Andy Miah

Genetics, cyberspace and bioethics: why not a public engagement with ethics?

Introduction: science and the media

The representation of science, medicine, and technology has been an emerging agenda item for cultural and media research in the last decade [START_REF] Henderson | The Human Drama of Genetics: 'Hard' and 'Soft' Media Representations of Inherited Breast Cancer[END_REF][START_REF] Seale | Health and Media: An Overview[END_REF][START_REF] Stockdale | Waiting for the Cure: Mapping the Social Relations of Human Gene Therapy Research[END_REF]. In part, its importance arises out of a concern for the public understanding of science (PUoS), which has been a priority in governmental policy discussions [START_REF] Sainsbury | Science in Society: Advice to the Office of Science and Technology from the British Association for the Advancement of Science[END_REF]. How medical science is mediated is a critical aspect of this discourse, partly because of its important therapeutic function. Yet, various researchers have cited its reporting as a case of irreconcilable, conflicting values between scientists and the media's articulation of public concern. On this view, it is not that the media does a bad job of reporting science, as is often the criticism from scientists [START_REF] Bubela | Do the Print Media 'Hype' Genetic Research? A Comparison of Newspaper Stories and Peer-reviewed Research Papers[END_REF]. Neither is it representative to claim that scientists are unable to articulate their work for the non-expert, as is often the criticism of scientists from the media. Rather, the agenda of each party is different and this leads to unsatisfactory reporting and misrepresentation.

This situation is captured in Purvis [START_REF] Purvis Cooper | Science Writers' Reactions to a Medical 'Breakthrough' Story[END_REF] analysis of a scientific writers' e-mail discussion list, who find "science writers to be cognizant and concerned about the impact of their work on the public" (p. 1894), but whose capacity to reflect subtleties of scientific discoveries is limited by editorial decisions, which require bold statements from articles. For the public, the exaggeration of scientific findings can explain the tendency for some science to lead to, what some have described as, moral panic, though perhaps moral confusion more accurately reflects the consequences of spectacular science.

While more can be said about the nuances of scientific journalism, the main priority of this paper is to consider how ethical debate can assist the development of the public understanding of science, specifically through considering gene transfer technology as the subject and computer-mediated communications (CMCs) as the mechanism for developing understanding. I wish to argue that the subject matter of human genetics and the intimate environment of CMCs offer a context where the aspiration of a PUoS can be better accomplished. Scientific journalism is integral to this conversation, to the extent that I question how emerging online communities and writings offer an opportunity to redress some of the limitations of conventional publishing, by circumventing established media gatekeepers. Moreover, the current proposal can be seen in the context of [START_REF] Hargreaves | Towards a Better Map: Science, the Public and the Media[END_REF] who draw attention to the limitedness of merely explaining science. Their Economic and Social Research Council (ESRC) report on the relationship between science, the public, and the media, identifies the broader parameters of public understanding in making science meaningful through connections with "policy and the broader public interest" (p. 5). 1 My argument raises critical issues about the role of scientific information and the power structures underpinning its dissemination. Importantly, I wish to re-position the PUoS and suggest that a way forward is through developing a "Public Engagement with Ethics" (PEwE). On this basis, I argue that an ethical engagement with science alleviates many of the concerns about the limitedness of scientific journalism. This is because the moral narrative surrounding science effectively contextualizes the subject and enhances the possibility of ensuring that non-experts come to terms with the significance of scientific news. While this proposal ought not to be construed as a mechanism to make people care about science, it does claim that an ethical discourse on science can promote its relevance for a wider range of people.

Genetic science is a particularly useful case on which to study this proposal, since it reflects the difficulty (and importance) of arriving at common ethical agreements in a global, scientific culture. Human genetics has already begun to create insurmountable problems for the development of global ethical policies and the development of science. Yet there remains considerable uncertainty about what has been achieved. For example, in the past five years, the media has described the "first" cloning of human beings on five different occasions, yet still there is no actual birth of a human clone. Journalism on this issue has raised considerable concern from the scientific community and has recently been the focus of empirical research. Notably, Hornig [START_REF] Priest | Cloning: A Study in News Production[END_REF] analysis of US news production surrounding Dolly the sheep emphasizes the ethical dimensions of the science. As well, [START_REF] Gaskell | Ambivalent GM Nation? Public Attitudes to Biotechnology in the UK, 1991-2002[END_REF] conclude their GM Nation report by drawing attention to the need for "public debate" on gene technology. While the study does not attempt to derive moral narratives in attitudes towards biotechnology, it does suggest that what might actually be at stake is, "not the science" (p. 19), but the moral concern about "what sort of society . . . we want" (p. 19). To this extent, my thesis develops along similar lines to that of [START_REF] Michael | The Facts about Fictions and Vice Versa: Public Understanding of Human Genetics[END_REF], who juxtapose their own "processive" model for a PUoS against the critical and traditional (deficit) accounts. Their claims about the role of fiction as narrative in representing science attest to the utility of new media discourses, which can be developed through computer-mediated communications. 2

Re-positioning the (ethical) expert

One of the major criticisms of the traditional view on PUoS is that it seems to describe the public as uninformed, which limits the kind of relationship scientists could have with the non-expert or public. Yet, even if one endorses the PUoS as an educative project, there are some doubts about its effectiveness. [START_REF] Stockdale | Waiting for the Cure: Mapping the Social Relations of Human Gene Therapy Research[END_REF] argues that the public debate about science has never actually taken place and even claims that the successes of developing a PUoS are overstated. Indeed, [START_REF] Reiss | Improving Nature?: The Science and Ethics of Genetic Engineering[END_REF] argue against the PUoS project on these grounds, suggesting that more consideration must be given to the relationship between scientists and the public. Distinctions must also be made between the various concepts integral to the PUoS, such as education, persuasion, informing, and regulation. In part, such criticisms have led to the development of "science communication," "critical PUoS," or "public engagement" as the preferred descriptors of the challenge faced by science educators and it is the last of these that I will advocate.

My critique is not specifically about the success of the PUoS or the relationship between the public and scientist, though these concerns are implied by my position. I am more concerned that the media often relies on the wrong kind of expert and that this undermines the capacity for non-experts to understand the salience of science. 3 Moreover, I am interested in considering what might be a suitable alternative model for developing public engagement with science through the media. Usually, the media utilizes scientific experts for both the explanation of science and the moral commentary that, typically, accompanies it. This is an unreasonable situation. If we are to give the notion of "expert" any value at alland there do seem good reasons to value experts, providing the nature of the dialogue with which expertise is communicated is not authoritarian-then there is a need for expert commentary on morality and communication to clarify what is at stake for the public when new science stories break.

Yet, when considering the possibilities of an ethical debate on science, asking who should be the expert on the morality of science further complicates the relationship between scientists and non-scientists. [START_REF] Turner | What is the Problem with Experts?[END_REF] analysis of experts provides a useful context for this discussion. Specifically, his Foucauldian claim about how expert knowledge is (mis)used reflects the implications of asking scientists for the wrong kind of expertise: if experts are the source of the public's knowledge, and this knowledge is not essentially superior to unaided public opinion, not genuinely expert, the "public" itself is presently not merely less competent than the experts but is more or less under the cultural or intellectual control of the experts. (p. 125)

The kind of "intellectual control" to which Turner refers is also implied by Hornig [START_REF] Priest | Cloning: A Study in News Production[END_REF] and by [START_REF] Holliman | Media Coverage of Cloning: A Study of Media Content, Production and Reception[END_REF], who question the legitimacy of moral perspectives on science and identifies the tendency for moral views to become politicized and, thus, prejudiced through the media. Hornig Priest also highlights some challenges raised by framing journalism with some ethical narrative, since, she argues, it can give rise to the legitimization of "maverick perspectives" (p. 62), which are given equal worth in the name of objective reporting. [START_REF] Holliman | Media Coverage of Cloning: A Study of Media Content, Production and Reception[END_REF] extends this thesis in his analysis of UK newspaper coverage of Dolly arguing that the influence of vocal "politicians, religious figures, and scientists . . . generated the conditions for the political and ethical controversy that displaced the scientific announcement" (p. 115). This position suggests that the use of ethics experts is similarly unhelpful (and dangerous), since it, again, places a particular kind of person in a position to control the nature of understanding. However, Turner's criticism seems related to the manner in which expertise is utilized and how it becomes part of the moral discourse surrounding science. Where morality is used as a judgment or as a way of framing the central issues concerning a subject, this has the capacity to limit the way that it becomes politicized. Indeed, this criticism has been made of the current US President's Council on Bioethics, specifically directed to the leadership of Leon Kass and his compatibility with the values of the Bush administration. A further level of criticism might be about the danger of bioethicists becoming shapers of moral discourses.

