Curative justice: Epistemic contestations of health in the case of type 1 diabetes and hepatitis C in Austria

Within the remit of so-called Western biomedicine, ideas of “targeted therapies”–like the “magic bullet” imagined by Paul Ehrlich over 100 years ago–act as powerful socio-medical imaginaries and reference points: entailed in such hopes, promises, and expectations is the idea of a treatment that fixes the disease for good without causing further harms. We analyze how this powerful imaginary and its enactment in practice may affect the implementation and lived experience of innovative therapies in Austria. We draw on a total of 60 qualitative interviews and two years of ethnographic research from two research projects on wearable glucose monitors and insulin pumps for Type 1 Diabetes and novel pharmaceutical cures for Hepatitis C viral infections. Following and expanding on the analytic of “epistemic injustice,” and its “pathocentric” specificities, our empirical findings show that the beliefs, interactions, and infrastructures related to “disease fixing” impinge on patients' capacity to articulate, disambiguate, and negotiate health “after the fix”–what we term patho-curative epistemic injustices. We use exemplary cases to pinpoint some of the lived consequences and mechanisms that underpin such injustices, finding that patients' experiences do not just trouble the idea of a “targeted fix” but are likewise troubled by its logics, which substantiate social life, care pathways, welfare politics, and healthcare resource allocation. In our discussion, we consider the implications of our findings not just for epistemic injustice studies but also for the role of (patient) knowledges in policymaking and the importance of considering epistemic injustices as part of ignorance research.