Introduction

As scientific and social scientific research methodologies have developed and expanded over the past 50 years, the field of research has been broadly divided according to methodological trajectory: qualitative versus quantitative methodology. Particularly, this categorization seems to shape the field of health-based research, providing a means through which health researchers identify themselves and their work. At the same time, alongside the entrenchment of this division has been the growth of the neoliberal knowledge economy,Footnote 1 characterized by a series of profound political, economic and ideological shifts in regards to the perceived importance of new knowledge production, translation and dissemination. Specifically, the rise of the neoliberal knowledge economy has been marked by a turn away from curiosity-driven research with potentially unpredictable outcomes, and a turn toward an increased demand for knowledge that is outcome-driven, with results are predictable, measurable and amenable to economic rationalization.

These shifts have had enormous consequences for the research community at large, both within traditional academic and non-academic settings (see, for example, Redshaw, 2004). Over the past two decades, social theorists have explored the impact of these larger political and ideological changes on knowledge production from multiple perspectives (see, for example, Gibbons et al, 1994; Nowotny et al, 2001; Moore et al, 2011). These theoretical inroads include the development of new terminology such as ‘academic capitalism’ (Slaughter and Leslie, 1997; Mazzolini, 2003) and new models for understanding the interplay between the academic, governmental and private spheres (see, for example, Etzkowitz and Leydesorff’s 1997 work regarding the ‘triple helix model’). However, work specifically theorizing the production of health-based knowledges is less abundant. In her 2007 discourse analysis of the ties between neoliberal ideology and health policy research funding, Shaw (2007) broadly asks ‘How do market forces influence [health] research?’ (p. 317). Shaw usefully invokes the notion of governmentality to address her own query, and, while this analysis is not Foucauldian in nature, our work attempts to answer Shaw’s call by aligning ourselves with the notion that health research is a social process worthy of study in its own right. From this perspective we theorize the impact of ideological shifts on the production of knowledge about health and health care by providing a new typology for categorizing research processes.

To do so, this article contends that the historical notion of a qualitative/quantitative divide is no longer adequate and thus proposes a new paradigm for understanding contemporary health research that contextualizes it within a neoliberal knowledge economy. Rather than categorizing contemporary social research according to methodological trajectory, we instead suggest that research may best be understood from its political/epistemological underpinnings. In other words, rather than classifying research according to the practical components of study design and execution, one must understand how the researcher positions him or herself in relation to the question of what knowledge is, what it is for and how it is acquired, produced and disseminated. This understanding is imperative in order to best typify contemporary health research. Namely, we propose that these shifts require us to move away from typifying health research as either ‘quantitative’ or ‘qualitative’ and move toward understanding the research process as either ends oriented and driven by the demands of the economized knowledge market (instrumental), or emergent and reflexively interpretive (hermeneutic).

In order to justify this challenge to conventional research taxonomies, we begin by contextualizing our argument against the backdrop of the neoliberal knowledge economy, which has had profound effects on systems of knowledge production. Next, we turn to our own characterization of the health research terrain and explore salient features and examples of what we define as instrumental and hermeneutic research. To illustrate these features, we draw from a Request for Proposals (RFP) from the Canadian Institutes for Health Research (CIHR) that provides a recent example of how instrumentalist research is encouraged, while hermeneutic research is systemically devalued and excluded. Finally, we explore the relation of this proposed recategorization to a particular political position. Here, we explore what is at stake in terms of the changing landscape of knowledge production and why the shift toward understanding epistemology is imperative in order to recognize the ways in which certain kinds of health research and knowledge production are deeply implicated within larger ideological schema. Theorizing health research as falling along particular epistemological lines demonstrates how and why health research practices are tied to the practices of neoliberalism. While this typology may be applied usefully to a number of disciplines, it has particular pertinence for health research. Spanning many disciplines, health research occupies an ambivalent position within the research arena: much health research is applied, or ends oriented, in nature, but health research may also be theoretical or creative. This is different from work emerging from solely applied disciplines: engineering, for example, is predominantly ends oriented and explicitly tied to the public market. Our analysis works to name, and thus critique, the ways in which health research is increasingly proscribed by market values, prizing some forms of knowledge production and limiting or truncating others, particularly those that are critical or creative in nature. In other words, this analysis works in service of promoting the importance of creative, critical approaches for health-based research and knowledge production.

