Rose's work. If the middleman is constrained, the how much more so are those down "below"?
Oops...I missed this posting of yours. I have it marked down now. Asking about the "middle" is a move worth making. Of course marking out the middle leaves us to ponder the 1/4 and 3/4 marks (then the 1/8, 3/8, 5/8 and 7/8 marks...then the 1/16...); you get my point—the continued halving the difference . And perhaps then about teasing out the details (and other players) in the "chain of obligation" that you imagine. Indeed, if one's primary care physician is a GP it's not unlikely that you will be referred to a specialist (whose feet are where along the chain?). How about the material connections between specialist and laboratory scientist? And what if the chain is fed (changing the metaphor) by tributaries that themselves are chain-like with THEIR own tributaries. You see where this is headed. The standardizing and normalizing practices are scattered, originating in a great many places. A distributed biopower/biopolitics.
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