Title The intimate uncertainties of kidney care: moral economy and treatment regimes in comparative perspective Contact Information Dr Ciara Kierans Department of Public Health and Policy, The University of Liverpool, 3rd Floor Whelan Building Quadrangle, Brownlow Hill Liverpool L69 3GB Tel: +44 [0] 151 7945602 Email: c.kierans@liverpool.ac.uk 1 Title: The intimate uncertainties of kidney care: moral economy and treatment regimes in comparative perspective Abstract Today the social and material situations of sick bodies are increasingly and intimately bound up with the variable moral economies of national healthcare systems in uncertain and contrastive ways. I approach these ‘intimate uncertainties’ comparatively and methodologically by drawing on ethnographic fieldwork on transplant medicine in Mexico in order to interrogate European healthcare, specifically the UK. The UK National Health Service is an exemplary site of moral economy, one which the Mexican case appears to stand in stark contrast to. However, as I show, the uncertainties we see at work in Mexico enable us to seek them out in the UK too, particularly those generated at the nexus of the state, failing organs and new strategies for healthcare rationing. The article traces the gendered and socioeconomic inequalities, which follow from these shifts, while offering a cultural critique of analyses which take the European and North American experience as methodologically foundational. Keywords: Moral economy, Biopolitics, Intimate uncertainties, Chronic Kidney Disease, Mexico, UK 2 Title: The intimate uncertainties of kidney care: moral economy and treatment regimes in comparative perspective Introduction This article takes, as its subject, transplant medicine and one of the conditions it seeks to alleviate, Chronic Kidney Disease (CKD). Both condition and treatment are intimately bound up with the variable biopolitics and moral economies of different national healthcare systems in uncertain and contrastive ways. Neither can be viewed as things in and of themselves with stable affects across different sites and settings, but are, instead, entangled with the social relations and material conditions within which they take form. Because of this, I will treat the exploration of the intimate uncertainties that arise from these entanglements as a comparative project. As an example of what that comparative project might deliver, I draw into play ethnographic fieldwork on transplant medicine in Mexico in order to think about how we might begin to interrogate European healthcare, specifically the British National Health Service (NHS). The NHS, on one reading, appears to stand in stark contrast to the Mexican case. However, as I will show, the uncertainties we see at work in Mexico enable us to seek them out in the UK, bringing both situations into clearer focus. Adopting a comparative perspective follows what I take to be one of anthropology’s central analytic frames, though one which has proved to be a persistent and vexing challenge for the discipline. Comparison, particularly in its more programmatic elements, fell from grace during the reflexive debates in the 1980s, suffering paralysis by its associations with grand theorising, objectivist frameworks, a reliance on bounded modes of cultural comparison and varied and variable links to the colonial project (Clifford and Marcus 1986). Recent years, 3 however, have marked seen a resurgence of interest in comparison and its potential to provide new perspectives on older concerns. This has been driven, inter alia, by preoccupations with global connectedness, uncertainty and insecurity, radical assertions from the periphery and changing public responsibilities to discourses of human rights and resource entitlement (see Gingrich and Fox 2002; Niewöhner and Scheffer 2010). As part of this reworking of the comparative project. Niewöhner and Scheffer argue for a tentative and reflexive engagement, recognising its limits but also its capacity to open-up new dialogues, producing new insights as well as methodological innovation and experimentation. And so, with access to biotechnical therapeutic regimes in mind, a comparative approach can work to denaturalise their stability and certainties, recognising that their take up and use across global sites and settings follows no uniform, predetermined path. Trying to establish what makes failing organs and the arrangements in place to deal with them specifi