Background

The knowledge economy

The term ‘knowledge economy’ was first used in the 1960s to describe a series of social and economic shifts in terms of production that accompanied the birth and growth of widespread neoliberalism. Early theorists such as Drucker (1969) and Bell (1976) argued that in a post-industrial society, knowledge was fast becoming a highly valuable commodity, and was taking an increasingly central place within the economy at large. Over the past several decades, this economic development approach to knowledge production has become more pronounced: knowledge has been redefined not as an external resource for growth and production, but rather a central object or goal of production, whether through the creation of ‘innovative’ new technologies and/or applications, or through the development of human capital (Macintyre, 2004, p. 24). Here human capital may be described as knowledge embodied within trained individuals or organizations (see, for example, Organization for Economic Co-operation and Development (OECD), 1996, p. 8).

This redefinition of knowledge has been realized at a policy level, both nationally and supranationally, where knowledge has been recast as an economic good and has assumed a prominent role in late-stage, global capitalist political agendas. The Government of Canada, for one, explicitly identifies knowledge as one of Canada’s predominant industrial drivers (Industry Canada, n.d.). This shift, which is realized at all levels of economic policymaking and implementation, encourages not only a very particular notion of knowledge production, but indeed, of knowledge itself. As ‘knowledge’ has come to dominate the socio-economic landscape, ideas and practices regarding knowledge production have also changed. Such changes in policy and practice have altered how knowledge functions within society. Kenway et al (2006) write:

[The Knowledge Economy metanarrative] has had a powerful impact on which knowledge is seen to matter, who has access to it, who controls it and for what purpose. The intensification of the economic function of knowledge has come at the expense of the social function of knowledge. (p. 25; emphases added)

As applicable (or ‘commericalizable’) forms of scientific and technological knowledge have been most highly valued within the changing schema of knowledge production (Redshaw, 2004), these shifting notions of how to produce, evaluate and disseminate knowledge have particularly affected health research systems and methodologies. Within this new economic landscape, we contend that two hallmark characteristics of knowledge and knowledge production emerge. These are: (i) the recasting of knowledge as an application or product; (ii) a desire for, or focus on ‘innovative’ research; and (iii) the measurement and evaluation of knowledge products in order to assess their worth or value.

The first key outcome is a shift from understanding knowledge as intangible to understanding knowledge as a commercializable entity, good or product. Gault (2006), for example, writes ‘knowledge is different from conventional economic products. It can be sold or given away, but it is still retained by its original owner, unlike a tangible good (a brick) or an intangible good (music, text or video on a medium)’ (p. 28). While Gault (2006) implies an understanding of knowledge’s unique properties, underlying his statement is the inherent notion that knowledge, in its economized form, is a thing and, as such, is an autonomous entity that can be moved, transferred, traded, stored and even counterfeited.

A second outcome is the use of the term ‘innovative’ to describe the research and its goals or outcomes. The term ‘innovation’ occurs repeatedly throughout the literature regarding the knowledge economy and production of new knowledge, where it is claimed as a key aspect and indicator of what makes knowledge and knowledge production productive (see, for example, Veugelers, 2006; OECD, 1990). However, the term ‘innovation’ is surprisingly bereft of clear definition in this context. Veugelers (2006), for example, describes the notion of ‘national innovation capacity’ as ‘the ability of a nation not only to produce new ideas but also to commercialize a flow of innovative technologies over the longer term’ (p. 45; emphasis added). From this definition, one may glean that innovation has something to do with novelty and payoff; however, Kenway et al (2006) remark that ‘innovation [in the context of the knowledge economy] denotes a complex of attributes and processes that extend far beyond the creation of something new’ (p. 35). As they suggest, the term ‘innovation’ signals a number of ideas central to the knowledge economy discourse. They write: ‘… key elements of innovation include new knowledge, scientific inventiveness, technology, markets, enterprise, competitiveness and entrepreneurialism. Innovation, therefore, means much more than a new idea or invention or even new knowledge alone’ (p. 35). Thus, innovation denotes not just something new and noteworthy, but something that is productive in terms of economic growth or knowledge productivity.

The third outcome in terms of knowledge production practices within the knowledge economy is the presumed importance of measurement and evaluation. Working within the twinned logic of economy on the one hand and the current emphasis on the accountability and utility of research on the other, an increasing insistence on evaluation, and the creation of evaluative measures, is a logical progression. This sentiment is echoed in the OECD’s document entitled The measurement of scientific and technological activities, which devotes itself to the provision of standardized (or standardizable) indices for knowledge producing loci, whether they be individual firms or nations. Envisioning knowledge as a product or commodity conceptually permits and even encourages its measurement (see, for example, Gault, 2006). It also means that only forms of knowledge that are amenable to quantified forms of evaluation are understood as valuable and therefore afforded systemic support.

