The open question Medical anthropology and open access Contributors :

Medicine Anthropology Theory seeks to ‘open up’ medical anthropology by ‘embracing the concept of open access’ (Moyer and Nguyen 2014). The hope is that making all content free and easily accessible on the MAT website will engage broader publics, including scholars at international institutes who are unable to afford the access fees of for-profit journals; scholars without a formal affiliation to a library, such as underemployed academics and recent graduates on the job market; and practitioners and advocates in the communities where we work.

openness and access is central to the practice of carrying out social science in the fields of health and medicine, we have gathered together six scholars who have worked in medical settings, and asked them to discuss frictions surrounding the dissemination of knowledge they have encountered in their research.
A word about the 'we' here.This conversation was initiated by Emily Yates-Doerr and curated in collaboration with Jenna Grant (Reviews Editor at MAT).We have asked the contributors to reflect on how 'open access' -in the broadest sense of the term -plays out in their research and writing.Our hope is that this collectively written document will enrich the open-access conversation, as it unfolds both within and beyond the field of medical anthropology.The aim is not to critique the current momentum of open access as much as it is to raise and think through some of its complexities.
Emma, when we contacted you about this project, you responded to say you've been grappling with the complexities of open-access publication in your work with geneticists in Indigenous Australia.We wonder if you might say more about this.

Emma Kowal
Thanks, Emily and Jenna, for the opportunity to begin the conversation.Here is my provocation: To be open is a moral good.We teach our children to share.Policies that once fought discrimination are now framed as social inclusion.The web has reached 40 percent of the world's population and rising, drawing ever more people into the open.
To some, sharing is good precisely because it betrays global capital.Sharing is subversive, as one of the first calls for open access put it (Harnad 1994).Battering down paywalls and flouting pending patents, scholars reach out to each other and the public for the greater good of global knowledge.Within science, sharing is mandated through a principle known in many circles as 'UPSIDE' -uniform principle for sharing integral data and materials expeditiously (Cozzarelli 2004).For some indigenous communities, however, UPSIDE has a downside.
We imagine indigenous cultures as the epitome of caring and sharing.In scholarly and popular representations of Indigenous Australians, resources are freely shared within kin groups.Land is a cosmological actor and cannot be owned.Besides, survival in harsh environments requires complete cooperation.But traditionally in Indigenous Australian cultures, knowledge is anything but open (Keen 1994).Controlling the circulation of knowledge is the basis of traditional authority (perhaps all human societies are 'knowledge economies').
In postcolonial societies, the control of knowledge held by indigenous communities and produced from indigenous resources (including indigenous bodies and body parts) has become 'political' as well as 'cultural'.Indigenous communities fight to maintain control over lands and peoples, and Western research is often in the firing line.Aware of the history of racial science and more recent scandals (Anderson 2002;Reardon 2005), indigenous people may be wary of participating in research (Smith 2012).Calls to global knowledge and the greater good that motivate 'altruistic' participation in the general community ring false to those who feel that scientific progress is made not for their benefit, but at their expense.
In my work on Indigenous health research in Australia, Indigenous communities, organisations, and ethics committees are ever more attuned to control over data and data sharing.Genetic researchers with whom I conduct participant observation have struggled to manage the expectations of journals that genome data will be uploaded onto open-access sites with the expectations of Indigenous groups that data will be inaccessible to third parties.Indigenous people can perceive open-data access as making them more vulnerable to negative effects of research, such as when a study of the gene encoding monoamine oxidase A (MAO-A) in Maori was reported in the international media as the discovery of the 'warrior gene', explicitly playing on stereotypes (Hook 2009).
This conflict between openness and control points to two broader trajectories in the way that we relate to data produced from and about us.We are sharing more all the time: our shopping habits on web searches, our political views on social media, and our genome sequences on crowd-sourcing and data-sharing websites like Genomera.com.But we are also demanding more control over data.We see this in the call for 'participant-centric initiatives' that give participants more power over the research process (Kaye et al. 2012), measures that echo the demands indigenous people have made since the 1980s.Another social movement seeking more control over data argues for the 'right to be forgotten' -the right to have personal data permanently deleted, which was just recently enshrined by the European Union in its General Data Protection Regulation.
Everywhere we are struggling with when to share and when to withhold.Perhaps the critical point is not whether something is open or closed, but who has the control to make this decision.The world of open access proliferates the decisions that need to be made.