My position on ethical experts adopts a somewhat different account of their role in communicating science. To explain this, one can refer back to the discussion about how scientific expertise is used. It is reasonable to claim that expertise has some utility in public debates. To reject the relevance of expertise is to reject the idea that people have specialized knowledge. However, such capacity might be a specialization in argument rather than a specific subject or profession. A physician is likely to have a greater general knowledge on medicine than a mechanic. As such, the latter is better qualified to repair a car; the former a human being. Acknowledging these different kinds of knowledge need not imply more than recognizing the value of specific kinds of skills and knowledge and does not give rise to [START_REF] Turner | What is the Problem with Experts?[END_REF] concern. Moreover, it need not imply elitism; though one can reasonably claim that some kinds of knowledge are accessible to only the few. In the present discussion, the claim is about the kinds of skills and qualities an ethicist has developed through their study. For instance, an ethicist might have a clearer understanding on the relationship between law, policy, and ethical discourses about science, than a scientist.

Thus, where the media relies on experts, it is necessary to distinguish technical or scientific from ethical expertise. Scientists are most certainly the wrong kind of expert to use for ethical commentaries on science in the same sense that ethicists are the wrong kind of experts to explain the technicalities of how science works. This does not imply that only certain kinds of people can acquire ethical expertise. Indeed, it argues the contrary and, moreover, acknowledges that a preferable situation might rely on developing expertise in both the technical and moral aspects of science. Indeed, this suggestion reflects [START_REF] Hoggart | A Healthy Society Needs Maggots in the Cheese[END_REF] appeal to higher education programs in the UK to foster social and philosophical tuition in scientific undergraduate programs. It also responds to [START_REF] Ziman | Why must Scientists become more Ethically Sensitive than They Used to Be?[END_REF] identification of a need for greater ethical sensitivity among scientists. Alternatively, it might entail opening up academic conferences to the broader public, thus widening the range of delegates who attend scientific congresses or even considering media strategies related to scientific meetings. 4 The ethicist should not be seen as a moral judge of science. To entertain this prospect would be inherently troubling and has led to a range of criticisms made about (bio)ethicists, some of which have been mentioned earlier. It would also fail to acknowledge the dangers of the "celebrity bioethicist" [START_REF] Turner | Beware the Celebrity Bioethicist[END_REF], who either finds their ethical views utilized to endorse the practices of corporations, or celebrates their ethical insights with the extensive fees they receive for their consultancy and alleged wisdom. These are each troubling prospects for developing a greater role for ethical experts as part of public engagement.

However, I argue that the ethicist's role in the communication of science must be somewhat pedagogic, rather than expressive. The kind of ethical expertise I propose calls upon ethicists to reconsider the media encounter as an opportunity to explain the range of moral concerns about a given case, rather than a chance to assert personally held beliefs about a subject. To this extent, the argument takes into account the criticisms of [START_REF] Turner | Beware the Celebrity Bioethicist[END_REF] and [START_REF] Miles | Medical Ethicists, Human Curiosities, and the New Media Midway[END_REF] with whom I share the frustration over the "soundbite" interview, which I have criticized elsewhere [START_REF] Miah | The Public Autopsy: Somewhere between Art, Education and Entertainment[END_REF]. As [START_REF] Miles | Medical Ethicists, Human Curiosities, and the New Media Midway[END_REF] argues "As in any teaching activity, a medical ethicist should know what he or she wants to teach before the reporter asks a question and should stick to that message rather than being drawn into a docu-soap's prefabricated story line" (p. 42). I am doubtful that many ethicists approach media attention as an opportunity to explain or teach the broad range of ethical issues arising from any given subject. More likely, they utilize the opportunity as a way of asserting their particular point of view on a subject. This might also reflect the novelty of media encounters within philosophy and ethics.

In sum, calling for a greater role of ethics and ethicists in the PUoS is twofold. First, I argue that the communication of science must be more closely allied to engaging the public with the ethics of science. Second, I argue that this should be accompanied by a reconsideration of how ethical commentaries are used in scientific journalism. This view need not entail elevating ethicists to some greater social status (even though law often relies on such a system). Indeed, I share Hornig [START_REF] Priest | Cloning: A Study in News Production[END_REF] concern about the use of ethical viewpoints in the media. I also support the criticisms of relying on ethics experts as a basis for setting public policy on science. Yet, there is still some merit in arguing that an academic (ethicist) occupies a special place in society, free from conflicts of interest, which might limit their views on how people should live [START_REF] Halwani | Introduction to the Philosopher as Public Intellectual[END_REF][START_REF] Nussbaum | Moral Expertise: Constitutional Narratives and Philosophical Argument[END_REF]. Indeed, [START_REF] Turner | Beware the Celebrity Bioethicist[END_REF] argument is relevant precisely because it acknowledges the importance of impartiality in ethical debate. These ideas find support from the claims made by [START_REF] Parsi | The Bioethicist as Public Intellectual[END_REF] that the public intellectual has all but disappeared from social discourses and that this is unfortunate. Their paper speaks specifically about the role of bioethicists and draws a distinction between the "public intellectuals" and "academic experts," the latter of which are inextricable from the concerns about how academics are utilized through the media.

Without making a distinction between different kinds of knowledge, the non-expert or public relies on the moralizing of an individual scientist, whose personal circumstances or beliefs might limit the kind of ethical discourse that is presented through the science. Moreover, the use of scientists as moral experts, as Hornig Priest argues, often misleads non-experts by equating the moral view with scientific opinion-as a matter of fact rather than judgment. My thesis calls more broadly for a development of a "Public Engagement with Ethics" (PEwE), both through considering how ethical engagement is theorized, but also how it is communicated through scientific journalism.

A considerable difficulty with this proposal is the lack of willingness of ethicists to embrace media coverage of their perspectives. There is sometimes considerable resistance from both scientists and ethicists to their participation in media discourses, since the nuances of science and morality are often simplified by the limitations of journalism. In response, [START_REF] Simonson | Bioethics and the Rituals of the Media[END_REF] argues that "popular media helps to constitute bioethics" (p. 32) and that "grumbling about media is a form of symbolic distancing that helps define scholarly bioethics as a field" (p. 33). While Simonson recognizes the importance of developing links with journalists, it is his suggestion of a "conversation" on the ethics of science and medicine that intrigues me and most suitably describes the context for this paper. Following the work of Albert Jonsen (1998), Simonson criticizes the "commercialised spectacle" of mass media and calls for a more "intimate" engagement with ethics. [START_REF] Simonson | Bioethics and the Rituals of the Media[END_REF] argument gives rise to a rationale for utilizing computer-mediated communications as a way of developing "intimacy" and for considering what a PEwE would entail.

Cyberspace, power and genetics

The suitability of cyberspace as a means of promoting ethical dialogue must be seen in the context of cybercultural theory or web studies, where such prospects have been informed by critical appraisals of what actually takes place online. The earlier claims that cyberspace would liberate marginal groups [START_REF] Rheingold | Virtual Reality[END_REF][START_REF] Turkle | Life on the Screen: Identity in the Age of the Internet[END_REF] have now been tempered by the realization that cyberspace is no panacea for society. While critics of the Internet identify the lack of evidence to support the claim that it is a more effective mechanism through which to free people from social constraints than non-virtual reality, there is considerable evidence that it offers a kind of leisure space where people experience some extended sense of intimacy or agency. Early theoretical work on the ontology of cyberspace draws attention to its capacity to develop shared, close, and intimate communities. As Markham (1998) describes, "even in purely text-based online contexts, people establish and maintain intimate friendships, romantic relationships and stable communities" (p. 17). [START_REF] Clayton | Are There Virtual Communities?[END_REF] offers further support for this, claiming that "virtual communities can return us to personal interaction, a culture of intimacy in which the individual can communicate with anyone."