Importantly, this third facet ties the knowledge economy to particular methodological traditions: these evaluative measures and indices rely almost exclusively on quantitative methodologies, specifically survey questionnaires that reduce knowledge to standardized units. For example, the aforementioned OECD (1990) report focuses singularly on the homogenization of units of measurement as the key to evaluative success. It states:

The statistical unit is the entity for which the required data is compiled. It may be observation units on which information is received and statistics are compiled, or analytical units which statisticians create by splitting or combining observation units with the help of estimations or imputations in order to supply more detailed and/or homogeneous data than would otherwise be possible. (p. 44)

Underlying quantitative research’s reliance on measurement and observation is a paradigmatic belief in the tenets of logical positivism and the scientific method. This epistemological position espouses not only the possibility, but the inherent superiority of comprehending the world through detached observation and experimentation on the part of the researcher (see, for example, Guba, 1990, p. 20; Guba and Lincoln, 2005, p. 194). Reality, from this perspective, is an apprehendable entity and is ‘out there to be studied, captured and understood’ (Denzin and Lincoln, 2005, p. 11). Knowledge about this reality in quantified form, from this perspective, allows for greater objectivity on the part of the researcher and aids in the generation of verifiable, generalizable and applicable facts about the world around us. Thus, the use of a positivist epistemology qua quantitative methodology is what allows the objectification of knowledge to a relatively standardized schema of valuation, and further, allows both the measurement and comparison of worth. While philosophers and social scientists alike have questioned the limits of positivism as the prevailing and undisputed social science research methodology (Guba, 1990; Denzin and Lincoln, 2005; Yanow and Schwartz-Shea, 2006), the deep ideological tie between positivist methodologies and the knowledge economy has caused a marked imbalance between research that is socially legitimated and research that is not.

Shifting the Landscape: Instrumental Versus Hermeneutic Research

Given our analysis of the role of knowledge and knowledge production within the knowledge economy, it is imperative to re-examine the role of research as a central locus of knowledge production and to develop a new paradigm for understanding health research that takes into account these changes. (see Table 1).However, it is important to acknowledge the complexity of the politics of the health knowledge generation, and to be clear that the knowledge economy is not an entity unto itself, but a set of ideologically driven beliefs about the nature and utility of the research process. In this, the demand for the kind of ends-oriented, accountable research that knowledge economy practices seem to offer may come from a number of sources, including tax payers, patients, health-care providers, policymakers and indeed, researchers themselves, all of whom may drive the research process to some extent. Our goal here is not to admonish the needs of any of these stakeholders, but rather to trace the lines between ideology and practice, and to actively name the ways in which the pressures for instrumental research shut down the possibility for more creative modes of investigation. In doing so we hope to open a dialogic space in which the benefits of a hermeneutic research practice might be considered.

Table 1 Salient features of instrumental and hermeneutic research
Full size table

Instrumental health research

In order to illustrate how these features emerge within what we are calling instrumental research, we examine the language currently used within research funding agencies. Specifically, we draw from CIHR’s RFP for a multidisciplinary team grant on gendered violence. Our point here is twofold: first, to call attention to the ways in which the qualities of instrumental health research are defined through and by funding agencies and second, to articulate how the knowledge economy’s demand for instrumental research is made manifest within funding bodies and thus has an enormous impact on what kinds of health-based research are made possible in this kind of research funding environment.

To better understand this, it is important to be clear about the history and mandate of CIHR as it relates to other federal granting bodies. CIHR was formed in 2000 to support Canadian health research. CIHR’s stated mandate is to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system. Thus, from its inception, the CIHR’s goals have been to support research that comes from a scientific methodological position and are, therefore, tied to positivist methodologies. From 2000 to 2010, social science and humanities health scholars could apply for funding from the Social Science and Humanities Research Council (SSHRC), the federal funding body responsible for arts and humanities research. However, in 2010, SSHRC made the decision to exclude all health research from their funding purview, leaving non-scientific health researchers with only the option to apply for CIHR funding. This decision has had an enormous impact on the kinds of health research that can occur in Canada, as we will further describe in our analysis. Finally, it is worth noting here that as a federally funded initiative, many of the outcomes and objectives outlined by CIHR described in the discussion below are required by the Treasury Board of Canada Secretariat, an administrative committee that monitors spending at the federal governmental level (CIHR, n.d.) and which presumably knows little about health research processes and even less about violence against women as a field of study.

Identifying instrumental knowledge and knowledge production

A key identifying feature of instrumental research is an explicitly ends-oriented approach to the research process, or an approach marked by pre-given objectives, outcomes and indices. This means that even before the project’s inception, the project’s goals are stated explicitly in terms of what knowledge the research will produce and for what ends. This often includes a detailed knowledge translation and dissemination strategy that is planned before the project begins. Again, it is important to be clear that we believe that research (whether instrumental or hermeneutic) should be widely disseminated; however, it is also our belief that predicting what knowledge will be developed through the project, and pre-developing a knowledge translation or dissemination strategy before the project begins, already predefines the shape of the research trajectory, thus signaling a level of instrumental control over not only the final knowledge product, but, crucially in our view, the knowledge production process.

