Regulators have long worried about how much to trust those they regulate. Trust can be efficient, allowing regulators to expend fewer resources on expensive, labor-intensive inspections. But trust also carries substantial risks. A regulator’s vote of confidence can open the door for shirking, inappropriate bending of rules, or even misrepresentation and deceit. For this reason, many regulatory systems make trust contingent on verification, as the Russian proverb advises.
This imperative to limit trust often leads to the creation and institutionalization of obligations for layered verification of one component after another. Such regulatory regimes create considerable work both for regulated entities, who must demonstrate that they have followed the rules, and for regulators, who must verify compliance.
But as accountability and verification regimes attempt to solve one set of problems — those arising from too fully trusting regulated entities’ compliance claims — these regimes risk creating fresh problems. Building on organizational research on “routine dynamics,” the article shows how regulatory regimes with detailed rules and elaborate verification routines may inadvertently reinscribe patterns of privilege and disadvantage as regulators enforce rules and guidelines that inevitably have biases built into them. The article also shows how the official, scripted universalism of regulatory stances can be diminished or magnified by the unscripted interactional stances of monitors and inspectors.
Drawing on research conducted in HIV clinics in the US, Thailand, South Africa, and Uganda, the article looks at regulatory encounters in healthcare and biomedical research. The regime of institutionalized skepticism, developed for oversight of clinical research, assumes that it is necessary to cast a distrustful eye on each stage of the research process. Yet it turns out that institutionalized skepticism is not always implemented or experienced the same way. Crucially, it is more likely to be coupled with disrespect in poorer countries than richer ones.
To register, contact Sophie Kofman at skofman@abfn.org.
Carol A. Heimer is Professor of Sociology at Northwestern University and Research Professor at the American Bar Foundation. She received her BA from Reed College and her PhD from the University of Chicago. Heimer has written on risk and insurance (Reactive Risk and Rational Action), organization theory (Organization Theory and Project Management, co-authored with Stinchcombe), the sociology of law and the sociology of medicine (For the Sake of the Children, co-authored with Staffen, winner of both the theory and medical sociology prizes of the American Sociological Association). A recipient of the Ver Steeg Award for graduate teaching, she usually teaches courses on law, medicine, and qualitative methods, with occasional forays in to topics such as the sociology of moral experience. She spent 2007-08 as a Visiting Fellow in the Program in Law and Public Affairs at Princeton. Heimer is currently writing a book from her NSF-funded comparative study of the role of law in medicine. In recent years, American medicine has been “legalized” as relatively informal regulation by professional peers has been supplanted by an increasingly rule-based system. By no means confined to the US, this rule-based regulation has diffused widely, sometimes freely adopted by medical workers eager for the legitimacy conferred by American medical science, at other times imposed on foreign scientific colleagues by American funding agencies and research organizations. The Legal Transformation of Medicine will be grounded in ethnographic work and interviews on the use of rules (broadly conceived) in HIV/AIDS clinics in the US, Uganda, South Africa, and Thailand.