Todd Meyers
As a medical anthropologist working in contexts of clinical trials research and addiction treatment, questions about vulnerability, disclosure, and openness present themselves as conceptual problems as much as problems of fieldwork and reporting mechanics.Some data are protected, some are personal, others are proprietary.As someone working on historical material, 'openness' is synonymous with 'porousness' as a concern for the ways information and ideas move between disciplinary domains (in medicine, in visual culture).And as someone engaged in editorial efforts of different sorts (with Eugene Raikhel on Somatosphere and with Stefanos Geroulanos on the Forms of Living series at Fordham University Press), I'm concerned with how 'openness' (as a certain comportment towards working and as a condition of access/distribution/rules of publishing) comes to shape both the content and form of work.
Most conversations about 'open access' tend to be framed by questions of value.Is it good?Is it bad?Is it part of a project directed at the democratization of knowledge?Is it subtle profiteering by academic publishers to appear invested in the wider availability of content as long as authors (and their funders) underwrite this effort?Does it dilute more traditional forms of scholarly output?Are all forms of 'open access' equal?Open access certainly frees scholars from the need of university affiliation to access published research.It affords scholars and practitioners working in places where resources are scarce the same privilege of accessing published research as those scholars and practitioners in rich (in every meaning of the word) environments.It also frees us from the annoyance of clicking on a link someone posts on Twitter or Facebook only to hit a paywall.On the consumer side, there isn't much to complain about when it comes to open access.I am not, however, convinced that greater accessibility of academic work is always attractive for the 'makers' of work, or that such appeal is felt uniformly by academics.Open access is as much about opening markets as it is about opening knowledge.I'm not sure what exactly is being untethered from what when individual scholars seek to offer work through openaccess peer-reviewed journals still mediated by the norms of academic production.If access is a question of value, then I wonder if there remains something prized about the cloister of elite journals that requires membership (in whatever form) for access to morsels of privileged knowledge.Of course this attitude makes most of us cringe (for different reasons).Yet when a journal is able to reach a readership no longer defined exclusively by members of a discipline (if this is ever the case), and anticipates that wider market of readers/consumers, does that not change the kinds of things (topics, concerns, methods) that are valued and thus supported by open-access journals and their editors, peer reviewers, etc.? Open access is not only about dissemination; it is about the expectation of an audience as a mode of scholarly production.Or is this all just a scramble for meaning after the fact?Digital humanities projects have been making material (new and old -the Internet Archive project at archive.org is one example) electronically available in creative forms for years.Articles circulate freely as email attachments.Our habits seem to have permanently changed when we search Google before logging in to university libraries, just to see if there's a PDF floating around.
Nietzsche regards 'openness' (at the risk of simplification) as vulnerability, as chance, as change.For Heidegger, 'openness' or Erschlossenheit (not between a subject and a world but as a state of 'disclosure') is just as fraught.Open access is an acknowledgment of the present, responding to transformations in the availability of scholarly materials that have already happened in various forms: from individuals flouting copyright law, to institutional myopias towards intellectual property rights and remunerations, to recriminations about the use and circulation of restricted materials.What is perhaps most radical (or what remains an open question) is how individuals who are making work will utilize open access amid such hand wringing and valuation in the academic marketplace.The free dissemination of findings required by funding agencies -when a portion of a grant is dedicated to subvention for authors to pay for the privilege of having Palgrave, Elsevier, or Springer give free access to research findings -has in no small way contributed to such change.And certainly open access can mean different things.An effort like Medicine Anthropology Theory has aims that open access helps to further along.Yet if there is an ethical concern, surely it is more than one regarding profit or a 'given good' that turns scholarly work along an interventionist pivot, but rather (or additionally) a concern for an ethical field where the possibilities of change and chance are opened with results that have yet to reveal their value.Perhaps the vulnerability of openness is a complement to the vulnerabilities under study in the journal.Maybe a different term is required to express what MAT is hoping to achieve with open access, one that distinguishes this effort from schemes by academic publishers to create free access of selected articles under the sign of 'open access'?So I will end where I began: is the question of open access always a question of value?Eugene Raikhel I'm going to chime in with a few thoughts that build on some of the ideas that Emma and Todd have already laid out.My thoughts on the issues of openness and access are largely shaped by my involvement in the medical anthropology website Somatosphere, which I have been working on with Todd and a number of other colleagues since 2008.One of the things Todd and I have been discussing recently is the emergent relationships between scholarly websites like Somatosphere -as well as the forms of writing, reading, and interaction that they facilitate -and other forms of academic writing and communication, ranging from field notes (or other forms of 'data') to conference papers to peer-reviewed academic journals.