One of the underlying assumptions of this approach is that the new knowledge created through this research process is predictable, rationalizable and immediately applicable. The RFP from CIHR provides a clear example of the call for ends-oriented research. The call announces a funding opportunity for a team grant regarding violence, gender and health from CIHR, the primary objective of which is ‘to support expert teams composed of researchers and knowledge users to conduct research on violence, gender and health’ (CIHR, n.d.; emphases added). In order to aid applicants, CIHR has provided a concise table outlining the grant’s objectives and outcomes, which are to be monitored through largely quantitative measures or indicators. For example, the first major objective listed is to ‘support multi-disciplinary research (and, where appropriate, the development of programs and interventions) related to violence, gender and health’ (CIHR, n.d.). The pre-given outcomes attached to this objective are (i) the generation of new knowledge; (ii) the development of new programs and/or interventions; (iii) new or improved methods and measures for examining the issue of gendered violence; and (iv) the generation of additional funding to support this research or its subsequent programs. The success of these outcomes are to be monitored through a series of measures that include (i) the number and description of new programs and/or interventions created through the research; (ii) the number and description of new or improved approaches, procedures or techniques for collecting and analyzing data; and (iii) sources, types and dollar value of new funds leveraged through the research process (CIHR, n.d.).

The underlying assumption of this call is that the development of new knowledge about gender and violence is not enough. Rather, this knowledge must be innovative and amenable for use or application in terms of making specific and measurable changes to current policies and systems of care provision. And, as further demonstrated in this call, these changes are necessarily bound to the rationalization of care, whether this is increased efficiency, cost savings or revenue generation.

The CIHR funding opportunity provides a scaffold for building a research program wherein the activation of the research process will produce predictable, regulated and accountable knowledge, with ends that are known even before the research begins. Knowledge, in this case, is meant to be delivered as a regulated good in the form of policies, programs, interventions, new methods and measures and additional funding. While the shape and design of the final ‘deliverables’ such as a program or intervention is not known at the outset of the process. Research that does not have a predictable outcome (such as a program or intervention), research for which an end point cannot be predicted before its inception, or research for which outcomes or impacts cannot be readily assessed in terms of pre-given measurement indicators does not find an easy home within this RFP. Thus, the drive to create new programs, interventions and tools, and the drive to save or generate revenue, precludes the notion that thinking, critique, debate, engagement and dialog are also very important results of engaging in the research process. Moreover, they are rendered invisible in terms of their importance and are not counted as productive outcomes of the research process.

Finally, it is important to note instrumental research’s orientation to the process of quantitative evaluation, beyond it being innovative, applicable and productive. As research’s applicability and utility are so highly prized within the knowledge economy, and because research must remain ‘accountable’ to its funders in terms of its success, there is a strong imperative to build into the research design itself a system of evaluation to measure and monitor a research program’s success. As is made clear in the example taken from CIHR’s funding call, research projects may be required to monitor the number of publications or number of new programs that have resulted from a grant or to provide survey data regarding a program or intervention’s ‘success’. However, while these approaches are often quantitative in nature, there is also room for qualitative and mixed-methods research in this area too, provided that this research can provide a set of generalizable evaluative statements that can be used as part of a broader measurement system.

Once again, it is not our intention to suggest that health research should not be evaluated or should not be involved in an ongoing system of reflexivity in terms of how a project has progressed or where a project might head next. Rather, it is our goal to illuminate the ways in which these evaluative systems, through which the utility of knowledge production is counted and rationalized, further imbricate research within the neoliberal knowledge economy. Our argument here is that evaluation in this context is the process of economization – it is the process by which knowledge is given a particular value, and thus is potentially amenable to further commodification. As such knowledge is transformed into a product that can enter into, and operate within, an economic market.

In its most basic description, instrumental research is research that, wittingly or not, is compatible with the demands of the knowledge economy where the goal is to produce knowledge that is understood in economic terms. Understanding health research in economic terms may take one of two forms: this may be research where the knowledge production process itself is ends oriented, and thus at some level predictable in terms of trajectory and outcome, or, it may be research that produces commercializable knowledge with the purpose to predict, control, modify or rationalize human systems and/or behavior. Often, instrumental research occupies both positions: it is the creation of commercializable knowledge products born of ends-oriented research processes.