In the context of science, it can be suggested that the Internet has been increasingly medicalized and that this has led to the creation of pseudo-scientific communities. The World Wide Web is celebrated as a means of providing greater opportunities for the public to engage with medicine [START_REF] Craigie | Reliability of Health Information on the Internet: An Examination of Experts' Ratings[END_REF] and to understand the nature of illness. This is reflected in studies that indicate the way in which support is developed through sharing information and experiences of illness through chat-based online environments [START_REF] Burrows | Virtual Community Care? Social Policy and the Emergence of Computer Mediated Social Support[END_REF]. The opening of "cyber-pharmacies" [START_REF] Oliver | Internet Pharmacies: Regulation of a Growing Industry[END_REF][START_REF] Scaria | Cyber-Pharmacies and Emerging Concerns on Marketing Drugs Online[END_REF], WebMD, and telemedicine, more broadly, make possible the opportunity for non-medics to become more aware of their conditions and to find others who can provide information for them. In short, it allows access to a range of discourses that have otherwise been impenetrable. As some indication of this shift, the emergence of online journalism and blogs (web-logs) displaces the institutional, commercial, and structural boundaries of scientific journalism. However, it would be mistaken to characterize them as apolitical. Rather, as [START_REF] Atton | An Alternative Internet: Radical Media, Politics and Creativity[END_REF] argues, "what appears as bias and the absence of balance in the alternative media is to be considered not as a set of absolute truths; instead it comprises a set of accounts told from different perspectives" (p. 39). Thus, the Internet provides a mechanism for anybody to write about science and for collective understanding to emerge. 5 One might argue that this emergence of new, expert voices has come at a price, where information about such drugs as Viagra bombards our e-mail in-boxes, boasting their capacity to improve our health and, perhaps more critically, our lifestyles [START_REF] Mamo | Potency in all the Right Places: Viagra as a Technology of the Gendered Body[END_REF]. The lack of regulation of such sites has the potential of translating into a greater lack of understanding about health and medicine, rather than offering a greater opportunity to inform people [START_REF] Burgermeister | UN Warns of Dangers of Drugs Sold on Internet[END_REF]. For example, the way that the Internet is offering access to medical information has created a number of alarming communities, such as the Pro-Ana (pro-anorexia) [START_REF] Ferreday | Unspeakable Bodies: Erasure, Embodiment and the Pro-Ana Community[END_REF] sites and the so-called suicide chatrooms [START_REF] Rajagopal | Editorial: Suicide Pacts and the Internet[END_REF]. The possibility for mis-information to gain credibility is also demonstrated by the Ron's Angels web-based company (www.ronsangels.com), which purported to sell female ova and male sperm, though seems to have turned into a promotional tool for Ron Harris' pornographic movie industry. Similarly, there remains some uncertainty about the level of comfort that online encounters can provide. The potential for "flaming" or misunderstanding seems considerable with CMCs and harassment can lead to considerably disempowering consequences [START_REF] Burrows | Virtual Community Care? Social Policy and the Emergence of Computer Mediated Social Support[END_REF]. This chal-lenge has been addressed in a variety of contexts, particularly those concerned with the provision of health care. The inter-disciplinary nature of how information is appropriated has not yet gained much academic attention. Yet, some researchers have argued that the risk involved with "sharing intimate feelings and embarrassing problems is minimised" through CMCs (Hardey, 2001: 393). Moreover, information management concerns and opportunities are only part of the problem with utilizing the Internet for moral conversation and there are no studies yet of moral discourses and science awareness to inform our debate.

A further concern about the Internet is that it has the potential to homogenize people or, at least, to blur the distinctions between cultures and values. One clear way that this effect has been articulated is through the dominance of the English language on the Internet, which itself is a product of the historical development of protocols, programming languages, and telecommunications more broadly. In relation to the ethics of human genetics, homogenization might be seen as positive, since it might be interpreted as a convergence of values. Particularly in the context of global ethical issues, this convergence could facilitate international agreements more effectively and a greater understanding of cultural differences. In this context, the example of human cloning is, again, useful to draw upon. Just recently, the United Nations approved a prohibition on human cloning (United Nations, 2004) after some months of delay and abstention (United Nations, 2005). While not legally binding, for some nations this is unfortunate, since the decision is characterized by the political weight of a majority who have been misinformed about the science. For others it is a relief, since there are insurmountable moral issues arising from human cloning.

This case is particularly interesting, since it relies significantly on cooperation and shared policies on the use of medical science. The acceptance of human cloning in one country has implications for the rest of humanity. While, this is not so different from how other technologies have a global impact, its perceived direct impact on the human gene pool would seem to have yielded some special status to this science. The significance of genetics as a global problem rather than a domestic one is recognized through UNESCO's (1997) declaration on the human genome and human rights. This makes it all the more interesting, since it assumes close ties to another context where a universal ethics is sought: human rights.

The UNESCO declaration makes explicit how human genetics can give rise to considerable challenges to individual liberties, norms, and laws that directly affect people's lives. This global character to genetics raises a question about whether a universal ethical policy is possible (or even desirable) in relation to science, which has always been poised uncomfortably between public and economic interest. Yet, one might also argue that the homogenization of ethical views would be undesirable. Rather, the end goal of ethical debate is sometimes to preserve variance of values and traditions and to maintain the right to hold such beliefs. Nevertheless, if we look further into the United Nation's work and consider its Universal Declaration on Human Rights (1948), as the best example of a globally accepted implementation of ethical principles, then one might argue that some form of universal ethics is possible and worthwhile to pursue. UNESCO's declaration on the human genome is a further attempt to think through probable concerns arising from the global impact of science. While this is not the place to inquire further into the possibility (and value) of making moral values universal, the difficulties implied by developing moral convergence on science are important to address. 6 The Internet can play a critical role in creating a space where values can be shared, thus offering a new opportunity to re-engage the public with science, rather than to patronizingly call for their understanding. For example, LaFollette (1993) offers further support for this proposal by drawing attention to the importance of intimacy in moral discourses. 7 Moreover, [START_REF] Triunfol | Dynamics of List-server Discussion on Genetically Modified Foods[END_REF] discuss how the Internet has been used to promote debate about genetically modified foods. Similarly, in a study of patients with cancer, [START_REF] Ziebland | The Importance of Being Expert: The Quest for Cancer Information on the Internet[END_REF] indicates that use of the Internet even responds to the "experts" debate, by promoting a greater sense of agency and knowledge in patients and, thus, collapsing the distinctions between expert and non-expert. 8

The public engagement with ethics

Critical PUoS acknowledges that the mediation of science, as a process of achieving public understanding, is fundamentally flawed. It unreasonably conceives of the public as having to be informed by the scientific community, thus placing the public in a subservient position, a position of deficit. MacIntyre (1995) criticizes this approach very early in its development, arguing that it misrepresents the relative positions and knowledge of scientists and the public. As one can argue that there is more than one kind of public, there is also more than one kind of scientist.

I wish to advance the proposals of public engagement by suggesting that it is engagement with ethics that would more effectively develop an understanding of science. Despite the vast amount of literature concerned with the PUoS, very little of it makes explicit the ethical or moral implications of medical science and technology. When discussing the nature of "understanding" there has been no attempt to extrapolate what kind of understanding is desirable: whether it is for the technical aspects of the information-how things work-or whether it is for the implications of the research-what things means. While one could argue that the rationale for developing understanding has always been to allay groundless fears, to build trust in the scientific process and to connect this process with the broader aspirations of society, the ends of science, or the value of scientific progress in general are rarely discussed. This is perhaps not surprising, since the development of the PUoS has emerged from the social sciences. In contrast, the kind of inquiry that would question the basis of such knowledge is more philosophical and would question the meaning of knowledge and discuss competing views about the importance of knowledge.

Yet, one has only to pick up any piece of scientific journalism to appreciate that the salient aspects of science, technology, and medicine have less to do with the technical details, than with the ethical, social, moral, and political implications of that technology. The public(s) are concerned primarily for what science "means," rather than for how it "works." When examining the literature on PUoS, it is clear that a number of moral concepts are implicit of this project. "Understanding" is assumed to imply an understanding of the moral issues. However, studies do not specifically address the non-expert's capacity to understand what kind of knowledge ethics entails. To develop such skills would require a very different kind of inquiry and, perhaps, would not be strictly about science or technology. The public understanding of ethical issues is clearly a critical issue in other sorts of current affairs, such as international terrorism or health-care priorities. For many of these topics, particularly science, the crucial aspect of understanding is the ethical context. As I have suggested, a good example can be found in relation to the announcement of the Human Genome Project (HGP), which is, for many people, a largely abstract development in science, for which the implications are not obvious. The only way in which the HGP is made meaningful is in relation to how it might change humanity ideologically, rather than technically.

There is some evidence to suggest that these proposals can be harnessed to develop a public engagement with science through ethics. [START_REF] Barns | What Do You Think about Genetic Medicine?' Facilitating Sociable Public Discourse on Developments in the New Genetics[END_REF] describe a study where human genetics provides a backdrop to an evolved "communal moral reasoning" through group discussions. Additionally, [START_REF] Etorre | Experts as 'Storytellers' in Reproductive Genetics: Exploring Key Issues[END_REF] provides a useful support for the problematization of experts within the context of genetics. Through an empirical analysis of experts as story-tellers, Etorre identifies the role of an ethical narrative within expert statements. Etorre even argues that "in order to be sustained as a viable scientific discourse, reproductive genetics is aided by the moral mediation of experts" (p. 553).

Conclusion: "wacky science" and ethical engagement

We are never going to be rid of Frankenstein, even if we want to be. (Turney, 1998: 220) Interestingly, my proposal has challenging implications for the earlier criticisms of scientific journalism. Thus, while some critics of media representations of science have argued for less "wacky science" (Hargreaves et al., 2003: 49) in news reporting, there is merit in thinking through the ethics of science by considering "wacky" prospects. An important way in which the ethical implications are made meaningful in various cultural texts (film, television, literature, news) is through the use of metaphor or the analogizing of science fiction to science fact [START_REF] Brem | The Bioethics of Fiction: The Chimera in Film and Print[END_REF]. As Christidou, Dimopoulos and Koulaidis' ( 2004) study of metaphor in scientific journalism indicates, "social representations evoked by the use of metaphors about science and technology in the press and popular scientific magazines contribute to the upheaval of the cultural authority of the corresponding field, hence playing a significant role in the maintenance of the social autonomy and integrity of the technoscientific profession" (p. 359). As well, critical to scientific journalism have been its linguistic aspects. [START_REF] Condit | How the Public Understands Genetics: Non-deterministic and Non-discriminatory Interpretations of the 'Blueprint' Metaphor[END_REF] and [START_REF] Liakopoulos | Pandora's Box or Panacea? Using Metaphors to Create the Public Representations of Biotechnology[END_REF] note how the use of metaphor has been essential to discourses on genetic technology, with such terms as "blueprint," "book of life," "Pandora's box," "Frankenstein," and "playing God" all appearing as key descriptors about what is implied by the development of new genetic technology.