It seems to me that any discussion of open access (OA) is incomplete without a broader exploration of how ecologies of scholarly communication, publication, and research are changing and how they are linked to the political economy of the academy.There's nothing particularly new about this argument -it's been made much more eloquently by people who have been thinking about it much longer and more subtly that I have (Kansa 2014;Boellstorff et al. 2008;Kelty 2014;Jackson and Anderson 2014) -but I think that it bears repeating.The idea is we can't really speak productively about OA -and what either 'openness' or 'access' might mean -without also thinking about a host of other issues such as the process of (and different models of) peer-review, the relationship between journals and other modes and sites of communication, the role of university libraries, the assessment of academic labor, as well as the big questions of what we want our research and writing to do in the world and to whom we want it to speak (Kelty 2014).Again, as others have pointed out repeatedly, this kind of ethnographic attention to the specificities of changing communication practices and infrastructures helps us to resist the kind of technological determinism that sometimes underlies debates about OA, and that is implicit in technolibertarian claims about information 'wanting to be free' (Christen 2012;Boellstorff et al. 2008).
Chris Kelty (2008, 10) has suggested that rather than devaluing the work of scholarly societies or journal editors, OA should draw our attention to all of the collective labor that fosters research, 'from pedagogy and constant interaction with peers, to delivering work at conferences and workshops, to having work peer reviewed, edited and checked, and to having it promoted, discussed, cited, taught and examined by others'.And of course whether or how this labor is valued -indeed, whether or not it is even visible as labor -has to do with the institutional and political economic conditions of the academy (Kelty 2014).So when we speak about OA, it's important to also think about the multiple transformations taking place in each of these sites that are involved in research as a social process.Indeed, the aim of the 'open science' movement is precisely to extend 'openness' beyond publications to other nodes in the research process: data, methods, research materials.And as Nadine Levin (2015) has recently pointed out, based on her and Sabina Leonelli's research on this movement, openness in these sites is 'not a binary, but rather indicates a particular strategy for engaging in a type of openness, in order to achieve a specific end result'.
The second point I'd like to raise echoes Todd's question about the relationship between OA and a journal's audience.Anthropologists have often lauded OA as a means of bringing the knowledge we produce 'back' to our ethnographic interlocutors -although as Emma reminds us, such 'openness' can be problematic when it conflicts with our collaborators' and interlocutors' claims to privacy or control over particular kinds of knowledge.But this is only one way of conceptualizing the potential for addressing (and, in an age of social media, quite literally assembling) new audiences and publics.As we know, the anthropology of medicine and health has its own particular challenges and potentials in this regard.Our subfield has historically had an ambivalent relationship to biomedicine and public health (with different researchers spanning a range of relationships from close collaboration to critique to observation), and increasingly we see anthropologists similarly working out their relationships with other groups of interlocutors or collaborators -whether these are scientific, medical, or health professionals; administrators; or patient advocates/activists.Aside from simply engendering more conversations, there's a great deal of potential for important conceptual, methodological, and practical work to be done here.
MAT's editors have signaled that this is a central part of this journal's project -'Building theory from practitioner and activist perspectives'.There's much that can be said about the challenges of such a project as well as what practical steps it would require.OA is clearly one important step toward this project, but allowing audiences to access a journal's content is not necessarily the same thing as 'opening' the conversations taking place on its pages.I don't mean to rehash stale arguments against 'jargon', to suggest that we don't need specialized technical language in certain contexts, or to argue that we all need to write like the New York Times Magazine.Some of the most productive engagements between medical anthropologists and 'practitioners' or 'activists' are often highly strategic and specific to certain venues and debates, and in this sense they would be 'open' only to very particular publics.But the broader point I'd like to make is that any prospect of such 'theory building' depends on our pushing strongly against the distinction (and even the opposition) between 'theory' or conceptual significance and 'engagement', which is currently dominant in much of anthropology (particularly in the United States) and which valorizes the former over the latter.Another way of putting is that if we want to realize the potential for MAT to be a space of critical experimentation and useful work, we have to set aside our expectations for what either 'theory' or 'engagement' is, what it looks like, and what it does.