Hermeneutic health research

The history of hermeneutic inquiry spans hundreds of years and has been taken up across multiple disciplines including theology, philosophy, linguistics and, most recently, social science (Allen and Jensen, 1990, p. 241). While the term ‘hermeneutics’ has acquired multiple discursive and methodological meanings over time, the heart of hermeneutic inquiry is ‘a living tradition of interpretation with a rich legacy of theory, philosophy, and practice’ (Moules, 2002, p. 2). As such, the term ‘hermeneutics’ is methodologically loaded and, without further clarification, its use seems to signal a commitment to a particular kind of research trajectory – one that is dedicated solely to the practice of interpretation, particularly through the careful interrogation of texts, and one that requires ongoing reflexivity on the part of the researcher (Smith, 1991).

It is our intention here to reclaim the term ‘hermeneutic’ for our own purposes and to use this term to signal a particular epistemological position vis a vis knowledge production rather than merely a particular methodological approach. In our use of the term, it is the potential for hermeneutic inquiry to engage the process of knowledge generation in a creative way that is of utmost importance. Central too is its underlying commitment to destabilizing knowledge, troubling the boundaries of what and how we know, and importantly, to resisting and questioning systems of power. Smith (1991), for example, identifies this quality of hermeneutics by warning potential inquirers to be ‘mindful that their interpretations could lead them into trouble with the “authorities” ’ (p. 187). Moules (2002) offers a similar warning by describing the role of hermeneutics’ theological namesake, Hermes: ‘Hermes has the character of complication, multiplicity, lies, jokes, irreverence, indirection and disdain for rules; however, he is the master of creativity and invention’ (p. 3). Thus, our commitment to providing a conceptual space for reclaiming the hermeneutics of inquiry has less to do with a commitment to a particular methodological approach, and more to do with naming a particular epistemological/political stance toward knowledge production in the face of the power of the knowledge economy.

Identifying hermeneutic knowledge and knowledge production

While the goal of hermeneutic inquiry from a traditional perspective is to uncover the meaning of experience and human understanding through interpretation, hermeneutics differs from instrumental inquiry because of its flexibility and commitment to knowledge generation as a creative practice. In other words, hermeneutic inquiry does not offer a pre-given set of methodological steps, but rather provides a philosophical and conceptual stance regarding the unfolding of the process of inquiry. As noted earlier, hermeneutics may be best understood as an epistemological position, stance or commitment the researcher takes in relation to the inquiry at hand. While hermeneutic research may not be bound by a rigid set of methodological steps, a few key features regarding knowledge production characterize this epistemological perspective.

First, hermeneutic health research is not dictated by an ends-oriented approach. This is to say, it does not set out with a clear goal regarding what kind of knowledge will be produced through the process of inquiry and for what ends. Rather, hermeneutic inquiry is emergent, reflexive and iterative. It is neither driven toward a pre-determined goal, nor is it linear in its progression, but instead understands both knowledge and methodological trajectory as continually emerging from the research question or problem. Thus, it is always involved in a flexible and unpredictable, often ‘messy’, process of questioning, gathering ideas and information, interpreting this new knowledge and returning to the original site of questioning: hermeneutic inquiry hopes to engage a problem or series of problems in a flexible and iterative manner, without a pre-given commitment to the problem’s answer or outcome. In this sense, hermeneutic research is unpredictable in nature.

A second, and related, aspect of hermeneutic knowledge production has to do with the way in which the knowledge production process is conceptualized. While instrumentalist health research envisions knowledge production and translation as a means to an end, hermeneutic health research understands the process of knowledge generation as a sufficient end unto itself, regardless of whether this process produces knowledge that is utilizable in the knowledge economy. This, of course, does not preclude dissemination (clearly a vital aspect of the research process), but rather, acknowledges that the work of creating knowledge is not necessarily to produce the raw material for further commercialization or application, but rather to actively and systematically engage and re-engage the research question, the results of which may take many forms in terms of knowledge dissemination. And, while hermeneutic research may ultimately produce something ‘useful’ – a policy, a program, or even a marketable product – a focus on innovation for innovation’s sake (that is, to make the end product more productive or marketable) is not the goal of this type of research. Thus, from this epistemological stance, the process of inquiry, or the process of intense contemplation or interrogation of a question, idea or subject, is not the route through which action occurs but is itself a legitimate form of action regardless of where the inquiry ends up or what it produces.

As a result, the knowledge that a hermeneutic inquiry produces is highly dependent on both the form of the inquiry and those engaged in the inquiry. However, a few important features separate hermeneutic from instrumental knowledge. Most importantly, knowledge produced through hermeneutic inquiry is not explicitly engaged in making people or systems perform in a more productive, efficient or rationalized manner (that is, the explicit development of a health-related program, policy or evaluation). In this sense, knowledge emerging from hermeneutic inquiry cannot be understood within the knowledge economy’s discourse of ‘utility’ and ‘applicability’; indeed, hermeneutic knowledge ‘products’ are not products at all, as they may not be amenable to easy application or commercialization.