Thus, scientific communication relies on the use of metaphor to create meaning, though this is often criticized-particularly by philosophers, bioethicists and scientists. For example, when discussing genetic technology, people often imagine this technology as "playing God," without giving much consideration of the content of that metaphor. Yet, very little has been discussed about how mediatized scientific metaphors inform the understanding of ethics [START_REF] Liakopoulos | Pandora's Box or Panacea? Using Metaphors to Create the Public Representations of Biotechnology[END_REF][START_REF] Condit | How the Public Understands Genetics: Non-deterministic and Non-discriminatory Interpretations of the 'Blueprint' Metaphor[END_REF]. This is an oversight in the literature, particularly since the use of metaphor is crucial to science, which itself relies on metaphor as part of its theoretical and conceptual landscape [START_REF] Pickering | Metaphors and Models in Medicine[END_REF]. In part, it is understandable that these metaphors often incite frustration for scientists about how their work is communicated. After all, part of the problem with the lack of inquiry into the use of metaphor within public discussions about science-which is highlighted by re-framing the PUoS as the PEwE-has to do with wondering what kinds of metaphors are appropriate to use. Is the use of gene transfer technology really like "playing God"? Is the human genome really the "book of life"?

Being able to answer these sorts of questions could help develop a more effective engagement with the salient aspects of science. It is not necessary for the non-expert to understand the specifics of particle physics or molecular biology. It is not particularly important that people understand that DNA looks something like a twisted double helix. Indeed, most scientists do not really have an in-depth knowledge of anything beyond their specialization, so the aspirations for public understanding must be capped somewhere. This cap should be on being able to make sense of these innovations in the context of a broad range of social values and priorities, or what might more typically be described as an understanding of social justice.

Through developing a Public Engagement with Ethics, further work must be done to develop new ways of conceptualizing and communicating science and medicine. The use of metaphor is a rich way of making science meaningful, yet we rely too much on metaphors from past eras, such as the frequently cited "Frankenstein" myth, which continues to overwhelm the public consciousness on genetics [START_REF] Turney | Frankenstein's Footsteps: Science, Genetics and Popular Culture[END_REF]. Criticisms are often made about such examples, since they simplify the implications of science significantly. Yet, it is these texts that inform the non-expert's understanding of science and they constitute imaginative articulations of how the future might develop if such technology is accepted. However, new analogies and new metaphors are needed and the media (and literature) must play a crucial role in this development. There is a need to move towards a public "engagement" with ethics, which can be achieved through developing a PEwE.

When considering this in the context of other media forms, [START_REF] Petersen | Replicating Our Bodies, Losing Our Selves: News Media Portrayals of Human Cloning in the Wake of Dolly[END_REF] identifies that print journalism fails to engage with the finer details of moral debate. For example, when considering the press coverage surrounding the birth of Dolly the sheep, Petersen notes that: "Those news stories that drew attention to threats to 'identity', 'individuality' or 'human dignity', or to the 'moral unacceptability' of human cloning, offered little or no analysis of 'what it means to be human' or what exactly was morally objectionable about human cloning" (p. 86). By utilizing computer-mediated communications and promoting informed dialogue, it is possible to circumvent the criticisms of "expert" discourses in science and technology. Furthermore, this proposal takes into account recommendations from the UK's Wellcome Trust and recent discussions within bioethics, which call for the integration of social science and ethical inquiry [START_REF] Haimes | What Can the Social Sciences Contribute to the Study of Ethics? Theoretical, Empirical and Substantive Considerations[END_REF][START_REF] Hedgecoe | Critical Bioethics: Beyond the Social Science Critique of Applied Ethics[END_REF].

These proposals imply the need to reconsider public engagement/understanding strategies by integrating ethical development as part of the educational/communicative model. This might entail the formal introduction of moral reasoning skills as part of a national curriculum, or could even emerge out of principles developed through philosophical counseling. Yet, it is also worthwhile considering the less-formal mechanisms that can offer opportunities to create ethical engagement with science, perhaps through the programming of science festivals, which can encompass the broader community of cultural industries in the processing of science.

5 Again, my emphasis here aims to alleviate [START_REF] Turner | Beware the Celebrity Bioethicist[END_REF] concern about the celebrity bioethicists, by emphasizing the importance of less-established media spaces as a place to discuss ethics in science. 6 On this matter, it would be useful to read recent discussions on Habermas' reappraisal of human rights, where he articulates its role as a political ethical reaction, rather than a universally justifiable moral code [START_REF] Abdel-Nour | Farewell to Justification: Habermas, Human Rights, and Universalist Morality[END_REF]Habermas, 2001aHabermas, , 2001b)). 7 Utilizing the Internet as a way of developing intimacy can also alleviate the burden posed by Giddens' (1991Giddens' ( /1996) ) description of the "pure relationship." 8 One might also consider this to imply a heavy responsibility, which itself might be ethically suspect, when the responsibility is borne by people who are unwell.

Public Understanding of Science 14 (4)

It is also useful to consider the recommendations of the earlier ESRC report, which call for the need to "research into the impact upon science communication of the Internet and other 'new media'"(Hargreaves and Ferguson,

2000). 2 Important overlaps between fiction, narrative, and bioethics are also important to this paper. In particular,[START_REF] Chambers | From the Ethicist's Point of View[END_REF] work argues that the way in which the story is told through narrative and metaphor plays a crucial role in its evaluation. 3[START_REF] Hargreaves | Towards a Better Map: Science, the Public and the Media[END_REF] also conclude that the current model for utilizing scientific experts in the media does not increase the public understanding of science, which further calls for alternative models and proposals. 4 An example of this is the Citizens' Conference on Advances in Human Biology in the Genomics Era, Montréal Science Centre (5-6 February 2005), initiated by the Groupe de recherche en bioéthique de l'Université de Montréal (see http://www.centredessciencesdemontreal.com/fr/activites/activites_evenement_genomique.htm).

Acknowledgement

I would like to thank the anonymous reviewers for their helpful and critical comments on this paper.

Notes

Author

Andy Miah is lecturer in media, bioethics and cyberculture at the University of Paisley. He is author of Genetically Modified Athletes: Biomedical Ethics, Gene Doping and Sport (Routledge, 2004) and the cybermedicine blog http://cybermedicine.blogspot.com. Correspondence: School of Media, Language and Music, University of Paisley, Ayr Campus. KA8 0SR, Scotland, UK, e-mail: email@andymiah.net, URL: http://www.andymiah.net


Rosa M Medina-Doménech

Alfredo Menéndez-Navarro

Cinematic representations of medical technologies in the Spanish official newsreel, 1943-1970

ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

Introduction

Recent historiography has paid attention to the audio-visual material generated by the Franco regime in an attempt to delve into the key elements that forged the collective imaginary of Spanish society, after the Civil War (1936-1939). The Spanish Cinematic Newsreel Service, known as NO-DO (acronym of Noticiario y Documentales Cinematográficos) enjoyed a monopoly over the production and screening of newsreels in Spain from 1943 to 1975. Alongside the mass communications media (press and radio) and educational system, NO-DO was one of the regime's primary mechanisms of enculturation. 1 Rodríguez Tranche and Sánchez Biosca (2001: 179-233) have argued that NO-DO, rather than being an instrument of propaganda in the traditional sense, was among the regime's principal means of generating representations-the combination of ideas and feelings that allow us to share a perception of the world (Hall, 1997)-of its imagined Spanish nation and society.