Peter Redfield I approach this discussion with two primary points of reference: several years of participating in the background deliberations of the Society for Cultural Anthropology's decision to take the journal Cultural Anthropology open access (http://www.culanth.org/fieldsights/142-cultural-anthropology-will-go-open-access-in-2014)and a longer period of following the humanitarian group Médecins Sans Frontières (MSF) in their various efforts to engage a public in the name of a humanitarian cause du jour.Although I played no major role in the Cultural Anthropology experience, I became newly attentive to the infrastructure of academic publishing, with all its attendant anxieties about labor, payment, and, well, the fragility of what once appeared a timeless, established system of scholarly production.And although I was a professional observer rather than participant with regard to MSF, taking a longer view only complicated the ethics of an otherwise painfully clear moral cause.
With this preamble out of the way, I can say that I have no quarrel with any of the insightful points already raised.To complement Emma's observations about openness, I would note that as well as sharing we also increasingly warn our children about security, which along with health remains one of the great inflationary values of this era (Collier et al. 2004).
Indeed, the open Internet is full of warnings and barriers.In practical terms many of us fumble through the maze of barriers with half-remembered passwords, encountering stern admonitions that they are hardly secure.So while openness, transparency, and inclusion are all classic liberal values, they also engender their accompanying anxieties about traps, deceptions, and lurking threats.Will someone enclose a commons or appropriate an idea?Will we trade good land for a handful of glass beads, five magic beans, or (as reportedly in the case of one of my own ancestors) a mule that goes lame?So we teach our children to share, but also to watch out for strangers and false friends.In case this seems too poetic an allusion, let me note the small and large jealousies attached to academic recognition: for any work, who gets credit (or risks potential blame)?The institutional economy of science -far beyond the little corner of anthropology -revolves around authorship (Biagioli and Galison 2003;Kelty 2014).Thus access may reach a limit in accounting and the comparative worth of different connections.Comments and reactions are fine, but are readers also potential authors?In an environment with highly regulated, defined cycles of professional credit, the question is not merely one of relative labor or engagement, but also a matter of that old and divisive form of value: property.
To complement the contributions of Todd and Eugene, I would just add that openness is also one of the dominant market logics of our time, and that 'access' (like so many of the terms we use these days) signals multiple values across contexts.Both appeal to moral sensibilities, but in more than one way across a range of potential uses and exchange.It is important to add that this ambiguity extends well beyond the control of any author or venue of publication.When putting information into circulation, there is never any certainty that it will flow in keeping with one's desired goals; original intentions offer no guarantee over interpretation, let alone use or effects.I will illustrate this last point with an example from medical humanitarianism.On occasions when MSF sees its humanitarian project in jeopardy, the organization has sometimes expressed its frustration and despair in public speech and advocacy.The legacy of these moments is uncertain, and many episodes remain a topic of continuing debate.A decade and a half ago, the group began a project to document these cases and create a record for its members.This endeavor itself proved internally controversial enough that the results remained in restricted circulation for many years; not all the participants had given permission for open circulation of their contributions.The 'Speaking Out' series has finally gone public, however, and is now available online at http://speakingout.msf.org.Due to the sensitive nature of opinions that swirl around the topic, the editorial approach is one of austere empiricism: each case tries to present an event, as experienced by different actors within this humanitarian organization, and as reported by the press around it.Rather than offering any definitive conclusion or list of 'lessons learned', the studies seek to remain open to ongoing analysis and reinterpretation.This process is not simply benign, however, as more than once MSF has found its pronouncements appropriated by others.And repeatedly the group has struggled to distinguish its expressions of outrage from the Realpolitik of state interest -its uncharacteristic call for military action during the Rwandan genocide versus its condemnation of the more cynical French intervention into that episode's endgame being a particularly distressing case in point.But such is the nature of open access.Circulation can evade control.
Finally, I will mention a pair of additional factors affecting relative accessibility: varieties of curiosity (or incuriosity), and the collective biography that shapes them.The realization of access ultimately involves interest, less in its commercial sense than as a baseline of inquisitiveness.In an era awash with information, fewer may feel compelled to actually seek it out, or follow any lead to its end.The manner in which people display interest or formulate questions clearly has a social history, just like truth (Shapin 1994).It also holds a potential anxiety for any aspiring author to face: what if no one notices your most excellent contribution, let alone actually reads it?However open and accessible in presentation, the relative likelihood of appreciation of any work, or any journal, depends on the receptiveness of networks as well as individual readers.The question of response ultimately lies beyond the control of the MAT collective.However, Eugene's final point about setting aside expectations regarding form (of theory or engagement) would seem a fruitful place to begin a project of shared experimentation.After all, access is also something we grant to each other, in the sense of thinking openly.

