The quest for universal knowledge
Let us first look more closely at how scientists have tried to create contexts in which their knowledge claims about sex hormones could be transformed into natural facts. The history of sex endocrinology shows both successes and failures, which can best be understood in terms of the notion of networks of knowledge. In this perspective, knowledge “never extends beyond and outside practices. It is always precisely as local or universal as the network in which it exists. The boundaries of the network of practices define, so to say, the boundaries of the universality of medical knowledge” (Pasveer 1992: 174). The successes and failures in scientists’ striving for universal knowledge are thus related to the extent to which they are successful in creating networks. Bruno Latour’s metaphor of the railroads exemplifies this point:
When people say that knowledge is “universally true,” we must understand that it is like railroads, which are found everywhere in the world but only to a limited extent. To shift to claiming that locomotives can move beyond their narrow, and expensive rails is another matter. Yet magicians try to dazzle us with “universal laws” which they claim to be valid even in the gaps between the networks.
In terms of this network perspective, the concept of sex hormones was a strong concept because of its pronounced connotations for sex and the body. Female sex hormones could be linked with “female diseases” and related medical institutions, and male sex hormones to “male diseases” and related medical professions. The concept of sex hormones simultaneously summarized and simplified the interests of specific groups. At this point, however, there existed vast differences between knowledge claims about female sex hormones and male sex hormones. The previous chapters have shown how the networks that evolved around statements about female sex hormones were much more extensive and substantial than the networks around male sex hormones.
First, there were major differences in the number of researchers who became involved in both types of research. Because methods as well as research materials for female sex hormones were well developed and easily available, more and more researchers became involved in research on female sex hormones. We saw how the number of publications on female sex hormones increased steadily in the 1920s and 1930s and soon outnumbered those on male sex hormones.
Second, there were striking differences in the number and variety of the groups outside the laboratory that became involved in research on female and male sex hormones. Knowledge claims about female sex hormones could be linked rather easily to relevant groups outside the laboratory. The making and the marketing of female sex hormones fitted nicely into already existing institutional structures formed earlier in the century. In the process of making female sex hormones into chemical substances, laboratory scientists were able to create networks with gynecologists and pharmaceutical companies prepared to provide them with the required research materials. In the transformation of sex hormones into drugs, we saw a further extension of these networks from the laboratory and the pharmaceutical industry to other medical professions, and to groups beyond the laboratory and the clinic. With respect to female sex hormones, Organon was quite successful in enrolling the relevant groups to promote new types of drugs to a wide variety of audiences, sponsors and consumers, including general practitioners, psychiatrists, neurologists, medical health institutions, women’s clinics, factory boards of directors and insurance companies. In the marketing of female sex hormones, the number of indications for which sex hormones were tested increased simultaneously with the involvement of more groups, in a process by which female sex hormones were made into drugs applicable for a wide variety of diseases in women.
What is important here is that some networks are easier to create than others. Negotiations to establish networks do take place in “a highly prestructured reality in which earlier choices delineate the space of further choices” (Berg 1992:2). In the case of female sex hormones, laboratory scientists and pharmaceutical companies did not have to start from scratch. They could rely on an already organized medical practice that could easily be transformed into an organized market for their products. The gynecological clinic functioned as a powerful institutional context that provided an available and established clientele with a broad range of diseases that could be treated with hormones.
Knowledge claims about male sex hormones were more difficult to link with relevant groups outside the laboratory. The production as well as the marketing of male sex hormones was rather constrained by the lack of an institutional context comparable with the gynecological clinic: men’s clinics specializing in the study of the male reproductive system did not exist in the 1920s. The production of male sex hormones was rather problematic because it was hard for laboratory scientists to gain access to the required raw materials. The marketing of male sex hormones remained confined to a smaller number of groups, thus lowering the number of indications that became included in the drug profile of male sex hormones. Although there existed a potential audience for the promotion of male sex hormones, this audience was not embedded in any organized market or resource network. These differences in institutional context had a major impact on the marketing of sex hormones. Because the promotion of female sex hormones could easily be linked to the interests of a well-established profession, female sex hormones developed into drugs that were prescribed for a far wider array of medical indications than male sex hormones.
In the case of sex endocrinology, successes and failures in creating networks were highly dependent on the fact that there existed a medical specialty for the reproductive functions of the female body, and not for the male body. It was this asymmetry in organizational structure that made the female body into the central focus of the hormonal enterprise. Sex endocrinologists depended on these organizational structures to provide them with the necessary tools and materials. These differences in institutionalization between the female and the male body are a very crucial factor in shaping the extent to which knowledge claims can be made into universal facts. The institutionalization of practices concerning the female body in a medical specialty transforms the female body into an easily accessible supplier of research materials, a convenient guinea-pig for tests and an organized audience for the products of science. These established practices facilitated a situation in which the hormonally constructed female body concept acquired its appearance as a universal, natural phenomenon.