It was compulsory for all cinemas in Spain to screen NO-DO as a trailer to the main feature film. The cinema was the most popular form of entertainment in Spain in the postwar years, when there were around 4,000 cinemas in operation. Consequently, the images of NO-DO became familiar to most of the population. Although it is difficult to calculate the total size of the cinema audience, the strict film censorship established by the new regime reveals its concerns about the potential impact of this mass medium. NO-DO was under the control of the Fascist Party and was funded by the state, with a small part of its income derived from the hire of the newsreels to the cinemas. The main mission of NO-DO was to display the official activities of the regime, thereby contributing to the creation of a public representation of its actions and of the actions of Franco himself. This symbiosis between NO-DO's cinematic production and the new state that violently emerged after the Civil War makes the newsreel an essential source for understanding Spanish culture under Franco. 2 The analysis of NO-DO as a technology of ideological production is of particular interest given the relative absence of historiography on the symbolic and cultural dimension of politics during the Franco regime. 3 We postulated that, as part of the regime's cultural apparatus, NO-DO played a critical role in providing Spanish society with new cultural meanings of science, scientists and technology. Thus, our research focused on NO-DO's coverage of health news, exploring the cultural representations conveyed by its reporting of medical technologies. 4 We analyzed 106 news items, i.e., 1.2 percent of all items screened by NO-DO between 1943 and 1970. NO-DO's portrayal of health matters had many objectives, but the health education of the public was not one of them. Innovations as well as established medical technologies were presented, although with no relation to the Spanish health context of the time. We suggest that health-care news items offered a new space for the legitimization of the regime and played a key role in the process of constructing a national identity, to which the regime gave very high priority. 5 First, we explore the inauguration genre, the most common treatment of health matters by NO-DO. This reporting genre helped to legitimize the regime and especially its leader, as the country's "true saviour," responsible for the economic boom and the modernization of Spain. In addition, the inauguration genre also served to display popular support for the regime. Second, we address the significance of medical technologies as objects of visualization for the production and reproduction of a Spanish national identity. Finally, we discuss the way that women were shown within the technological scenario. In all cases, we examine changes from the so-called First Francoism, an autarchic period of violent political repression and isolation in the years immediately after the Civil War, up to the late 1960s, by which time Spanish television had supplanted NO-DO as the principal source of visual information for the population. 6

First space of representation: the inauguration genre

What we have called the "inauguration genre" was predominant in NO-DO. [START_REF]The historic archives of NO-DO are deposited at the Filmoteca Nacional in Madrid. The complete production of NO-DO from 1943 until its official disappearance in 1981 consisted of 1,966 newsreels. We use the citation system commonly used in studies of NO-DO, giving the number of the newsreel, the series (A, B, or C), and the year of its screening. 8 Coverage of tuberculosis sanatoria[END_REF] Fifty-two of the 106 news items on health matters screened between 1943 and 1970 belonged to this modality, covering events that commonly counted on the presence of Franco, or in his absence, the Government Minister or Director-General of Health. During the first decade, the inaugurations recorded by NO-DO included the opening of tuberculosis sanatoria or non-specialized centers such as rural health dispensaries, provincial and military hospitals, and primary care clinics. 8 In the early 1950s, NO-DO staged its representations of health care in yet more locations, including the African colony of Equatorial Guinea or new maternity clinics. 9 The inauguration genre flourished in the second half of the 1950s and the 1960s, when NO-DO gave extensive coverage to the setting up of new hospitals and outpatient clinics mandated by the National Plan for Hospital Construction approved in the late 1940s. [START_REF]Out-patient clinics and dispensaries belonging to the National Health Insurance System were opened in Bermeo (NO-DO 660[END_REF] The pace of construction increased in the late 1960s, with the creation of new centers, the enlargement of existing ones, and the opening of specialist centers for obstetrics, pediatrics, and orthopedics, all covered by NO-DO. [START_REF]The decrees on the National Plan for Hospital Construction were issued in 1945 and 1947[END_REF] Medical historiography has shown the legitimizing role played by disease epidemics during the first years of the Franco regime. The extreme living conditions endured by wide sectors of the population in the post-war period favored the outbreak of major epidemics, with a substantial increase in child mortality and death from infections. As Jiménez Lucena (1994) has pointed out, it was not unusual for the regime to blame the defeated republicans for the epidemics' existence, thereby exonerating itself from any responsibility for the conditions under which they flourished. Tuberculosis, one of the severest epidemic problems in the post-war period, is especially illustrative of NO-DO's role in the state's selflegitimating use of disease. From 1943 to 1960, the eight documentary sequences on the inauguration of tuberculosis sanatoria served to glorify the regime rather than to reflect actual Spanish health provision and sanitary conditions at the time. [START_REF] Menéndez-Navarro | [END_REF] These cinematic representations worked to uphold the regime's ideals of order, strength, and cleanliness by avoiding any mention of tuberculosis as a social disease aggravated by the effects of war. Instead, they used inauguration scenes to celebrate the New State as a benefactor responsible for the solution of health problems. [START_REF]For an examination of the campaign against tuberculosis as a priority in the health policy undertaken by the Franco regime after the Civil War, see Molero Mesa[END_REF] The inauguration genre served not only to reinforce and consolidate the regime but also, and perhaps more importantly, to deny any sign of historical continuity with the previous Republican period. Different filming strategies effected this rupture with the past. In addition to avoiding images of the patients-a point to which we will return later-the visual and spoken narrative did not refer to institutions, individuals, or health-care programs from previous times. [START_REF]An exception to the rule is the inauguration[END_REF] In fact, policies directed at building tuberculosis sanatoria and developing maternal-child health programs within secondary rural health centers were inherited from past governments, including that of the Republican period. [START_REF] Ocaña | analyses the elements of continuity and rupture between Republican and Francoist health administrations. For the case of the campaign against tuberculosis see the studies by Molero Mesa[END_REF] This de-contextualization of contemporary events from the wider historical setting was further supported by the production and design of the newsreels. Rodríguez Tranche and Sánchez Biosca (2001: 151-3) have pointed out that the voice-over narrative was written only after the film sequence had been produced, thereby allowing (intentionally or not) greater flexibility and control over the meanings that would be promoted by the combination of image and voice in the newsreel. The effect of this sequential mode of production was the trivialization of events. In other words, rather than providing an account of health issues and the government's response to them, or even a description of the health facilities and their uses, the newsreels offered banal descriptions of the images appearing on the screen, adding nothing to the viewer's experience but a further glorification of the regime.

It may be possible to argue that this temporal and social de-contextualization of the present may have offered an escape for a population overwhelmed by very real problems, particularly in the post-war period. In any case, it was a fundamental instrument for the Franco regime's construction of a common national identity, which was so wounded and fractured by the Civil War. De-contextualized news generated modes of atemporality and essentialism that, as Pérez Garzón (2000) has argued, were both very effective tools for constructing a Spanish national identity divorced from both the past and the wider world. Thus, NO-DO contributed to the Francoist goal of a purified and isolated society, suppressing anything that was considered "anti-Spanish" (Richards, 1998).

A further feature of the inauguration genre was the triangular narrative of "flagcrucifix-dictator." [START_REF]Particularly illustrative is the inauguration of a rural health dispensary in Águilas (NO-DO 255-A[END_REF] These three pillars of the regime-army, church, dictatorshipprovided a further means of consolidating the Franco regime in NO-DO newsreels. The filmic militarization of inaugurations, especially frequent in the Basque Country, was produced not only through the appearance of army personnel and military parades but also by the filming itself. [START_REF] Ocaña | [END_REF] The newsreels systematically evoked military orderings of space by using forced and symmetric perspectives for shots of facades, rooms, or corridors. [START_REF][END_REF] (See Figures 1, 2 and3.) In some cases, patients and health-care staff were also filmed standing "in formation." These militarized filmic spaces reproduced an esthetic of order against chaos, with the latter presented by the regime as characteristic of the Republican period. 19 The montage of the newsreel items, repeated in almost all the inaugurations, started with long shots and low angles of buildings (for example the Provincial Hospital of Madrid, in NO-DO I-91, 1946, with statues to the right and large trees) that reinforced the monumental grandiosity of the regime. Subsequent shots offered more detailed but still panoramic views of the building's interior, and of the inauguration ceremony. As Rodríguez Tranche and Sánchez Biosca (2001: 295-321) have explained, this montage displayed the grandiosity of the regime's accomplishments in the framework of a fascist esthetic that extended beyond the strictly "martial model" exclusively associated with the filming of military parades. 20 This type of film structure declined in the mid-1950s, when the newsreels began to feature shots of health-care centers in operation, with patients and health staff carrying out their work. The inauguration of the Concepción Clinic in 1955 (NO-DO 648-B, 1955) is a good example of the transition. The initial long shot of the dictator's arrival shows an ordered composition of the health-care staff, almost "in formation." In the last scene, the public (authorities and health-care staff) are also distributed according to a very hierarchical pattern. However, the remaining sequences, which include visits to the center's facilities, lack such a "militarized" ordering of objects (actors) in space.