Sharon Abramowitz
Many thanks to all of you for having invited me to participate in this challenging discussion.I feel quite daunted about engaging -and I feel that I can best contribute to the discussion by reflecting on the meaning of open access in the context of the Emergency Ebola Anthropology Network and its partners, the UK-based Ebola Anthropology Platform and the Social and Human Sciences (SHS) Ebola Network, and as a scholar who has often worked in closed-information environments in humanitarian contexts.
Though I have been a long-time observer of the complex debates surrounding open access, I seem to have quite accidentally stumbled into the crux of the matter through recent work on the Emergency Ebola Anthropology Initiative.In the initiative, a loose coalition of over two hundred scholars and practitioners from thirteen countries have come together to share data, reports, research networks, and information across a global digital network that is comprised of a website (the Ebola Response Anthropology Platform (http://www.ebola-anthropology.net/), a listserv (https://lists.capalon.com/lists/listinfo/ebola-anthropology-initiative),and a private discussion board.To bring the initiative into focus for this discussion, it is important to emphasize that global anthropologists' response to the Ebola crisis has been principally focused on promoting open access to information about West Africa, medical anthropology, and epidemiology, and to local qualitative and quantitative data.We have tried to deploy many mechanisms, such as circulating reports and publications, crowdsourcing local and international information, sharing contacts, and publishing extensive studies and short guidance briefs in order to bring ethnographic information and analyses to bear on the Ebola response.Crucially, while many participants have been located within key agencies and institutions, the network itself has operated from an independent position.This has made it possible to challenge some of the most pernicious myths that have surrounded the epidemic about the ignorance and culpability of local populations; the exoticization of religious, burial, and food practices; and the inadequacy of the international response.
A central part of this process has involved the adoption of several media platforms to crowdsource information.It's worth reflecting on how strongly the spirit of open access has entered the field of anthropology by considering how readily contributors to the epidemic response converged on the following six principles of practice: 1. Local contexts are diverse and complex, but they are knowable.Maximizing resources efficiently and effectively in a crisis requires using available sociocultural, economic, and political information and data.2. Working from shared platforms in crisis response, rather than developing multiple parallel communications networks, promotes the free exchange of data, reports, and analyses, and access points.3.All forms of information and knowledge, including working papers, essays, analyses, and unpublished social science and public health findings, are important in a crisis, regardless of publication status.4. International anthropologists can play a crucial role in connecting local researchers, experts, and journalists with international agencies, and can act as a 'megaphone' for the often-ignored voices of local communities.5. Resources and information must be targeted, brief, timely, and accessible for humanitarian practitioners working in humanitarian response.6. Mobile, flexible, rapid-response anthropological network structures require long-term maintenance and continuity in order to sustain durable relationships with the humanitarian establishment.
Our efforts have been widely appreciated, but they have not gone without resistance.There has been concern over the intrusion of scholars not presently based in the field of action; over the circulation of reports and studies in draft form; over who has the right to originate research; and over who has an ethical responsibility to share their identities publicly in the process of contributing information.In holding to these principles, the anthropologists who have engaged with the Ebola response have had to bypass professional conventions like single-authorship, extensive bibliographies, and peer-review, which has set the products of this initiative rather far from conventional anthropological publications and products.Doing so has been crucial for maintaining an environment of open access between anthropologists and the humanitarian community, but it also has led to questions about the academic and scholarly integrity of the work that we are doing collectively.
These considerations about open access diverge, in some ways, from anthropology's usual characterization of open access as access to published research.This may be an inevitable byproduct of recent innovations in academic publishing, but it requires us to reconsider what 'open source' means for how we engage with the truth value of past research, how we use the breadth of the anthropological corpus, and how we arrive at ethnographic knowledges of the present.In the 1950s and 1960s, anthropology was regarded as a cumulative discipline, in which specializations of research were utterly indebted to an aggregation of the whole -so much so that citation conventions were often disregarded or dispensed with in the interest of making a case.Today, we are primarily engaged in practices of scholarly production that epistemically structure new research as a far more selective improvement upon past research, rather than as a collective inheritance.Through the politics of selective citations in the peerreview publication process, the whole of the field of research is lost in the service of specifics that support the 'truthiness' of the present research offering.I might even go so far as to say that one's ability to engage in anthropological production in today's scholarly market is closely tied to setting one's own contribution apart from the contributions of peers, rather than pooling knowledge in the service of gaining a view of the whole.A problem presented by open-sourced crowdsourcing is that when many contribute to the research, no one 'owns' the final product, inverting the current academic market model.
