On social plasticity: the transformative power of pharmaceuticals on health, nature and identity

Normal isn't normal: On the medicalization of health

BACKGROUND

This study investigated the proportion of the U.S. population classified as healthy based on 10 common indicators, examined in two ways: (1) above or below (in the healthy direction) the sample median (termed "normal"), and (2) below diagnostic cut-off points for clinical caseness or high risk (termed "ideal").

METHODS

Data are from the 2017-March 2020 round of the National Health and Nutrition Examination Survey (NHANES). Sample sizes ranged from 3,956 to 8,961 for respective health indicators, with a total of 3,102 respondents for two weighted multi-item measures described below. Measures included the Alameda 5 health behaviors (smoking, drinking exercising, sleeping, and body mass index) and five standard biomarkers (systolic and diastolic blood pressure, resting heart rate, fasting glucose, and total cholesterol). Besides point prevalences for the normal and ideal categories for each indicator, we also calculated the proportion healthy for all 10 indicators, again calculated both ways, termed "meta-normal" and "meta-ideal."

RESULTS

The prevalence of meta-normality was 1.05%, suggesting that hardly any adult Americans are completely healthy according to population norms. Findings for meta-ideality showed that while most Americans are not clinical cases for any respective indicator, only 5.55% met the official criteria for being healthy according to all 10 indicators.

CONCLUSION

Most Americans appear healthy according to nearly all key health indicators and biomarkers, according to "normal" or "ideal" criteria. However, the proportion healthy according to all measures is extremely small. Relatively few U.S. adults are completely healthy according to clinical criteria (meta-ideal), and even fewer are completely healthy according to population norms (meta-normal). Results are interpreted through sociological writing on medicalization.

Recovery from Childhood Psychiatric Treatment: Addressing the Meaning of Medications

Medications exert effects not only through biological mechanisms but also through the meanings that they carry. While positive effects (e.g., the placebo effect) are broadly recognized, psychiatry is often less attuned to the negative effects that are mediated through the meaning of medications. These negative effects may be especially pronounced when noxious meanings and countertherapeutic aspects of medications are incorporated into the unfolding development of a child and not countered by psychotherapeutic experiences that allow iatrogenic meanings to be placed in context. In this paper, psychosocial mechanisms, by which medications may cause harm, are explored. These include adverse effects on identity, impaired agency, impaired affective competence, and negative effects on the patient's relationship with care. When such harm has occurred at the level of meaning, it is best addressed at the level of meaning. Examples of psychotherapeutic work with young adults is offered to demonstrate the process of reworking developmental harm related to the meaning of medications.

Vidas precárias: tecnologias de governo e modos de gestão da fecundidade de mulheres “vulneráveis”

Resumo Lacunas no planejamento reprodutivo, após 25 anos da Lei de Planejamento Familiar, no Brasil, têm promovido uma ressignificação do controle reprodutivo. As expressivas dificuldades para realização da laqueadura tubária no Sistema Único de Saúde têm permitido o florescimento de estratégias governamentais fomentando acesso estratificado e racializado a métodos contraceptivos reversíveis de longa duração (LARC). A pesquisa etnográfica apoiou-se em fontes documentais sobre iniciativas institucionais para inclusão de LARC no sistema público de saúde, tomando-se o município de São Paulo como caso empírico paradigmático. Envoltas no ideário da cidadania, argumenta-se que tais tecnologias de governo são acionadas na direção contrária à ampliação de direitos sexuais e reprodutivos, para reificar estereótipos sociais que subtraem a autonomia reprodutiva das mulheres. Tomando o conceito de “coerção contraceptiva” como categoria de análise, demonstra-se como tais expedientes ferem o paradigma da justiça reprodutiva no Brasil ao se institucionalizar a exclusão social pelo útero das mulheres “vulneráveis”.

