Abstract:
This paper asks whose evidence counts when attending to new epidemics of unexplained kidney failure. Categorised as Chronic Kidney Disease of Unknown Origin (CKDu), this condition has been identified across parts of the global south, notably Central America, Southeast Asia and parts of Mexico. It has been described as a ‘medical enigma’, in that it cannot be accounted for in conventional aetiological terms, i.e. not directly attributable to increases in diabetes or hypertension, but variously linked to social, cultural and environmental concerns. CKDu affects a comparatively younger demographic, is linked to informal, precarious work, (e.g. agri-industries and mining), as well as to long-term environmental harm and risk. Those affected by it tend to be from poor communities, often working with pesticides, and/or in the context of heavy metals and contaminated water supplies. However, despite growing efforts among different scientific communities, the search for single causes and the reliance on conventional metrics and evidential forms have made little progress. CKDu, as its classification suggests, resists standard explanations and approaches across both the biosciences and the social sciences, with no one discipline claiming epistemic authority. CKDu constitutes a contemporary scientific controversy, which, I argue, acquires its relevance, and understandings within a political economy of harm.