The dictator was present at half of the 52 inaugurations covered by NO-DO between 1943 and1970. 21 The selection of locations for his appearance does not appear to have been random. In the aftermath of the Civil War, Franco seemed particularly active in the Basque Country, which had an especially damaged relationship with the "Spanish" national identity, where he appeared at five inaugurations. [START_REF][END_REF] In the 1960s, once the regime gained international backing, Franco was represented in the newsreel as a modern statesman in contrast to his earlier depiction as a military dictator. Madrid, the political and cultural center of the new state, became the main arena for his appearances (five out of 11). 23 The representation of popular support for the regime in the shots showing the arrival of the dictator at the centers played a key role in the process of the regime's social legitimization and in the construction of a new national identity. 24 It is no coincidence that the first ambient sound effects incorporated into the newsreels, in the early 1950s, were simulations of applause and cheering at the arrival and departure of the dictator. [START_REF]Inauguration of a rural health dispensary and maternity clinic in Tolosa (NO-DO 504-A) and the opening of the Clinic Hospital in Granada (NO-DO 511-A)[END_REF] The presence of the Head of State (or of a high-level government authority) became the axis around which the film text was structured. In this way, the film reinforced the representation of the state in the physical presence of Franco or an equivalent authority figure as the principal agent and galvanizer of the film's action and, by extension, of political action in general. This representation of a new entrepreneurial state was contradicted at certain moments, when Franco's personality eluded the firm control over his image. Fleeting shots sometimes appeared that showed the General's inability to connect with the population and revealed his passivity and muteness, or even his unmistakable expressions of boredom. [START_REF]NO-DO 321-B[END_REF] The overarching representation of the regime as a providing, magnanimous state was constructed using both the film procedures described above and the voice-over of the narrator. Far from using the voice as an informative resource, the NO-DO narrator was a spokesman for the regime. As Rodríguez Tranche and Sánchez Biosca (2001: 89 and 125) have argued, the same anonymous off-screen voice was always used, with the same delivery, giving a strong sense of a continual presence throughout all of the films-the "voice of the One." A symbolic sense of unity was evoked-"we are all one under the One." The single anonymous voice enacted a form of political subjugation and worked to reconstruct the submissive national identity under discussion here. Although the effect of the voice in domesticating NO-DO documentary images has been pointed out (Rodríguez Tranche and Sánchez Biosca, 2001: 121-3), we suggest that in the inauguration genre the off-screen voice was at the service of the film narrative. The narrator habitually underlined the visual sequences with laudatory claims, for example identifying a newly opened health center as "new evidence of our State's concern for all health problems." Moreover, the film montage, which linked inaugurations of hospitals to the openings of reservoirs, electric power stations, and schools, underlined the spectacular and grandiose nature of the works of the regime. In 1949, for example, Franco was shown at the inauguration of a Health Centre of the Railway Work Accident Insurance Service, and also at several industrial centers (NO-DO 352 -A, 1949). These sections of the film were further linked with sequences of him supervising the construction of a dam and opening the Las Conchas power station. Another newsreel, in 1954, offered the "first visit" of Franco to the city of Logroño. In the space of just one minute and 20 seconds, the item (NO-DO 616-B, 1954) screened Franco inaugurating the Provincial Institute of Hygiene, visiting a wool factory "of great importance to the national economy," touring a tuberculosis sanatorium, handing out symbolic ownership titles for a housing block constructed by the "Obra Sindical del Hogar," and finally calling on the National Health Insurance General Hospital of the town.

The newsreel item on the inauguration of Madrid Provincial Hospital (NO-DO I-91, 1946) is particularly relevant with regard to the use of set formulas that nurtured an essential Spanish identity (castizo) to justify the regime's achievements. We shall see how the plot unfolded. A sequence on the hospital pharmacy with a shot of shelves containing rows of ceramic containers links the hospital space to the Spanish essence (lo español): "where the art of Spanish pottery shines with all its splendor in these classic pots." This cliché about the quintessential nature of Spanish identity again appeared in a sequence on a bullfight held to raise funds for hospital construction: "and to this end it came about, thanks to the bullfight benefit, that the traditional splendor of the fiesta was renewed in 1946."

The militaristic filmic pattern gradually changed in the 1960s. Thus, the inaugurations of hospitals and clinics showed not only patients and popular support but also a growing population gaining access to state medicine and crowding the waiting rooms. Male patients were described by the narrator as "producers," strengthening the link between the National Insurance system and industry, both portrayed as committed to efficiency and the modernization of the country. News on medical care and rehabilitation of injured and disabled workers epitomized the regime's efforts to recover and fortify a national industrial sector. 27 The filmic narrative pattern also changed with science replacing religion in the leading role. Technocracy, one of the key supports of the Franco regime in the 1960s and advocated by members of the Opus Dei, was clearly represented in the newsreel. Doctors, scientists, and technicians acted as advisers to the dictator, guiding him into the world of science and technology and, metaphorically, guiding Spain towards national prosperity.

Second space of representation: from still artifacts to medical technologies in motion

Medical technologies offered an essential resource for representing the all-providing and magnanimous state and especially for linking the regime to ideals of modernization and efficacy symbolized through technical display. The narrator was responsible for extolling the fact that health centers were equipped with "modern technological advances" while shots of varied technologies were shown. It is worth examining these in some detail.

In the early 1940s, there were frequent shots showing basic technologies in hospital buildings: heating apparatus for patient wards, industrial kitchens among other fixtures and fittings (cupboards, examination tables, operating theater lamps), and in some cases, laboratory equipment (sterilizers, ovens and, above all, microscopes). The evident technological deficiencies of the centers did not prevent the narrator from praising them as "perfectly equipped." At the inauguration of the Trillo Leper Sanatorium in 1943 (NO-DO 52 -A, 1943), the sequence showing the very modest microbiology laboratory (just one optic microscope and one incubator) concluded with a dramatic sustained close-up of a metal container (a centrifuge) inscribed with the word "extra." The narrator gave this otherwise meaningless object a new significance by proclaiming, as the container filled the screen, that the sanatorium was equipped with "the most advanced scientific facilities." Thus, the editing and voice-over seemed to endow the new center with a certain technological appearance.

International support for the Franco regime in the mid-1950s, which brought the autarchic stage to an end, was reflected in the medical technologies shown on NO-DO at the time. From the mid-1950s, NO-DO's newsreels converted medical technologies into a second means of articulating the filmic text and discourse besides the figure of the dictator. The technologies filmed covered a wide spectrum: operating theaters, X-ray apparatus, clinical laboratories, ophthalmology and dental clinics, delivery rooms, incubators and cots, and so on. All of these items were beginning to be widespread in hospitals and out-patient clinics set up under the National Health Insurance Plan for Hospital Construction mentioned above (Rodríguez Ocaña, 2001). Alongside these technologies appeared images of much more sophisticated ones, often taken from North American news broadcasts (Rodríguez Tranche and Sánchez Biosca, 2001: 117-19). This was the case with gamma cameras, the cobalt beam, and the betatron, all technologies linked to the use of nuclear energy for cancer treatment. 28 The original news items were part of a campaign mounted by the United States in 1953 through its "Atoms for Peace" program, to promote a positive image of atomic energy by focusing on its employment for civilian and peaceful purposes, especially emphasizing its medical uses. 29 As well as the types of technology shown, it is interesting to note the way they were filmed. Generally, in the first few years, the presentation of objects and centers was static. In many cases it was a matter of merely cataloging "advances" that underlined the narrator's praise for the regime's modernizing endeavors. For instance, in a story on the Madrid Provincial Hospital, the voice-over recited that "Since 1939, over 9 million pesetas have been invested in Madrid for the reconstruction of the Provincial Hospital . . . which is being extended and improved, making it into a modern center whose wards and corridors boast a new look" (NO-DO I-91, 1946).

It is important to note that during the first decade of NO-DO, stories on medical center inaugurations always lacked a crucial element, namely patients. Almost all the inauguration sequences offered "evacuated" images of immense empty wards. It is surprising that NO-DO chose not to show fully functioning wards with physicians at the bedside, or clinics in active operation. This approach, although it might have resulted from the haste of the reporting and the impatience of the regime to show off its new works, led in any case to a powerful representation, which emphasized that the center was in no way inherited from the previous Republican regime but was rather a product of the new order. Thus, the absence of patients came to epitomize a rupture with the past, a memory that had also been emptied, evacuated. 30 As mentioned above, this treatment substantially changed in the second half of the 1950s, in which both wards and technologies were shown in action. It was not unusual to see images of surgical operations carried out in front of NO-DO cameras. 31 Notable importance was given to the new-born. By that time, the discursive recourse to the baby as an image of the future nation was a common propaganda tool (Castañeda, 2003; Steedman, 1995). NO-DO newsreels gave generous space to images of maternity rooms at new hospitals, with sequences of babies in cots or in the arms of the health-care staff and shots of the technologies that guaranteed their survival, such as the incubator. 32 The images in an extensive documentary report shown in 1947, "Penicillin in Spain" (NO-DO I-149, 1947), are especially revealing in this respect. In the second part of the report, under the title "Prevention," children are shown receiving the care of nurses and enjoying a healthy life in the open air at a summer residence, where under the sun or ultraviolet rays, they are helped to "strengthen their health." The underlying narrative is clear: healthy children become a metaphor for the future of Spain under the maternal care of a state in charge of preventing any "social dystocia." 33 The greater technological facilities and the steadily increased presence of patients and health-care staff in the news were also represented in terms of a wider international context. The opening of National Health Service general hospitals, and above all the incorporation of anti-cancer technologies and lung and kidney machines in care centers at the end of the 1950s, brought about a new phase in the process of constructing a national identity. With the autarchic period now in the past, the news supported the idea of placing our health-care system in an international context, with the narrator making the novel and often-repeated claim that Spanish facilities and technologies were not only "among the best in Spain" but also as good as "the best in the world." 34 This new international context must be understood as going beyond the spiritual extension that Latin America had always represented for the regime. 35 This strategy of defining the nation in relation to a wider international world first emerged in a 1952 documentary that showed new ambulances and health materials of the Spanish Red Cross (NO-DO 477 -A, 1952). The presence of Paul Ruegger, President of the International Red Cross, lent international approval to the facilities and work of the Spanish section, and by extension, to the regime. At a later date, the holding of international congresses and courses in Spain, 36 the donation of national technologies to other countries, 37 and the export of Spanish science abroad 38 were shown as sanctioning the full inclusion of Spain into the Western world. In other words, after a period engrossed in the construction of a new national identity, the regime was ready to look outwards towards the external world in a new phase of this identity-building process-with unmistakable signs of historic amnesia towards exiled scientists. Santesmases (2000a) has convincingly argued that the treatment handed out in the case of Severo Ochoa (1905-1993) was unusual in this regard. When he was awarded the Nobel Prize for Medicine in October 1959, he was working in the United States and had dual nationality. The prize exceeded all the hopes of the regime, who immediately re-established official contact with him (in January 1960 he was named honorary consultant to the Centro Superior de Investigaciones Científicas, CSIC). Although we have found no news items devoted to his Nobel Prize in NO-DO, the Spanish press (Abc, El Alcázar, Pueblo or Ya) claimed the glory for the country and treated Ochoa as a national hero. Some professional journals, such as Medicina y Cirugía Auxiliar and Revista Clínica Española also took this line. Such claims were not extended to the rest of the numerous and prestigious group of exiled Spanish scientists successfully working in centers abroad about whom there was a deathly silence (Giral, 1994).