Médicalisation et autonomie des femmes affectées par le syndrome des ovaires polykystiques

Le syndrome des ovaires polykystiques (SOPK) est un trouble endocrinien répandu qui affecte environ 10% des femmes en âge de procréer. Bien qu’il soit principalement connu pour ses effets sur la fertilité, le SOPK est considéré comme un facteur de risque pouvant mener au diabète de type 2. Il est également associé à des conditions comme les cancers hormono-dépendants, les troubles psychiatriques ou encore les maladies cardio-vasculaires. La volonté de prévenir les conditions associées pourrait pousser à une plus grande médicalisation des femmes atteintes par le SOPK, notamment par d’éventuels dépistages. Cet article examine les facteurs potentiels pouvant contribuer à la médicalisation de ces femmes et la manière dont leur autonomie pourrait être affectée par ce phénomène. Entre autres, l’article met en évidence comment la médicalisation façonne des représentations collectives et individuelles par rapport aux notions de santé, de maladie et de traitement. Dans une perspective relationnelle de l’autonomie, il attire l’attention sur l’importance de reconnaitre comment la médicalisation influence ces représentations et l’impact potentiel que cela pourrait avoir sur les femmes. Encourager la démédicalisation du SOPK par une approche visant à soutenir la santé pousse à interroger ces représentations et fait partie des pistes de solution permettant de favoriser l’autonomie des femmes affectées par le SOPK. Il devient alors possible non seulement de contrôler la maladie, mais aussi de soutenir la santé, voire de faire les deux selon la situation individuelle.

[Circulation of information on drugs and other substances to increase cognitive performance: a study of a Brazilian blog (2015-2017)]

By observing the processes of (bio)medicalization and pharmacologization of society, this article addresses drugs that have been used by healthy individuals to increase cognitive dimensions such as alertness, memory, and concentration. The use of so-called "smart drugs" or "nootropics" has spread among young people, aided by the internet. The circulation of information about such drugs are analyzed using a Brazilian blog called "Cérebro Turbinado," through publications available for public access between 2015 and 2017. The study adopts theoretical and methodological frameworks of the social sciences, including an anthropological perspective. Documental research was conducted on the internet, specifically with scientific dissemination materials and the material available from the aforementioned blog. The results show that the blog acts as a medium for spreading biomedical knowledge among the lay public and indicates the production of new forms of subjectivity by revealing the meanings attributed to these substances in socialization processes.

Aprimoramento cognitivo e a produção de modos de subjetividade: um estudo sobre o uso de substâncias “nootrópicas” a partir de um blog brasileiro

Resumo O consumo de medicamentos para aprimorar processos mentais, como memória, concentração e estado de alerta, tem se expandido. As chamadas smart drugs e fármacos nootrópicos são utilizados na expectativa de obter melhor desempenho em tarefas profissionais e acadêmicas. Este artigo analisa a difusão do uso de medicamentos para aprimoramento cognitivo, a partir de um blog brasileiro chamado Cérebro Turbinado, com ênfase na discussão da categoria “nootrópicos”. A metodologia adotada foi a pesquisa socioantropológica documental, baseada em materiais de divulgação científica que integram o conteúdo do blog, criado em 2015 por um estudante de medicina de uma universidade pública. O blog apresenta os nootrópicos como opções mais acessíveis, seguras e igualmente eficazes em comparação com os medicamentos psicotrópicos utilizados como smart drugs. Editor e leitores produzem um saber coletivo para otimizar o desempenho cerebral. As experiências pessoais evidenciam a maneira como os indivíduos interpretam seus estados corporais e os relacionam com os medicamentos. Na esteira dos processos de farmacologização da sociedade, a produção de modos de subjetividade baseadas em uma concepção individualista dos processos de saúde/doença/incapacidade, apoiada na compreensão neuromolecular do cérebro, fundamenta-se no compartilhamento de práticas e conhecimentos sobre tais substâncias.

Ayurveda and medicalisation today: The loss of important knowledge and practice in health?