Rather, knowledge emerging from hermeneutic inquiry often destabilizes or works to undo what we currently know about the world and how we have to come to know it. This type of knowledge is often critical in nature and, as such, is comfortable with ambiguity, indeterminacy, contradiction and a lack of measurable outcomes. As hermeneutic inquiry is not bound to the creation of applicable knowledge products, the end result of hermeneutic inquiry may be a call for more sustained questioning and thoughtful engagement. Or, the end result of a hermeneutic inquiry may be creative in form. For example, this type of inquiry may draw from and combine multiple disciplinary sources in a unique manner, or engage non-traditional methods such as the use of fine art or performance in the process of knowledge generation or dissemination. This creative use of alternate forms of knowledge generation, synthesis or dissemination in hermeneutic research is not an ‘innovative’ gimmick through which knowledge products are made more easily applicable or commercializable. Rather, it is sufficient as a fundamentally important means of meaning-making, of making sense of the world.

To return to the example of CIHR’s call for proposals regarding gendered violence, a hermeneutic approach might consider a completely different kind of project emerging in response to this area. For example, health scholars might propose to work with dance scholars and survivors of gendered violence in order to create a movement-based piece that considers the embodied impact of violence. The impact and outcomes of such a project would, of course, be hard to predict from the outset and bear as-yet-to-be imagined evaluative terms. But this does not, of course, render the project useless. It could generate powerful insights regarding women’s lived and embodied experiences of violence; it could allow significant healing and community development for women involved; it could provide a jumping-off point for future projects regarding the development of progressive policy or care provisions regarding gendered violence; it could form the basis for the development of nuanced theoretical perspectives regarding experiences of violence and the body.

As is perhaps becoming apparent, hermeneutic research does not readily fit into the evaluative parameters defined and prized by the knowledge economy, which is to say, evaluations that work to generalize or quantify findings. Rather, hermeneutic research requires an ongoing commitment to reflexivity on the part of the researcher and a sustained attention to his or her own position within, and relationship to, the research. As such, hermeneutic health research may not appear as particularly ‘accountable’ within the terms provided by the knowledge economy, subscribing instead to a very different set of checks and balances as a means of monitoring the project’s process and outcomes. Such measures may include keeping track of the research process through detailed documentation of the research process, engaging in ongoing dialog with colleagues, returning to the original site of inquiry in order to maintain contact with the project’s original goals and maintaining open contact with project participants in order to understand what their experience of the research process has been.

Second, given that the epistemological perspective of hermeneutic inquiry understands thinking as a form of action, the meaning of research ‘utility’ shifts, further rendering hermeneutic inquiry incompatible within an economized perspective. This is to say that if the process of knowledge production is perceived as useful in and of itself, ‘proof’ of ‘utility’ through further application and commercialization becomes a secondary if not irrelevant concern. This, however, is problematic, as the pervasive force of the knowledge economy often requires that all research makes itself accountable and rationalizable within an economized framework, as evidenced by the demand for the provision of pre-determined required outcome measures and indices.

Third, because hermeneutic studies are inextricably bound to both the researcher and the context of his or her inquiry, hermeneutic inquiries may be highly individual and thus not amenable to particular, highly valued forms of evaluation within the knowledge economy, including syntheses or meta-analyses, which form the backbone of emergent evidence-based medical practices (see, for example, Timmermans and Kolker, 2004). These forms of evaluating and organizing research are driven by the putative need to cull and reduce bodies of knowledge to single points of ‘useful’, or ‘applicable’ evidence. This approach is often inappropriate for hermeneutic research for several reasons: first, these studies (which may be either qualitative or quantitative in nature) may be singular or unique and thus comparative data may not exist, and second, these studies may be in-depth examinations of a subject or area (for example, small-scale, singular studies or work emerging from the arts and humanities) and thus the process of generalization robs the research of its profound analytic nuance and depth.

These aforementioned aspects of hermeneutic inquiry do not simply define it as different from instrumental research, but actively place hermeneutic research problematically at odds with the knowledge economy ideology. Hermeneutic health research does not take the modification or rationalization of humans or human systems as its primary, or even secondary, goal, thus, the ‘value’ of knowledge resulting from such studies, which may be critical, complicated, messy or indeterminate in nature, may not be immediately clear or may be at odds with the need to change, enhance or better predict current practices. As such, pre-given indicators of success so often used to assess and rationalize instrumentalist research are wholly inappropriate and hermeneutic health researchers often find themselves struggling to fit within the parameters of the demands of certain kinds of grant applications. For example, the evaluative indicators outlined within CIHR’s funding call (numbers of papers, numbers of programs developed, numbers of dollars leveraged through the project) are entirely incommensurate with a research project whose aim it is to engage, unsettle, critique or pursue a question about a field rather than to provide a solution or an application. In fact, the end result of a hermeneutic study may not only be a dearth of immediately applicable solutions, but indeed, more questions.