Absent and delicate: women and medical technologies

A gender reading of NO-DO's health items is especially revealing. 39 In the first few years after the war, women were practically absent from view, with the exception of nuns, the occasional group of female patients celebrating Franco, and two reports showing women working in laboratories (NO-DO 35 -A, 1943; NO-DO I-149, 1947).

The "evacuated scene" that characterized the early years of NO-DO, was particularly marked in relation to women. Women played an important political role in the Republican period and were the icon of the República itself, so that it was advisable not to display them on screen. This absence changed after the mid-1950s, when women began to appear, usually in the role of mother, patient, nurse, or technician.

We focused our analysis on NO-DO representations of women as health professionals, an aspect that has incited growing attention in the past two decades (Rossitter, 1982, 1995; Witz, 1995; Santesmases, 2000b). Certainly, there was a marked gender subordination of women in the health professions, although relatively subtle in comparison with the crude sexism of the regime. This was largely represented through coverage of the activities of the "Female Section of the Fascist Party" (Sección Femenina de la Falange) (Sánchez López, 1990).

In the 1940s, NO-DO included two reports produced abroad, "How the Medical Institute for the study of tropical diseases of Berlin works" (Cómo funciona en Berlín el Instituto Médico dedicado al estudio de las enfermedades tropicales) (NO-DO 35-A) in 1943 and "Penicillin in Spain" (La Penicilina en España) (NO-DO I-149) in 1947. The latter included some Spanish-produced material. Both are clear in their positioning of gender. The first documentary showed a German Army laboratory for the study of vectors of tropical diseases. The sexual division of the laboratory tasks was evident. From the first sequence, a long shot of the hall in which the women (laboratory technicians) occupied the back row, the film offered an image of women as subordinated and supplementary. The work of the female technicians is carefully filmed, representing their tasks in a way that could be characterized as "feminine," as if their tasks were those of a manicurist, showing their delicate, precise, and even maternal handling of the material. This is especially clear in a close-up of the hands of a female assistant who proceeds to tie a bow in a string in order to close an animal cage, and in another shot where the assistant cuddles a bird used as experimental animal. Before inoculating it and handing it to the official standing next to her, she raises it to her face and gives it a delicate kiss (Figure 4, NO-DO 35-A, 1943). The tasks of the women, who had no microscopes, were displayed as subordinate to the male physicians, who carried out the more "complex" work of microscopy and did the brainwork. This idea was underscored by a shot of the men in a thinking pose. The documentary devoted to the discovery and uses of penicillin abounded in the same type of segregationist treatment and in symbolic representations of feminine qualities applied to scientific work. The images highlight the women's delicate and careful handling of mice as if they were human babies. Meanwhile, the males are shown using the microscope and the X-ray machines (NO-DO I-149, 1947).

In a 1951 report on the manufacture of flu vaccines at the National Spanish School of Health (NO-DO 423-A, 1951), fading shots and lighting effects lent a certain glamour to the scene, emphasizing the delicacy, fragility, and almost fairy-tale-like quality of the repetitive tasks permitted to women in the intimacy of the laboratory. In the images of the 1957 documentary "Eye Protection Campaign" (Campaña de Protección Ocular) (NO-DO I-631, 1957), both the industrial work with lathes or drills and the intellectual work in the lecture hall were undertaken by males. The importance of preventing eye disease or impairment in men was linked to productivity ("performance at work"), successful schooling, road safety, and enjoyment of life (itself portrayed through male admiration of female beauty among other "marvels of creation"). For women, shown mainly as patients in this documentary, the wearing of glasses and their selection was presented as an esthetic issue. The representation of scientific work (in ophthalmology clinics) or technical work (in the manufacture of lenses) also followed this segregationist pattern. A news item of the same year, reporting on the manufacture of vaccines against Asian flu, showed a production process at the IBYS laboratory in Madrid in which all of the staff was female (NO-DO 767 -A, 1957). The documentary represented the work of women as automatic and unskilled, which in turn converted them into an undifferentiated collective mass, bereft of all historic agency. The metaphor of military threat used to describe the flu epidemic allowed the uniformed laboratory assistants to be presented as an enthusiastic legion of defenders of the Franco regime.

Gender subordination in the technological setting was sustained throughout the late 1950s and the 1960s. In the late 1960s, an increasingly dynamic Spanish population reached the screen and was represented gaining access to state medicine. Women, usually carrying children in their arms, crowded the waiting rooms and roamed through the facilities of the out-patient clinics. Thus, the overwhelming representation conveyed in these news items reinforced the woman's role as mother and contributor to the "miracle" of the Spanish baby boom generation. 40

Conclusions

When this study was designed, its aim was to analyze the specific ways in which Franco's regime popularized medical technologies within an incipient Spanish mass-culture. However, it soon became clear that public health education was not a goal of NO-DO, which rather formed part of a broader political program directed towards the reconstruction of a single Spanish national identity. Most of the newsreels contained no clear or even comprehensible information on health or medicine and made no attempt to educate or inform the public on health issues or policy. Consequently, our research was transformed into a study of NO-DO as an historical resource produced by the regime that became a powerful discursive tool for Francoist ideology. From this perspective, medical technologies or health innovations could be understood as providing an exceptional scenario for the portrayal of Franco's political program. Film analysis provided the tools for de-codifying the close connections between the content and form of medical news. Precise contextualization of this news in its historical context explained the images of medical technologies and situated Franco's political program for Spanish nationhood within the dictatorship culture. We have tried to develop a more complex and intentional idea of the Franco regime and its power strategies. As historians, this research has taught us that historical sources can sometimes put the researcher in an extraordinarily challenging position in trying to decodify and fully make sense of historical traces. Historical sources do not always respond to our initial expectations about their content or what we might obtain from them. In this situation, an interdisciplinary approach can be invaluable. Numerous theoretical and methodological tools from different disciplines are available to the contemporary historian. We used some of these tools in the present study to improve our understanding of NO-DO, which proved to be a complex visual source very different from the information-oriented documentary material we had initially expected to investigate.

After the Spanish Civil War, the reconstruction of a common national identity was intertwined with the need to represent Franco's regime as a paternalistic and magnanimous state. The regime built a new national identity based on a break with the past. NO-DO was not only a visual technology of political propaganda but, as we have shown in this paper, a crucial technology in the production of an essentialist and monolithic Spanish identity severely damaged and fragmented after the Civil War.

To summarize, our analysis of the changing patterns of visual representation of medical technologies in NO-DO reveals a clear link between their representations and the process of constructing a unified national identity, precluding other alternative conceptions of nation. In this paper, we have described two strategies directed towards the construction of a national identity: one concerned with the "national space" and the other built in relation to the mirror provided by the "foreign space." The form and content of NO-DO were articulated to produce both representations at different points in its history.

In the inauguration genre of health-care facilities, the state was represented as the only character in the action, both politically and visually. The prominence of the state, the erasing of the Spanish past, the castizismo (purism), the military visual code, and the support of the multitude for the regime, all provided the basis for the creation of a common Spanish identity.