Openness is attained, but it is uneasily contracted; the result is the perception that there is a lack of transparency, rather than an open forum for crowdsourced research and documentation.
Open access poses a fundamental challenge to how we define data, analysis, and ethnography.What is the difference between data and analysis in ethnographic writing?Some would say, very little.The importance of ethnographic writing as both a form of data and a form of analysis leaves ethnographic writing in a kind of limbo in discussions about open access to evidence.What kind of evidence are we really willing or able to share?Is it a World Health Organization database?Is it my colleague's unfiltered (or redacted) field notes from Liberia?Is it my pre-published research reports?Or is it the peer-reviewed article or book that requires my primary and secondary acts of representation and analysis?Is the process of peer review work evaluating truth claims, is it disputing interpretations, or is it enforcing stylistic norms and conventions at the expense of rapid open access that makes information available when it is needed, rather than after it is vetted?
These kinds of questions have profound implications for how we train students, organize our research practice, understand epistemology and experience, and engage in legal and market arrangements regarding data access and archiving.Until we sort out our thoughts on these issues, we have a very thin framework to work from when we engage with institutions that impose embargoes on research findings and deprive communities of practice of access to information.Violating embargoes or bypassing legal arrangements presents more than an ethical burden; it can fundamentally impact one's freedoms and liberties by leading to imprisonment, job loss, professional intimidation, or professional exclusion.
With all of our focus on 'being there' and ethnographic writing, anthropology is giving very few signposts to anthropologists who are trying to do anthropological work on nonanthropological data.For example, my team of researchers has had to engage in processual flip-flops in order to do anthropological work on non-anthropological data collected by the World Health Organization.As a second example, NSF's own anthropology program, and other anthropology research funding initiatives, regularly refuse to support the costs of publishing in existing open-access venues.What messages are we receiving and sending about open access in research conditions like these?
Open-access issues are directly related to the ethics of repeating research among vulnerable populations.How efficiently do we seek to engage with existing data sources?To what extent does the structure of anthropological production endorse data hoarding or repetitive solo research, rather than collaboration and nonduplication?In the Ebola response, many dozens of academics have discussed the hoarding of data by specific organizations, the failure to release data to academic partners for analysis and interpretation, and the failure of international organizations to share local research findings with local research populations.All of this is resulting in the needless replication of research.Our colleagues in the sciences have been vocal critics of the paywalls, informational barriers, and data embargoes that have prevented researchers from accessing obtained data.We need to take a more active role in this fight, too.Can we reconsider how we participate in the global circulation of data, and make a case for greater access and movement by inserting ourselves in these global flows through interdisciplinary collaboration and advocacy?
Perhaps like many of you, I regularly have conversations with graduate students who are circumscribing their research to meet the perceived informational demands of the political realities of academia or the field, and who are consciously choosing to exclude politically challenging accounts.As anthropologists, we need to re-engage with the fact that not all spaces are safe for openness, especially those characterized by corrupt governments, autocratic political leaders, highly competitive research environments, and repressive attitudes towards independent researchers.Openness can, at times, conflict starkly with a scholar's to conduct independent research that speaks truth to power.The call for greater and greater transparency in an increasingly closed environment for the market of anthropology can impede medical anthropologists' ability to tell the hard truths.
I'll conclude by reminding us all that we have an ethical responsibility to make this conversation real, accessible, and relevant to our graduate students and colleagues who conduct research in local environments of extreme vulnerability and repression.The local is not necessarily the same as the 'open', and neither crowdsourcing nor local refereeing should be required or applied in all contexts.We need to be able to apply a standard of informed and judicious judgment.Sharing data with local authorities, community leaders, or institutions can result in harm to researchers and can inhibit our ability to tell authentic truths of the field.In the Ebola context, for example, both the Guinea and the Liberian governments have actively sought to restrain information that represented both the epidemic and the state's role in the response negatively.(Anderson 2008;Street 2014).When I tried to reassure gatekeepers that the identity of informants would be protected, some rebutted that this was not the point: the issue was outsiders coming in, 'eating off our labor' (kaikai long skin bilong mipela), making careers out of the experience, and contributing to a globally accessible archive of false representations of Papua New Guinea and its people.