Ayurveda translates as 'life science'. Its knowledge is not limited to medicine, cure or therapy and is for laypersons, households, communities, as well as for physicians. Throughout its evolutionary history, Ayurveda and Local Health Traditions have reciprocally influenced each other. In modern times, the influence of biomedicine on Ayurveda is leading to its medicalisation. Over the past century, the introduction and perspective of biomedicine into India has made the human being an object for positive knowledge, a being who can be understood with scientific reason and can be governed and controlled through medical knowledge. This paper explores how this shift towards medicalisation is affecting the knowledge, teaching, and practice of Ayurveda. It examines the impact and contribution of processes like standardisation, professionalisation, bio-medicalisation and pharmaceuticalisation on Ayurveda education, knowledge, practice and policies. To maintain health and wellbeing Ayurveda's ancient knowledge and practice needs to be applied at individual, community and health care provider levels and not be limited to the medical system. The current over medicalisation of society is a potential threat to human health and well-being. Ayurveda and LHT knowledge can provide essential teachings and practices to counter-balance this current trend through encouraging a population's self-reliance in its health.

Recovery from Childhood Psychiatric Treatment: Addressing the Meaning of Medications

Medications exert effects not only through biological mechanisms but also through the meanings that they carry. While positive effects (e.g., the placebo effect) are broadly recognized, psychiatry is often less attuned to the negative effects that are mediated through the meaning of medications. These negative effects may be especially pronounced when noxious meanings and countertherapeutic aspects of medications are incorporated into the unfolding development of a child and not countered by psychotherapeutic experiences that allow iatrogenic meanings to be placed in context. In this paper, psychosocial mechanisms, by which medications may cause harm, are explored. These include adverse effects on identity, impaired agency, impaired affective competence, and negative effects on the patient's relationship with care. When such harm has occurred at the level of meaning, it is best addressed at the level of meaning. Examples of psychotherapeutic work with young adults is offered to demonstrate the process of reworking developmental harm related to the meaning of medications.

Developing expertise, customising sleep, enhancing study practices: exploring the legitimisation of modafinil use within the accounts of UK undergraduate students

Introduction and aim: Increasing numbers of students are reportedly using prescription medications to enhance cognition. This study aimed to generate qualitative data on UK students' understandings and perspectives of the risks and benefits surrounding so-called 'study drugs' (particularly, modafinil). Design and methods: Fifteen undergraduate students studying biomedical science subjects were interviewed about their perspectives on study drugs. Interviews were recorded and transcribed for thematic analysis. Users and non-users were included in the sample. Results: The prescription status and comparisons to other legal and illicit stimulants informed accounts of the (lack of) risks associated with study drugs, legitimising use. The customisation of sleep(iness) and wakefulness was described as a key benefit of study drug use. Drivers of use related to university pressures and desires to increase productivity. In periods of heightened stress, such as examinations, students reported altered practices and perspectives on risk. Discussion and conclusions: We noted the contextual nature of students' use and risk appraisals, with fluctuating social contexts and pressures over time being capable of altering prior assessments and current practices (including the legitimisation of study drug consumption). Further, we highlighted the degree to which students leveraged their biomedical and experiential expertise to account for drug consumption.

"This drug turned me into a robot": an actor-network analysis of a web-based ethnographic study of psychostimulant use

OBJECTIVES

This study aims to understand contemporary psychostimulant use within the socio-cultural context of Western societies. Two objectives are addressed: to describe accounts of practices related to psychostimulant use among members of selected online fora and to examine how these are related to representations of the self.

METHODS

This research is a qualitative study of psychostimulant use among members of selected online fora. Drawing on actor-network theory (ANT), this study focuses on three publicly accessible online discussion fora belonging to the Reddit website. Non-participant observation was performed over a period of 18 months to observe exchanges between members, interactions with moderators, and esthetic elements. In total, 331 postings were collected from the selected fora for qualitative analysis. We present our analysis of one discussion forum, corresponding to 149 posts (515 pages, double spaced).

RESULTS

Our study reveals the emergence of an online socio-cultural space formed around psychostimulant use. Members share their experiences openly and some offer guidance, sometimes contrary to prescribers' directives. An ANT analysis points to translations fostering positive or negative subjectivities, related to psychostimulant effects, and to translations fostering healthy or harmful practices, related to r/Adderall as an agentic space.