To what semiotic subject did NO-DO address itself? Who was supposed to be the audience for the NO-DO representations? Our analysis of the NO-DO films suggests that the semiotic subject screened in NO-DO was referred to the fascist desire for a national subject modeled on men as the unified national citizen: amnesiac, vigorous, credulous, and patronized by a paternalistic state; a Spanish male with no sense of historical agency but fortified in opposition to the otherness of women, first absent from the screen and then present in a subordinate and passive role. Evidently, NO-DO played a major role in the representation of a collective militaristic and masculinized identity.

From the mid-1950s, international support for Franco's regime widened the stage. Spanish identity could now be framed in relation to the "Western world." Scientific and technological developments capitalized on the regime's "modernization" discourse for Spain. In demonstrating modern medical technologies, NO-DO represented Spain as a leading member of the international scientific community.

Further research is warranted on the impact on Spaniards of NO-DO as a means of ideological production for the construction of a single, excluding, and undivided national identity. However, it could be argued that the Franco regime did not succeed in ridding Spain of its plurality of national identities. Thus, the Spanish Constitution (1978) established during the democratic transition recognizes the plurality of the national identity, and active debate continues to this day on the social, cultural, and political status of the different nationalities that make up Spain-all very far from the monolithic and static concept of an "Eternal Spain" (Abellán, 2005), promoted by NO-DO. Studies, "Cinema and History" (Oxford, May 2001), the International Workshop "Science and Power in the European Periphery during the Cold War" (Barcelona, November 2001), and the Summer Conference of the Society for the Social History of Medicine, "Devices and Designs: Medical Innovation in Historical Perspective" (Manchester, July 2003). We are grateful to participants for their valuable suggestions. We are particularly indebted to Claudia Castaneda who helped us to fruitfully re-shape some of its contents. We also thank Richard Davies for his professional assistance to translate the paper and the anonymous referees for their invaluable and positive suggestions.

Notes

1 Despite the key role of propaganda and the communications media as domination systems intrinsic to dictatorial regimes, they have not been an object of historiographic attention in Spain until recently. Sevillano Calero (1998) focuses on the daily press and the radio. The education system as a means of ideological framing has been addressed in studies such as those of Cámara Villar (1984), Ruiz Carnicer (1996), and Sáez Marín (1988).

The study of Rodríguez Tranche and Sánchez Biosca ( 2001) is the result of a decade of research work and is undoubtedly the key contribution on NO-DO history. Another recent contribution, although of less interest, is Rodríguez Martínez (1999). NO-DO and other cinematographic products of the so-called first Francoism are examined in Yraola (1997). 2 There is sparse historiography on daily life under Franco, although the genre of personal testimony is on the rise. Titles include those of: Abella (1996), Aguilar Fernández (1996), Castilla del Pino (1997, 2004), Fontana (1998), Richards (1998), Solomon (1999), Vázquez Montalbán (1998), and Gracia and Ruiz Carnicer (2001).

We are grateful to Miguel Ángel Ruiz Carnicer for his guidance on this issue. 3 Sevillano Calero (1999) has emphasized the relevance of these approaches and has also illustrated the still evident methodological obstacles to exploring the internalization process of dictatorial regime. Santos Juliá (2001) in his review of Rodríguez Tranche and Sánchez Biosca's book has also underlined the challenge that this approach poses to social historians. 4 Notwithstanding growing consensus on the utility of audio-visual sources for the history of medicine and science, their use is still scant. The special issue of the journal Arbor edited by Elena (1993), the recent article by Loughlin (2000), and the conference "Picturing Health? Archival Medical Film and History," organized by the Wellcome Institute for the History of Medicine and the Society for the Social History of Medicine (April 1996) are fine exponents of this approach. NO-DO's scientific contents came under scrutiny in Sánchez Biosca and Rodríguez Tranche (1997). For a general overview of the role of newsreels as historical sources see Paz and Sánchez (1999). For an updated historiography review on medical technologies see Stanton (2000). 5 A key book for the understanding of the role played by different technologies in the construction of national identities is Anderson (1996). The construction of national identities is, of course, a matter of sustained interest in the humanities as well as the social sciences, and has been addressed in many different ways, see, for example, Reicher and Hopkins (2001), Isin and Wood (1999), and Kandiyotu (1997). 6 For a recent update on the historiography of this period, see the special issue of the journal Ayer edited by Sánchez Recio (1999). For the history of Spanish television see Baget Herms (1993).

29 See Hewlett and Holl (1989), and Sánchez Ron (1999: 426-8) for an overview of the program "Atoms for Peace" and its reception in Spain. 30 The presentation and comments by Paul Julian Smith in the forum "Cinema and History" (6th Forum for Iberian Studies, University of Oxford 18-19 May 2001) have been of great importance for our analysis of these aspects. 31 NO-DO 479-A, 1952; NO-DO I-631, 1957; NO-DO 803-B, 1958; NO-DO 823-A, 1958; NO-DO 885-A, 1959. 32 NO-DO 667-B, 1955; NO-DO 696-A, 1956; NO-DO 730-A, 1957; NO-DO I-660, 1957; NO-DO 1125-A, 1965; NO-DO 1177-B, 1965. 33 We are grateful to Cristina Moreiras Menor for her insightful comment. 34 See for instance the item on Barcelona General Hospital (NO-DO 667-B, 1955) (1886-1972), which was translated into French, English, and German. 39 A seminal work in the feminist critique of cinema as a social technology is De Lauretis (1984). Unfortunately, this text seems to have gone unnoticed by most Spanish film critics, still tied to their old analytic tools. The fecundity of the gender analysis when applied to news on health matters has been pointed out by Cartwright (1995). For an extended analysis of the representation of women in NO-DO see Menéndez Navarro and Medina Doménech (2003). 40 A fine example of such a representation is the news item on the inauguration of an out-patient clinic in Badalona in 1968 (NO-DO 1347-A). The final sequence showed a sustained medium close shot of a smiling mother with her son in her arms waiting to take an elevator.

Figure 1 .

 1 Figure 1. NO-DO 321-B, 1949. Copyright Archivo Histórico NO-DO, Filmoteca Española, Ministerio de Cultura. Reproduced with permission.

Figure 2 .

 2 Figure 2. NO-DO 321-B, 1949. Copyright Archivo Histórico NO-DO, Filmoteca Española, Ministerio de Cultura. Reproduced with permission.

Figure 3 .

 3 Figure 3. NO-DO 511-A, 1952. Copyright Archivo Histórico NO-DO, Filmoteca Española, Ministerio de Cultura. Reproduced with permission.

Figure 4 .

 4 Figure 4. NO-DO 35-A, 1943. Copyright Archivo Histórico NO-DO, Filmoteca Española, Ministerio de Cultura. Reproduced with permission.

  ; the installation of a cobalt beam in Madrid(NO-DO 734-B, 1957); or the documentary dealing with new resources against cancer available at the Clinic Hospital, Madrid (NO-DO 743-A, 1957). 35 DelgadoGómez-Escalonilla (1992) provides a suggestive insight into the role played by Latin America as a reference point for cultural and foreign policies during the early Francoist regime. 36 As in the case of the Hispano-Portuguese Health Meeting held in 1960 (NO-DO 933-B, 1960), or the Ophthalmology International Course organized by the Instituto Barraquer of Barcelona in 1958 (NO-DO 823-A, 1958). 37 See for instance the item covering the donation to the University of Puerto Rico of electrophoresis equipment designed by Dr. Francisco Segovia (NO-DO 753-A, 1957). 38 The "Eye Protection Campaign" (NO-DO I-631, 1957) contains an image of the front cover of El desprendimiento de la retina (1936) by Dr. Hermenegildo Arruga

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Acknowledgements

This research was supported by the Spanish Ministry of Education Project PB97-0782-C03-01. Earlier versions of this article were presented at the 6th Forum for Iberian

Authors

Rosa M. Medina-Doménech, Ph.D., is Senior Lecturer in the History of Science Department and a member of the Peace Research Institute at the University of Granada. She has published on the history of medical specialization and radiation technologies in France, England and Spain. She is now researching the history of colonial medicine in the Spanish African colony of Equatorial Guinea, as well as the history of scientific and popular ideas of romantic love in contemporary Spain. Correspondence: Department of History of Science, School of Medicine, University of Granada, Avda. de Madrid, 11. 18071 Granada, Spain, e-mail: rosam@ugr.es Alfredo Menéndez-Navarro, Ph.D., is Senior Lecturer in the History of Science Department, University of Granada. His main research interests are in the history of occupational health, history of science information and history of medical technologies. Since 1999, he has been engaged in the project "Technology, Medical Care and Prevention in Contemporary Spanish Medicine," a research program concerned with the role played by medical technologies in the configuration of the present hospital-centered model of health care.

Both authors are responsible for the program "Cinema, History and Medicine," a pioneering initiative oriented to teach history of science to medical students through films and documentaries. Recently, they have edited a special issue of the journal Dynamis devoted to medical technologies: "Medical Technologies in the Contemporary World: an Historical Approach from the Peripheries" (2004).