Discussion: What’s At Stake?

As may be clear from our analysis, our proposed characterization of systems of inquiry does not simply represent two different ways of approaching knowledge production. Rather, it represents a pair of unequal positions in terms of power and legitimacy. Differently put: because instrumental health research abides by the logic of knowledge production within late-stage global capitalism (that is, the logic of unbridled knowledge accumulation that occurs through the process of commercialization of knowledge ‘products’), this type of health research is highly valued within the field of knowledge generation. As evidenced by funding calls such as the one described earlier in this paper, instrumental research is not simply funded more regularly, but rather the entire field of health research is shaped to produce instrumental research: the political privileging of one epistemological position over another has wide-scale, detrimental effects on or for knowledge generation and research generally.

Circumscribing thought and discovery

If hermeneutic research characterizes a particular mode of generating knowledge and insight, what is lost when this approach is curtailed? We contend that the drive for certain kinds of accountability and rationalization of knowledge and knowledge production severely limits forms of inquiry that rely on unpredictable discovery and the capability for insight (whether it be scientific invention, program development or cultural critique). Many processes of discovery do not follow the logic of prediction and control set out by narrow knowledge generation formulas (that is, pre-defined objectives, outcomes and indices) demanded by the knowledge economy. The encroachment of instrumentalism as the predominant mode of inquiry troubles multiple areas of health research, including basic sciences, ‘soft’ sciences and the humanities. In his recent book entitled The Black Swan, cultural critic Nassib Taleb contemplates the erosion of discovery in an era where prediction and control are highly prized, and particularly focuses on the effects of these changes on scientific discovery. He writes:

If you think that the inventions we see around us came from someone sitting in a cubicle and concocting them according to a timetable, think again: almost everything of the moment is the product of serendipity … As happens so often in discovery, those looking for evidence did not find it; those not looking for it found it and were hailed as discoverers. (Taleb, 2010, pp. 167–168)

Further, Taleb (2010) argues that the notion of predictability, which we argue manifests within instrumental research through pre-given knowledge outcomes, is counterintuitive to many forms of inquiry. He explains:

Prediction requires knowing about technologiesFootnote 2 that will be discovered in the future. But that very knowledge would almost automatically allow us to start developing those technologies right away. Ergo, we do not know what we will know. (Taleb, 2010, p. 173; emphasis added)

We would add the corollary ‘we do not yet know what we do not know’ which, we argue, lies at the epistemological core of hermeneutic inquiry. Similarly, Taleb lauds existing institutions that allow discovery to occur organically through what we have called a hermeneutic process. Taleb (2010) recounts his analysis of a biotechnology company that has profited richly from this approach: ‘I was told that a scientist managed the company and that he had the instinct, as a scientist, to just let scientists look wherever their instinct took them. Commercialization came later. [The scientist] understood that research involves a large element of serendipity …’ (p. 170; emphasis added).

Such an analysis, whether applied to the field of biotechnology, the sociology of health or the medical humanities gets at the heart of a hermeneutic approach to inquiry: to follow one’s instinct or curiosity along an unpredictable path, which may or may not lead to discovery, without being held hostage by the need to produce commercializable or applicable research products. The perceived need for research and inquiry to justify themselves in terms of pre-given notions of utility, efficacy or functionality therefore deeply constrains, and even destroys, modes of inquiry that welcome ambiguity, rely on intellectual serendipity and work outside the bounds of prediction and rationalization.

Instrumental knowledge products as a form of control

As we have argued, only particular types of knowledge are prized within the knowledge economy; namely, knowledge that may be understood as readily applicable or commercializable. But what does it mean to understand knowledge as a commercializable product? As we have described earlier, commercializable knowledge is knowledge that can be put to some particular, predictable, pre-designated use. In other words, commercializable knowledge is knowledge that is deemed ‘applicable’ in terms of making people or systems operate in a more productive manner – faster, more complete, more efficient, more cost effective or more predictable in nature. Thus, commercializable knowledge products may be understood as tools that may engender certain forms of control over both people and systems. It is imperative to recognize how this designation refigures knowledge as a means to exert control, and thus is implicated in forms of domination. Our argument here is that certain types of knowledge, and the constraint of knowledge production in order to create these forms of knowledge, mark one channel through which the potential for domination over human subjects may occur within neoliberalism.