CONCLUSION

These findings may contribute to shaping public health policies and interventions that acknowledge the values of the individuals they seek to help, and that attempt to reduce the potential harms associated with these pharmaceuticals as an alternative to more prohibitive approaches.

Beyond unequal access: Acculturation, race, and resistance to pharmaceuticalization in the United States

Trends toward pharmaceuticalization in Western countries have led to increased research and theorizing about the roles macro-level institutions, structures, and collective actors play in contributing to patients' reliance on prescription drugs. Relatively less work has focused on the degree to which patients resist pharmaceuticalization pressures, and even less research has explored the factors contributing to patients' resistance to pharmaceuticalization. Drawing on focus groups with patients who had been recently prescribed a prescription drug, this paper investigates how marginalization in the mainstream US society, as measured by acculturation and race, contributes to differences in patients' subjective experiences and responses to prescription drugs. We find that racial minorities report a greater skepticism of prescription drugs compared to whites and express that they turn to prescription drugs as a last resort. While highly acculturated participants rarely discuss alternatives to prescription drugs, less acculturated racial minorities indicate a preference for complementary and alternative remedies. We draw on the literatures on the pharmaceuticalization of society and the social nature of medicine to examine the role marginalization plays in patients' views of prescription drugs. Public health research conceives of racial minorities' lower rates of prescription drug usage compared to whites as primarily a problem of lack of access. Our results suggest another piece to the puzzle: minorities resist pharmaceuticalization pressures to express their cultural and racial identities.

Reflections on the history of bareback sex through ethnography: the works of subjectivity and PrEP

Throughout the history of bareback sex (condomless sex between men), 'subjects' have been created, particularly through scientific literature, to characterise the men who engage in the sexual practice. For example, a gay man who does not use a condom may be framed as a pathologised subject. This paper first presents this history. Afterwards, by relying upon ethnographic data such as interviews collected from fieldwork research done in Toronto in 2014 with young gay men who have bareback sex, it shows exactly how these young gay men related themselves to those subjects. Then, it focuses on the pre-exposure prophylaxis (PrEP) Truvada as a new HIV prevention technology. Although PrEP can allow condomless sex to occur while diminishing the risk of HIV transmission, at the time of the research, none of the young gay men were interested in using this tool despite being the subjects for whom the drug is tailored. This paper argues that PrEP and subjectivity are coproduced and can have conflicting meanings. This contradiction of meanings is a result of the various representations and symbols of bareback sex and the men who engage in the practice that have been produced throughout the history of bareback sex.

'PrEP is not ready for our community, and our community is not ready for PrEP': pre-exposure prophylaxis for HIV for people who inject drugs and limits to the HIV prevention response

BACKGROUND AND AIMS

Pre-exposure prophylaxis for HIV, or 'PrEP', is the use of antiretroviral medicines by people who are HIV-negative to protect themselves against acquiring HIV. PrEP has shown efficacy for preventing HIV acquisition. Despite the potential, many concerns have been voiced by people who inject drugs (PWID) and their organizations. There is a need to engage with these views and ensure their integration in to policy and strategy. This paper presents PWID views on PrEP to foster the uptake of these opinions into scientific and policy debate around PrEP METHODS: Critical analysis of a report of a community consultation led by the International Network of People who Use Drugs (INPUD).

RESULTS

The INPUD report highlights enthusiasm from PWID for PrEP, but also three main concerns: the feasibility and ethics of PrEP, its potential use as a substitute for other harm reduction strategies and how a focus on PrEP heralds a re-medicalization of HIV. Each concern relates to evidenced gaps in essential services or opposition to harm reduction and PWID human rights.

CONCLUSIONS

People who use drugs have fundamental concerns about the potential impacts of pre-exposure prophylaxis for HIV which reflect a 'fault line' in HIV prevention: a predominance of biomedical approaches over community perspectives. Greater community engagement in HIV prevention strategy is needed, or we risk continuing to ignore the need for action on the underlying structural drivers and social context of the HIV epidemic.