One discussion in particular stood out for me.Explaining why I was denied approval to conduct research in a public hospital, one gatekeeper asked if I had seen the picture, then circulating on the web, of President Obama's head photoshopped onto the body of a Huli 'Wigman'.(This racist image had been created by a member of the Tea Party political faction in order to satirize Obama's 'tribal' origins; apparently its creator mistook the Huli for Africans [Mullaney 2012]).That was what foreign researchers did, he said: they appropriated images and knowledge about Papua New Guinea societies and then left them 'out there' to be misused and decontextualized.Meanwhile, the people who conducted such research were awarded huge grants and prestigious university jobs.The 'openness' or accessibility of research results, he suggested, contributed to the ongoing humiliation of the entire nation, continually misrepresented as a tribal, dysfunctional, failed state still stuck in the Stone Age (West 2012).
As a graduate student struggling to get my research off the ground, I found these claims frustrating.After all, my intention was to study the role of the nursing profession in creating modern Papua New Guinea and nurses as educated, professional people with a unique social location in a complex multicultural nation.With time I realized that these complaints were sincere and legitimate.I was indeed 'eating off their labor' and there was no guarantee that my work would benefit anyone other than myself.Opening my findings to the world would allow even more strangers (some well intentioned, others not) to extract value from them.
'Opening' work to collaboration with local actors (as described by Sharon above) does not necessary lead to greater equality.I think we should question the notions of the public sphere and of sharing that underlie normative understandings of open access.As any anthropologist who has read their Mauss can tell you, sharing can be a profoundly coercive practice as much as a leveling one.Sharing and collaboration restrain as much as they generate.One of the strategies the medical research community in Papua New Guinea has adopted has been to require a national to be a co-PI on any research study deemed medical that is conducted within the country, and to insist that this collaborator is a named author on any published results.This is an admirable strategy in a country that has long been positioned as an object of study not just in anthropology, but also in biology, zoology, conservation and environmental science, virology, and beyond.It has been successfully implemented as a policy for controlling social science research in Vanuatu (Geismar 2005;Taylor and Thieberger 2011).Collaboration -efforts to 'share' or 'redistribute' the labor and prestige that research entails -is in these cases an assertion of sovereignty and ownership, not 'openness'.There are very good reasons why some researchers and subjects of research may wish to limit access to knowledge, especially when that knowledge is attached to their name.
These concerns are more about the politics of representation than about open access as a publishing model per se.However, I believe that values of transparency and public engagement -in anthropology at least -are often explicitly promoted through conversations about open access.A final concern I want to articulate is how the open access movement in anthropology is co-produced with new pressures on junior scholars to ramp up their production of 'deliverables' and to curate a public presence for themselves online.
Maintaining an active research Twitter feed, blog, LinkedIn page, academia.eduprofile, ad nauseum are increasingly expected from US-based anthropologists, as part of the performance of 'openness'.Fulfilling these expectations requires a huge amount of (unpaid) work that may be second nature to some professionals (those who have a lot to say and the expectation that people want to hear it) but can be burdensome for others.Maintaining a public professional presence online is unpaid emotional labor, and emerging norms of 'openness' may reinforce this expansion of academic work into hard-won spaces of privacy and leisure.
Reflection I: Emily Yates-Doerr and Jenna Grant In the spirit of openness, rather than draw the piece together into a single conclusion, we end with a brief reflection of some of the key points that emerged in the discussion above and a final commentary from MAT co-editor, Eileen Moyer.
As the concept of open access gains momentum, important questions emerge about how appeals for openness alter the politics of research and practices of writing.Tempering wholesale optimism that openness is a moral good and that open-access publishing will engage diverse publics and stakeholders and improve efficiency, several of the above contributors have expressed caution that open access -much like democracy itself -can become a foil for exclusionary practices: Indigenous populations who are further disenfranchised, vulnerable populations who are made ever-more exposed.Even as an openaccess platform addresses some concerns about the ownership of academic knowledge, the question of control persists: what structures the distribution and circulation of samples, stories, images, and interpretations, and who do these structures favor and ignore?The contributors here have drawn attention to new forms of implicit, still unpaid, labor that go into participating and responding openly.They have also suggested that it is critical to pay attention to whose voices are calling for openness, and how certain languages -and certain ways of speaking -remain privileged by this call.
MAT is able to appear in the form that it takes because of the open-access movement, which has begun to dismantle the scaffolding of paywalls and, with this, to configure new modes of scholarship.The way that the editors of Cultural Anthropology, HAU, and Mattering Press (among others) have made the byzantine, profit-incentivized conditions of academic publishing visible is welcome and long overdue.We add to this an observation from the standpoint of medical anthropology: openness and access are never just values; they are also practices, carried out in unexpected ways with unpredictable effects.