This critique is complicated by the fact that much instrumental research rests firmly within a compelling discourse of both productivity and improvement. For example, the implicit goal of the CIHR RFP referred to earlier in this article is to increase our understanding of gender and violence such that we might improve systems of care, surely an important and worthy goal. However, three underlying issues undermine the potentially libratory aspects of this project. First, as demonstrated by the stated objectives of the call, ‘improvement’ and ‘productivity’ are often bound to an underlying agenda of cost effectiveness in some manner, whether by providing faster or cheaper service or by generating new revenue. Thus, the potential for meaningful social change may be undermined by the necessity for economic rationalization. Second, the reliance on knowledge products to create meaningful behavioral or systemic change relies on a remarkably linear understanding of knowledge ‘transfer’. Indeed, such a term implies that ‘knowledge users’ (who may previously have been known as ‘learners’) will take and apply this knowledge in a straightforward manner, uncomplicated by the messiness of both personal and cultural practices and limitations. This designation misses the fact that learning is very often a complex and non-linear process, shaped as much by the learner and his or her context as by the quality and nature of the knowledge itself. Third, and relatedly, this model of knowledge transfer relies on ‘knowledge using’ subjects (whether individuals or systems) doing exactly what they are told within the process of knowledge transfer. This of course ignores the fact that both people and human systems are far more complex than such a model implies and may not want or be able to simply ‘apply’ knowledge products to themselves or their practices as expected in this relationship.

Buttressing this model is a series of assumptions regarding the power of knowledge to make people and human systems perform both differently (more productively or efficiently) and more predictably. As hermeneutic inquiry is not fundamentally oriented toward the creation of applicable knowledge products, its investment in making ‘productive’ change as such is far less. This on the one hand allows hermeneutic inquiry to be far less constrained in scope and trajectory, but on the other places hermeneutic research at odds with the knowledge economy discourse as realized through broader research agendas and funding policies.

What’s to be gained?

While we contend that instrumental research is ideologically aligned with the knowledge economy, and thus may be deeply implicated in neoliberal practices of control and domination, what we have made less clear is the potential importance of maintaining a space for hermeneutic modes of inquiry, particularly within state funded research models. Despite our critique, we still believe that there is much to be gained from instrumental research. Our aim is not to challenge the notion that instrumental research practice is important or valuable, but rather to challenge the belief that it is the only practice that is important or valuable. As such, our goal is to broaden the field of health-based inquiry such that hermeneutic research is equally valued.

Currently, and particularly in the face of pervasive economic scarcity for state funded research activities, hermeneutic research is regarded as a luxury – a superfluous frill perhaps best left to private funding bodies (or left altogether unfunded). This belief is both narrow minded and dangerous. As we have described above, the process of hermeneutic inquiry is one that is less concerned with solving problems and more concerned with raising questions. Instrumental research practice is wonderful for solving problems, but less adept at identifying questions that have not yet been asked, or indeed, challenging the way in which the question, problem or field has been perceived. Clearly within the field of health inquiry there needs to be ample room to discover not just solutions but problems that were previously ‘unseeable’ given our existing perspective. It is unquestionably within the public interest to value and uphold this kind of experimental criticality, regardless of where or what form its end product might be. We believe that holding a social space open for reflexive, creative, critical engagement is foundational to any society which takes seriously the notion that free thought is a precursor to genuine discovery.

Thus, returning to the earlier hypothetical example of a health-dance project regarding women’s experience of violence, such an endeavor might open new embodied spaces for survivors of violence to ‘speak’ about their experiences, and in so doing help redefine important facets of knowledge regarding resilience, healing and change, all of which would be impossible to access if ‘program creation’ or ‘cost savings’ was the underlying instrumental goal of the research project. This, we argue, is not a ‘frill’ but an absolutely essential component within the larger field of health research.

Conclusion

We have argued that in the face of the pervasive demands of a neoliberal knowledge economy, the field of health research has shifted, and thus the need to recategorize systems of inquiry is both warranted and necessary. As such, we have proposed a movement from typifying health research methodologically, as ‘qualitative’ or ‘quantitative’, to reconceptualizing inquiry along political/epistemological lines. To do so, we have provided a detailed description of two opposing epistemological standpoints vis a vis inquiry: commercializable, ends-oriented ‘instrumental’ research versus emergent, iterative and unpredictable ‘hermeneutic’ investigation.

This recategorization of the field of inquiry along political/epistemological lines is imperative not simply because it provides a new lens for conceptualizing the research process, but because it provides a means of clearly articulating the ways in which knowledge, and the process of knowledge production, is inextricably bound up with systems economy and therefore of power. We would argue that this recategorization is particularly important because it allows us to understand what is at stake as the field of health research is being reoriented along instrumental lines, providing a means to navigate our own political/epistemological positions and thus make choices regarding the direction of our own research agendas.