The contributors to the discussion have indicated that in addition to advocating for openness and access, we must also attend to the effects that openness and access have in our various sites.

Reflection II: Eileen Moyer
Let me begin by thanking Emily and Jenna for initiating and curating this conversation, as well as all those who have thoughtfully contributed.A special thanks to Jenna for inviting me to comment.These pieces, with their various, sometimes conflicting, and unresolvable concerns echo discussions we have been having in our editorial meetings related to how we, as editors of MAT, envisioned the journal's professed project of openness.Among other things, these discussions have touched on technological accessibility; geopolitical inequalities; linguistic, stylistic, and aesthetic hegemonies; the contested value of anonymity in the review process; and the politics of representation.
Although anthropology has long been concerned with the politics of representation and 'othering', when depicting the illness and suffering of human bodies, or the political and economic inequalities that produce them, such issues become increasingly impossible to ignore.This is true for text, but even more so for photography and film.As a researcher who has spent most of my career working on HIV in Africa, I have often reflected on the consequences of public representations.Both 'HIV' and 'Africa' are endlessly useful for thinking and teaching about the allure and the danger of othering.How many of us have relied on Binyavanga Wainaina's provocative How to Write about Africa (2008) to unsettle our undergraduates?To ask how we can represent suffering bodies, or corrupt or coercive governance, and not reinforce stereotypes and exoticize?In an age when tropes of humanitarianism have come to be equated with images of sick, wounded, malnourished, and otherwise scarred bodies, is it possible to engage readers ethically without resorting to affective ploys?When we as a journal decide to do our best to not contribute to the exoticized portrayal of other peoples and places, are we not foreclosing a discussion and practicing a form of censorship?When we reject contributions or coax contributors to conform to our norms of representation through the review and editorial process, are we not necessarily and violently establishing boundaries based on views that are political, both implicitly and explicitly?
My field of research has also given me many opportunities to reflect on the advantages and challenges of the 'idea of openness'.Many of the activist and academic (and these are often intertwined) projects that have been central to the HIV response around the globe over the last thirty years have centered on the normative value of openness.Take, for example, treatment activists' demands for open access to both HIV drugs and drug-development science (Epstein 1996), or the oft-heard tautological claim that the 'secret' to HIV prevention and fighting HIV stigma and discrimination is 'openness' about the disease (whatever that might mean) among those already infected -preferably in the form of prepackaged testimonials and confessional morality tales (Nguyen 2010;Moyer, Burchardt, and van Dijk 2013).Simultaneously, both activists and academic researchers have stressed the importance of confidentiality, privacy, silence, and even secrecy, enshrining these as individual 'rights' (Hardon and Posel 2012).This has resulted in a contested public health domain as well as an ongoing ethical dilemma to which, in truth, we have no answer.Which humanist value is more important in the fight against HIV: openness for the individual/collective good or the right to individual/collective privacy?
As a scholar and sometimes advocate, I have tried to err on the side of those with less power, providing a space where their voices might have a chance of being heard and doing my best to protect their privacy.For me, at least, the journal is an extension of that imperfect and fraught project.I am relieved to read that most of the contributors to this conversation are concerned about the relationship between openness and privacy.I don't expect that MAT will ever develop a clear set of guidelines about how to balance these related principles.I do have hope, however, that the journal can provide a space through which we as a discipline can continue to reflect on these important issues.
Should they -and the local voices they represent -have final say over what is open and what is closed for ethnographic observation?Maybe they should.But this requires discussion.I share Sharon and Emma's concerns about the chilling effect that open access might have on research with vulnerable populations, and would emphasize that medical anthropology seems to be in a particularly fraught position.In my own experience conducting research on nursing education in Papua New Guinea, my work fell on a jurisdictional boundary between medical research (tightly controlled through national gatekeepers) and sociocultural research (more loosely monitored, with access controlled through local authorities).Local and national gatekeepers had very different understandings of ethical practice and the dangers of foreign research.Different institutions claimed jurisdiction over my access to field sites as well as rights to control access to research results.Very legitimate concerns about research sovereignty and foreign extraction of data were at play here, as well as local politics at multiple scales They raise the need for 'open-access' to be accompanied by watchful, carefilled consideration for how control is maintained and evaded, and the need for keeping alive the important question, as Barbara Andersen reminds us, of who is eating and who is being eaten.The commitment to make publications open and accessible carries with it the commitment to recognize that what 'open access' will achieve in practice remains an open question.